Minnesota - October 2012 Archives

NOTE: UPDATED EMBARBO TIME OF 8AM ET ROCHESTER, Minn. — October 17, 2012.  Clostridium difficile infections are becoming more common and more severe in hospitalized children and the elderly, in large part due to greater use of antibiotics, Mayo Clinic researchers report in studies being presented at the American College of Gastroenterology annual meeting. The bacterium, also known as C. difficile or C. diff, can cause an infection with symptoms ranging from diarrhea to life-threatening inflammation of the colon. It is the most common cause of diarrhea in hospitals and is linked to 14,000 U.S. deaths each year. MULTIMEDIA ALERT: A video interview with Dr. Khanna is available for journalists to download on the Mayo Clinic News Network. The Mayo study analyzed five years of data from the National Hospital Discharge Survey and found that of an estimated 13.7 million hospitalized children, the 46,176 with C. diff infections had significantly longer hospital stays, more instances of colectomy (partial or total removal of the colon), increased admission to long or short-term care facilities, and higher risk of death. "Despite increased awareness of C. difficile in children, and advancements in management and prevention, this remains a major problem in hospitalized children," says Sahil Khanna, M.B.B.S., a Mayo Clinic gastroenterologist. Elderly patients also have a greater risk of complications from C. difficile and dying from the infection. In a separate study of 1.3 million adult patients hospitalized with C. diff, patients over 65 were in the hospital longer, sent to nursing homes more frequently and had a greater risk of death. That suggests being over age 65 is an independent risk factor for adverse outcomes associated with the infection. Researchers say increased use of antibiotics is a main reason for the increasing infection rates. When a person takes antibiotics, good bacteria or flora that protect against infection are destroyed. When these bacteria are destroyed, patients are vulnerable to C. difficile picked up from contaminated surfaces or spread from a health care provider's hands. Treatments depend on the severity and number of times a patient has had a C. diff infection. Typically, physicians will treat it with the antibiotic metronidazole or oral vancomycin. For severe cases and patients with recurrent C. diff, fecal transplants are an option. Stool transplant restores healthy intestinal bacteria by placing donor stool in the colon. Recurrent C. difficile is a major problem with the risk of recurrence being 20 percent after a first infection and as much as 60 percent after multiple infections. People who have had C. difficile are twice as likely to get it again. Other known risk factors include proton-pump inhibitors for gastric reflux, immunosuppression, and long hospital stays. It costs at least $1 billion annually to treat C. difficile infections.

ROCHESTER, Minn. — October 16, 2012.  People 70 and older who eat food high in carbohydrates have nearly four times the risk of developing mild cognitive impairment, and the danger also rises with a diet heavy in sugar, Mayo Clinic researchers have found. Those who consume a lot of protein and fat relative to carbohydrates are less likely to become cognitively impaired, the study found. The findings are published in the Journal of Alzheimer's Disease. MULTIMEDIA ALERT:: For audio and video of Dr. Roberts talking about the study, visit Mayo Clinic News Network. The research highlights the importance of a well-rounded diet, says lead author Rosebud Roberts, M.B., Ch.B., a Mayo Clinic epidemiologist. "We think it's important that you eat a healthy balance of protein, carbohydrates and fat, because each of these nutrients has an important role in the body," Dr. Roberts says. Researchers tracked 1,230 people ages 70 to 89 who provided information on what they ate during the previous year. At that time, their cognitive function was evaluated by an expert panel of physicians, nurses and neuropsychologists. Of those participants, only the roughly 940 who showed no signs of cognitive impairment were asked to return for follow-up evaluations of their cognitive function. About four years into the study, 200 of those 940 were beginning to show mild cognitive impairment, problems with memory, language, thinking and judgment that are greater than normal age-related changes. Those who reported the highest carbohydrate intake at the beginning of the study were 1.9 times likelier to develop mild cognitive impairment than those with the lowest intake of carbohydrates. Participants with the highest sugar intake were 1.5 times likelier to experience mild cognitive impairment than those with the lowest levels.

SPARTA, Wis. — October 10, 2012.  The hectic fall harvest is under way, and that means the dangers of everyday farm work — one of the nation's most hazardous occupations — are compounded by the rush to bring in crops on time. Many agricultural injuries can be prevented with basic safety equipment and mindfulness about the need for caution on the job, says emergency medicine physician Howard Schumaker, M.D., of the Mayo Clinic Health System in Sparta. "We've seen everything from broken bones and amputations to unfortunate traumatic situations," Dr. Schumaker says. "Many times farmers feel that due to the weather, they need to hurry to complete their field work. It's important to just slow down and make sure farm work gets done safely and efficiently." Dr. Schumaker outlines several important safety steps for harvest season and routine farm work: *Regular inhalation of dust from grain bins, silos, milk vats and manure pits can cause respiratory issues such as bronchitis and other dangerous cardiac conditions. Wearing a mask over your nose and mouth can reduce risk. *Farm vehicles such as tractors and all-terrain vehicles cause many injuries, particularly among children. Wearing a seat belt and helmet can help prevent traumatic brain injuries or even death. Children should be supervised and given only age-appropriate tasks and access to vehicles and other farm gear. *Grain augers are one of the most dangerous pieces of farm equipment. Broken bones, electrocutions and amputations can occur if augers aren't handled properly. *Livestock is another common source of injury. Cattle and other farm animals can bite, kick, ram or trample someone without warning. Stay attentive and alert. *Working long days and evenings in the field can cause dangerous levels of fatigue. Farmers may experience shortness of breath, stroke or heart attack. Try to take breaks, eat a healthy diet and get plenty of sleep. *Only enter a grain bin or gravity wagon when absolutely necessary, especially when grain is flowing. You can quickly become trapped and suffocate. If you must enter a grain bin, use a body harness and safety line secured outside the bin, and always have someone watching in case you are entrapped. *Take special care to avoid falls, another common farm injury and the source of not only broken bones, but head injuries and other physical trauma. *Protect eyes from debris whipped up by farm machinery.

ROCHESTER, Minn. — October 9, 2012.  Few physicians recommend active surveillance for low-risk prostate cancer rather than pursuing surgery or radiation, according to a Mayo Clinic study being presented at the North Central Section of the American Urological Association's annual meeting Oct. 10–13 in Chicago. Mayo Clinic urologists also are discussing findings on enlarged prostates, bladder cancer and other research and will be available to provide expert comment to journalists on others' studies. Mayo studies being presented, and their embargo dates and times, include: Active Surveillance for Low-risk Prostate Cancer Recommended Least Often by Physicians Friday, Oct. 12, 2012 While active surveillance is widely regarded as an effective strategy for managing low-risk prostate cancer, a Mayo Clinic study of 643 urologists and radiation oncologists found that only 21 percent of physicians studied recommended the strategy while 47 percent recommended surgery and 32 percent recommended radiation therapy. Overall, physician recommendations aligned with their area of expertise. Most urologists recommended surgery, and most radiation oncologists recommended radiation therapy. "Our results may explain in part the relatively low use of active surveillance for low-risk prostate cancer in the United States," says lead author Simon Kim, M.D., M.P.H., a urologic oncologist at Mayo Clinic. Laser Surgery Relieves Symptoms After Unsuccessful Surgery for Enlarged Prostate Tuesday, Oct. 9, 2012 Holmium laser prostate surgery is safe and effective at relieving persistent lower urinary tract symptoms after an unsuccessful surgery to treat an enlarged prostate, a Mayo Clinic study has found. The laser surgery reduces the size of the prostate gland or increases the size of the channel through which urine flows. The study compared surgical and postsurgical outcomes among patients who had a previous unsuccessful surgery for enlarged prostate and a group with no previous surgery. "Other than a slower morcellation rate — the rate at which the laser removes tissue — and a slower average urine flow rate for patients who had a previous surgery, the study found no significant difference in outcomes between the groups," says urologist Amy Krambeck, M.D., the study's senior author. Half of Urothelial Cancer Patients Who Get Surgery Aren't Cisplatin Chemotherapy Candidates Friday, Oct. 12, 2012 Nearly 50 percent of urothelial cancer patients receiving a radical cystectomy are not eligible to receive cisplatin-based chemotherapy before surgery, based on their kidney function alone, a Mayo Clinic study shows. Urothelial cancer is the most common form of bladder cancer in the United States. The study also found that nearly one in five patients who were candidates for cisplatin-based chemotherapy before surgery were no longer eligible for it after surgery. Older patients and patients undergoing a continent urinary diversion, such as a neobladder, were more likely to have reduced kidney function after surgery. The study included 741 patients with urothelial cancer who had a radical cystectomy at Mayo Clinic between 1980 and 2005. "This study highlights the fact that many patients who need a cystectomy for bladder cancer are not great candidates for cisplatin-based chemotherapy, both before and after surgery," says lead author R. Houston Thompson, M.D., a Mayo urologist. "It also is notable that after surgery some patients become ineligible for cisplatin-based chemotherapy, and this should be kept in mind as doctors counsel patients.

ROCHESTER, Minn. — October 9, 2012.  Physical and mental decline are common side effects of hospital stays, particularly among older patients. That can hold true even if someone is hospitalized for just a day or two for a common procedure such as knee replacement surgery. There are steps patients can take to regain strength, stamina and mental sharpness after time in the hospital, say Mayo Clinic aging and fitness experts Nathan LeBrasseur, Ph.D., and Michael Joyner, M.D., who are highlighting the issue as part of National Physical Therapy Month. VIDEO ALERT: For video of Dr. LeBrasseur and Dr. Joyner, visit the Mayo Clinic News Network. One of the most important moves a hospitalized patient can make is to simply get moving again as quickly as possible, to whatever extent is possible, Dr. LeBrasseur says. As people age, it takes less and less to push them off track, and being incredibly inactive during a hospital stay further stresses the body and can induce another degree of disability and functional decline, he says. "This kind of long-held belief or dogma that 'rest is best' is clearly not the right answer. We know from a number of different studies in different settings that exercise plays a very active role in the recovery process," says Dr. LeBrasseur, who is with Physical Medicine & Rehabilitation and the Mayo Clinic Robert and Arlene Kogod Center on Aging. "Also, just simple forms of activity are very important." Physical deconditioning during or after a hospital stay or illness isn't something that only happens to frail patients, says Dr. Joyner, an anesthesiologist and physiologist. Cognitive issues can also emerge. Anesthesia and pain-relieving drugs can sometimes cause confusion or delirium or make existing cognitive problems worse, Dr. Joyner says. "It can happen to anyone and it can happen quickly. Older people are at higher risk because they typically start at a lower baseline, so there is less reserve," Dr. Joyner says. "Each person and each case is different. However, the evidence for all sorts of conditions is that more aggressive rehabilitation strategies typically work far better than people realize."

ROCHESTER, Minn. — October 9, 2012.   Mayo Medical Laboratories is introducing two comprehensive mobile applications for iPhones and iPads, allowing physicians and pathologists unparalleled access to clinical laboratory expertise from Mayo Clinic. The Lab Catalog app provides guidance on test selection and result interpretation, enabling physicians to search for tests by disease, test name or test ID. In addition to test information, the app provides direct access to educational resources such as videos, articles and testing algorithms. The Lab Reference app provides users with quick access to reference values, uses, method names, cautions, testing algorithms, and clinical and interpretive information for each test. "Mayo Clinic has always put the needs of patients first, and the mobile test catalog and reference apps were developed to provide physicians the information they need to care for their patients and provide the best health care possible," says Franklin Cockerill, M.D., president and CEO, Mayo Medical Laboratories. "The Mayo Medical Laboratories apps are literally an in-your-pocket resource for physicians across the world, extending beyond our walls and following them wherever they go."