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Tue, Jan 9 6:00am · Research News Roundup — December 2017

On Advancing the Science, in addition to sharing unique research-related news and information from across Mayo Clinic, we like to make sure you didn’t miss any of the ‘big news’ stories.

To make it easy, we round up all our research news releases from the previous month into one post.

In December we had a number of news releases highlighting some of the latest Mayo Clinic Cancer Center work presented at the American Society of Hematology annual meeting. Those are summarized in a previous post, but as you can see, there’s a whole lot more. Enjoy!

Senior citizen couple taking a walk in a park during autumn morningFor patients with mild cognitive impairment, don’t be surprised if your health care provider prescribes exercise rather than medication. A new guideline for medical practitioners says they should recommend twice-weekly exercise to people with mild cognitive impairment to improve memory and thinking.

The recommendation is part of an updated guideline for mild cognitive impairment published in the Dec. 27 online issue of Neurology, the medical journal of the American Academy of Neurology.

The lead author of this guidelines article was Ronald Petersen, M.D., Ph.D., who also directs the Alzheimer’s Disease Research Center at Mayo Clinic, and the Mayo Clinic Study of Aging.

MRI of brain showing cavernous malformationMayo Clinic has been named a Center of Excellence by Angioma Alliance for treatment and research into cerebral cavernous angiomas.

These abnormally shaped blood vessels in the brain or spine have the appearance of raspberries or a small cluster of grapes. They can cause symptoms such as bleeding, seizures, motor problems, memory problems and muscle weakness. They go by many names, such as cerebral cavernous malformations, cavernous hemangiomas and cavernomas.

Read more about this rare condition and what being a Center of Excellence entails.

DNA extraction imageGene editing has captivated scientists and medical providers with tantalizing visions of wiping out debilitating inherited diseases. Could conditions like Huntington’s disease, for example, be cured by using a tool that acts as a “molecular scissors” to remove and replace disease-causing DNA? Or, would gene editing tempt some to engineer designer babies with genes encoded for superior intelligence, beauty or athletic abilities?

Although Mayo Clinic does not use gene editing as part of any treatment, it is studying the implications. Megan Allyse, Ph.D., a bioethicist who works with the Bioethics Program of the Mayo Clinic Center for Individualized Medicine and the Department of Obstetrics and Gynecology, warns that, along with improvements in understanding of the genome, gene editing also poses ethical concerns.

athletes on soccer sports field holding injured heads, perhaps concussionsMost high school athletes, their parents and coaches can identify the possible effects of concussion, but only about one-third know that it is a brain injury. Those findings are outlined in a new Mayo Clinic study. Athletes were more likely than parents and coaches to correctly identify a concussion as a brain injury.

Identifying trends and gaps in knowledge can guide help educate athletes and others about concussions, the authors say. The findings appear in Mayo Clinic Proceedings.

A new clinical trials consortium funded by the National Institutes of Health (NIH) is expected to accelerate and expand research into therapies that treat or prevent Alzheimer’s disease and related dementias.

Called the Alzheimer’s Clinical Trial Consortium, the cooperative agreement awarded today is expected to total $70 million over five years, pending the availability of funds.

The consortium will be led jointly by research teams from Mayo ClinicUniversity of Southern California, San Diego; and Harvard University-affiliated Brigham and Women’s Hospital and Massachusetts General Hospital. The National Institute on Aging will provide scientific input.

Contrast-enhanced digital mammography is comparable to breast MRI in evaluating residual breast cancer after neoadjuvant endocrine therapy or chemotherapy, according to the results of a study presented by Mayo Clinic researchers today at the 2017 San Antonio Breast Cancer Symposium.

“Our study aimed to compare contrast-enhanced mammography with breast MRI in evaluating residual breast cancer in patients undergoing presurgical systemic treatment to shrink their tumor size,” says Bhavika Patel, M.D., a radiologist at Mayo Clinic’s Arizona campus. “We identified patients who had both contrast-enhanced digital mammography and MRI after treatment to shrink their tumors and before additional therapy or a mastectomy.”

Mayo Clinic’s Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome and Children’s Minnesota are collaborating to prevent heart failure for hypoplastic left heart syndrome, a rare and complex form of congenital heart disease in which the left side of a child’s heart is severely underdeveloped.

The program seeks to work with five to seven regional centers across the U.S. to fund the development of cell-based, innovative research opportunities that can transform the lives of people living with hypoplastic left heart syndrome. Together, the consortium will accelerate innovation on hypoplastic left heart syndrome, discovery sciences and clinical expertise by investing local resources back into research.

In the December issue of Mayo Clinic Proceedings, Mayo Clinic researchers reviewed the importance of the microbiome as a key component of personalized medicine to improve diagnosis, reduce disease risk and optimize early detection and treatment. The microbiome is the combined genetic material of the microorganisms in a particular environment.

“The ability to characterize the microbiome, which includes all the microbes that reside within and upon us and all their genetic elements, using next-generation sequencing, allows us to now incorporate this important contributor to human disease in developing new preventive and therapeutic strategies,” says Purna Kashyap, M.B.B.S., a Mayo Clinic gastroenterologist and lead author of the review.

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

Cancer-related stories of hope and healing can be found in Forefront, the online version of Mayo Clinic Cancer Center‘s 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.

Dec 26, 2017 · Mayo Clinic at the American Society of Hematology

Every year, the American Society of Hematology (ASH) hosts an annual meeting to highlight groundbreaking scientific research and the latest advances in patient care.

The Society cites its mission as furthering “the understanding, diagnosis, treatment, and prevention of disorders affecting the blood, bone marrow, and the immunologic, hemostatic and vascular systems, by promoting research, clinical care, education, training, and advocacy in hematology.”

Mayo Clinic has long had a strong presence at ASH, and 2017 was no exception. Below are brief summaries and links to the news releases we sent out during the conference, which was held in Atlanta, Dec. 9-12.

An observational study by researchers at Mayo Clinic has found that increasing physical activity not only decreased the risk of death from all causes but also decreased the risk of death specifically from lymphoma. Lymphoma is a cancer of the lymphatic system, the part of the body’s germ-fighting network which includes the lymph nodes (lymph glands), spleen, thymus gland and bone marrow. Lymphoma can affect those areas as well as other organs throughout the body. Study results were presented during the 59th American Society of Hematology annual meeting in Atlanta by Priyanka Pophali, M.B.B.S., a hematologist at Mayo Clinic.

A study by researchers at Mayo Clinic’s campus in Jacksonville, Florida, has found that barriers to patients receiving stem cell therapy as part of their treatment for multiple myeloma include income, education, insurance status and access to care at an academic center or facility that treats a high volume of patients.

“Stem cell transplants are a standard treatment for patients with multiple myeloma and have been shown to benefit patients by delaying the recurrence of disease and, in some cases, improving patient survival,” says Sikander Ailawadhi, M.D., a hematologist at Mayo Clinic in Florida and the lead investigator of this study. “While stem cell transplant utilization for patients with multiple myeloma has increased for all racial and ethnic subgroups over time, population-based studies have repeatedly shown that certain racial minorities are less likely to receive it.”

Dr. Ailawadhi and his colleagues decided to explore factors that determine stem cell transplant utilization among patients from minority communities to better understand the issue and come up with solutions to eliminate barriers and improve access for all patients.

A group of investigators from Mayo Clinic and multiple academic research centers in Italy have identified a genetic model for predicting outcomes in patients with primary myelofibrosis who are 70 years or younger and candidates for stem cell transplant to treat their disease. The group’s findings were presented today at the 59thAmerican Society of Hematology annual meeting in Atlanta by lead authors Alessandro Vannucchi, M.D. from the University of Florence and Ayalew Tefferi, M.D., a hematologist at Mayo Clinic.

In findings presented to the American Society of Hematology, Mayo Clinic researchers found that using emojis instead of traditional emotional scales were helpful in assessing patients’ physical, emotional and overall quality of life. Researchers found that using iPhones and Apple Watches were favored by patients, and the technology helped collect study data accurately and efficiently. The study, created using Apple’s ResearchKit framework, showed that Apple Watch provides objective, continuous activity data that correlates with established cancer patient-reported outcomes.

The study was led by Carrie Thompson, M.D., a hematologist at Mayo Clinic.

You can visit the conference website to find the full listing of Mayo Clinic research presented at ASH 2017.

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Dec 14, 2017 · Flipping the Script

Given a Diagnosis That May Result in Blindness, a Film School Graduate Seeks a Second Opinion at Mayo Clinic

As a young girl growing up in Buffalo, New York, Devan Brady’s bedtime story selection was more a survey of American literature than preschool perennials. She remembers her father reading Moby- Dick to her when she was just 3 years old.

“My dad went for the big guns,” Devan says. “The bigger the book, the better.”

These adventures unleashed Devan’s imagination. As she grew older, she saw some of her favorite books, such as the Harry Potter series, leap from the page to the big screen. Devan knew there was only one path forward for her: creating magical worlds for kids who love to escape through books and film, just like she did.

But after graduating from college in 2016 with a degree in media production, a medical scare threatened to steal this dream from Devan.

An avid traveler, Devan was on a flight to Japan in January when her legs kept falling asleep, which she knew was common, but the frequency and severity were still puzzling. Several months later in August, Devan was working three part-time jobs: production assistant on a local film crew, wedding photographer and restaurant server. While on her feet for a restaurant shift, Devan felt her legs go numb again. She didn’t regain full sensation for several hours.

Worried, Devan called her local primary care provider, who ran some blood and imaging tests. The results were normal, but her doctor referred Devan to a neurologist for further evaluation.

In the weeks between appointments, Devan didn’t experience any additional episodes and started thinking she was in the clear. After completing a more rigorous set of tests with the neurologist, Devan expected to hear that she had something relatively simple like a pinched nerve.

She didn’t expect to leave his office with a diagnosis of the autoimmune disease neuromyelitis optica, more commonly known as NMO.

NMO occurs when the body’s immune system produces a molecule called an antibody that mistakenly targets healthy tissue. Antibodies normally attack targets such as cancer or infection so that the immune system can clear those damaged cells out of the body. But with NMO, these antibodies attach to healthy tissue in the central nervous system, mainly in the optic nerves and spinal cord, but sometimes in the brain, too. As a result, people can experience blindness, weakness or paralysis in the legs or arms, and painful spasms.

An Uncertain Future

“For the whole month of October, I was on edge, nervous,” says Devan. “NMO is a serious disease, and to tell a 22-year-old girl that you could lose your eyesight or use of your legs, that’s scary. What is my life going to be like? I’m going to live in constant fear of losing the ability to do what I love.”

While the neurologist couldn’t confirm the diagnosis through an MRI, Devan tested positive for the NMO antibody in two blood tests, so he prescribed an immune system-suppressing drug to inactivate the circulating antibodies and stop their production, which in turn could prevent further attacks.

A lifetime of taking powerful drugs was just as startling to Devan as the diagnosis. Because her local neurologist had only seen a handful of patients with NMO in the last decade, Devan and her father, a nurse with the Veterans Health Administration, began researching options for a second opinion.

Through friends and her father’s colleagues, Devan learned about Mayo Clinic’s Department of Neurology and its expertise in NMO.

For at least the last 75 years, what is now known as a spectrum of NMO disorders — sometimes called Devic’s disease — was commonly misdiagnosed as multiple sclerosis (MS). Because MS is treated with medication that boosts immune system action, these therapies could be ineffective and even harmful in the case of NMO. In 2005, physician-scientists and basic researchers at Mayo
Clinic discovered a unique antibody specific to NMO. This breakthrough allowed for the development of a diagnostic test, ensuring that NMO patients get the right treatment right away.

“Especially since the test for NMO was created at Mayo Clinic, we thought if anyone would know about this, they would,” Devan says.

The Value of a Second Opinion

As a major referral center, Mayo Clinic sees many patients such as Devan who seek a second opinion — and for good reason. In a recent study, Mayo researchers found that as many as 66 percent of these patients have their original diagnosis refined and in 21 percent of cases, changed.

Receiving care for the wrong diagnosis can send patients down a medical rabbit hole involving costly, ineffective treatments, recurring symptoms and a nagging feeling that something just isn’t right. In the worst cases, diagnostic error can even be deadly.

That’s where Mayo Clinic’s expertise can be a true lifesaver, says internist Jon O. Ebbert, M.D. He serves as associate medical director for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, which led the second opinion study. The center investigates the “how” of effective, efficient care, with the ultimate goal of establishing evidence-based best practices that can be shared broadly within and beyond Mayo Clinic to improve health care for all.

According to Dr. Ebbert, there are pressing reasons for proving the value Mayo Clinic brings to patients with uncertain diagnoses.

“It’s about the right diagnosis in the right patient at the right time, and then making the right treatment recommendation. As we go through changes in the health care system, we’re going to need to continue demonstrating the value of referral centers in providing expertise for making the right diagnosis.”

Devan’s second opinion benefited from several factors: a high-volume multiple sclerosis and NMO practice that sees thousands of patients a year, a team of experts who consult with each other, and the close integration of research into patient care that results in the most advanced diagnostic techniques.

The difference did not escape Devan.

“Mayo Clinic is just in a completely different wheelhouse — it’s how health care should be.”

Scene Two

Devan and her father made the trip to Rochester, Minnesota, in November and met with neurologists B. Mark Keegan, M.D., and Natalie Parks, M.D., a former Mayo Clinic fellow now at Dalhousie University in Canada. As a provider in Mayo’s Division of Multiple Sclerosis and Autoimmune Neurology, Dr. Keegan regularly sees patients seeking second opinions for diagnoses ranging from multiple sclerosis to NMO and a variety of rare inflammatory diseases affecting the central nervous system.

The team explained that Dr. Parks would do an in-depth examination with Devan and discuss the results with Dr. Keegan. Then, Dr. Keegan would do a second examination.

After comparing their notes on Devan’s medical history and physical tests, Dr. Keegan shared the team’s conclusion.

“He said, ‘If you would have come here after that first day that you had issues and told me your symptoms, I never would have even thought to test for NMO. But because your doctor did, and the result was positive, now we have to deal with it,’” Devan recalls.

The first step was to repeat Devan’s bloodwork, but this time using a much more sophisticated version of the NMO test, which Mayo Clinic has continuously refined over the past decade. If the test came back positive, Dr. Keegan would perform an MRI to look for lesions on her spine. If it came back negative, he would be reasonably confident that Devan did not have NMO. Because getting the blood test results would take a few days, Devan and her father returned to Buffalo to await the news.

A week later, Devan was back at work on a film set when she got a call from Mayo Clinic. It was Dr. Parks with her test results: Devan did not have NMO.

Listening to Dr. Parks explain that the local test results were false positives, Devan started crying tears of relief. She immediately called her father, who interpreted the emotion in Devan’s voice as
a bad sign.

“He was like, ‘It’s OK, it’s OK. We’ll book a flight to Rochester.’ And I was saying, ‘No, Dad, the test was negative.’ And I just heard him go, ‘Woo-hoo!’ Like, screaming on the phone.”

Dr. Keegan called a few days later to reassure Devan of the results. In his opinion, Devan’s local neurologist likely relied too heavily on the less sophisticated blood test to make a diagnosis and didn’t factor in the complete picture — Devan’s normal medical history, evaluations and MRI test, plus the fact that Devan’s symptoms were nonspecific to NMO.

Devan has been in good health since her visit to Mayo Clinic, which she credits to staying active and sticking to her workout routine. She now says her only fear for the future is the same as any postcollege graduate’s: finding a job.

But armed with the same boundless imagination that fueled her childhood dreams, she knows the possibilities are limitless.

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This article was originally published in Mayo Clinic Magazine, Volume 2, 2017.

Related resources:

Dec 12, 2017 · What in the world is an extracellular vesicle? Find out this and more from Mayo Clinic Research

Not an extraterrestrial spaceship, but something equally fascinating—extracellular vesicles are biological nanoparticles secreted by all cells. Extracellular vesicles contain biomolecules, such as RNA, proteins, lipids and carbohydrates, which play an important role in cell communication.

Extracellular vesicles are just part of what you can learn about on the newest Mayo Clinic research websites. And as you read, we hope you’ll see the way research and education are tied into our medical practice, enabling Mayo Clinic to provide something special for our patients and for the improvement of health and health care delivery everywhere.

In her research program, based on Mayo Clinic’s Florida campus, Joy Wolfram, Ph.D., is advancing research on the use of nanotechnology (teeny, tiny), to make treatments more effective for breast cancer and other conditions, and to reduce side effects.

She and her team are also investigating extracellular vesicles for their potential role in tissue regeneration—specifically related to liver regeneration and transplant. This video tells you a little more about this amazing science.

Tonometry to assess carotid-femoral pulse wave velocity and central aortic pressures.

Most of us know that genetics play a role in individual health, but may not know much more than that. In his lab, Iftikhar J. Kullo, M.D., and his team, are studying the genetics of atherosclerotic cardiovascular diseases—a fancy way to say “plaque buildup in your arteries,” and hereditary lipid disorders—also known as high levels of “bad” cholesterol or fat (triglycerides).

The team is trying to figure out what part of heart and vascular diseases and conditions we can blame on our genes, and then how to reduce or prevent them. This work, which comes out of Rochester, Minnesota, sounds like good news we can share with our relatives.

Sex (which one you are) causes differences in inflammation caused by environmental exposures, which can lead to various chronic inflammatory diseases.

As an expert in myocarditis, dilated cardiomyopathy and heart failure, DeLisa Fairweather, Ph.D., leads a research team, on the Florida campus, seeking advances in diagnostic techniques and novel therapies. You can check out her lab in this virtual tour:

Thanks for visiting. If you missed them, here’s a couple recent new research content launch articles for more investigative fun.

Keep watching Advancing the Science for the latest Mayo Clinic research news and information. Or, you can sign up for an account, and then you’ll get updates directly to your inbox.

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Dec 6, 2017 · Research Roundup—November 2017

The Research Roundup is a compilation of research news releases from Mayo Clinic during the last month. You can read the brief summaries in this post, or click through for the full news release and related content. Thanks for visiting Advancing the Science!

In a new study published today in Menopause, researchers have found that the hot flashes and night sweats faced by upward of 80 percent of middle-aged women may be linked to an increased risk of obstructive sleep apnea.

Obstructive sleep apnea, the most common form of sleep apnea, is characterized by repeated stopping and starting of breathing during sleep. Besides affecting the quality of sleep, obstructive sleep apnea can lead to serious health concerns in women, including increased risks of coronary heart diseasehigh blood pressure and stroke.

Researchers at Mayo Clinic Center for Individualized Medicine have uncovered genetic clues to why tumors resist a specific therapy used for treating advanced prostate cancer. This discovery can guide health care providers to individualized treatments for castration-resistant prostate cancer, a deadly disease that does not respond to standard hormone therapy. Several U.S. Food and Drug Administration approved therapies are available for castration-resistant prostate cancer, but the treatments affect each patient differently.

Reflecting on your education, you probably remember one or two extraordinary teachers who stand out. They were the instructors who were able to make dull subjects interesting or complex information easily understandable. They had the humor, empathy and passion for teaching that made you look forward to their classes.

In early November, the Association of American Medical Colleges (AAMC) honored Joseph Grande, M.D., Ph.D., professor of laboratory medicine and pathology at Mayo Clinic College of Medicine and Science with the 2017 Alpha Omega Alpha Robert J. Glaser Distinguished Teacher Award for his outstanding contributions to medical education. Dr. Grande was one of four recipients to receive the national Alpha Omega Alpha award at the Association of American Medical Colleges’ annual meeting in Boston. Dr. Grande is one of those teachers students at Mayo tend to remember.

Caption: Joseph Grande, M.D., Ph.D., center, of Mayo Clinic College of Medicine and Science receives the Association of American Medical Colleges’ Distinguished Teacher Award from Marsha Rappley, M.D., left, who is chair, Association of American Medical Colleges Board of Directors, and Darrell Kirch, M.D., right, who is president and CEO, Association of American Medical Colleges.

Neurologist Thomas Brott, M.D., the Eugene and Marcia Applebaum Professor of Neurosciences on Mayo Clinic’s Florida campus, has been selected as the recipient of the 2017 Research Achievement Award from the American Heart Association. He received the honor on November 12, during the American Heart Association’s Scientific Sessions in Anaheim, California. The recognition rewards distinguished lifetime scientific achievement in the field of cardiovascular research.

Stephen Challachombe, Ph.D., Donald Greydanus, M.D., Robert Nirschl, M.D., Thomas Spelsberg, Ph.D. and Robert Waller, M.D., recently were named honorees at the 2017 Mayo Clinic Distinguished Alumni Award ceremony. The award acknowledges and shows appreciation for the exceptional contributions of Mayo Clinic alumni to the field of medicine.

You will note that education, research and medical practice are tightly woven in the achievements of these individuals, as they are across all of Mayo Clinic. It is through this synergy that we are able to provide the best possible care to our patients, and continuously work to improve health and health care delivery for people everywhere.

People sometimes joke that easy tasks are “not brain surgery.” But what happens when it actually is brain surgery? How old is too old to be a neurosurgeon? In a new Mayo Clinic Proceedings study, most neurosurgeons disagreed with an absolute age cutoff, but half favored additional testing for neurosurgeons 65 and older.

Some professions, including commercial pilots, FBI agents and air traffic controllers, have mandatory retirement ages. This study is the first to survey neurosurgeons on their attitudes toward ceasing practice and testing in late career.

Mayo Clinic researchers have shown a link between which type of oral anticoagulant (blood-thinning medication) a patient takes to prevent a stroke and increased risks of kidney function decline or failure.

Their study, published online November 20, in the Journal of the American College of Cardiology, is the most recent in a series of studies seeking to determine the safety and efficacy of non-vitamin K antagonist oral anticoagulants versus the long-standard warfarin. Patients with atrial fibrillation – a potent risk factor for stroke ─ commonly take these medications.

Mayo Clinic has launched a first-in-the-U.S. clinical test that will help patients who recently have been diagnosed with an inflammatory demyelinating disease (IDD) but may be unsure of the exact disorder. Neurologic-related diseases commonly affect the brain, optic nerves and the spinal cord, and this new test can distinguish other IDDs such as neuromyelitis optica, acute disseminated encephalomyelitis, optic neuritis, and transverse myelitis from multiple sclerosis (MS).

The test uses live cells to identify patients who are positive for an antibody to myelin oligodendrocyte glycoprotein (or “MOG,” for short). But why is this sticky protein so important? Read the news release for more on the research and findings.

For J. William Charboneau, M.D., life is a journey of unknown possibilities, filled with family. And Tuesday, Nov. 28, with family both personal and professional by his side and in the audience, Dr. Charboneau’s journey reached another destination.

Dr. Charboneau, an emeritus professor of radiology at Mayo Clinic, thanked those family members — his wife, colleagues, friends, protégés and mentors — as he received the 2017 Gold Medal from the Radiological Society of North America at its 103rd Scientific Assembly and Annual Meeting in Chicago. The Radiological Society of North America Board of Directors determines Gold Medal winners, who must receive a unanimous vote. Considered the Radiological Society of North America’s highest honor, the medal is given to “those persons who, in the judgment of the board, have rendered unusual service to the science of radiology.”

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

Cancer-related stories of hope and healing can be found in Forefront, the online version of Mayo Clinic Cancer Center‘s 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.

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

Nov 30, 2017 · New Population Health Science Scholars Announced

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (CSHCD) Population Health Science Program and Employee & Community Health are pleased to announce that three physicians have been selected into the Population Health Science Scholar Program, and will join July 1, 2018.

Maya Kessler, M.D.

Primary Care Internal Medicine

Dr. Kessler is a primary care physician with expertise in clinical informatics and public health, whose goals are to leverage data stored in the electronic environment to improve population health.

As a scholar, she will conduct a systematic review on the clinical factors that influence the effectiveness of clinical decision support systems. She plans to explore how features unique to the clinical environment in Employee & Community Health impact the success of clinical decision support tools. Dr. Kessler hopes to improve the use of existing tools and develop new tools to improve uptake of preventive services and evidence-based management of chronic diseases.

Kathy MacLaughlin, M.D.

Family Medicine

A family medicine physician, Dr. MacLaughlin’s work is focused on improving rates of cervical cancer screening and guideline-consistent follow-up of abnormal Pap, human papillomavirus (HPV) and colposcopy biopsy results, using an information technology tool called a clinical decision support system.

During her time as a Population Health Scholar, Dr. MacLaughlin will pursue research examining appropriate use of cervical cancer screening services in Mayo Clinic Health System. In addition, given the significant disease and cost consequences of not improving this preventive intervention, she will explore ways to improve the uptake of and completion of the HPV vaccine series for both sexes.

Tamim Rajjo, M.D.

Family Medicine

Dr. Rajjo is also a family medicine physician. His research interests center on obesity, and he seeks to better understand and improve patient care—addressing obesity at the individual level.

His work as a scholar will focus on the delivery of health care for obesity management in the following areas:

  • Identification and management of high cost patients
  • Innovative approaches to prevention, early detection, and management of chronic conditions and treatment burden
  • Facilitation of patient engagement to lower costs and improve self-management

These physicians will have 40 percent protected research time for three years, commencing July 1, 2018. During their time as a Population Health Science Scholar, they will engage in the scientific evaluation of population-based, health care interventions at Mayo Clinic. They will receive training and mentoring as they develop and test innovative and feasible population-based interventions that embody evidence-based practices of wellness and primary, secondary, and tertiary prevention across the care continuum.

In general, Population Health Science Scholar efforts focus on advancing healthy lifestyles and many seek to address disparities in population health with regard to these practices and their benefits. When they have completed the program, scholars will be prepared to seek extramural funding and lead population health research.

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Nov 27, 2017 · Bijan Borah, Ph.D., selected to National Quality Forum’s Scientific Methods Panel

Bijan Borah, Ph.D., is a health services researcher who specializes in comparative effectiveness research (CER) including economic evaluation of heath care interventions, as well as in novel statistical and econometric methods used in CER.

Bijan Borah, Ph.D., who leads the Economic Evaluation Service within the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, has been named to the inaugural Scientific Methods Panel of the National Quality Forum (NQF).

The NQF is a not-for-profit, nonpartisan, membership-based organization that works to catalyze and accelerate improvements in health care. Mayo Clinic is a member of the NQF, along with some 400+ other leading organizations (see linked PDF for current list).

The NQF’s mission is to lead national collaboration to improve health and health care quality through measurement. They further this mission through three key activities:

  • Convening key public- and private-sector leaders to establish national priorities and goals to achieve healthcare that is safe, effective, patient-centered, timely, efficient, and equitable
  • Working to ensure that NQF-endorsed standards will be the primary standards used to measure and report on the quality and efficiency of healthcare in the United States
  • Serving as a major driving force for and facilitator of continuous quality improvement of American healthcare quality

Within the NQF, the Scientific Methods Panel (linked PDF) consists of 24 individuals with methodological expertise who will provide NQF standing committees with evaluations of submitted measures’ Scientific Acceptability (specifically, the “must-pass” sub-criteria of reliability and validity), using NQF’s standard measure evaluation criteria for new and maintenance measures.

The goal of the Scientific Methods Panel is to assist in conducting methodological reviews of submitted measures and to provide guidance to NQF for methods/testing-related issues.

Panel members were appointed to an initial two- or three-year term, with an optional three-year term to follow. Prerequisites for appointment to this panel were relevant knowledge and/or proficiency in methodology, implementation of measures, and/or broad clinical expertise that would lend itself to the evaluation of complex measures.

Dr. Borah is a health economist and econometrician by training. In addition to his leadership role in the center, and this new appointment, he holds a number of other leadership roles across Mayo Clinic.

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Nov 16, 2017 · What the heck is a nomogram? And other medical research questions answered.

Surgical team led by Judy Boughey, M.D., one of the nomogram study’s co-authors.

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery focuses on the science of best practice. Best practice in health care, that is.

Across the center, researchers work together with the medical practice to find ways to improve health, and the ways people (patients, caregivers, providers) experience health care. This includes identifying what adds value to care experiences, and where we can find cost savings. Health care delivery research encompasses diverse areas, such as human-centered design, data collection and analysis, systems and physical engineering, qualitative research, and much more.

So much research is going on at Mayo Clinic that it’s hard to get our arms around it, and even just within the center, it can be a challenge. But we want to share what we can. We’ve all heard the statistic that it takes 17 years for a practice changing research finding to actually change practice. While that may not always be the case, we figured we’d do our part to spread the news, and maybe shave off a few days here and there.

Here’s a couple of our latest for:

People with herniated disks

Researchers from our Knowledge Synthesis group partnered with others from the Neuro-Informatics Laboratory to dig through all the publications available discussing extraforaminal disk herniation. This particular type of herniation is difficult to diagnose – and treat – because of where it occurs. However, they account for as many as 11 percent of all disk hernias.

The question of how best to treat this condition came from two areas in Mayo Clinic:

Together they made up the rest of the research team.

One might assume there would be a commonly understood best practice for how to treat them. But as the research team says in its paper, “Despite the heterogeneity of spinal procedures, there is a paucity of literature comparing the outcomes from different surgical approaches.”

When they completed their search for relevant studies, they found 41 studies with 1,810 patients. Of these, about two-thirds had received open surgery, and the remaining third minimally invasive surgery. Volume does not indicate best practice though.

The team found that compared to open surgery; minimally invasive procedures resulted in lower estimated blood loss, shorter operative times, shorter hospital stays, and faster return-to-work times. They also found that tubular microscopic procedures for extraforaminal disk herniation have the lowest reoperation rate of all minimally invasive surgery types.

Sounds like a cost saving, value adding, experience enhancing finding to me!

Women with breast cancer

Surgical Outcomes is another area we constantly are seeking best (and better) practices. Recently a research team with members from the center and a number of areas across Mayo Clinic including: Surgery, Diagnostic Radiology, Anatomic Pathology, Mayo Clinic School of Medicine,  and Health Sciences Research, published a paper describing a new nomogram they developed.

First you may be wondering, what the heck is a nomogram?

Basically it’s a set of lines that each have a scale marked off—in this case lines representing different characteristics of a type of non-invasive breast cancer (ductal carcinoma in situ)—and arranged in a way that connecting a straight line between two known characteristics will allow you to determine a third one.

The team’s nomogram is able to predict which women will actually be found to have invasive breast cancer (a more serious form of the disease) when they go in to have the ductal carcinoma in situ (DCIS) removed.

Doctors can help their patients make more informed decisions before surgery using this new nomogram.

If a woman having a lumpectomy for DCIS is found to have invasive disease, she often will have to come back for a second surgery. However, with this new tool, if the lines predict the woman will have invasive breast cancer, she may wish to have a different surgery up front. She also can go into surgery agreeing to a more aggressive surgery at the time if invasive cancer is seen by the surgeon.

One of the team members we’re especially proud of is Brittany Murphy, M.D. She just completed her time as a Surgical Outcomes Research Fellow in the center, and is well on her way to a great career as a breast surgeon and health care delivery researcher.

The nomogram is likely to be a welcome addition to her and other breast surgeons’ toolkits, and a boon for patients.

About 800 words is all there’s time for today, but check out our website and stay tuned for other updates from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

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