August 27th, 2015 · Leave a Comment

Sequencing patient DNA to prevent adverse drug reactions and maximize drug efficacy

By Catherine Benson Catherine Benson

photo1Mayo Clinic, in collaboration with Baylor College of Medicine, is planning to sequence the DNA of 10,000 Mayo patients for 69 genes that can affect how the body metabolizes, transports and reacts to certain drugs. The gene variations observed that are known to influence drug response will be entered into each patient’s electronic health record and a drug alert will pop up when the prescription is written for a drug for which that patient might have an adverse reaction or require a special dose.

“All of us carry common variations in our genes that might mean we respond differently to drugs,” according to Richard Weinshilboum, M.D., Pharmacogenomics Program Director at Mayo Clinic’s Center for Individualized Medicine and the Mary Lou and John H. Dasburg Professor of Cancer Genomics. For example, most people express the CYP2D6 gene, which the body uses to metabolize codeine into morphine. However, some people don’t have the gene, which means codeine won’t reduce their pain. Other people have too many copies of the CYP2D6 gene and make too much morphine, which could lead to a life-threatening drug reaction that causes a patient’s breathing to become dangerously depressed.

Over the past four years, Mayo Clinic’s Center for Individualized Medicine photo2has been adding drug-gene alerts to its electronic health records, but they weren’t specific to a patient. Instead, if a clinician prescribed one of 20 specific drugs, an alert would pop up recommending the physician consider testing the patient for a genetic variation.

However, for the 10,000 patients in this study, the alert would say, “Your patient has the genetic variant”—no additional testing would be required. Mayo will be able to analyze the results to evaluate the potential value of having the genomic information pre-emptively. The theory is that this critical information will help prevent life-threatening drug reactions and reduce health care spending.

Dr. Weinshilboum hopes that the results of the study will help to determine the value—medically and financially—of pre-emptive pharmacogenomic testing. “The speed at which this is happening is astonishing,” Dr. Weinshilboum said. “This is the aspect of clinical genomics that will have the greatest potential impact, earliest, for the largest number of people.”

This study builds on foundational research and experience gained through funding from the Pharmacogenomics Research Network, funded by the National Institute of General Medical Sciences at the National Institutes of Health — and from experience obtained via eMERGE, a national network organized and funded by the National Human Genome Research Institute that combines DNA biorepositories with electronic medical record systems for large scale, high-throughput genetic research in support of implementing genomic medicine.

August 17th, 2015 · Leave a Comment

First-year residents rethink daily labs, improve patient care

By Amy Olson Amy Olson

Sometimes, it’s the simplest things that make the biggest differences in a patient’s care.

Fresh out of medical school at the University of North Dakota and weeks into his first year of residency, Joel Beachey, M.D., found himself contemplating a challenge from his attending physicians and chief residents: Just how frequently do hospital patients need certain blood tests?

Not as often as one might think.

Dr. Beachey and seven other residents – Drs. Urshila Durani, Elsie Mensah, Priya Joel Beachey, M.D.Vijayvargiya, Gaya Acharya, Kalie Kebed, Megha Prasad, and Matthew Thoendel – embarked on a quality improvement project to see if something as simple as talking through expectations could reduce two tests: Electrolyte panels and complete blood counts. Those tests are among those most commonly ordered, Beachey said.

“Dr. Beachey and the team looked at the literature and found close to 70 percent of lab tests done in the hospital on patients were unnecessary,” said Amy Oxentenko, M.D., director for the Internal Medicine Residency program.

The two tests – complete blood count and electrolyte panel – have important uses: Complete blood counts can help a physician assess whether a patient is fighting an infection or has internal bleeding. An electrolyte panel can help monitor for kidney function.

Having the tests may not change overall management of patients’ conditions. In some cases, it can harm patients, said Dr. John Ratelle, Internal Medicine, co-coordinator of the Quality Improvement curriculum during which Dr. Beachey and the team completed the project.

“We kind of assume if you’re in the hospital, you’ve got to have your blood drawn, right? That’s just something that needs to be done,” Dr. Ratelle said. “But maybe that’s not the case. Maybe things have been stable and it’s not really influencing day-to-day care.”

A number of factors play into physicians ordering the tests.

“A lot of it is lack of provider comfort and lack of knowledge what the cost of testing is,” Dr. Beachey said. “It’s also a lack of knowing what consultant expectations are for daily labs.”

Dr. Beachey and his team collaborated with other stakeholders across several departments and work areas. Based upon their analysis, they put together a short education session and then compared the number of the two tests ordered per patient for three days before the session and three days after the session. The number of tests ordered per patient per day dropped by 33 percent following the education session.

“We were kind of surprised that within that short period of time that we had that significant of a result,” Dr. Beachey said. “It really showed us that just a simple intervention, such as providing education and encouraging providers to think about their daily ordering, can make a really large difference.”

For Dr. Oxentenko, it highlighted the need for faculty to set clear expectations as well as a cultural shift in medicine.

“We need to give trainees permission to not order things. When I think back to when I was a resident, more was better. You felt that you were a better resident if you thought of everything and ordered all these laboratory tests while someone was in the hospital,” Dr. Oxentenko said. “The culture is completely different now.”

For Dr. Sara Bonnes, General Internal Medicine, the project demonstrates the power of small changes and the need to teach quality improvement methodology.

“It’s not necessarily the big things that make the greatest difference,” said Dr. Bonnes, co-coordinator of the Quality Improvement curriculum  in which Dr. Beachey and the team completed the project. “A lot of times, they like to focus on changing the electronic orders or other things. Sometimes, it’s just communication that is key.”

Dr. Bonnes said it’s important to share findings of quality improvement projects, both within and outside Mayo. In November, Dr. Beachey presented their findings at the Minnesota American College of Physicians meeting and won the quality improvement poster competition. In April, he was able to share their findings with a larger audience at the national American College of Physicians conference.

Dr. Beachey is interested in continuing the improvement efforts to see how the results might be sustained.

Watch Drs. Beachey, Bonnes, Oxentenko and Ratelle describe the project:

Tags: Amy Oxentenko, hospital care, internal medicine residency program, Joel Beachey, John Ratelle, MD, Mayo Clinic, quality improvement, reducing unnecessary laboratory testing, Sara Bonnes

August 13th, 2015 · Leave a Comment

Mayo Clinic educates high schoolers about career options as U.S. faces shortage of health care workers

By Catherine Benson Catherine Benson

The United States is facing a shortage of health care workers in the next few decades, as our population continues to grow and to age. The Association of American Medical Colleges predicts a doctor shortage of 46,000 to 90,000 physicians by 2025, and the Bureau of Labor Statistics projects that the U.S. will need 526,800 more nurses by 2022. The BLS also projects that health care support occupations will increase 28.1 percent from 2012 to 2022, which represents the fastest growth of any major occupational group. This can include home health aides, medical technicians and medical assistants.

To address this health care shortage and prepare for the future, Mayo Clinic is reaching out to high school students and their teachers and counselors to educate them about the array of health care professions and to help students identify and prepare for career paths that are right for them.

“Our Career Awareness programs aimed at the high school level move from exploration to confirmation,” said Guy Finne, manager of recruitment strategies at Mayo Clinic. “They give students opportunities to confirm that this is what they want to do. We have a system of programs that start at the seventh through ninth grade levels with career exploration for the masses. We get preliminary information to as many students as we can. For example, we have a classroom speaker program to send our experts out to partnering schools. As we work with them, some of them raise their hands (as being) interested in careers.”

Students taking part in Career Awareness Day try their hands at a giant version of Operation.

Students taking part in Career Awareness Day try their hands at a giant version of Operation.

Finne said the efforts are critical for Mayo Clinic long-term.

“Mayo Clinic’s success is directly connected to the skill, knowledge, passion and efforts of our workforce,” Finne said. “We want to do our part in making sure our local and regional talent is well informed of the career opportunities in health care in order to ensure that our future applicant pools are diverse, talented and see Mayo Clinic as an employer of choice.”

According to the College Choice Report by ACT, which administers the ACT college readiness exam, 24 percent of 2014 high school graduates who were surveyed planned to major in the area of health sciences and technologies (e.g., physicians, nurses, physician assistants, dentists, EMTs and physical and mental therapists). Only 4 percent planned to major in health administration and assisting (e.g., health services administration and medical and dental assistants).

By their second years of college, however, high school students who planned a career in health care administration/assisting were among the most likely to switch majors. Only 7 percent of students who had planned to pursue these fields actually declared a major consistent with their stated plans. But many of the students stayed in the health care arena, with 43 percent intending to major in health care administration/assisting but majoring in health sciences/technologies instead. On the flip side, only 16 percent of those declaring a major in health care administration/assisting had planned to do so, while 53 percent had originally planned to major in health sciences/technologies.

“Research shows that counseling activities in high school designed to affect career choice, exploration and planning can be effective. In particular, effective interventions include things such as written exercises allowing for the comparison of occupational information and for setting goals and plans. There are tools out there, such as ACT Profile, that students can access without cost which may provide them personalized data and valuable information that will really help match them to the career that makes the most sense,” said Wayne Camara, senior vice president of research at ACT.

Mayo Clinic also has partnered with Rochester Public Schools and Rochester Community and Technical College to open and provide ongoing support for the Health Science Careers Center.

“All enrolled students start with the Introduction to Health Sciences and then have the chance to specialize in the second semester in one of four areas: nursing assistant, pharmacy technician, therapeutic medicine or biomedical science,” Finne explained. “We know that those students who’ve participated were prepared for college because of the experiences they’ve had with our programs. A number who take part in the Health Science Career Center program leave high school having their certified nursing assistant credentials, and some put themselves through college that way. Many end up at Mayo.”

Mayo Clinic programs for high schoolers
Mayo Clinic has developed or partnered with several programs to educate students about the many different careers available in health care. These programs include:

Exploring-Learning for Life— a partnership with the Boy Scouts of America, the program provides a learning experience for high schoolers revolving around the goals of career exploration, life skill development, service learning experiences, character education and leadership opportunities.

Career Observation Program—intended to help confirm interest in health care career paths. Students receive information for career decision-making and insight into Mayo Clinic careers and Mayo Clinic as a potential employer.

High School Mentorship—brings students to Mayo Clinic to work with a mentor on an identified, specific project for a minimum of 60 hours. The program is intended for high academic performers to introduce them to career opportunities in a wide variety of biomedical science fields.

Health Occupation Students of America—a national career and technical student organization endorsed by the U.S. Department of Education. Nationally, there are more than 66,000 members. Mayo Clinic works with local chapters and supports them with classroom resources, on-campus tours and more.

Mayo Clinic Health Care Career Festival— offers high school students in Southeastern Minnesota the opportunity each October to explore a wide range of exciting career opportunities in a festive, engaging atmosphere. More than 900 students from 45 area schools (who apply to attend) participate each year.

Youth Apprenticeship—a paid experience in which a student works at Mayo Clinic for 400 hours in the summer between his or her high school junior and senior years and 400 hours during the student’s senior year. The opportunity is open to students enrolled in the Health Science Careers Center in Rochester, Minn.

Teacher Externship—a continuing education graduate credit course for five secondary career educators, health occupations educators and counselors for 40 hours over the summer. They work as a cohort, and the experience is hands-on. In the health care industry, Mayo Clinic realizes many students who express interest in health care careers are poorly informed about the variety of opportunities available. This program helps educators learn more so they can guide students.

Tags: ACT, career, doctor shortage, health care occupations, high school, teacher externship, career awareness, health care careers

August 12th, 2015 · Leave a Comment

Mayo Clinic THINK BIG Challenge to offer entrepreneurs $100,000 start-up funds, expert guidance

By Catherine Benson Catherine Benson

Mayo Clinic Center for Innovation, Mayo Clinic Ventures and AVIA have issued the Mayo Clinic THINK BIG Challenge, a national competition offering awards totaling $100,000 for entrepreneurs with innovative ideas to transform the future of health and health care.

Entrepreneurs can apply for one of two $50,000 THINK BIG challenge awards in these categories:

Got Health?
This challenge will focus on healthy people staying healthy and explore areas such as eating healthy, enhancing well-being, monitoring risk factors and engaging in daily exercise.

I Am Not My Disease
This challenge will tackle the presumption that people are defined by their disease and explore areas such as access to health data, health literacy and behavior modification.

In addition, Mayo Clinic experts will guide winners for a year as they develop their concepts for market. Apply for the Mayo Clinic THINK BIG Challenge by Saturday, Aug. 15, at transformconference.mayo.edu/think-big.

The THINK BIG competition will culminate on Thursday, Oct. 1, in Rochester, Minnesota, at the Transform 2015 conference, a gathering of industry leaders exploring the future of health and health care. Finalists will compete on stage in a live presentation. A panel of judges will select the winners with input from the Transform audience using smartphone technology.

Tags: AVIA, CFI, Entrepreneur, Mayo Clinic Center for Innovation, Mayo Clinic Ventures, Think Big Challenge

July 29th, 2015 · Leave a Comment

Mayo Medical School takes on bold new initiatives to improve medical education

By Amy Olson Amy Olson

Mayo Medical School is at the forefront of a major transformation in medical education.

The school is expanding to Arizona and Florida to become one of the first national medical schools in the United States, offering a single curriculum across three campuses. In addition, Mayo will be among the first medical schools in the nation to offer a Science of Health Care Delivery curriculum, providing future physicians and researchers with innovative approaches to improve the quality and value of patient care.

The system of medical education has not changed much in 100 years. The first two years of medical school traditionally focus on the biological sciences, while the second two focus on the clinical sciences. But Mayo Medical School is expanding on that notion to include a “third science” of health care delivery, which will be integrated throughout the students’ four years.

Michele Halyard, M.D., interim dean of the Mayo Medical School

Michele Halyard, M.D., interim dean of the Mayo Medical School

“At Mayo Medical School, we are working to provide our students with the knowledge and skills to heal not only the patient, but the health care system as well,” said Michele Halyard, M.D., interim dean of the school.

Currently, Mayo Medical School receives nearly 5,000 applications each year for its 54 student slots. Expanding the medical school will nearly double the enrollment and allow the school to offer unparalleled medical education to 50 additional incoming students a year on the four-year Arizona campus, beginning in 2017. The total student body for the school will surpass 400 medical students by 2021.

Mayo Medical School is also launching a 2 + 2 program in 2016, allowing up to eight students each year who have completed their first two years of training on the Rochester, Minnesota, campus to complete their third and fourth year on the Florida campus. In addition, students in the M.D.-Ph.D. program will also have the opportunity to complete their Ph.D. training on the Florida campus.

The expansion of Mayo’s medical school and its unique collaborations with other health care organizations across its sites will offer students access to diverse patient populations across multiple care settings. In Florida, for example, which is known for its Transplant, Cancer and Neuroscience programs, students can expand their training by also doing rotations at neighboring health care organizations with high volumes of Medicaid or pediatric cases.

Mayo Medical School receives AMA grant to develop innovative curriculum

Mayo Medical School’s bold new advances in medical education and its dynamic, personalized learning environment set the bar high for medical education. The new Science of Health Care Delivery curriculum, which is being jointly developed with Arizona State University, is supported through an American Medical Association grant called Accelerating Change in Medical Education. Mayo—which was one of only 11 medical schools in the nation awarded the grant—will receive $1 million over five years to develop this transformative curriculum.

Mayo Medical School, the other 10 medical schools and the AMA will work through a consortium to rapidly spread innovations and best practices for innovative medical education. “The beauty of the consortium is that the schools are sharing their knowledge across the consortium, and hopefully we’ll share this unique focus to other medical schools across the country,” Dr. Halyard said.

The science of health care curriculum will have six domains:

  1. High-value care
  2. Population-centered care
  3. Teamwork
  4. Leadership
  5. Person-centered care
  6. Health policy, economics and technology

The curriculum will focus on modern-day lessons that are not traditionally taught during medical school but are critical for future physicians to be well-versed in. These issues might include spiraling health care costs; changing payment structures; new technology, such as electronic health records; medical simulations and team-based care; and caring for the whole patient, not simply treating the disease.

“Besides training students in the Mayo Model of care, we will help students become well-rounded and understand the complexities of the health care system and have the abilities to address those complexities,” Dr. Halyard said.

The curriculum will also have an additional component focusing on wellness and resiliency that has already been implemented at the Rochester campus. “At Mayo Medical School, we really take seriously the well-being of our students and want to help them be equipped to manage their own well-being,” Dr. Halyard said.

With the development of a national medical school and an innovative new curriculum, Mayo Medical School will continue to be a leader in the forefront of medical education.

July 24th, 2015 · Leave a Comment

U.S. Department of Labor features Mayo employee who founded employee resource group for those with disabilities

By Amy Olson Amy Olson

When Gretl Kruse saw a need, she jumped into action. In 2014, the Mayo Clinic project manager formed Mayo Clinic’s disABILITY employee resource group with several other colleagues.

Kruse said they started the group to improve the experience of Mayo Clinic’s patients and employees with disabilities.

Kruse and the group’s efforts are featured by the U.S. Department of Labor on its website, commemorating of the 25th anniversary of the Americans with Disabilities Act (ADA). Signed into law in 1990, the Americans with Disabilities Act is civil rights legislation that works to increase inclusion of people with disabilities in all aspects of community life, including the workforce.

“The group is formed of Mayo employees with disabilities and colleague allies who, together, work to connect employees and patients with needed resources. Together, we advocate for positive change,” Kruse told the Department of Labor. Gretl Kruse, project manager at Mayo Clinic, helped found the disABILITY employee resource group at Mayo Clinic.

For example, the employee resource group regularly consults with Mayo Clinic care teams to help them better understand and respond to the needs of people with disabilities, whether they are patients or employees.

Open to all employees, Mayo Employee Resource Groups – or MERGs – are groups of employees formed around shared characteristics or life experiences. Ninety percent of Fortune 500 companies use employee resource groups. Each MERG now has a strategic focus that supports one or more of Mayo Clinic’s diversity and inclusion goals. The Office of Diversity and Inclusion provides financial and administrative support.

Diversity and inclusion are central to Mayo Clinic’s mission to provide excellent, culturally relevant care in a welcoming environment to patients from a variety of backgrounds. Diversity and inclusion also are important to creating a work environment where differences are valued, allowing Mayo Clinic’s staff members to achieve their fullest potential. Since 2011, Mayo Clinic has been recognized by Diversity Inc. as a Top Hospital and Health System.

To read the profile on Kruse and the Employee Resource Group, go to the U.S. Department of Labor’s site and scroll down the page.

Tags: Americans with Disabilities Act, disABILITY employee resource group, Employee Resource Groups, Gretl Kruse, Mayo Clinic, US Department of Labor

July 21st, 2015 · Leave a Comment

Mayo Clinic among top hospitals in U.S. News & World Report Honor Roll

By Amy Olson Amy Olson

Mayo Clinic today has been named one of the best hospitals nationwide by U.S. News and World Report. Mayo Clinic earned more No. 1 rankings in individual specialties than any other provider based on reputation, services and volumes, safety and clinical outcomes.

“This ranking underscores our long-standing commitment to provide the highest-quality care that best meets our patients’ needs,” says John Noseworthy, M.D., president and CEO, Mayo MSS_571426Clinic. “Mayo Clinic is fortunate to be ranked No. 1 in more specialties than any other hospital in the nation. We owe our success to staff members who dedicate themselves daily to this shared mission.”

Mayo Clinic was second overall on U.S. News & World
Report’s
 2015-2016 Best Hospitals list and earned a No. 1 ranking in eight specialties:

Read the full article on the Mayo Clinic News Network.

Tags: Best Hospitals, US News and World Report

July 17th, 2015 · Leave a Comment

Repairing mitochondrial disease

By Amy Olson Amy Olson

A multidisciplinary team has successfully eliminated fatal mitochondrial DNA mutations in stem cells from patients with mitochondrial diseases. The study is published in the journal Nature as a collaboration between some of the top research institutions and Mayo Clinic’s Center for Regenerative Medicine.

Mitochondrial diseases are a particular struggle for patients and their families as treatment options are limited, something made even more dire as many of those affected are children. Andre Terzic, M.D., Ph.D., director of Mayo Clinic’s Center

Andre Terzic, M.D., director, Mayo Clinic Center for Regenerative Medicine

Andre Terzic, M.D., director, Mayo Clinic Center for Regenerative Medicine

for Regenerative Medicine, explains: “These are life threatening conditions where standard care is limited to alleviating symptoms of disease. Our proof-of-concept study shows that functionally corrected stem cells can be generated from these patients, providing initial steps towards regenerative therapy for mitochondrial disease.”

Read the full post on the Center for Regenerative Medicine’s blog.

Tags: DNA mutations, mitochondrial disease

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