Advancing the Science

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


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4 days ago · REAL WORLD EVIDENCE in health care improvement

In late 2012 Optum and Mayo Clinic came together to form OptumLabs, an open, collaborative research and innovation center, dedicated to improving patient care and patient value through data-driven health care research, leading-edge data science and strong partner collaboration. 

Since that time, approximately 150 collaborative projects have led to peer-reviewed publication, a critical step towards evidence-based practice improvements. Most of these leverage the real world data available in the OptumLabs Data Warehouse.

Recently OptumLabs Chief Scientific Officer William Crown, Ph.D., connected with research collaborator David Kent, M.D., director of the Predictive Analytics and Comparative Effectiveness (PACE) Center at Tufts Medical Center and the Clinical and Translational Science Graduate Program at Tufts University, to share perspectives on the use of real world evidence based on their extensive experience working with data from both clinical trials and real-world data from the OptumLabs Data Warehouse.

Among others, they highlighted two Mayo-led studies in their discussion, a clinical trial examining the comparative effectiveness of cardiac ablation or medication to treat atrial fibrillation. (Read related news release.) The other was an observational study, using the OptumLabs Data Warehouse, and conducted in parallel to the clinical trial. (Read related news release.)

You can read their whole discussion in the OptumLabs spotlight, as they explore:

  • The Real World Evidence landscape
  • Benefits of Real World Evidence
  • Real World Evidence and clinical trials
  • Data quality and opportunities
  • What lies ahead for use of Real World Evidence?


5 days ago · Behind the scenes--Mayo Clinic Research

Everything health care has to offer for patients is the result of research and education related to that research. At Mayo Clinic, research drives everything we do, resulting in evidence-based treatments and continuous improvements in the way patients, caregivers and others experience health care.

At Mayo Clinic we share information about our programs and projects through many means, including the website

This site provides the opportunity to get behind the scenes with our researchers and learn about new findings and ongoing exploration. Below are brief summaries of what you will find on the pages of our newest research programs, as well as a few areas with substantially updated content to share.

Skeletal muscle is a hub for metabolic health, physical function and quality of life. In the Muscle Physiology and Metabolism Lab, Ian Lanza, Ph.D., and his team focus on understanding how skeletal muscle can be leveraged as a therapeutic target to lessen the burden of such chronic diseases as Type 2 diabetes, cancer cachexia and sarcopenia of aging.

Skeletal muscle is critical to health and quality of life. Beyond allowing us to navigate our environment and live independently, muscle is important to metabolic health through influence on glucose homeostasis, redox balance and whole-body energy metabolism.

A major goal of the research in Dr. Lanza’s lab is to gain new insights into the molecular events that either promote or interfere with adaptive responses to exercise. An area of particular interest is the impact of such lifestyle interventions as exercise and nutrition on skeletal muscle function, energy metabolism and adaptations to exercise.

Related lab: Skeletal Muscle Wasting and Progenitor Cell Biology, led by Jason Doles, Ph.D.

Cellular therapies taken to the next level. This is the mission of the Cancer Research and Cellular Therapies Lab, led by Januario Castro, M.D., which is working to improve existing cancer treatments, such as chimeric antigen receptor (CAR)-T cell therapy, and investigating new treatment targets, including alternative splicing mechanisms and epitope spreading.

Dr. Castro’s team studies advanced cellular therapies for cancer, with a particular emphasis on hematological malignancies. They also collaborate on research projects involving solid tumors.

Special areas of research interest include:

Related labs and programs include:

Patient-centered research is the focus of the Cardiovascular Disease and Outcomes Research Program. Led by co-directors Veronique Roger, M.D., and Suzette Bielinski, Ph.D., the program’s research agenda is to drive improvements in prevention, diagnosis and treatment of cardiovascular disease. Their multidisciplinary team investigates the individual differences in cardiovascular disease that can ultimately be used to tailor care to a patient’s specific molecular and risk profile. Their research also informs models of patient-centered care and can be used to design more-effective interventions to manage patients with cardiovascular disease.

Much of the work in the Cardiovascular Disease and Outcomes Program originates from a massive amount of patient data collected through the Heart Disease in Communities cohort. The cohort is comprised of comprehensive electronic health records indexed by the Rochester Epidemiology Project. The research team is able to analyze cohort data, developing accurate and scalable computable phenotypes (patient groupings based on observable physical, behavioral and environmental characteristics). Identifying phenotypes allows the development of more individualized interventions.

Research in the Renal Disease Laboratory focuses on understanding the development and treatment of bone disease seen in patients with kidney failure, osteoporosis and hypophosphatemia. Led by Rajiv Kumar, M.D., some of the team’s work is in examining the role of phosphate in the body, and novel phosphate-regulating hormones. Another area of investigation is the function of vitamin D in muscle, bone and the central nervous system.

Specific projects include:

  • The regulation of serum and whole body phosphate by novel phosphate-regulating hormones
  • The mechanism of action 1α,25-dihydroxyvitamin D in muscle, bone and the central nervous system
  • The regulation of vascular remodeling in arteriovenous fistulas (AVFs) that is required for hemodialysis and the treatment of vascular stenosis in AVFs with various novel chemical agents
  • The pathogenesis of urinary stone disease focusing on defects in vitamin D metabolism
  • The pathophysiology of skeletal muscle loss, cardiac abnormalities and bone loss in cancer cachexia
  • The structural biology of DNA polymerase ζ (zeta)
  • Clinical bone mineral physiology in health and disease

Addressing right and wrong is what the Biomedical Ethics Research Program at Mayo Clinic exists for. The team, led by Richard Sharp, Ph.D., assesses and addresses difficult questions about right and wrong in medicine and biomedical science.

As scientific discoveries are made and health care evolves, the values at stake in biomedical science and health care are contested and debated. The solutions to these debates are rarely straightforward, and they involve complex trade-offs for scientists, clinicians and health care organizations.

Members of the Biomedical Ethics Research Program conduct rigorous research, teach and engage in policy discussions about ethical questions. Their work helps ensure that biomedical science and health care are conducted with human decency and fairness.

Hemodialysis — filtering the blood of a person whose kidneys don’t work correctly — requires a permanent point of entry into the body’s vascular (blood vessel) system. This access allows blood to be pumped through an artificial kidney machine, cleaned, and returned to the body. In the Vascular and Interventional Radiology Translational Research Laboratory, the team led by Sanjay Misra, M.D., is working on ways to improve the function and longevity of these access points.

There are two types of permanent vascular access used in hemodialysis — arteriovenous fistulae and arteriovenous grafts. In the Vascular and Interventional Radiology Translational Research Laboratory, Dr. Misra’s team is trying to identify the cause for graft failure, as well as potential interventions. They also are developing new ways to improve patency (how well it stays clear and open) of the hemodialysis vascular access.

The team has clinical trials ongoing in support of this research.

Elbow and Shoulder Laboratory team members study the development and refinement of techniques to repair and reconstruct injured elbows and shoulders. Led by Shawn O’Driscoll, M.D., Ph.D., projects in the Elbow and Shoulder Lab include studying the biomechanics of prosthetic radial head (top of radius bone, just below elbow) replacement and the development of a coronoid (projecting part of the ulna bone) fracture classification system to help determine the best course of action to treat posteromedial rotatory instability (a common type of elbow instability).

Research advances that translate into new and better treatment options would improve outcomes for patients with elbow and shoulder injuries and decrease long-term health care costs.

Unmet needs in health care drive research at Mayo Clinic. One major need in modern medicine is preventing the neurodegeneration that is responsible for the development of Alzheimer’s disease, dementia, cognitive impairment and related cognitive disorders. Led by Zvonimir Katusic, M.D., Ph.D., the research team in the Vascular Biology Laboratory hopes to help meet that need.

Dr. Katusic and his team focus their research efforts on the blood vessels of the brain, and their role in the pathogenesis of neurodegeneration (how and why the brain loses neurons, resulting in breakdown of neurological function).

Specifically they are looking for keys to cognitive disorders by studying endothelial dysfunction, microglia and the role of proteins in the protection of vascular function. They hope to expand treatment and prevention options in Alzheimer’s disease and dementia.


Tue, Sep 3 6:00am · Research News Roundup--August 2019

three male researchers in suits in lab, Dr. Gores on right

Each month, we publish Mayo Clinic’s Research News Roundup. This article 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.

Read on for recent findings of Mayo Clinic Research:

Colorectal cancer outcomes may improve by genetically altering an immune-regulatory protein in cancer cells, making the cells more vulnerable to chemotherapy. That’s according to new Mayo Clinic research.

The findings, published this month in Oncogene, indicate that increasing the expression of the PD-L1 protein in colorectal cancer cells can improve the effectiveness of chemotherapy.

“These findings, if verified by subsequent research, suggest that the level of tumor cell PD-L1 may be important in drug sensitivity and suggest that enhancing PD-L1 expression may be a potential strategy to improve treatment outcomes in this malignancy,” says Frank Sinicrope, M.D., a Mayo Clinic medical oncologist and gastroenterologist. Dr. Sinicrope is co-director of the Gastrointestinal Cancer Program at Mayo Clinic and corresponding author of the study.

Owning a pet may help maintain a healthy heart, especially if that pet is a dog, according to the first analysis of data from the Kardiozive Brno 2030 study. The study examines the association of pet ownership — specifically dog ownership — with cardiovascular disease risk factors and cardiovascular health. The results are published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.

The study first established baseline health and socio-economic information on more than 2,000 subjects in the city of Brno, Czech Republic, from January 2013 through Dec. 2014. Follow-up evaluations are scheduled for five-year intervals until 2030.

The study was performed in collaboration with Mayo Clinic, the International Clinic Research Center at St. Anne’s University Hospital, and the University of Catania. This research was supported by the National Program of Sustainability and the European Regional Development Fund. 

Cannabidiol (CBD) oils and products have become increasingly popular with consumers as ways to find relief from aches and pains, anxiety, sleep disturbances and other chronic issues. But are these products safe, and are they helpful?

A review of the latest research, published online in Mayo Clinic Proceedings, finds there’s a growing body of preclinical and clinical evidence to suggest that CBD oils may hold promise for treating conditions such as chronic pain and opioid addiction. But few clinical studies on the safety and efficacy of CBD have been reported, and more research involving humans is needed before health care providers can say definitely that they’re helpful and safe, according to Mayo Clinic researchers.

“There are many intriguing findings in pre-clinical studies that suggest CBD and hemp oil have anti-inflammatory effects and may be helpful with improving sleep and anxiety,” says Brent Bauer, M.D., an internist and director of research for the Mayo Clinic Integrative Medicine program. “But trials in humans are still limited, so it is too early to be definitive about efficacy and safety.”

The news story also contains a video interview with Dr. Bauer and colleague Karen Mauck, M.D.

Parents, siblings and children of people with celiac disease are at high risk of also having the disease, according to a Mayo Clinic study. This study calls for screening of all first-degree relatives of patients — not just those who show symptoms.

The retrospective study, to be published in Mayo Clinic Proceedings in September, found that 44% of screened first-degree relatives had celiac disease. Of those patients, 94% had symptoms that were not classic or had no symptoms at all.

“Research has shown that family members of celiac disease patients are at higher risk, and we used our Mayo Clinic data to show that proactive screening of first-degree relatives, regardless of whether they showed symptoms, resulted in diagnoses that would have been missed,” says Imad Absah, M.D., a Mayo Clinic pediatric gastroenterologist and the study’s lead author.

For people with diabetes, taking medications and monitoring their blood sugar is part of the rhythm of their daily lives. However, according to new research from Mayo Clinic, more than 2.3 million adult patients in the U.S. are likely treated too intensively. This has caused thousands of potentially preventable emergency department visits and hospitalizations for hypoglycemia (low blood sugar).

The study team, led by Rozalina McCoy, M.D., an endocrinologist and primary care physician at Mayo Clinic, sought to identify the real-world implications of intensive glucose-lowering therapy across the U.S. The team showed that overly intensive glucose-lowering therapy — when patients receive more medication than is required based on their hemoglobin A1C level — was not only common across the U.S., but also directly contributed to 4,774 hospitalizations and 4,804 emergency department visits in a two-year period. Their findings were published online Aug. 15 in Mayo Clinic Proceedings.

“Importantly, these numbers are a large underestimation of the true scope of overtreatment-induced hypoglycemic events,” says Dr. McCoy.

Medical doctors in the United States are twice as likely to experience symptoms of burnout as other workers, which can compromise quality of care and place patients at risk. In a study in JAMA Internal Medicine, Mayo Clinic researchers suggest a new approach to fighting burnout: external professional coaching.

Defined by the World Health Organization as “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy,” burnout creates problems for both physicians and the patients they treat. This study, led by Liselotte Dyrbye, M.D. and Colin West, M.D., Ph.D., investigates the use of external professional coaching—focused on professional goal setting, work choices, professional relationships, and influencing change at work—to reduce burnout. Though researchers have previously studied coaching in other contexts, this is the first study specifically exploring its effects on physician burnout.

A new Mayo Clinic research study shows that artificial intelligence (AI) can detect the signs of an irregular heart rhythm — atrial fibrillation (AF) — in an EKG, even if the heart is in normal rhythm at the time of a test. In other words, the AI-enabled EKG can detect recent atrial fibrillation that occurred without symptoms or that is impending, potentially improving treatment options. This research could improve the efficiency of the EKG, a noninvasive and widely available method of heart disease screening. The findings and an accompanying commentary are published in The Lancet.

Known for its poor prognosis, lung adenocarcinoma is the most common type of lung cancer, responsible for about 4 of 10 diagnoses, according to the National Cancer Institute. Researchers on Mayo Clinic’s Florida campus can now distinguish between two pathways where this deadly cancer can develop. They say their discovery could help future patients. The findings appear in Cancer Cell.

“The ability to identify the specific pathway by which a patient’s lung adenocarcinoma came about increases our ability to predict which patients are likely — or unlikely — to benefit from a particular treatment, and hopefully offer alternative options to patients whose cancer subtype is unlikely to respond,” says Alan Fields, Ph.D., a cancer biologist and the study’s senior author. Dr. Fields is the Monica Flynn Jacoby Professor of Cancer Research at Mayo Clinic.


Thu, Aug 1 6:00am · Research News Roundup--July 2019

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.

A longitudinal study of 3,756 U.S. medical students provides evidence that racism in medical schools influenced their decisions on whether to practice in minority or underserved communities.

“Structural racism is deeply embedded in all areas of society, and medical education is no exception,” according to the study in the August issue of Academic Medicine.

“This study provides evidence that racism manifested at multiple levels in medical schools was associated with graduating students’ decisions to provide care in high-need communities,” the article concludes. “Strategies to identify and eliminate structural racism, and its manifestations in medical school are needed.”

Mayo Clinic and Boston Scientific Corp. have launched a new venture to accelerate the development of medical technology and new minimally invasive treatments for many health conditions that impede quality and longevity of life.

The accelerator, known as Motion Medical, will have its research facilities in One Discovery Square, the bioscience center in the Discovery Square research district. Both parties have committed millions of dollars over three years to develop and bring new solutions to the market to address unmet medical needs.

“Mayo Clinic is committed to accelerating the pace of discoveries to bring new technologies and treatments to patients faster,” said Gianrico Farrugia, M.D., president and CEO of Mayo Clinic. “This collaboration and others like it will continue to strengthen Rochester and Minnesota as a biomedical innovation and economic powerhouse.”

Baseball pitchers often are asked to take some heat off the ball, and lower the stress on their elbow and arm muscle tissue, after an injury. But pitchers may be misjudging how much stress and velocity they’re holding back.

A study by Mayo Clinic orthopedic researchers has found that for every 25% decrease in a pitcher’s self-reported effort, elbow torque decreased only 7% and the ball’s velocity dropped only 11%. The athlete’s perceived reduction in effort was markedly greater than the actual reduction, according to the study.

This has significant implications for physical therapists, trainers, coaches and athletes as they monitor elbow stress as part of the recovery process, says Christopher Camp, M.D., a Mayo Clinic orthopedic surgeon.

Mayo Clinic researchers have found an association between increased symptoms of burnout and heightened racial bias in medical residents. The study appears in JAMA Network Open.

“When physicians aren’t operating in an optimal mental and emotional state, they may find it harder to push back against their own biases,” says Liselotte Dyrbye, M.D., who led the study. “If burnout contributes to disparities in care, perhaps fighting burnout can help narrow that gap.”

The results of the study suggest it can. Read more about the research.

A phase I clinical trial is the first research monitored by the Food and Drug Administration that demonstrates the potential of regenerative therapy for hypoplastic left heart syndrome (HLHS) through collecting, processing and injecting an infant’s own stem cells directly into the heart at the time of surgery. A paper detailing the clinical trial was published in The Journal of Thoracic and Cardiovascular Surgery.

More information about clinical trials at Mayo Clinic is available on Mayo’s website, as well as on

One of the most commonly performed surgeries to treat stress urinary incontinence in women may have better long-term results than another common surgical technique, according to a study led by Mayo Clinic researchers.

The retrospective study of more than 1,800 cases at Mayo Clinic from 2002 to 2012 found that the need for additional surgery was twice as high after a transobturator sling surgery compared with a retropubic sling procedure. Reoperation rates within eight years after surgery were 11.2% for patients in the transobturator group compared with 5.2% in the retropubic group, according to the study, which was published in the journal Obstetrics and Gynecology in August.

Using advanced technology, scientists at Chan Zuckerberg (CZ) BiohubMayo Clinic and University of California, San Francisco (UCSF), have discovered an autoimmune disease that appears to affect men with testicular cancer.

Called “testicular cancer-associated paraneoplastic encephalitis,” the disease causes severe neurological symptoms in men. They progressively lose control of their limbs, eye movements, and, in some cases, speech. The disease begins with a testicular tumor, which appears to cause the immune system to attack the brain. Affected men often find themselves misdiagnosed or undiagnosed and appropriate treatment is delayed.

Read about the research that led to identifying this new disease.


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.

Tue, Jul 2 6:00am · Research News Roundup-June 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.

Sometimes a physician thinks the outcome of a patient’s treatment is a great success. Sometimes that patient thinks it was a flop.

That disconnect may go unexpressed by patients or unrecognized by health care providers. Even if there is a “outcome satisfaction” survey, it may not collect the right information or the outcomes measured for patients and physicians may be different and thus not comparable.

Shawn O’Driscoll, M.D., a Mayo Clinic orthopedic surgeon, wanted to develop an assessment process that would be informative, reliable and flexible enough to use across medical specialties.

Read about his research in developing the Summary Outcome Determination Score.

Micronutrient deficiencies, including vitamins B12 and D, as well as folate, iron, zinc and copper, are common in adults at the time of diagnosis with celiac disease. These deficiencies should be addressed at that time, according to a study by Mayo Clinic researchers.

The retrospective study of 309 adults newly diagnosed with celiac disease at Mayo Clinic from 2000 to 2014 also found that low body weight and weight loss, which are commonly associated with celiac disease, were less common. Weight loss was seen in only 25.2% of patients, and the average body mass index was categorized as overweight. The study will appear in the July print issue of Mayo Clinic Proceedings.

Despite improvements in median and short-term survival rates for patients with glioblastoma, the most common brain tumor in adults, the percentage of patients achieving five-year survival remains low, according to new Mayo Clinic research.

A study published June 20 in Mayo Clinic Proceedings finds that little has changed in terms of five-year survival — only 5.5% of patients live for five years after diagnosis — and calls for more aggressive treatments to be considered for all glioblastoma patients.

A new study by Mayo Clinic researchers may have broad implications for treatment of patients with predominantly benign thyroid disease and newly treated hypothyroidism.

The study published in the Mayo Clinic Proceedings July print edition, looked at whether generic and brand-name levothyroxine therapy affected hospitalization for cardiovascular events for those patients who are more at risk of coronary heart disease and heart failure. Levothyroxine is the most prescribed medication in the U.S., with more than 23 million prescriptions written annually.

A Minnesota statewide bipartisan initiative is transforming health care from a focus on treating disease to one of tapping the body’s ability to heal itself. Regenerative Medicine Minnesota is a legislative initiative aimed at improving health by advancing regenerative medicine in research, technology, education and patient care across the state.

The 2019 annual meeting was held June 17, in Rochester, and co-chairs Andre Terzic, M.D., Ph.D., director of the Mayo Clinic Center for Regenerative Medicine and Jakub Tolar, M.D., Ph.D., dean of the Medical School and vice president for Clinical Affairs at the University of Minnesota, highlighted six “firsts” in advancing regenerative medicine toward patient care.

Read about them in the news release.

A generous $32 million gift from the New York-based Anna-Maria and Stephen Kellen Foundation will enable Mayo Clinic to expand its research mission with the construction of a four-story, 64,000-square-foot research building in Rochester, Minn.

“We cannot overstate our gratitude to the Anna-Maria and Stephen Kellen Foundation,” says Gianrico Farrugia, M.D., Mayo Clinic’s president and CEO. “Research is critical to infusing new knowledge into patient care. It paves the way to solve serious or complex medical challenges for our patients at Mayo as well as patients around the world. This remarkable gift will allow us to meet a critical need for research space on our Rochester campus.”

Discrimination and bias in health care were the subject of some of Mayo’s studies.

Mayo Clinic Cancer Center has long had a strong presence at the American Society of Clinical Oncology’s annual meeting – the largest gathering of its kind, and #ASCO19 was no exception. This linked blog post contains brief summaries of (and links to) the four Mayo news releases sent out from the 2019 ASCO Annual Meeting in Chicago.


Find out more:

Mon, Jul 1 6:00am · Community preparedness for future outbreaks: Lessons from whooping cough

the news has contained many stories of illness or death that could have been
prevented by vaccination. Although in 2019 the stories have mostly been about
measles, in 2016 it was pertussis, or whooping cough, as it was in 2012, and

The Centers for Disease Control estimates 24.1 million cases of whooping cough occur each year worldwide, resulting in 160,700 deaths. As with measles, the most effective way to prevent whooping cough is through vaccination.

Recently Young Juhn, M.D., a clinical informatistician, pediatrician and population health researcher at Mayo Clinic, led a study using spatio-temporal, or hot-spot, analysis to better understand the pertussis outbreaks. His team analyzed the onset and spread of pertussis during two time periods, in Olmsted County, Minnesota, using a microbiology database and the Rochester Epidemiology Project. This unique medical records linkage system and longtime regional research collaborative originated in Olmsted County, Minnesota, and now includes 27 counties across Minnesota and Wisconsin.

Young Juhn, M.D.

Dr. Juhn and his team found that during 2004-2005 and 2012, whooping cough was diagnosed in Olmsted County at rates 5-10 times higher than average, as well as significantly higher than across the rest of Minnesota. Only whooping cough cases with diagnosis as confirmed by laboratory testing conducted by Mayo Clinic Laboratories were included. No individuals were counted who did not have confirmed laboratory results.

found that adolescents (age 11-13) had the highest incidence rate during both
outbreaks. Furthermore, the researchers observed that early in both outbreaks,
a specific geographic area/neighborhood had the highest incidence levels.

locations have not been typically taken into account as a risk factor for
infectious diseases,” says Dr. Juhn. “However, our study results indicate
that we need to change that.”

Dr. Juhn
can’t say yet why that neighborhood was disproportionately affected, but he has
some theories he is pursuing with his research team.

next steps are to further characterize children living in this area compared to
other areas,” he says. “We want to examine school attendance, school
bus route, after school activities, and so forth.”

addition, Dr. Juhn and his fellow researchers see an opportunity to use the
rich data of electronic health records, including the resources of the Rochester
Epidemiology Project, to examine how well the pertussis vaccine helps provide
herd immunity, and also whether its protective effect lessens over time since

the team has several questions they still want to answer, Dr. Juhn says,
“Vaccination is still the best strategy to prevent whooping cough and
reduce its spread.”

Dr. Juhn
also encourages parents and teachers to encourage hand washing and other
precautions to prevent spread of infectious diseases. He also says that as
public health organizations become aware of whooping cough diagnoses,
coordination with the school district for early recognition and timely
isolation of cases could help prevent spread.

In their
continuing investigation around whooping cough, Dr. Juhn and his team are
planning to test and implement an innovative approach at a population level
called precision population medicine.

He says
that the geographic hotspots identified now and in the future could help them
to identify “first, which children and adolescents reside in such
geographic areas; second, which are susceptible to whooping cough due to not
up-to-date vaccinations; and finally, which schools they attend.”

“We need to educate parents and teachers about whooping cough and other common infectious diseases – both about symptoms and prevention,” Dr. Juhn says. “In Olmsted and Dodge counties in particular, we have partnerships with the schools and public health department already, through which we may be able to offer this and other vaccinations at school settings such as the School Flu Vaccine Program, making it easier and more timely for parents to protect their children.”

Dr. Juhn
reiterates that public health issues such as this are best addressed through
interagency coordination – wherever the outbreak may occur. He believes that understanding
historical trends in the spread of disease is “an important aspect of
improving a community’s preparedness for future outbreaks of emerging and
re-remerging infectious diseases.”

also could provide an opportunity to assess and address unmet health needs of
geographically under-served populations leading to health disparities,” he

addition to Dr. Juhn, the research team included:

  • Chung-Il Wi, M.D., and Euijung Ryu, Ph.D., of Mayo Clinic
  • Philip Wheeler, research consultant, former director of Olmsted and Rochester Planning Department
  • Harsheen Kaur, M.D., University of New Mexico
  • Dohyeong Kim, Ph.D., University of Texas


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.

The REP receives administrative support from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Improving public health is in alignment with the center’s overall goal to transform the experience of health and health care.

Wed, Jun 19 6:00am · App may make diabetes self-management and personalized health care decisions easier

young woman on city street looking at her phone

Bithika Thompson, M.D., an endocrinologist at Mayo Clinic in Phoenix, and M. Adela Grando, PhD., a biomedical informaticist at Arizona State University, recently teamed up on a health care research project that could transform the way individuals manage their diabetes.

1 diabetes is a chronic disease that affects more than 1.2 million people in
the U.S. There is no cure for Type 1 diabetes. Patients must consistently
engage with ongoing self-management behaviors to manage the disease effectively
and prevent the numerous complications that can result from poorly controlled diabetes.
These self-management behaviors include frequent monitoring of blood glucose
levels, adherence to diet, and administration of insulin based on blood sugar
levels and carbohydrates consumed.

screen shot of app

the complexity of managing these behaviors in daily life makes diabetes
management difficult. When the researchers started the project, they wanted to
better understand patient behaviors with respect to diabetes self-management.
Armed with that knowledge, they and their team hoped to develop custom
interventions that would help each person better control their blood glucose
levels, thereby lessening the likelihood of diabetes-related adverse health

Specifically, they developed and tested a new way to design individualized data-driven educational interventions to improve Type 1 diabetes adherence. To do this, the researchers collected:

  • Real-time self-reported data collected daily by a smartphone app
    they had previously developed,
  • Objective data collected daily from the patients’ insulin pump
    and continuous glucose monitoring systems, and
  • Patient disease and device comprehension and self-management routines,
    as captured through surveys and interviews.

The app tracks
real-time information such as exercise plans, food and beverage intake, and
diabetes compensation techniques (eating a snack prior to exercise to prevent a
low blood sugar).

Additional computer
algorithms were developed to automatically collect and analyze all the
information brought in, and provide actionable information for clinicians.

have unique self-care preferences and behaviors that should be taken into
consideration by clinicians,” says Dr. Thompson, “particularly as
patients are more likely to achieve adherence when incorporating lifestyle and
self-management preferences.”

on what the team found out about patient behavior, they were able to help
develop more specific educational materials for patients. They also developed
talking points for clinicians to lead discussions on the patients’ individual
self-management behaviors that could lead to positive or negative health

hope that targeted patient education, and facilitating individualized
conversations, will lead to better health outcomes,” she says.

This research was funded by Arizona State University and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.


Mon, Jun 17 6:00am · Finding what works best to stop osteoporosis in its tracks

two older women walking outdoors

According to the International Osteoporosis Foundation, more than 200 million people worldwide suffer from osteoporosis, or insufficient regeneration of bone tissue and fragile bones. At least 40% of postmenopausal women and 15-30% of older men will sustain one or more fractures due to fragility. Osteopenia, a lesser form of bone loss, affects many millions as well, and may progress to a full osteoporosis diagnosis.

Because of the widespread nature of these disorders, and the
associated risk of fractures and related health issues, many treatments have
been developed. There are numerous medications and hormone treatments used to slow
or prevent bone loss, each with different indications and side effect profiles.
The variety of treatments and volume of related information can be difficult
for physicians to sort through to find the appropriate therapy for their

effectiveness research

Illustration of a portion of spine, with a close-up section of normal bone and osteoporotic bone.

“There are too many drugs that are used for osteoporosis,” says M. Hassan Murad, M.D., an internal medicine doctor and a clinical epidemiologist in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. “We wanted to compare them so that patients and physicians can make informed decisions.”

In order to determine which treatments work best, medical
researchers conduct comparative effectiveness research, in which they collect
and analyze the results of many clinical trials testing treatments for a
particular disease or condition. This can be done using a complex statistical
technique called network meta-analysis. The researchers then figure out which
interventions consistently rise to the top as being most effective.

Dr. Murad, who also leads Mayo Clinic’s Evidence-Based Practice Center, accepted the challenge of the Endocrine Society to provide the evidence to support the society’s guidelines for the treatment of postmenopausal women with osteoporosis.

practice recommendations

His multidisciplinary team reviewed and analyzed the results from 107 randomized clinical trials that enrolled postmenopausal women with primary osteoporosis or osteopenia and evaluated different treatments to prevent hip, vertebral (back/spine) or other fractures. These studies, conducted around the world, tested one or more of the following interventions: various bisphosphonates, teriparatide, selective estrogen receptor modulators, denosumab, abaloparatide, romosozumab, estrogen with or without progesterone, calcitonin, lasofoxifene, strontium ranelate, tibolone, PTH 1-84, calcium, or vitamin D.

They found that some treatments did indeed rise to the top
as most effective for halting the progression of osteoporosis and resulting
bone fragility.

“The most effective treatments to prevent fractures
were bisphosphonates and some newer medications: romosozumab, denosumab and
teriparatide,” says Dr. Murad.

It is possible that these findings could be practice
changing, he says. “When physicians prescribe these medications to women
with osteoporosis, they can use the results of this study to guide their

The research identified several effective treatments, so Dr.
Murad says, “Patients should ask about side effects and costs, as well as
ease of administration – some of these drugs are injectable and some are orals.”


The Mayo Clinic Evidence-Based Practice Center is so designated by the Agency for Healthcare Research and Quality. Recently it also became designated as a Cochrane affiliate within the Cochrane US Network. The evidence-based practice research program seeks to improve the quality, effectiveness and appropriateness of health care by synthesizing research evidence and facilitating the translation findings into clinical practice.

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