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Mayo Clinic Medical Science Blog

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2 days ago · 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:

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!


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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For more research news from Mayo Clinic, you can:

5 days ago · Research Roundup—October 2017

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.

October 2017

woman measuring her waistThe average weight gain for women in their 50s and 60s is 1.5 pounds per year. For this group of women, much of that weight gain resides in the midsection. This type of fat is linked to a higher risk of cardiovascular disease, which is also the No. 1 cause of death for postmenopausal women. In addition to cardiovascular disease, central weight distribution puts this population at risk for abnormal glucose and lipid levels and high blood pressure.

A review of the weight gain risks and challenges faced by women in midlife has led Mayo Clinic researchers to a series of recommendations for this patient population. The findings were published in the October edition of Mayo Clinic Proceedings.

Stressed young female medical doctor sitting at the desk in office.Despite growing problems with psychological distress, many physicians avoid seeking mental health treatment due to concern for their license. Mayo Clinic research shows that licensing requirements in many states include questions about past mental health treatments or diagnoses, with the implication that they may limit a doctor’s right to practice medicine.

These findings also were published in the October edition of Mayo Clinic Proceedings.

a stem cell researcher working with specimens in the labThe National Institutes of Health has renewed one of Mayo Clinic’s largest government research grants for five more years, ensuring support for clinical and translational research and training through 2022. The grant supports Mayo researchers in translating discoveries to address unmet patient needs, while engaging physicians and scientists at all levels.

 

Oxford UniversityMayo Clinic, the University of Oxford, and Oxford University Hospitals NHS Foundation Trust have signed an agreement to work together, driving advances in medical research and patient care. This agreement will underpin collaboration in all areas of innovation.

Mayo Clinic and Oxford will bring together their respective expertise to improve patient care, make scientific discoveries and educate the health care providers and researchers of the future.

 

The first students in Mayo Clinic's Regenerative Sciences Training Program are, from left, Emma Goddery, Paige Arneson and Christopher Paradise. Seeking to spur development of innovative medical breakthroughs, Mayo Clinic Graduate School of Biomedical Sciences has started one of the nation’s first doctoral (Ph.D.) research training programs in regenerative sciences.

The Regenerative Sciences Training Program will prepare the next generation of scientists to accelerate the discovery, translation and application of cutting-edge regenerative diagnostics and therapeutics.

3D image of the female reproductive systemA group of international cancer researchers led by investigators from Mayo Clinic and University of New South Wales Sydney has found that the level of a type of white blood cell, called tumor-infiltrating lymphocytes, present in the tumors of patients with high-grade ovarian cancer may predict a patient’s survival. Results of the study by the Ovarian Tumor Tissue Analysis Consortium were published October 12 in JAMA Oncology.

medical staff with patient in proton beam therapy processA study led by Mayo Clinic researchers has found that proton beam therapy, in combination with chemotherapy, prior to surgery, may be a better option than a combination using traditional radiation therapy techniques with chemotherapy when treating elderly patients with esophageal cancer. Standard X-ray radiation therapy techniques include 3-D conformal radiation and intensity-modulated radiation therapy.

Results were presented October 24, by Scott Lester, M.D., a radiation oncologist at Mayo Clinic, at the fourth-annual Particle Therapy Cooperative Group ─ North America Fourth Annual Conference in Chicago.

Alzheimer's medical illustration of amyloid plaquesResearchers have known for several years that being overweight and having Type 2 diabetes can increase the risk of developing Alzheimer’s disease. But they’re now beginning to talk about another form of diabetes: Type 3 diabetes. This form of diabetes is associated with Alzheimer’s disease.

Type 3 diabetes occurs when neurons in the brain become unable to respond to insulin, which is essential for basic tasks, including memory and learning.

A new study led by Guojun Bu, Ph.D., a Mayo Clinic neuroscientist and Mary Lowell Leary Professor of Medicine, connected this to a variant of the Alzheimer’s gene known as APOE4. Their findings are published in Neuron.

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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 as well.

Tue, Nov 7 6:00am · No moss here - Mayo Clinic research websites rolling along

They say that a rolling stone gathers no moss, and at Mayo Clinic, our research and research education programs are always on the move. It’s hard to keep track of all the exciting work being done to help improve health for our patients, or the way they – and patients everywhere – experience health care. But checking out these websites, with the newest research content we have available, is one way to learn more. Thanks for visiting!

Led by Dev Mukhopadhyay, Ph.D., the Translational Nanomedicine Program, based on the Florida campus of Mayo Clinic, conducts basic science research to synthesize and create detailed characterizations of novel nanomaterials.

A precise understanding of the chemical and physical properties of nanomaterials paves the path for clinician-investigators to explore the uses of these materials in translational nanomedicine applied to patient care.

Read more about the program’s beginning.

Within the Department of Molecular Medicine, a multidisciplinary team of scientists and physicians are building a premier virus, gene and cell therapy program and working to translate promising therapeutics from bench to bedside in a timely manner.

Led by Evanthia Galanis, M.D., the department provides core facilities and services to support research efforts across the entire discovery-translation-application spectrum. Basic science discoveries in virology, cell biology, genomics and immunology lead to testing of these novel concepts in clinical trials, such as trials using modified viruses to kill tumors (oncolytic virus therapy).

In this research image, muscle cells fluoresce green after gene transfer.

In his lab, Christopher H. Evans, Ph.D., and his team are hoping that new genes may be the answer to osteoarthritis.

Among other projects, they are studying the use of a viral vector to introduce an anti-arthritic gene into the knee joints of patients with osteoarthritis. They also are investigating ways to help bones, tendons and cartilage heal.

By studying the biochemistry of life, Louis (Jim) J. Maher III, Ph.D., and his team hope to learn more about how the actual shapes of DNA and RNA influence gene expression. Further, they  want to find ways to use RNA and DNA in new medications, and how errors in DNA cause cancer.

RNA aptamers binding NF-kappaB transcription factor.

Projects include:

  • DNA flexibility in cells
  • Artificial gene regulation by RNA molecules
  • Aptamers in multiple sclerosis research
  • Biochemistry of human parganglioma

Watch a TEDx talk and other videos from Dr. Maher describing some of this research.

Overhead photo of face transplant team.

As a global leader in transplantation, Mayo Clinic performs an unparalleled number of solid organ transplants and blood and bone marrow transplants.

Led by Michael J. Krowka, M.D., in the Transplant Research Center, programs leverage the unique integrated practice, research and education programs of Mayo Clinic to conduct interdisciplinary research in solid organ transplantation, blood and bone marrow transplantation, and reconstructive transplantation.

In addition to seeking ways to improve outcomes and the overall patient experience for people needing transplants, some research in the center also focuses on finding alternative therapies for people who may not need a transplant.

Mayo Clinic Transplant Research Center activities also encompass state-of-the-art clinical transplant programs and graduate medical education opportunities.

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Wed, Nov 1 6:00am · From the Office of Health Disparities Research

2017 OHDR Retreat Keynote Address by David R. Williams, Ph.D.

By Sumedha Penheiter, Ph.D.

Approximately 100 researchers, clinicians, educators and administrators from across Mayo Clinic attended the 2017 Office of Health Disparities Research retreat, held Aug. 22–23 in Rochester, Minn. The event kicked off with an inspiring keynote address presented by David R. Williams, Ph.D., Harvard University, entitled “The House That Racism Built: Consequences and Opportunities for Health Equity.”  Key points of Dr. Williams’ presentation included:

  • Allostatic load due to everyday discrimination and racism leads to early onset of disease due to biological weathering.
  • Socioeconomic status is a major cultural determinant of health.
  • To prevent unequal treatment by providers, stereotype replacement is necessary.
  • When cultural competence in providers is high, racial disparities are minimized.

Watch Dr. Williams’ stirring presentation:

View the presentation slides:

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This article first appeared on the Mayo Clinic Office of Health Disparities Research blog. The Office of Health Disparities Research supports meaningful research to identify and address health disparities and to help ensure Mayo Clinic patients reflect the diversity of our communities.

Tue, Oct 31 6:00am · Education changes perception of sepsis screening tool among nurses

Left to right are emergency nurses Becky Butler, Christina VanLandschoot, Albert Razo, Heidi Hayden and Cindy Landis.

Sepsis, a complication of an infection, a time-critical and potentially life-threatening disease, is one of Mayo Clinic’s top 10 patient safety risks. To mitigate this risk, sepsis screening alert tools were developed to help staff in the Emergency Department identify patients at risk. Nurses play an important role in minimizing the risk of sepsis by acknowledging and acting on the sepsis alerts.

However, nurses in the Emergency Department at Mayo Clinic Hospital in Arizona, questioned the functionality of the sepsis screening alert tools. They say they felt that:

  • The alerts fired for all patients.
  • The tool’s findings were not accurate.
  • The frequent and inaccurate alerts were distracters that could lead to them being ignored.

A team from the Emergency Department, led by certified emergency nurse Heidi Hayden, decided to explore whether education regarding validation would improve confidence among staff in the accuracy of the sepsis screening tool. “We wondered whether Emergency Department nurses who had been educated on the sepsis screening tool’s accuracy would have a different perception and confidence about the alerts, compared with nurses who had not been educated,” Hayden says. “And would education impact nurses’ response to sepsis alerts?”

PRESENTING HARD DATA, EDUCATION

The team developed a two-year retrospective chart review of 61,694 Emergency Department patient visits. The review revealed that the sepsis screening alerts had fired on only 9 percent of patients. The alerts were more than 91 percent accurate, sensitive and specific at identifying patients at risk for sepsis, severe sepsis and septic shock.

As part of professional development in the Emergency Department, the team educated nurses about the retrospective chart review data, which validated the sepsis screening alerts.

The team then conducted a survey to determine whether increased knowledge would boost nurses’ confidence in the sepsis screening tool and affect nursing practice.

Nurses taking surveys before and after education were asked to evaluate the accuracy of three statements on a scale of 1 to 5:

  • All the sepsis screening alerts fire too often.
  • Sepsis screening alerts are accurate in identifying patients with potential sepsis.
  • Sepsis screening alerts fire an estimated 10 percent of all patients in the Emergency Department.

The number of accurate responses improved for all three statements, and the survey conducted following education indicated that on a scale of 1 to 5:

  • Acknowledged changed perception (4.2 on a 5-point scale)
  • Acknowledged improved confidence in the sepsis screening tool (4.2 on a 5-point scale)
  • Acknowledged a change in how they planned to respond to alerts (4 on a 5-point scale)

PERCEPTIONS CAN BE CHANGED

“A fundamental principle for practice implementation of evidence-based care is that users and stakeholders need to know that the efforts to improve patient safety have a positive impact on quality of care,” Hayden says. “Our post-education survey responses supported that education had a positive impact on nursing perception, confidence and response to sepsis screening alerts and indicate that nurse-developed, evidence-based sepsis alert screening tools are beneficial in the early identification of sepsis in Emergency Department patients.”

The research team included Hayden’s fellow nurses:  Cindy Landis, Christina VanLandschoot, Albert Razo, and Rebecca Butler.

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Read about other nursing research at Mayo Clinic.

Wed, Oct 25 9:50am · Paper, Paper, Paper, and all those little black dots!

https://hbr.org/2017/10/how-hospitals-are-using-patient-reported-outcomes-to-improve-care

New article in Harvard Business Review, highlighting this work at Mayo Clinic (specifically Dr. Niazi’s use of ePROMs), as well as some other groups.

Tue, Oct 17 8:00am · New fish in the sea - Mayo Clinic research websites expanding content

At Mayo Clinic, research is integral to everything we do. We would be unable to offer the highest possible levels of care and continually improve the practice of medicine without research, and the education programs and processes to make it a reality.

Thanks for visiting, and we hope you enjoy learning more about some of our newest fish…that is, programs launching or expanding their online presence. Here are the latest new sites, as well as some with fresh content and updated information:

Jennifer J. Westendorf, Ph.D., and her team are revealing novel insights into numerous musculoskeletal diseases. The lab’s ultimate goal is to increase knowledge that leads to the rational design of novel therapeutics for such diseases as:

In his Florida-based lab, John A. Copland III, Ph.D., and his team seek to discover novel cancer genes, better understand molecular mechanisms of carcinogenesis and tumor progression, and develop effective molecular-targeted therapeutics.

The Brain Tumor Patient-Derived Xenograft (PDX) National Resource characterizes and provides phenotypic and molecular information about patient-derived xenograft cell lines, allowing researchers to readily identify tumor lines of greatest interest for their research on brain cancer and glioblastoma. Services also include genome-wide profiling data, tumor extracts, frozen PDX tumor tissue, cryopreserved PDX tissue and derivative PDX cell lines.

The PDX National Resource at Mayo Clinic operates under the direction of Jann N. Sarkaria, M.D. and his Translational Neuro-Oncology Laboratory.

In his lab, Roberto P. Benzo, M.D., and his team, develop interventions to improve quality of life through mindfulness, rehabilitation and behavior change. They study how self-awareness, mindfulness and self-management affect lung cancer, COPD and other diseases.

We hope you take a little time for mindfulness in your daily life, as well as time to check out our latest updates.

If you subscribe to Advancing the Science, you’ll get regular updates about Mayo Clinic research news and information.

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Thu, Oct 5 8:00am · Research News Roundup--September 2017

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.

September 2017

pain medication, pills in a bottleOpioid prescriptions from the emergency department (ED) are written for a shorter duration and smaller dose than those written elsewhere, shows new research led by Mayo Clinic. The study, published today in the Annals of Emergency Medicine, also demonstrates that patients who receive an opioid prescription in the ED are less likely to progress to long-term use.

This challenges common perceptions about the ED as the main source of opioid prescriptions, researchers say.

portrait of woman recovering after chemotherapyMayo Clinic researchers have found that a 50 percent reduction in the intensity and dose of radiation therapy for patients with HPV-related throat cancer reduced side effects with no loss in survival and no decrease in cure rates. Results of a phase II study were presented today at the 59th Annual Meeting of the American Society for Radiation Oncology in San Diego by Daniel Ma, M.D. a radiation oncologist at Mayo Clinic.

 

Mayo Clinic scientists have shown that injections of a hunger hormone blocker in mice can halt the typical weight gain after dieting and help prevent rebound obesity in the long term. The research findings appear in the Proceedings of the National Academy of Sciences.

Researcher looking at slide through a microscope

“We think this approach – combined reduction of calories and hormone ─ may be a highly successful strategy for long-term weight control,” says W. Stephen Brimijoin, Ph.D., a Mayo Clinic molecular pharmacologist and senior author of the article. “Given the growing obesity crisis worldwide, we are working hard to validate our findings for medical intervention.”

Efforts to develop new payment models in radiation oncology also should consider measures to address behavioral health to reduce the total cost of care during and after radiotherapy, according to the results of study performed by researchers at

Mayo Clinic and presented today at the 59th Annual Meeting of the American Society for Radiation Oncology in San Diego.

“Most people assume having pets in the bedroom is a disruption,” says Lois Krahn, M.D., a sleep medicine specialist at the Center for Sleep Medicine on Mayo Clinic’s Arizona campus and an author of the study. “We found that many people actually find comfort and a sense of security from sleeping with their pets.”

Researchers are moving closer to realizing the clinical potential of drugs that have previously been shown to support healthy aging in animals. In a review article published online in the Journal of the American Geriatrics Society, Mayo Clinic aging experts say that, if proven to be effective and safe in humans, these drugs could be “transformative” by preventing or delaying chronic conditions as a group instead of one at a time.

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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 as well.

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