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.

About

Member has chosen to not make this information public.

Posts (20)

Tue, Jul 24 10:26am · Mayo scientists presenting at Alzheimer's Association conference

About 30 Mayo Clinic scientists are presenting at this week’s Alzheimer’s Association International Conference in Chicago, and another roughly two dozen researchers are contributing authors. They’re among more than 5,600 scientists from 65 countries.

The schedule and abstracts are available on the Alzheimer’s Association conference website.

All the research has one goal: to help the growing number of patients and their families dealing with this difficult illness. “With the enormous impact of Alzheimer’s disease — on society, on the health care economy — if we can make progress with regard to treatments that may reduce the number of people with the disease, delay the onset, slow the progression of the disease, that would be huge for individuals, families and the health care systems,” says Ronald Petersen, M.D., Ph.D., director of the Mayo Clinic Alzheimer’s Disease Research Center and the Mayo Clinic Study of Aging.

Some Mayo Clinic highlights at #AAIC18:

Wednesday, July 25

Guojon Bu, Ph.D.

Guojon Bu, Ph.D., will give a plenary discussion on “Pathobiology of ApoE in Alzheimer’s Disease.” Dr. Bu is a leader in the field of apolipoprotein E (ApoE) biology and ApoE receptors, which play critical roles in brain lipid transport, synaptic function, injury repair and beta-amyloid protein metabolism in Alzheimer’s disease. He is the Mary Lowell Leary Professor of Medicine at Mayo Clinic’s Florida campus and an associate director of the Mayo Clinic Alzheimer’s Disease Research Center.

Dr. Petersen and David Knopman, M.D., will present “Operationalizing the NIA-AA Alzheimer’s Disease Research Framework.” The new National Institute on Aging-Alzheimer’s Association research framework defines Alzheimer’s disease on its biological basis — the presence of amyloid protein plaques and tau protein tangles — not on clinical symptoms such as trouble with memory and thinking. This symposium will include criteria for future evaluation of the framework. Dr. Petersen is the Cora Kanow Professor of Alzheimer’s Disease Research. Dr. Knopman is a clinical neurologist involved in research in late-life cognitive disorders. He also is associate director of the Alzheimer’s Disease Research Center at Mayo Clinic.

Thursday, July 26

 

Prashanthi Vemuri, Ph.D.

Prashanthi Vemuri, Ph.D., will present emerging research in her plenary talk on “Alzheimer’s Disease Biomarker Epidemiology in the Aging Population: Prevalence‚ Risk Factors and Outcomes.” Amyloid and tau protein deposition in the brain are the underlying causes of Alzheimer’s disease dementia. Over the past couple of decades, research has developed and validated biological markers, also called biomarkers, for measuring these Alzheimer’s disease brain changes connected to amyloid and tau. “Improving our understanding of Alzheimer’s disease biomarker epidemiology will contribute to better understanding of disease mechanisms as well as lead to early detection, treatment and prevention of Alzheimer’s disease,” Dr. Vemuri says. Her talk will focus on the Mayo Clinic Study of Aging. The Olmsted County, Minn., population-based study is a rich resource of longitudinal biomarker and cognition data across the lifespan.

Award winners

Two researchers received de Leon Prizes in Neuroimaging at #AAIC18. The awards are presented annually to a senior scientist and a new investigator judged to have published the best paper in a peer-reviewed journal on advanced medical imaging of the brains of people with diseases such as Alzheimer’s or Parkinson’s.

  • Kejal Kantarci, M.D., earned the senior prize for “White-matter integrity on DTI and the pathologic staging of Alzheimer’s disease,” published in Neurobiology of Aging in August 2017.
  • David T. Jones, M.D., earned the new investigator prize for “Tau, amyloid, and cascading network failure across the Alzheimer’s disease spectrum,” published in Cortex in December 2017.

Mon, May 28 6:03am · Registration ends June 7 for workshop to teach application of video research method in medical practice

Register now for Video Reflexive Ethnography course – June 28-30

Video reflexive ethnography (VRE) is an established, collaborative methodology that uses video to capture the complexities of health care and to identify – with participants – ways to improve the delivery of health care from the “bottom up.” Clinicians and researchers interested in learning more about this qualitative research method – and applying it to their work to address unmet patient needs – will have that opportunity at the Video Reflexive Ethnography in Health Care course June 28-30 at Mayo Clinic in Rochester, Minnesota.

The course is for clinicians and researchers completely new to the method, as well as those with some experience who want to increase their understanding. The course, offered as one- and three-day options, features an introduction to VRE, explains the theory of VRE and its practical application, and the three-day course finishes with a day-long practice session. Together with peers and leaders in the science, attendees will learn practical ways to implement VRE into their practice-improvement and health care delivery research program.

“Observing patients and care providers through the lens of a video camera can provide insights that help us bridge gaps in health care and the way people experience health care,” says Joan Griffin, Ph.D., the Robert D. and Patricia E. Kern Scientific Director for Care Experience at Mayo Clinic.

Judy Boughey, M.D., and a team of researchers used VRE to assess routine everyday practice within general breast surgery at Mayo Clinic.

“It provided us with a novel method to see our practice from different perspectives,” says Dr. Boughey. “Importantly it allowed us to step into each other’s shoes and have a greater understanding of the team interactions and also to observe our interactions as an outsider. It was a powerful learning experience to realize the strengths of our collaboration and reinforce the positive aspects of our practice.”

Find more information and register for the course by clicking here, and find an agenda here. For more information, contact Meghan French at french.meghan@mayo.edu. The registration deadline is June 7.

The course is hosted by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Thu, May 17 1:20pm · New Mayo guidelines cut some opioid prescriptions by half

Please see a response from Elizabeth Habermann, Ph.D., Mayo Clinic Robert D. and Patricia E. Kern Scientific Director for Surgical Outcomes:

Thank you for your question and an opportunity to respond.

Optimal patient care is always our goal. In fact, we have found the CDC recommendations too low for many procedures, including total knee and total hip arthroplasties, so our recommended discharge prescriptions for these two procedures are actually in excess of CDC and current State of Minnesota guidelines of one week or 200 oral morphine equivalents.

In response to your question regarding pain scores, we have studied the relationships between inpatient pain scores and discharge prescription amounts and have work underway to better monitor post-discharge pain scores and pain management needs. However, to our knowledge, patients in need of refills have been able to access them the same way both before and after guideline implementation, yet no difference in refill rate has been noted.

Fri, May 4 6:44am · Workshop to teach application of video research method in medical practice

Register now for Video Reflexive Ethnography course – June 28-30

Video reflexive ethnography (VRE) is an established, collaborative methodology that uses video to capture the complexities of health care and to identify – with participants – ways to improve the delivery of health care from the “bottom up.” Clinicians and researchers interested in learning more about this qualitative research method – and applying it to their work to address unmet patient needs – will have that opportunity at the Video Reflexive Ethnography in Health Care course June 28-30 at Mayo Clinic in Rochester, Minnesota.

The course is for clinicians and researchers completely new to the method, as well as those with some experience who want to increase their understanding. The course, offered as one- and three-day options, features an introduction to VRE, explains the theory of VRE and its practical application, and the three-day course finishes with a day-long practice session. Together with peers and leaders in the science, attendees will learn practical ways to implement VRE into their practice-improvement and health care delivery research program.

“Observing patients and care providers through the lens of a video camera can provide insights that help us bridge gaps in health care and the way people experience health care,” says Joan Griffin, Ph.D., the Robert D. and Patricia E. Kern Scientific Director for Care Experience at Mayo Clinic.

Judy Boughey, M.D., and a team of researchers used VRE to assess routine everyday practice within general breast surgery at Mayo Clinic.

“It provided us with a novel method to see our practice from different perspectives,” says Dr. Boughey. “Importantly it allowed us to step into each other’s shoes and have a greater understanding of the team interactions and also to observe our interactions as an outsider. It was a powerful learning experience to realize the strengths of our collaboration and reinforce the positive aspects of our practice.”

Find more information and register for the course by clicking here, and find an agenda here. For more information, contact Meghan French at french.meghan@mayo.edu. The registration deadline is June 7.

The course is hosted by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Mon, Apr 16 6:00am · New Mayo guidelines cut some opioid prescriptions by half

Mayo Clinic researchers are studying the clinic’s opioid prescribing practices after surgery, discovering areas for improvement based on that evidence, and applying it to optimize care for individual patients. The result in the Mayo Clinic Department of Orthopedic Surgery is a 48 percent reduction in the amount of opioids prescribed for hip and knee replacement surgery. The team also noted that the prescription refill rate remained the same. The research was published recently in Clinical Orthopaedics and Related Research.

“These findings show that simply creating and adhering to procedure-specific opioid prescribing guidelines based on scientific research can yield significant results,” says lead author Cody Wyles, M.D., a Mayo Clinic orthopedic surgical resident.

The work to refine opioid prescriptions post-surgery began with a collaborative effort among Mayo Clinic physicians, pharmacists, pain medicine specialists, nurses and research scientists in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The cross-specialty research team looked at opioid prescriptions written at Mayo Clinic for 25 common surgeries, and found areas for improvement. To address the issues, the team created opioid prescribing guidelines for the common surgeries, which were first implemented by the Department of Orthopedic Surgery.

The study compared opioid prescriptions and refill rates for knee and hip replacement surgery patients on the Rochester campus of Mayo Clinic who hadn’t received a prescription in the previous 90 days. The team compared 751 patients during the five months after the guidelines took effect (August-December 2017), to the 1,822 hip and knee patients during 2016 who met those criteria.

The authors found that the median prescription dropped 48 percent, from the equivalent of roughly 95 pills of five-milligram oxycodone to about 50 pills. Overall, the middle 50 percent range of prescriptions decreased from about 70-115 pills to 45-50 pills. They also report no statistically significant change in refill rates.

“The fact that refill rates remained the same is significant because it means we can adequately control most of our patients’ pain with these lower doses,” says senior author Tad Mabry, M.D., a Mayo Clinic orthopedic surgeon. “We want to make a reduction in an informed way so we don’t under-treat patients’ pain. We want to achieve the best possible patient outcomes, and patient experience, with minimal exposure to opioids.”

Opioid prescription totals in the United States, while decreasing from 2011 to 2015, were still three times higher in 2015 than they were in 1999, according to the newest data from Centers for Disease Control and Prevention. And from 1999 to 2016, the number of opioid overdose deaths increased fivefold, the CDC says.

Although the CDC and other entities have created opioid prescribing guidelines, the research team emphasizes that procedure-specific guidelines are needed to provide appropriate pain management for patients.

The team also notes it’s important to counsel patients before surgery on pain expectations.

“One of the most underappreciated aspects of addressing pain management is appropriate patient counseling and expectations management. The mind-body interaction with pain is one of the most powerful in all of medicine,” Dr. Wyles says.

The research team chose hip and knee replacement surgeries for this study because they had the two highest median opioid prescriptions and highest variability in their previous study. The team also continues to follow adherence to the guidelines, reporting that compliance steadily increased over the five month study period. Dr. Mabry says they will continue to evaluate and refine the guidelines to ensure they address patient need.

The study co-authors, all from Mayo Clinic, are:

This research was made possible by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery seeks to discover new ways to improve health; translate those discoveries into evidence-based, actionable treatments, processes and procedures; and apply this new knowledge to improve care for patients everywhere.

Wed, Feb 21 6:00am · Research establishes questions to address unmet needs of patients with disabilities

To address inequities for patients with disabilities, research led by Mayo Clinic has established six essential questions for health care organizations to ask at the point of care. The broad, evidence-based questions are a first step in determining unmet needs of individual patients for whom disabilities are not always easily identified, the researchers say.

Mayo Clinic has incorporated the questions into its electronic health record, currently in use by nurses for in-patient care. Eventually, the researchers hope, the questions will be implemented throughout Mayo. There are also plans to include the questions in the international Logical Observational Identifiers, Names and Codes (LOINC) database, a standardized coding of medical laboratory tests and patient care data sets for use across health care systems.

“The majority of disabilities aren’t immediately apparent,” says John Knudsen, M.D., medical director for the Clinical Practice Office of Health Equity and Inclusion. “This is an important step toward understanding our patients’ needs in regards to disabilities, whether that’s permanent or temporary.”

The questions, published recently in The Joint Commission Journal on Quality and Patient Safety, can be used when making an appointment to identify patients who may need hearing assistance, for example. Clinicians could provide an adjustable exam table for patients with mobility issues, or communication assistance for those with difficulties being understood.

“Literature shows that people with disabilities get suboptimal care. They’re not getting the same type of preventative treatment and chronic disease management that people without disabilities are getting,” says the study’s senior author, Joan Griffin, Ph.D., a scientific director in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. “These are yes or no questions, they’re relatively easy, and they can then lead to deeper questions about specific accommodations.”

The cross-specialty team of researchers used a multistage process to identify and refine the questions. First, they held a focus group of 54 patients and caregivers from southeastern Minnesota and interviewed 15 health care providers. Next, national disability organization leaders and research authors participated in a panel to modify the questions. And finally, the researchers refined the questions further after interviewing 46 patients with and without disabilities.

The six essential questions are:

  • Are you blind or do you have difficulty seeing, even when wearing glasses?
  • Are you deaf or do you have serious difficulty hearing?
  • Do you have serious difficulty walking or climbing stairs?
  • Do you have difficulty remembering or concentrating?
  • Do you have difficulty dressing or bathing?
  • Using your usual language, do you have difficulty communicating (for example, understanding or being understood)?

The researchers also recommend three additional questions:

  • Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone, such as visiting a doctor’s office or shopping?
  • Do you have difficulty reading or writing?
  • Due to a disability, do you need any additional assistance or accommodations during your visit?

The questions are based on U.S. Census Bureau disability questions, which were also used by the U.S. Department of Health and Human Services. But those questions were developed for large surveys of populations, not for health care organizations to identify individual patients who may need accommodations, the researchers say.

The essential questions cover the spectrum of disabilities: hearing, visual, mobility, cognitive, activities of daily living/fine motor, and communication. The additional recommended questions also cover additional activities of daily living, learning disabilities, and any disabilities that may have been missed.

The researchers did not include mental health or social disability questions among the six essential questions, though some of these disabilities may be covered by the existing questions. The focus group and interview participants had significant concerns about including a mental health question, which would be recorded in patients’ individual electronic health records, because of the stigma associated with mental health issues.

Health care organizations will have to determine which questions to ask and how frequently to ask, as disability status may change over time, the researchers say.

The research was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The study was led by Megan Morris, Ph.D., who was a researcher in the center at the time. Dr. Morris is now an assistant professor at the Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) at the University of Colorado Anschutz Medical Campus.

To learn more about Mayo Clinic’s efforts to address health disparities through research, visit the Office of Health Disparities Research blog.

Thu, Jan 11 8:00am · Presence of adjustable exam tables doesn’t ensure equitable care for patients with disabilities, research shows

Research has shown patients with disabilities can face challenges to receiving the same level of care as those without disabilities. One way that health care organizations and policymakers attempt to address this issue is by providing accessibility equipment.

But new research led by Mayo Clinic finds simply having this equipment, like height-adjustable exam tables, may not be enough to increase quality of care overall or even ensure their use.

“It is often assumed that if we had more disability-friendly equipment and exam rooms, we would ‘fix’ the disparities,” says Megan Morris, Ph.D., who led the research while she was with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. “But it looks like simply having the tables is not enough to provide equitable care.”

The researchers, who published their findings recently in the Journal of General Internal Medicine, surveyed 399 adults who received care at Mayo Clinic. Half of those surveyed were at a clinic with adjustable exam tables, and half were at one without them. When comparing the two clinics, the researchers didn’t find a difference in the percentage of patients evaluated on an exam table; but they did find age and disability status were determining factors as to whether patients were examined on a table. Patients 65 and older and those with a disability were 20 and 27 percent less likely, respectively, to be examined on a table.

Also across both clinics, patients without disabilities reported positive perceptions of their clinicians’ bedside manner 74 percent of the time, compared with just 59 percent of patients with disabilities. And patients — with and without disabilities — who received an exam on a table were significantly more likely to rate their visit positively.

“This tells us that there is a portion of our patients who are less satisfied with their care, and that further efforts to improve these patients’ care experiences are needed,” says the study’s senior author, Sean Phelan, Ph.D., a researcher in the Mayo Clinic Robert D. and Patria E. Kern Center for the Science of Health Care Delivery.

The researchers say that while having adjustable tables is a necessary step, clinician education and systematic changes to clinical processes or policies may be needed. They say regardless of whether an exam room has an adjustable table, clinicians may not have time to transfer patients to the table, or they may not have the training or resources to do so. Knowing what accommodations a patient needs before the visit also would help clinicians meet those needs, the researchers say.

“Training clinicians on strategies to improve patient-centered, empathetic communication with patients with disabilities may also help,” Dr. Phelan suggests. “This could include reducing the likelihood that conscious or unconscious negative attitudes about certain patient groups affects care.”

The research was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Dr. Morris is now an assistant professor at the Adult and Child Consortium for Health Outcomes Research and Delivery Science at the University of Colorado Anschutz Medical Campus.

Nov 6, 2017 · Larger-dose opioid prescriptions not coming from emergency departments, study shows

Opioid 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.

“There are a few things that many people assume about opioids, and one is that, in the ED, they give them out like candy,” says lead author Molly Jeffery, Ph.D., a researcher in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. “This idea didn’t really fit with the clinical experience of the ED physicians at Mayo Clinic, but there wasn’t much information out there to know what’s going on nationally.”

To study 5.2 million opioid prescriptions written for acute – or new-onset – pain across the U.S. between 2009 and 2015, the researchers used the OptumLabs Data Warehouse, a database of de-identified, linked clinical and administrative claims information. None of the patients in the study had received an opioid prescription for the previous six months. This made it easier to compare doses by eliminating patients who built up a tolerance to the drugs.

Read more about this study on the Mayo Clinic News Network, and find a Mayo Clinic Minute video on the subject here.

Contact Us · Privacy Policy