Minnesota - April 2012 Archives

ROCHESTER, Minn. — Physicians, researchers, psychologists, social workers and educators are gathering April 18-21 at the American Association of Suicidology Conference in Baltimore to discuss and present the latest in suicide prevention and research on topics such as post-traumatic stress disorder, college and youth mental health and bullying. "This meeting is a gathering of some of the great minds in the fields of suicide prevention, clinical practice, postvention and research," says Timothy Lineberry, M.D., Board Chair, American Association of Suicidology and a Mayo Clinic psychiatrist who specializes in suicide prevention. "Suicide is a significant public health problem in the United States and there are treatments and interventions that can make a difference." Every 15 minutes, someone dies by suicide in the United States, according to the Centers for Disease Control and Prevention. For every person who dies, many more think about, plan or attempt suicide. In 2008, a total of 36,035 people died as a result of suicide, and about 666,000 visited hospital emergency departments for nonfatal, self-inflicted injuries, the CDC found in a recent nationwide study. The conference will include presenters from national organizations such as the United States Department of Defense, Veterans Affairs Medical Centers, the Substance Abuse and Mental Health Services Administration and the National Institutes of Health. New research and presentations also will stem from a gamut of medical institutions including Johns Hopkins University, the University of Washington and Mayo Clinic. U.S. Surgeon General Regina Benjamin, M.D., also is slated to attend and give a presentation on suicide prevention Thursday, April 19. New research of note (for a complete conference agenda with all new research posters and presentations, or to request a copy of a study, Email Amy Kulp at ajkulp@suicidology.org):

ROCHESTER, Minn. — Cardiologists have long grappled with how to best manage patients with coronary artery disease who report skin hypersensitivity to nickel or other metal components found in stents — small tubes placed in narrowed or weakened arteries to help improve blood flow to the heart. But new Mayo Clinic research, published in the April 16, 2012, issue of Circulation: Cardiovascular Interventions, may help allay these concerns. "Most interventional cardiologists will, at some stage, have to decide whether to place a coronary stent in a patient with a history of skin allergy to one of the metal components, most commonly nickel. Our study found no evidence of an increased risk of heart attack, death or restenosis, which is a recurrent narrowing within a stent, in patients who reported themselves to be allergic to metal prior to implantation," says Rajiv Gulati, M.D., Ph.D., an interventional cardiologist at Mayo Clinic in Rochester, Minn. "These findings should provide some reassurance to clinicians and patients who are faced with this clinical issue, especially as there has been scarce and conflicting information in the literature." Researchers at Mayo Clinic conducted a retrospective evaluation of early and long-term clinical outcomes in 29 patients with a history of metal allergy who subsequently underwent coronary stent implantation, and compared them with a closely matched control group of 250 nonallergic patients. Data revealed no significant differences in the rates of heart attack, death at 30 days and four years, or repeat revascularization of the originally treated coronary artery between these groups. The research team also looked at markers of an allergic response before and after stent placement, and found that white blood cell, eosinophil and lymphocyte counts did not change after the stents were placed. This lends weight to the idea that there is no worrisome systemic immune reaction in those with a history of skin allergy to metal components. While previous studies have examined metal allergy and stent placement, this earlier research primarily focused on the risk of restenosis. These studies had some limitations in design and yielded conflicting results, according to Dr. Gulati. Coronary stents used in the United States since 1997 have been constructed using 316L stainless steel, cobalt-chromium alloy, or platinum-chromium alloy platforms. In varying amounts, all stents contain nickel (10 percent to 35 percent) and chromium as chromate (18 percent to 20 percent). Nickel allergy is one of the most common causes of allergic contact dermatitis and is thought to affect about 8 percent of the population. Nickel allergy is more common in women and is often triggered by exposure to earrings and other nickel-containing jewelry or body piercings. Patients with known or suspected skin allergy usually report a skin rash, itching, redness or dry patches within 12 to 48 hours after initial contact with the metal. In this study, hypersensitivity to nickel was reported in 26 of 29 cases and to chromium in nine of 29 cases. Patch testing performed in 11 of 29 patients was positive in all; the remaining patients were presumed to have allergies by history alone. Still, it is unknown how many patients with coronary artery disease might be affected.

ROCHESTER, Minn., and CALGARY, Alberta — Mayo Clinic and Assured Diagnosis Inc. (ADI) of Calgary, Alberta, announced today the launch of two new health insurance options that will provide more Canadians access to Mayo Clinic's expertise and care in the event of serious illness. The two new offerings, MyCare Health Benefit Option (HBO) and MyCare Advantage Insurance, are now available to companies and associations as an addition to their benefit packages. Like the original MyCare plan, designed for individuals and families, these two new products are available nationwide in Canada, initially excluding Quebec. "The May 2011 launch of the MyCare Insurance program for individuals and families was very well received and we were inundated with requests from employers and associations to provide a similar product for their groups. MyCare HBO and MyCare Advantage insurance are in direct response to that need," says Jim Viccars, president and CEO of ADI. MyCare HBO assists members in obtaining a diagnosis of serious illness and providing diagnostic scans and necessary specialist assessments. This provides more service than the traditional second opinion products attached to many group benefit programs. MyCare HBO members will have access to Mayo Clinic expertise delivered remotely via an electronic medical opinion consultation, and will have the option to upgrade to MyCare Advantage Insurance at group rates for on-site care at Mayo Clinic campuses in Jacksonville, Fla., Scottsdale/Phoenix, Ariz., and Rochester, Minn. "MyCare Health Benefit Option and optional upgrade to MyCare Advantage Insurance were developed to remove barriers to obtaining required medical services for plan members and their families," says Viccars. "Mayo Clinic has provided hope and solutions for tens of thousands of Canadians for more than a century," says Mikel Prieto, M.D., medical director of the International Office at Mayo Clinic. "We strive to build meaningful relationships with our patients at home and abroad, serving them not only when they are ill, but anticipating their needs before they become ill. We look forward to the opportunity to extend our expertise to Canadians through the latest MyCare offerings."

ROCHESTER, Minn. — Mayo Clinic researchers will present findings on stroke and aneurysm treatments and other neurosurgery research at the American Association of Neurological Surgeons annual scientific meeting April 14-18 in Miami. Mayo Clinic neurosurgeons will be available to provide comment for reporters covering the conference. Mayo Clinic studies that will be presented and their embargo dates include: Carotid endarterectomy is a safe, less expensive treatment for stroke A Mayo Clinic study of 1,492 patients found endarerectomaties are a safe, less expensive treatment option for certain patients at risk for stroke. Endarterectomy is used to treat carotid artery disease, a condition in which the carotid arteries narrow or clog, and blood struggles to reach the brain, causing a stroke. "In our study, we found endarterectomy was largely effective," says co-author Fredric Meyer, M.D., a Mayo Clinic neurosurgeon. "Endarterectomy is less expensive than the other treatment for carotid artery disease, so this is important for physicians to recognize." Endarerectomaties cost roughly $200 to $400 less per procedure than carotid angioplasty, the other main treatment to restore proper blood flow to the head. In an endarterectomy, plaque is separated from an artery wall. Angioplasty involves temporarily inserting and inflating a tiny balloon to widen the clogged artery. Different techniques safe and effective for stroke treatment A treatment strategy using different techniques alone or together based on clinical and angiographic features is an effective and safe way to manage intracranial dural arteriovenous fistulas (DAVF), says study co-author Giuseppe Lanzino, M.D., a Mayo Clinic neurosurgeon. Intracranial dural arteriovenous fistulas are abnormal connections between an artery and a vein inside the brain. "The most dangerous complication of a cranial DAVF is brain hemorrhage," says David Daniels, M.D., Ph.D., a Mayo Clinic neurosurgeon and study co-author. Depending on the location, an unruptured fistula can cause neurological problems and blindness. Researchers studied 60 consecutive patients evaluated for intracranial dural arteriovenous fistulas at Mayo Clinic since 2008. Data collected include patient demographics, presenting symptoms and signs, angioarchitecture, treatment recommendations, clinical outcomes, complications and radiological follow-up.

A Mayo Clinic research team of physiologists will leave for Nepal and Mount Everest on Monday afternoon, April 16, from the Rochester, Minn., airport. The ...

ROCHESTER, Minn. — Simply asking patients who are about to receive a bone marrow transplant whether or not they smoke may not prompt them to disclose their tobacco habit or to kick it, and smoking can lead to poorer outcomes after a transplant. Testing patients for traces of a chemical that tobacco leaves behind can identify smokers and open the door for physicians to help them quit, Mayo Clinic researchers say. Their study was presented April 14 at the Society of Behavioral Medicine Conference in New Orleans. Bone marrow transplant patients can face serious consequences from tobacco use after a transplant, such as increased risk of death, complications requiring longer hospitalization and a higher likelihood of developing a secondary medical condition. When asked, some patients say they don't use tobacco, yet tests show they have traces of cotinine in their blood – a metabolite of nicotine and the most commonly employed biochemical marker for tobacco. The researchers estimate that 35 to 44 percent of patients about to have a bone marrow transplant have recently used tobacco. Of those, 14 to 17 percent describe themselves as smokers before and after the transplant. "Reasons for misclassification of smoking status among chronically ill smokers are unclear, but may be impacted by exposure to environmental tobacco smoke, use of nicotine replacement, societal pressure to be smoke-free and distress related to smoking status," says lead researcher Shawna Ehlers, Ph.D., a Mayo Clinic psychologist. "But as health care providers, we need to accurately identify every tobacco user, so we can ensure best patient outcomes and help people return home to their loved ones and the life they are fighting so hard to preserve." Accurate identification of smoking or recent smoking behavior among patients before and after transplants provides a unique opportunity to help tobacco users quit and avoid relapses — also logical considering patients may be in the hospital for a long time and have better access to those programs. Dr. Ehlers says physicians need to reassure patients that disclosing tobacco use is in their best interests and will be treated like any other risk factor. "Until we treat all known risk factors, we are not providing best transplant care," she says. Tests for cotinine can detect tobacco exposure over the last three to five days and can be collected from urine, blood or saliva. The accuracy of cotinine measures in identifying smoking behavior has been estimated to be greater than 90 percent.

ROCHESTER, Minn. — April is National Cancer Control Month, which focuses on the prevention, detection, and treatment of cancer and on efforts to improve the ...

ROCHESTER, Minn. — April 10, 2012.  Patients who went to the emergency room with chest pain but were at low risk for a heart attack were less likely to seek more tests after their conditions were explained to them using an educational tool known as a decision aid, a Mayo Clinic study found. The findings are published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal. Chest pain is the No. 2 reason people seek emergency care at U.S. hospitals. It accounts for about $8 billion in health care costs annually, researchers estimate. "To avoid missing a diagnosis of heart attack — which could have substantial medical and legal implications — emergency physicians often admit patients to observation units for stress testing, even though patients are at a very low risk for heart attack," says lead author Erik Hess, M.D., a Mayo Clinic emergency room physician. "This results in false-positive test results, unnecessary additional procedures, exposure to radiation and increased cost." Researchers randomly assigned 204 chest pain patients at low risk of heart attacks additional counseling through a decision aid — a tool that summarizes the evidence and helps educate and engage patients in making decisions about their care — or the typical care. The decision aid included initial results of the patient's chest pain diagnosis, the patient's personal risk for heart attack within the next 45 days and a menu of evaluation options ranging from urgent cardiac stress testing to making an appointment with a primary care doctor within 72 hours. Both patient groups were followed for 30 days, and no acute heart problems occurred in either group after leaving the hospital. "In this study, we found that low-risk chest pain patients who participated in shared decision making often chose less extensive testing once it was clear that they weren't having a heart attack," says co-author Victor Montori, M.D., director of the research program within Mayo Clinic's Center for the Science of Health Care Delivery. Researchers surveyed both groups of patients immediately after the ER visit to test their knowledge and analyze their involvement in decision making. Findings include: Decision-aid patients decided to be admitted to the observation unit for stress testing 58 percent of the time, compared to 77 percent for patients in the traditional care group. Patients in the decision-aid group were significantly more knowledgeable about their heart attack risk and options than those in the traditional care group. The degree of involvement in care decisions in patients who received the decision aid was four times greater than those who didn't receive the decision aid. Patients in the decision-aid group said the information was clear and helpful, and 3 of 4 surveyed said they would recommend it to others.

ROCHESTER, Minn. — April 9, 2012.   The Breast Cancer Genome Guided Therapy Study (BEAUTY Project) will help physicians tailor chemotherapy to breast cancer patients based on their individual genomes and the genomes of their tumors. Mayo Clinic researchers will obtain three whole genome sequences: one from the patients' healthy cells before treatment, and two tumor genomes – one before chemotherapy and one after. Patients will be paired with mouse "avatars" that will help physicians identify the best treatment for each person. "What is so exciting about this study is that it has the potential to really bring individualized medicine to our patients," says Matthew Goetz, M.D., Mayo oncologist and study co-leader. "It will transform how we conduct breast cancer research and how drug therapies are delivered to women with breast cancer." In phase one of the BEAUTY Project, researchers will study the first 200 participants to look for common mutations that allow some tumors to adapt and thrive during chemotherapy. This information will help doctors identify new drugs and treatment strategies. Women diagnosed with "high-risk" cancers who are scheduled to receive standard chemotherapy before surgery will have their healthy genome and their breast cancer tumor cells sequenced before treatment, and then receive the commonly prescribed chemotherapy to shrink the tumor. At surgery, the residual cancer tumor cells will be sequenced again to evaluate how they have mutated and adapted to chemotherapy. In addition, patients' tumor tissue will be kept alive by implanting cell lines in immune-compromised mice — before and after chemotherapy. The use of these mouse "avatars'' will let researchers study the effects of chemotherapy on individual patient tumors and identify the best treatment, without risk of harm to the patient. "Patients are pleased after definitive breast surgery to be cancer free," says Judy Boughey, M.D., a Mayo breast surgeon and study co-leader. "Unfortunately, a subset of high-risk patients still may experience recurrence, even months or years later. We designed this study to give those patients hope that our ability to decode the genome of every patient might give us new tools to treat cancer."

ROCHESTER, Minn. — Don't assume that a favorite wheat bread is offering the benefits of whole grains. The April issue of Mayo Clinic Health ...

ROCHESTER, Minn. — Clostridium difficile (klos-TRID-e-uhm dif-uh-SEEL) is a bug that can be difficult to beat. The April issue of Mayo Clinic Health Letter covers ...

ROCHESTER, Minn. — Adult scoliosis — the development of asymmetrical curvature and twisting of the spine — isn't necessarily a problem until symptoms develop, according ...