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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5 days ago · Did you know? Mayo Clinic publishes two peer-reviewed journals

image of the cover of the January 2020 issue of journal

Continuously published since 1926, Mayo Clinic Proceedings is a peer-reviewed journal, ranked among the top 10% of the 160 clinical journals in the Medicine, General and Internal category. The journal has a distribution of approximately 127,000.

Articles published in peer-reviewed journals have been reviewed by experts in the relevant field to ensure they contain high quality science and valid interpretations. For more discussion, read this article.

Although sponsored by Mayo Clinic, Mayo Clinic Proceedings publishes articles submitted by authors worldwide — approximately 80% of submissions come from non-Mayo authors.

Editor-in-Chief, Karl Nath, M.D., recently published the 2020 Vision for Mayo Clinic Proceedings, recapping some of its history and reminding readers of the diverse and deep content it has provided. In the article, Dr. Nath explains that the “defining nature of the Proceedings, one that will be both sustained and nurtured, reflects and speaks to the heterogeneity in interests and readership that exist in clinical practice, research, and education.” 

Several new features were launched in 2019, and 2020 has already seen the launch of another new section “Radiology, Imaging, and Intervention,” led by James Andrews, M.D.

The sister journal, Mayo Clinic Proceedings: Innovations, Quality & Outcomes, is online-only, open access, and has its own editorial board.

Mayo Clinic Proceedings: Innovations, Quality & Outcomes publishes content focusing on clinical innovations, quality improvement, and optimal outcomes, in medicine and surgery.

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Tue, Jan 7 6:00am · Research News Roundup--December 2019

diverse research team, female researcher readys slide on microscope tray while two male colleagues watch

December’s Research News Roundup highlights a number of advancements in understanding and treating different cancers, including blood, breast and gastrointestinal; in addition to other research news from Mayo Clinic.

The Roundup also connects readers to related resources. Read on for more information from Mayo Clinic Research.

male doctor in conversation with male patient, both are middle-aged

A Mayo Clinic study involving 5,540 patients with metastatic colorectal cancer found maintenance chemotherapy after initial treatment is more beneficial for patients whose disease is under control, compared with more aggressive treatment.

A maintenance strategy with a fluoropyrimidine chemotherapy, such as 5-FU or capecitabine, is preferred, though observation (no chemo) is an acceptable option for some patients, according to the analysis of results from 12 randomized clinical trials. The study appears in JAMA Oncology.


diverse group of resident physicians in clinical hallway at Mayo Clinic

Gender pay equity in the field of medicine remains elusive. Gender-based pay differences have been shown to persist, even when controlling for experience, clinical productivity, academic rank and other factors. These inequities result in significantly lower lifetime earnings, job burnout and negative attitudes toward work, and adverse effects on the profession and society.

One model for eliminating pay disparities among physicians is a structured, salary-only plan that incorporates national benchmarks, and standardized pay steps and increments, such as the plan that is used at Mayo Clinic.

A Mayo Clinic study set out to assess how well the institution adheres to its own compensation model and achieves pay equity.  Read more in the news release.


This is an alarming trend, as stomach cancer is a devastating disease. There is little awareness in the U.S. of the signs and symptoms of stomach cancer, and many younger patients may be diagnosed late.

Many people under 60 who develop stomach cancer have a “genetically and clinically distinct” disease, new Mayo Clinic research has discovered.

female doctor examining younger middle-aged African American female patient

Compared to stomach cancer in older adults, this new, early onset form often grows and spreads more quickly, has a worse prognosis, and is more resistant to traditional chemotherapy treatments, the study finds. The research was published recently in the journal Surgery.

While rates of stomach cancer in older patients have been declining for decades, this early onset cancer is increasing and now makes up more than 30% of stomach cancer diagnoses.


artist's interpretation of microbes, colorful cells of different shapes and sizes

Endometrial cancer is the most common gynecological malignancy in the U.S. and the fourth most common cancer among women. In addition, endometrial cancer incidence rates are on the rise in the western world, suggesting that alterations in environmental factors such as diet, lifestyle, and the vaginal microbiome may be important drivers in its cause.

In a study published in Scientific Reports Mayo Clinic researchers identified a vaginal microbiome signature associated with endometrial cancer, which is in part promoted by post menopause. The goal of the study was to understand how endometrial cancer risk factors alter the reproductive tract microbiome and endometrial cancer risk.


Researchers found most women who survive breast cancer beyond 10 years are at risk to develop serious medical conditions including heart disease, cerebrovascular disease and Alzheimer’s disease

close up shot of woman in white tank top with pink ribbon attached over left breast

Overall survival of patients with breast cancer in the U.S. has significantly improved over the past two decades. However, as breast cancer survivors live longer, their risk of developing other serious medical conditions also increases, according to a Mayo Clinic-led study published in the journal Cancer.

The retrospective study provides the largest and most recent population-based, long- term analysis to date of non-cancer causes of death among women diagnosed with breast cancer. It also provides a detailed assessment of changes in the risk of each cause of death, compared to those in the general U.S. population over the same period.


smiling young woman with new hair growth just beginning to show on her head

Mayo Clinic researchers presented 22 different studies during the 2019 San Antonio Breast Cancer Symposium, Dec. 10–14.

Three in particular were highlighted in the Mayo Clinic news release. Titles below are taken from the plain language release, but link to the abstracts presented at the symposium.


group of people lifting kettlebells in a fitness class

High-intensity group workout classes are increasingly popular at fitness centers. While research has shown that these workouts can have cardiovascular and other benefits, few studies have been conducted on whether they lead to more injuries.

Mayo Clinic study that closely tracked 100 participants in a six-week high-intensity functional training program showed a statistically insignificant increase in the rate of injury, compared with less intensive workouts.

The study, published in Mayo Clinic Proceedings, reported an injury rate of 9 injuries per 1,000 training hours during the six-week training, compared with 5 injuries per 1,000 training hours during the six weeks preceding enrollment. The data showed that 18% of participants reported an injury during the training period, and 37.5% reported an injury during a training session.


gloved, with lab coat and dark rimmed glasses; female researcher pipetting samples

There were dozens of presentations featuring Mayo Clinic research throughout the American Society of Hematology Annual Meeting, Dec. 7–10 in Orlando.

Three were featured in the news release from Mayo. The below titles are drawn from the news release, but are linked to the related abstracts:

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Find out more:

Dec 12, 2019 · A unique competition showcases Mayo's innovative capabilities

a hospital staff person wearing protective eye wear and a head cover, touching a futuristic medical concept of artificial intelligence images on transparent glass.

An innovative artificial intelligence project from a group of Mayo Clinic investigators was among the top 25 participants selected to advance to Stage 1 of the Centers for Medicare & Medicaid Services (CMS) Artificial Intelligence Health Outcomes Challenge.

The challenge is to develop
technology that can be used to predict unplanned hospital and skilled nursing
facility admissions, and adverse events within 30 days – using Medicare claims
data.

Patrick Wilson
Patrick Wilson is a statistician at Mayo Clinic in Rochester, Minn.

“In addition, teams are expected to develop strategies to explain AI-derived predictions to front-line clinicians and patients, and identify ways to increase use of AI-enhanced data for quality improvement,” says Patrick Wilson, a statistician in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Along with James Naessens, Sc.D., a researcher in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, focused on issues in quality and safety, Wilson co-leads Mayo Clinic’s project that made it through the first cut in the competition.

More than 300 teams submitted
entries in response to the CMS challenge. Now 25 are competing for 7 spots in Stage
2 of the Challenge.

Mayo’s advancing project is
“Building Interpretable Model Ensembles to Reduce Unnecessary Hospital and SNF
Admissions – A Claims-based Learning Framework to Improve Patient Care through
Policy.”

James Naessens, Sc.D.
James Naessens, Sc.D.

“More than 10 years ago, then President and CEO Dr. Denny
Cortese and collaborators developed the Mayo Clinic value equation,” says Dr.
Naessens. “Value equals quality over cost, with quality defined as outcomes,
safety, and service, and cost considered over time.”

“This work is an outgrowth of that value equation – and a
chance for us to share our expertise and potentially transfer some of our value
to the nation’s health care system.”

Dr. Naessens
and Wilson are leading a diverse team to design a claims-based learning framework for developing machine learning
models. They are using what the team refers to as ‘ensemble models’ – a
methodology that incorporates multiple machine learning algorithms to leverage
the diversity of different concepts, expertise and backgrounds.

“These ‘ensemble models’ will predict
unplanned hospital and skilled nursing facility admissions and readmissions, as
well as other adverse events,” says Wilson. “We are developing the ensemble
model to work with the current data delivery and management capabilities of CMS.”

word graphic titled 'Design Process' that shows three separate work loops. First loop has three boxes: Develop Features, Testing, Clinician in the Loop! Second loop has three boxes: Developing visualizations, building dashboards, clinician in the loop!! third loop has three boxes: Develop proof of concept, dockerize models, clinician in the loop!!!

To build a scalable and sustainable artificial intelligence framework
with a high likelihood of integrating into a CMS health innovation model, Wilson
says the following five design principles are critical. The model must:

  • Be iterative
  • Have a low barrier to implementation
  • Be highly accurate
  • Be easily interpretable
  • Be open and trustworthy

Usability is ensured by integrating clinicians throughout the process.

“Our team is leveraging the
collective knowledge and experience of several health services researchers and
health care policy analysts, as well as potential physician users, and
combining it with the power of artificial intelligence/machine learning,” says
Dr. Naessens. “This multidisciplinary, team science approach is one of the
critical elements of Mayo Clinic’s practice transforming research and value for
our patients.”

He and Wilson say that Mayo
Clinic’s algorithms will produce clear, actionable insights, and if selected as
a winning proposal, CMS could incorporate them into an innovation solution for
quality improvement across model participants.

“We view this as the main
objective for this project,” says Wilson. “However, the claims-based learning
framework we are developing could be leveraged for multiple purposes involving
other prediction models, quality improvement initiatives, risk adjustment and
testing for subgroups of program treatment response.”

Wish them luck and stay tuned – winners
of Stage 1 will advance to Stage 2 in April 2020.

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Dec 3, 2019 · Research News Roundup--November 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.

stem cell trial patient Chris Barr in shorts and a t-shirt, smiling and standing a clinic exam room with Dr. Mohamad Bydon and wife Debbie Barr looking on

Stem cells derived from a patient’s own fat offer a step toward improving — not just stabilizing — motor and sensory function of people with spinal cord injuries, according to early research from Mayo Clinic.

A clinical trial enrolled 10 adults to treat paralysis from traumatic spinal cord injury. After stem cell injection, the first patient demonstrated improvement in motor and sensory functions, and had no significant adverse effects, according to a case report published in Mayo Clinic Proceedings.


closeup photo of hands of older person, loosely folded on table

Mayo Clinic-led study involving 3,276 patients has found that people with inflammatory bowel disease, Type 1 diabetes or blood clots may be at increased risk of developing rheumatoid arthritis.

The study, published in Mayo Clinic Proceedings, also found that people who have rheumatoid arthritis are at increased risk of developing heart disease, blood clots and sleep apnea.


graphic of carbon ion beam breaking up a DNA strand

Mayo Clinic and Hitachi, Ltd. have reached an agreement in principle to build a carbon ion treatment facility as part of Mayo Clinic’s recently announced integrated oncology facility which will be constructed at Mayo Clinic’s campus in Jacksonville, Florida.

While carbon ion therapy was discovered in the United States in the 1970s, there currently are no carbon ion therapy treatment centers in North America. The technology is only available at a handful of centers in Asia and Europe. Read a related news article on Wired.com.

Steven Buskirk, M.D., chair of the Department of Radiation Oncology at Mayo Clinic in Florida says, “the availability of carbon ion technology will allow Mayo Clinic researchers to evaluate the efficacy of carbon ion therapy for the treatment of various cancer types including exploration into new and expanded therapies, including multi-modality treatment options.”


photo of Mayo Clinic building in Arizona

Mayo Clinic in Arizona has been recognized as a Center of Excellence for Enhanced Recovery After Surgery (ERAS), the second medical center in the U.S. to earn that distinction.

Enhanced Recovery After Surgery aims to improve care of surgery patients and enhance postoperative recovery through implementation of evidence-based practice, audit, education and research. Protocols that have been developed emphasize a culture of inclusivity and recognition of the importance of multidisciplinary collaboration.

Since implementing ERAS protocols, Mayo Clinic in Arizona has reported decreased lengths of hospital stays, and fewer complications and readmissions, while achieving significant cost savings. Among other achievements, the Division of Colon and Rectal Surgery has reported a 70% reduction in narcotic use postoperatively over the past three years.


stock image of female doctor holding toy red heart

Twice-yearly injections of an experimental cholesterol-lowering drug, inclisiran, were effective at reducing low-density lipoprotein (LDL) cholesterol, often called bad cholesterol, in patients already taking the maximum dose of statin drugs, according to data of the ORION-10 trial presented Saturday, Nov. 16, at the American Heart Association’s Scientific Sessions 2019.

High levels of LDL cholesterol — which builds up in the walls of the arteries, making them hard and narrow, thereby leading to blockages — causes increased risk of heart attacks and strokes.


stock image of a row of adults sitting on yoga mats, turning towards their back

A Mayo Clinic study published in the American Journal of Health Behavior investigates differences in how men and women perceive their own health. The study finds that confidence in maintaining good health habits can be influenced by gender.

Men reported higher levels of physical activity and greater confidence in their ability to remain physically active, according to the study, which surveyed 2,784 users at the Mayo Clinic Dan Abraham Healthy Living Center, an employee wellness center. Men and women had comparable levels of confidence that they would maintain a healthy diet.

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

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

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

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

Nov 8, 2019 · Strengthening the case for palliative care

student team simulating intensive care activities for simulated patient

The Mayo
Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care
Delivery
is the group at Mayo Clinic charged with driving practice
transformation. Basically, this means to help Mayo Clinic improve the way health care
is delivered, reaching patients where they are, with the right answers when
they are needed.

Center researchers work within multi-disciplinary teams
across Mayo Clinic on projects ranging from better ways to support women during
pregnancy, to faster visits in the ER and new ways to help elderly patients
stay out of the hospital.

One
recent research project
with the Department
of Cardiovascular Medicine
looked at how often palliative care is part of
the care plan for patients who suffer a heart attack accompanied by cardiogenic
shock. Public Affairs sat down with two of the study authors to find out more
about their project, and how it may lead to better care for patients.

The study first author, Saraschandra Vallabhajosyula,
M.B.B.S., is a cardiology
fellow
at Mayo Clinic, with prior training in critical care medicine. His
mentor and the study’s senior author is Gregory
Barsness, M.D.
, the medical director of the Mayo Clinic Cardiac Intensive
Care Unit with additional expertise in interventional cardiology and radiology.


Dr. Vallabhajosyula,
what made you decide to study this topic?

Saraschandra Vallabhajosyula, M.B.B.S.

Cardiogenic
shock
after acute myocardial infarction is my clinical and
research interest. These patients are often admitted to the cardiac intensive
care unit with multi-organ failure needing cardiac and non-cardiac organ
support.

They have a high risk of death in
the cardiac intensive care unit and the hospital. Therefore, there is an
important need to understand the issues surrounding end-of-life in these
complex patients.

Furthermore, palliative
care
is frequently mistaken as ‘futile care’ rather than ‘patient-centric
care’ by both patients and physicians. We sought to understand the national
trends and predictors in this population.

Dr. Vallabhajosyula:
What is cardiogenic shock, and what makes these heart attacks different for
patients experiencing them?

Cardiogenic shock is a state of low cardiac
output (pumping ability of the heart) and about 80% of these cases are due to an
acute myocardial infarction – commonly known as a heart attack. While there are
other reasons a person might develop cardiogenic shock, when it occurs as a
result of cardiac muscle damage during a heart attack, it happens very quickly.
It is difficult to predict how well a patient will do in this situation, and in
fact, nearly a third of these patients die in the hospital.

This results in a rather urgent need to quickly develop a
patient-centric care plan, one that incorporates the patient’s condition and
wishes, as well as that of their family when they are unable to communicate.

The typical health care team surrounding a patient who
has had a heart attack is well versed in the technologies and procedures needed
to extend life. However, this has to be balanced with detailed conversations
about the risks and benefits of each with patients and families, or to develop
a palliative care plan that aligns interventions with patient goals.

Dr. Barsness, what is palliative care, and what do
palliative care specialists do?

Gregory Barsness, M.D.

The practice
of palliative care aligns what is possible with what is desired. In modern
medicine, there are a great many more treatment options available to patients
and these treatments carry different potential benefits and risks. The health care
decisions that patients and their families make are directly related to how
patients understand these risks and benefits and how the results might align
with their overall life goals. 

Palliative
care specialists provide insight and guidance to help patients and their
families understand and integrate advanced diagnostics and treatments therapeutics
with their social, emotional and spiritual needs.

Palliative
care specialists play a crucial role in the care of patients with acute or
chronic conditions. In particular, in the acute cardiac ICU setting, they can
assist patients and families faced with choices that include treatments that prolong
life but do not cure. For example, there are a number of different machines
that help the heart pump, breathe for the patient or filter a patient’s blood
when their kidneys stop working.

Many of these
patients may also experience significant changes in their health and needs
during their time in the hospital, leading to later decisions that could be
inconsistent with their overall goals of care.

Dr. Barsness: Why is it important
to make palliative care an integral offering in the cardiac ICU?

A team-based approach incorporating palliative care
specialists to care for patients with cardiogenic shock following a heart
attack is crucial to individualizing care based on each patient’s specific
goals and desires. This is actually an ideal approach for patients with any
acute or chronic condition that has substantial implications for quality and
longevity of life.

The cardiac ICU, in particular, is a fast-paced environment
where crucial decisions often revolve around technical feasibility with an
emphasis on the science of medicine. Involving team members with special skills
in palliative medicine assures that we place appropriate emphasis on individual
values and choices.

At Mayo Clinic, we do that routinely via scheduled family
conferences and open visitation schedules and health care providers present and
available around-the-clock. Use of palliative care is an extension of the same
philosophy wherein we value the patients’ and families’ emotional, spiritual
and social concerns along with the science of care delivery. So incorporating
palliative care specialists is like getting a different set of eyes, i.e.
different perspective, on the same core issue – the needs of the patient.

Dr. Vallabhajosyula,
while at Mayo Clinic including palliative care support may be more the norm,
your study showed that in general, across the U.S., palliative care is not provided
to these patients. Do you have any thoughts as to why?

I think it is a combination of factors that largely have to
do with the perception of palliative care. Hospice care, end-of-life care and
palliative care are presumed to be interchangeable, potentially resulting in
late referrals of ‘actively dying’ patients.

As Dr. Barsness and I previously noted, the philosophy of
palliative care is compatible with continued medical care and does not mean
‘giving up,’ or the cessation of care. That being said, we all can do better.

Only 4.5% of the nearly 450,000 patients (admitted to
hospital) in our national study were offered palliative care. Other research
has shown that the national rates for palliative care use in a range of
critical care settings, 7%-13%, are still very low.

Dr. Barsness: Your study showed
that people receiving palliative care support were more likely to die in
hospital or not return home. Were there any things about this finding that
concerned you?

As
noted in the study, patients with palliative care visits were sicker, had
higher acute organ failure and were likely offered palliative care too late in
their hospital course.

Our
results might suggest that patients with palliative care support received
futile care less often and adopted life limiting decisions more frequently –
that is, they perhaps chose to reduce or decline use of equipment and
technologies that prolonged life. They also may have sought non-hospitalization
care during end-of-life.

However,
to draw firm conclusions, more data are needed on the timing of palliative care
consultation, as well as any changes care in management plans that result from
palliative care consultation.

Dr. Vallabhajosyula continues:

The
major findings of our study are the strikingly low use of palliative care
specialists in a patient population that has nearly 30% in-hospital mortality.

Though
the time trends analyses show higher use in more recent years, there still
remain multiple barriers. Perceptions of palliative care and other barriers to
incorporation are common as we noted previously. Additionally, we found geographic,
racial, sex and age-related disparities.

These
factors indicate the need for more qualitative research to understand these
barriers to implementing high-quality care.

Dr.
Barsness: Do you expect Mayo Clinic practice to change as a result of these
findings?

These
national results are certainly eye-opening and would make many of us working in
the cardiac ICU reflect on our practice. Given Mayo’s emphasis on
multidisciplinary care, the high spirit of collaboration and prioritizing the
needs of our patients, our numbers are significantly better than these national
statistics. However, in our relentless efforts to provide the best possible
care for our patients, we seek to continually improve on this aspect and many
others relating to health care delivery in the CICU.


When asked if there was anything else they’d like to add, both doctors chimed in with thanks to that same multidisciplinary team they mentioned – the nurses, therapists, pharmacists and technicians of the cardiac ICU that make it possible to deliver high quality care to critically ill patients, while providing hope and healing to these patients and their families. They went on to credit other groups without which they would not have been able to conduct this research, the Divisions of Pulmonary and Critical Care Medicine and General Internal Medicine, Mayo Clinic Center for Palliative Medicine, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic Center for Clinical and Translational Science and the Mayo Clinic School of Graduate Medical Education.

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Nov 5, 2019 · Research News Roundup--October 2019

If you were camping near the Boundary Waters, hiking the Grand Canyon, or snorkeling off the Florida Keys last month, you might have missed some of Mayo Clinic’s research news.

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-led study involving 488 cardiac patients whose cases were followed for up to 12 years finds that microvascular endothelial dysfunction, a common early sign of cardiovascular disease, is associated with a greater than twofold risk of cancer.

The study, published in the European Journal of Preventive Cardiology, finds that microvascular endothelial dysfunction may be a useful marker for predicting risk of solid-tumor cancer, in addition to its known ability to predict more advanced cardiovascular disease, says Amir Lerman, M.D., a Mayo Clinic cardiologist and the study’s senior author.


New research from the Well Living Lab, a Delos and Mayo Clinic collaboration, shows that office areas with windows, which provide people with natural light and views of the outdoors, improve workers’ cognitive performance and satisfaction with their office environment. Modern shading and glass tinting techniques can mitigate eyestrain, reducing discomfort from daylight glare.

These findings are published in the November volume of Building and Environment. The study was conducted by researchers from the fields of environmental, health and behavioral science.


In cell and mouse models, Mayo Clinic researchers and collaborators have identified a way to slow and reverse the process of uncontrolled internal scarring, called fibrosis.

This disease process has few effective therapies, no cure and can be fatal when it occurs in organs such as the liver (cirrhosis) or lungs (pulmonary fibrosis). The findings appear Wednesday, Oct. 30, in Science Translational Medicine.


Among other Mayo Clinic research, four studies were of particular interest – the news release describes these more fully:

  • Patients with microscopic colitis do not have reduced risk of developing colon polyps
  • Anti-tumor necrosis factor (TNF) therapy linked to preeclampsia in women with inflammatory bowel disease
  • Positive polymerase chain reaction (PCR) test results may not predict recurrence of common infection
  • Study proposes new method, protocol to study stomach function after bariatric surgery


The largest randomized trial in asymptomatic patients with smoldering multiple myeloma suggests that lenalidomide, a cancer drug, may delay the onset of bone and other myeloma-related organ damage.

Results of the study, which was conducted by the Eastern Cooperative Oncology Group and funded by the National Cancer Institute, were published Friday, Oct. 25, in the Journal of Clinical Oncology.


Courtesy of The New England Journal of Medicine. This figure shows photos of four participants (top two rows) and corresponding reconstructions of their faces (bottom row) created from their research MRI scans.

Though identifying data typically are removed from medical image files before they are shared for research, a Mayo Clinic study finds that this may not be enough to protect patient privacy.

The study, described in a letter published in The New England Journal of Medicine, finds that it’s possible to use commercial facial recognition software to identify people from brain MRI that includes imagery of the face, despite steps that researchers typically take to protect patient privacy. 


In a consensus report released Wednesday, Oct. 23, the National Academy of Medicine makes recommendations for system-level change needed to improve the professional well-being of clinicians, students and trainees across health care.

Lotte Dyrbye, M.D., co-director of Mayo Clinic’s Program on Physician Well-Being, was on the committee that developed the report and presented its findings to Congress and the nation.

Clinician burnout has been identified as a major problem in the U.S., affecting 35%–54% of nurses and physicians, and 45%–60% of medical students and residents. Some research suggests that these numbers are reflected in all areas of health care (oral, pharmacy, etc.). Along with burnout comes a corresponding threat to organizations’ abilities to provide high-quality patient care.

The new report, “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being,” hopes to reduce these numbers, and states, “Taking action to mitigate burnout requires a bold vision for redesigning clinical systems — one which focuses on the activities that patients find important to their care, and which enables and empowers clinicians to provide high-quality care.”


Chronic kidney disease, which afflicts an estimated 6.4% of U.S. adults 45 and older, is associated with an increased risk of heart attack and other adverse cardiovascular outcomes, according to new research from Mayo Clinic.

The retrospective review of 1,981 patients who were treated for chronic kidney disease at Mayo Clinic between 1997 and 2000 found that over a 10.2-year follow-up period, these patients had significantly elevated cardiac biomarkers, and were at increased risk of heart attack, congestive heart failure, stroke and other adverse cardiovascular events.

According to the study, which is published in Mayo Clinic Proceedings, the results regarding heart attack were especially striking: Chronic kidney disease was associated with a 95% increased risk of heart attack during the follow-up period.


Frontotemporal lobar degeneration is the overarching term for a group of disorders that involve shrinkage of the frontal and temporal lobes of the brain.

Frontotemporal lobar degeneration is the overarching term for a group of disorders that involve shrinkage of the frontal and temporal lobes of the brain.

The National Institutes of Health has awarded a five-year, multi-investigator research grant expected to total more than $63 million to Mayo Clinic and the University of California, San Francisco, to advance treatments for frontotemporal lobar degeneration.

Frontotemporal lobar degeneration is the overarching term for a group of neurodegenerative disorders that primarily affect areas of the brain associated with personality, behavior, memory and language. These disorders are estimated to account for 10%–20% of dementia cases in the U.S.

Unlike Alzheimer’s disease, which typically affects people over 65 and often progresses slowly, frontotemporal lobar degeneration frequently affects people in their 40s, 50s and 60s who are still working and raising families. It often leads to rapid cognitive and physical decline, and death, in less than 10 years. There are no effective treatments.


Although this release was mainly to provide reporters with some experts to contact during National Breast Cancer Awareness Month, it also offered a glimpse of the results of new research showing that young breast cancer patients may experience more advanced cancers.

Judy Boughey, M.D., a Mayo Clinic breast surgeon, recently conducted a study of more than 46,000 women ages 15–49. This study found that while adolescents and young women account for less than 2% of breast cancer patients, they tended to be diagnosed with more advanced breast cancer and more aggressive tumor biology, including triple-negative and HER2-positive breast cancers.

“Our study found that very young women, ages 15–29 years, experienced more advanced disease than women ages 30–39 years, so it’s very important that these women take note of any changes in their breasts and discuss those changes with their physician,” says Dr. Boughey.


Research into the pathology of vaping-associated lung injury is in its early stages, but a Mayo Clinic study published in The New England Journal of Medicine finds that lung injuries from vaping most likely are caused by direct toxicity or tissue damage from noxious chemical fumes.

Researchers reviewed lung biopsies from 17 patients, all of whom had vaped and were suspected to have vaping-associated lung injury. The study was the first to examine a group of biopsies from patients with lung injury due to vaping. Researchers found no evidence of tissue injury caused by accumulation of lipids — fatty substances such as mineral oils — which has been suspected as a possible cause of the lung injuries associated with vaping.

Brandon Larsen, M.D., Ph.D., a surgical pathologist at Mayo Clinic Arizona, and a national expert in lung pathology, discusses the vaping-associated lung injury study.

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Other ways to connect with Mayo Clinic:

Oct 24, 2019 · New research shows spinal stimulation may work better than medication for long-term pain reduction

In a recent study, a team of Mayo Clinic researchers
examined the effectiveness of spinal stimulation for pain control, compared to
medical therapy or multiple surgeries for patients with long-term spine or limb
pain.

They found spinal stimulation was significantly more likely to reduce pain than medication for patients with intractable pain. Their findings were published in Mayo Clinic Proceedings.

“Intractable pain, or refractory pain is pain that occurs when multiple evidence‐based treatments have been tried and the patient has not reached treatment goals,” says study first author Tim Lamer, M.D., an anesthesiologist, pain management, and spine care specialist at Mayo Clinic. “Typically this means they have not achieved satisfactory pain reduction and/or functional improvement.”

According to the National Institutes of Health, “almost 11 million U.S. adults have ‘High Impact Chronic Pain,’ that is, pain that has lasted 3 months or longer and is accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores.”

Because back and/or limb problems are the commonest pain
complaints, Dr. Lamer says it made sense to try and determine the most
effective ways to help patients.

The research

In this meta-analysis (analysis of a collection of relevant
studies), the team study used a random-effects model to compare any type of
spinal stimulation to medical therapy. They also compared newer stimulation technologies
such as high frequency spinal cord stimulation and dorsal root ganglion
stimulation to conventional spinal stimulation.

“This kind of research (random-effects) incorporates uncertainties due to differences between the settings of the studies, like patient or provider characteristics,” says senior author M. Hassan Murad, M.D., a preventive medicine physician and health services researcher at Mayo Clinic. “It’s a common tool in meta-analyses.”

After conducting a search of peer-reviewed publications,
they found 17 manuscripts, from 12 clinical trials comparing medical therapy or
repeated surgeries to either conventional or new spinal stimulation for pain
control.

Physical therapy doctor discusses spine model with patient.

The researchers also employed the indirect comparison
technique. “If studies compare treatments A vs B, and B vs C, we can indirectly
compare A and C,” explains Dr. Murad.

“Because we found no studies comparing new spinal
stimulation technologies to medical therapy, we needed to indirectly compare
them.”

Although there are some limitations, Dr. Murad says this
kind of research can help lead to the best possible outcomes for patients.

“The estimates we provide should be used to support shared-decision
making,” he says. “Other factors, such as patient’s values and preferences,
feasibility and accessibility of treatment also need to be considered when
making treatment decisions.”

Publishing the meta-analysis in and of itself may prove to
be helpful for patients, as it calls attention to the option of spinal
stimulation for pain control.

“Many non-pain specialists are not generally aware of spinal
cord stimulation,” says Dr. Lamer, “and how effective it can be for properly
selected patients with difficult to manage chronic pain.”

He says that this includes patients with complex spinal pain
syndromes, painful neuropathies including diabetic neuropathy, and
post-traumatic pain syndromes such as complex regional pain syndrome.  

“Patients who are not responding to conventional
conservative measures such as medications and physical therapy should be
referred to a qualified interventional pain specialist to be evaluated for
spinal cord stimulation candidacy.” 

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Dr. Murad leads knowledge synthesis research like this
meta-analysis, in the Mayo Clinic Robert D. and Patricia E. Kern Center for the
Science of Health Care Delivery
. He also is the director of the Evidence-based Practice Center.

Related resources:

Implantable spinal cord stimulator (video news item)

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Oct 4, 2019 · Chemo first for better outcomes in bile duct cancer, says new research

Oncology care teams frequently use chemotherapy along with surgery to treat cholangiocarcinoma, or bile duct cancer. However, until now, little evidence existed regarding if and when receiving chemotherapy was likely to have the best effect.

Recently Mayo Clinic researchers found that patients who
received chemotherapy before surgery to remove their bile duct cancer were more
likely to live longer than patients who received chemotherapy after surgery. Their
findings
are published in the European Journal of Surgical Oncology.

“Cholangiocarcinoma is a rare malignancy with poor outcomes and limited treatment options,” says Siddhartha Yadav, M.D., F.A.C.P., study first author, and a hematology/oncology fellow at Mayo Clinic in Rochester, Minnesota. “We hope that our findings will lead to clinical trials to further evaluate the role of neoadjuvant chemotherapy in cholangiocarcinoma and significantly improve the outcomes of patients with this rare and aggressive tumor.”

According to the American Cancer Society, cholangiocarcinoma
is rare, with about
8,000 people in the U.S. diagnosed each year
. The outlook for these
patients is not good, with 5-year
survival rates
ranging from less than 25% in the best case (localized
cancer, within the liver), and 1% worst case (cancer has spread beyond bile
ducts to distant parts of the body).

“At Mayo Clinic, we get referrals from all over the world to
our tertiary care center,” says Amit Mahipal, M.B.B.S., study senior author,
and a gastrointestinal oncologist at Mayo Clinic in Rochester, Minnesota. “We
do research into rare conditions because little research exits for these
conditions due to small numbers. But because of our unique institution and
patient population, we are able to conduct research with select groups of
patients with rare diseases like cholangiocarcinoma.”

The researchers used the National Cancer Database to
identify patients who underwent
surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and
2014. Of 1,450 patients, the team found that 299 received chemotherapy before
surgery, and 1,151 received it after surgery. They investigated subgroups of
these, matching 278 patients who received pre-surgery chemo to 700 patients
with similar characteristics to the post-surgery chemo group.

On average, the
patients who received chemotherapy before surgery lived 7.5 months longer than
those receiving it after surgery. Their 5-year survival rate was also more than
10% higher (42.5% versus 31.7%).

“We have other
research showing neoadjuvant (before surgery) chemotherapy nets better results
for patients with pancreatic or breast cancer,” says Dr. Mahipal, “so these
results were not very surprising. However, because of this research, we now
know what the best practice should be, and we hope to see application of this
evidence into treatment for patients everywhere with bile duct cancer.”

This research was the result multidisciplinary collaboration across several departments at Mayo Clinic and Yale New Haven Health. It was supported by Mayo Clinic Cancer Center and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. This study was presented in part as a poster presentation at the 2018 European Society of Medical Oncology Annual Congress in Munich, Germany.

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