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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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Fri, Oct 25 4:28pm · Upcoming documentary 'The Opioid Fix' to address national issue

The Opioid Fix is a documentary about the opioid crisis in America.
Mayo Clinic and Twin Cities Public Television have partnered to produce “The Opioid Fix,” a three-part documentary series to drive action to address the opioid crisis in the U.S. The series will begin airing Oct. 27 and can also be streamed at https://www.tpt.org/the-opioid-fix/

Mayo Clinic has done extensive research into the use of opioids across the U.S., and this work has led to prescribing guidelines that are being used across Mayo Clinic and at other health care organizations.

With a shared goal to increase public awareness and drive action, Mayo Clinic and Twin Cities PBS have partnered to produce “The Opioid Fix,” a three-part documentary series.

The first episode of the documentary will air 6 p.m. CST Sunday, Oct. 27, on Twin Cities PBS. The episode provides an overview of opioids, and features Mayo Clinic’s research and education.

The second and third episodes air Nov. 3 and Nov. 10, respectively, and offer a look at how communities — both geographic and population-based — play a role in effectively addressing the opioid epidemic.

The documentary series, also available for streaming on tpt.org, highlights Mayo’s research on prescribing habits, as well as how research is used to create prescribing guidelines, address opioid abuse, educate providers and patients, and promote appropriate pain management. It also details the different perspectives of the medical community, legislators, law enforcement and community groups as they address what many are calling an opioid epidemic.

Halena Gazelka, M.D.

“As physicians and medical providers, we cannot underestimate our responsibility in being good stewards of these medicines and what we have contributed to this problem,” Halena Gazelka, M.D., chair of the Mayo Clinic Opioid Stewardship Program, says in the film.

The series features more than a dozen Mayo Clinic physicians, nurses, anesthetists, pharmacists, psychologists, students and scientists working together to monitor, manage and transform pain management plans to best serve patients everywhere.

Educators, medical students and prescribing clinicians train with actors at the Mayo Clinic Multidisciplinary Simulation Center, for example, on how to communicate with patients about opioids. Mayo also is working with local law enforcement to reduce extra opioids sitting in medicine cabinets with drug take-back days, such as the one taking place in Rochester on Saturday, Oct. 26, from 9 a.m. to 1 p.m., at the Gonda West entrance (200 1st St. SW, Rochester, Minnesota).

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About Twin Cities PBS (TPT) 

Twin
Cities PBS (TPT)’s mission is to enrich lives and strengthen our community
through the power of media. Established in Saint Paul 58 years ago, TPT now
operates as a public service media organization that harnesses a range of media
tools to serve citizens in new ways — with multiple broadcast channels, online
teaching resources, educational outreach and community engagement activities.
Over its nearly 60-year history, TPT has been recognized for its
innovation and creativity with numerous awards, including Peabody awards and
national and regional Emmy® Awards.

About Mayo Clinic
Mayo Clinic is
a nonprofit organization committed to innovation in clinical practice,
education and research, and providing compassion, expertise and answers to
everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news and An Inside
Look at Mayo Clinic 
for more information about Mayo.

Mon, Sep 30 6:00am · People with kidney disease should be cautious with supplements, Mayo researchers say

More than one-third of the 15.7 million Americans with moderate or advanced chronic kidney disease use dietary or herbal supplements, reports new research from Mayo Clinic. Many Americans decide to take supplements on their own, not because of a doctor’s recommendation, the researchers found, most often with the goal of improving their health. However, some of these supplements contain potassium or phosphorous – minerals that are often restricted for that population – or can otherwise be harmful to people with impaired kidney function. The study published recently in the American Journal of Kidney Diseases.

“Many people take supplements without discussing it with their health care providers, likely because they assume these supplements to be safe and potentially beneficial,” says senior author Rozalina McCoy, M.D., a Mayo Clinic endocrinologist and general internal medicine doctor. “Yet some of these supplements may be harmful, particularly if patients have underlying kidney disease, or even if they do not.”

Chronic kidney disease – which affects roughly 1 in 7 Americans, according to the Centers for Disease Control and Prevention – is the gradual loss of kidney function that can lead to kidney failure. People with kidney disease have a harder time filtering medications, wastes, and excess fluids from the body, so it’s especially important for this population to know the safety risks of any supplements they’re taking, the researchers say. When the kidney’s filtering ability is impaired, supplements may accumulate and lead to toxicity. In all people, but especially among those with kidney disease, supplements may cause acute kidney injury or intensify the long-term deterioration of kidney function. Supplements can also interact with other medications, either amplifying or diminishing their effects.

In addition to patient care, Dr. McCoy conducts health services research. Her interests lie in understanding, individualizing and improving the care for people with diabetes and other chronic diseases. Her ultimate goal is developing and facilitating patient-centered, evidence-based, timely and equitable approaches to care.

“It is critical that patients share what supplements and herbs they are taking or thinking of taking with their health care providers and pharmacists,” says Dr. McCoy, who also is a researcher in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. “And as clinicians, we need to do a better job of routinely asking our patients about what non-prescription medications and supplements they may be taking, and doing it without judgement.”

What do the numbers say?

The multidisciplinary research team studied 10,005 Americans with varying levels of kidney function, using data from the National Health and Nutrition Examination Survey collected between 2011 and 2014. This survey combines both interviews and physical examinations, and is used to study many aspects of health and nutrition across the U.S.

Dr.
McCoy and her fellow researchers divided survey respondents into several
categories: those with normal or mildly reduced kidney function, those with
moderate kidney impairment (stage 3 chronic kidney disease), and those with
advanced or end-stage kidney disease (stages 4 and 5 chronic kidney disease).
Their study focused specifically on those with stage 3 or worse kidney disease
because this population is at highest risk for complications related to
supplement use.

Because
people often decide to take supplements without consulting their doctors, the
research team also looked at whether people whose lab studies revealed the
presence of chronic kidney disease were actually aware that they had this
disease. Only 12% of people with moderate kidney disease, and 63% of people
with advanced kidney disease, reported having kidney disease at the time of the
survey.

The Mayo Clinic researchers found between 2.3 and 3.4 percent of Americans with moderate kidney disease took supplements considered as “especially risky” by the National Kidney Foundation. Other supplements may also be harmful for people with kidney disease, the researchers caution, since there is little research in this area and supplements are not regulated in the same way that prescription and over-the-counter medications are in the U.S.

What’s in the box could hurt you

“Supplements,
in many ways, are a ‘black box,’” Dr. McCoy says. “We need better data to know
whether supplements are safe because for most supplements and herbs, we just
have no idea. We do not accept such ambiguity for medications, and we should
not tolerate it for supplements, either.”

Flaxseed in various forms.

Flaxseed oil, the most commonly used high risk supplement that contains phosphorus, was taken by 16 percent of patients with normal or mildly reduced kidney function. In addition, 1.3 percent of patients who were unaware they had moderate kidney impairment took flaxseed oil, which translates to 167,500 Americans. And while phosphorus is not listed on the flaxseed oil nutrition information label, a tablespoon (about 10 grams) of whole flaxseeds has about 62 milligrams of phosphorus, or about 7% of the daily value for a person without chronic kidney disease. In addition, flaxseed and flaxseed oil may interact with blood-thinning and blood pressure drugs, and may decrease absorption for any oral drug, according to Mayo Clinic.

The
good news, Dr. McCoy says, is no Americans surveyed who had advanced or end-stage
kidney disease took supplements flagged as potentially risky by the National
Kidney Foundation.

“That
may mean that awareness translates to caution or to greater odds of discussing
supplement use with their clinical team,” she says. “The problem is that many
people who have kidney disease are not aware of it.”

The study’s lead author is Shaheen Kurani, Sc.M., a student in the Mayo Clinic Graduate School of Biomedical Sciences.

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

The
researchers report no conflicts of interest.

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About 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. Learn more about the center.

Mon, Aug 5 6:00am · Blood thinners in combination increase bleeding risk, Mayo study finds

Gastrointestinal bleeding is a common side effect for many blood-thinning medications. But new Mayo Clinic research finds that risk is amplified when patients receive more than one blood thinner – especially if they’re 75 or older.

The study, published in Clinical Gastroenterology and Hepatology, found patients receiving an anticoagulant drug and an antiplatelet drug, in combination, were at a significantly higher risk of gastrointestinal bleeding. Anticoagulant drugs (such as warfarin and apixaban) slow down blood clotting, while antiplatelets (such as aspirin and clopidogrel) prevent platelets from clumping. Both types of blood thinners are commonly used to prevent strokes in patients with heart conditions.

Dr. Neena Abraham
Neena Abraham, M.D.

“Most of the literature on bleeding risks for blood-thinning medications compares one medication to another, or focuses on patients with one condition,” says lead author Neena Abraham, M.D., a Mayo Clinic gastroenterologist, and site director in Arizona for health care delivery research in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. “By not limiting our investigation to one cardiovascular group, we were successful in demonstrating the magnitude of risk of all commonly prescribed antiplatelet and anticoagulant regimens among a broad range of cardiovascular patients.”

The Mayo team of researchers and physicians analyzed 311,211 patients receiving blood-thinning medication between Oct. 1, 2010, and May 31, 2017, using the OptumLabs Data Warehouse — a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data.  

After one year, patients being treated for both atrial fibrillation and coronary artery disease, for example, had a similar risk of bleeding (4 percent) when getting just an anticoagulant or just an antiplatelet, but a 7.4 percent risk when receiving both. Only 29 patients with atrial fibrillation and coronary artery disease would need to be treated with an anticoagulant and antiplatelet in combination to cause one additional bleeding event, according to the study. The researchers say it’s important for physicians to be aware of the increased risk; patients with both of these conditions received a combination of blood thinners 56.8 percent of the time.

The study also found that patients 75 and older were twice
as likely as younger patients to have gastrointestinal bleeding when on two
blood thinners. Patients were at a similar risk for bleeding when using just an
anticoagulant or just an antiplatelet drug, the researchers say.

“Many providers assume that antiplatelets may be safer compared to anticoagulants for patients at moderate-to-high bleeding risks,” Dr. Abraham says. “However, this study demonstrates that these risks may be similar – an important consideration as providers decide on optimal treatment strategies.”

Study co-investigators are Nilay Shah, Ph.D., Peter Noseworthy, M.D., Jonathan Inselman, Xiaoxi Yao, Ph.D., Lindsey Sangaralingham, Gabriella Cornish, and Che Ngufor, Ph.D., all Mayo Clinic, and Jeph Herrin, Ph.D., Yale School of Medicine.

The research was funded by a grant from the Agency for Healthcare Research and Quality, for which Dr. Abraham is the principal investigator.

All Mayo Clinic investigators on this project are affiliated with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Center research focuses on transforming clinical practice. Researchers seek 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 patient care.

About OptumLabs
OptumLabs is a collaborative center for research and innovation co-founded by Optum and Mayo Clinic, and focused on improving patient care and patient value. The OptumLabs Data Warehouse is a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data.

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, which leads the relationship with OptumLabs for Mayo Clinic, has published a number of studies identifying areas for potential improvements in health care delivery using the OptumLabs Data Warehouse.

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Jul 24, 2018 · 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

Guojun Bu, Ph.D.

Guojun 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.

May 28, 2018 · 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.

May 17, 2018 · 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.

May 4, 2018 · 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.

Apr 16, 2018 · 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.

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