A recent Mayo Clinic study highlights how a new debriefing tool is helping to improve the mental well-being of nurses.

The tool, which goes by the acronym BONE Break, is a structured approach designed to help address the emotional and psychological distress known as Second Victim Syndrome which can be experienced by people within healthcare teams.

"Second Victim Syndrome is the emotional toll that can occur after an adverse event in the hospital," says Amberly Hess, D.N.P., lead author of the study. "It's the feeling of guilt, self-blame and trauma that can arise when a healthcare worker is involved in or witnesses an adverse patient event."

To understand the debriefing tool's impact, researchers examined its use with registered nurses (RNs) in a 24-bed inpatient unit at Mayo Clinic over a nine-month time frame.

The BONE break tool is designed to be implemented within the first 30 minutes following an event, and to offer peer support and emotional processing to the nurses involved. The nurses who participated reported that they considered over 95% of the sessions helpful.

"One of the most significant insights we gained within the study was the difference between intellectualizing and emotionally processing what happens to us," says Hess.

"When I would run the BONE Break tool, I saw the physiologic changes in nurses," she adds. "I watched the shoulders relax and release tension."

Hess emphasizes that the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery played a pivotal role in developing and evaluating the BONE Break tool.

"The Kern Center provided the framework and allowed the study to grow," says Hess.

"The nursing staff brought this study to the Kern Center and the collaboration was great," says Renaldo Blocker, Ph.D., a human factors engineering researcher and senior author of the study.

Dr. Blocker is a Robert D. and Patricia E. Kern Honored Investigator and leads a research team on cognitive engineering and neuroergonomics within the Kern Center.            

Researchers note that the nurses who participated were responsible for collecting data immediately following each BONE Break session, including the type of event, such as a patient fall.

The BONE Break debriefing process consisted of the following steps.

• Buoy/Break: Nurses took a silent break or short pause to allow for space, then reflected on the statement, "You are a good nurse working in a very complex environment." Peers then offered support using phrases such as "I cannot imagine what that must have been like for you. Can we talk about it?"
• Open-Up: The nurses then invited each other to talk about the event that had just occurred: "This has to be difficult. Are you OK?" and "How are you doing after the event?"
• Needs: Nurses assessed one another’s needs following the event: "What do you need right now to be able to be successful in returning to work?" They offered each other affirmations surrounding those needs: "I believe in you."
• Exit/Evaluate: Afterward, nurses discussed the effectiveness of the debriefing before returning to the floor.

"This study highlights the importance of practitioners and scientists working together to evaluate, assess and implement these formative tools," says Dr. Blocker.

Researchers hope to expand the debriefing tool to other healthcare teams.

"This is an easy tool to implement, and it takes just a couple of people to make it happen," says Hess. "If anybody's interested in enhancing the culture of their team, this is a good tool to have available."

Review the study for a complete list of authors, disclosures and funding.

About 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 collaborates with clinical areas across Mayo to create and evaluate data-driven solutions to transform the experience of health and healthcare for patients, staff and communities. It drives continuous improvement of Mayo Clinic as a learning health system, enabling safe, evidence-based, high-quality care.

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Billie, who has smoked most of his life, understands how using tobacco can negatively affect many aspects of a person's health. He is also a member of the Navajo Nation and has witnessed the challenges that family, friends and other members of his tribe have faced quitting tobacco. In recent years, he has watched the rising use of vaping among Navajo youth with concern. He wants to discourage young people from using tobacco except for ceremonial purposes.

"Science seeking to cure disease and transform the way we deliver healthcare requires a direct connection to the people we serve."

Annie Rusk, M.D.

Billie's experiences made him an ideal candidate to advise Dr. Rusk on her research through a Mayo Clinic program called Community Engagement (CE) Studios.

CE Studios is a consultation service that connects researchers to a group of "community experts" who represent the researcher's population of interest. These experts meet with the researcher, usually during a study's planning phase, to learn how the study is being designed, ask questions and provide feedback.

Since Mayo Clinic introduced CE Studios in 2021, Dr. Rusk has used it numerous times. She believes community input is essential for all research projects, regardless of their focus. 

"By involving people with lived experiences, we can gain valuable insights and ensure our research is relevant and impactful," says Dr. Rusk. "Even discovery science projects taking place in a lab can benefit from community perspectives."

Lived experiences provide key insights

For the CE Studios session with Dr. Rusk, Billie joined three other community experts from tribes in the Midwest, Alaska and Canada in a virtual meeting. The four community experts were there to advise Dr. Rusk on a new clinical trial.

Kory Billie, a member of the Navajo Nation from Phoenix, wants to discourage youth in his community from using tobacco, except for ceremonial purposes.

Dr. Rusk's research focuses on understanding barriers to smoking cessation among Native Americans. She felt it was important to consult with people from a variety of Indigenous communities to ensure her research aligned with their community health needs and priorities.

Billie says he enjoyed this opportunity to connect with like-minded people from similar backgrounds, and to speak with Dr. Rusk about how tobacco use was affecting communities like his. He shared his experiences with homelessness and addiction, as well as the difficulty of accessing smoking cessation resources in Indian Country.

What Dr. Rusk learned from Billie and the other community experts during the CE Studios session motivated her to make an important change to her study design.

The elements of the study that resonated best with the community experts were those geared toward developing practical behavioral health interventions. Billie and the other experts emphasized that understanding the social and cultural drivers of smoking would be key to achieving meaningful outcomes.  "You have to understand a person's environment and the way they're brought up," says Billie.

The community experts were less keen on a genetic analysis component Dr. Rusk had planned to include. They felt this aspect did not align meaningfully with community health priorities. Based on this feedback, Dr. Rusk eliminated this component from her study. 

While incorporating this kind of feedback can be challenging, Dr. Rusk says the long-term benefits are worth it for all.

"Science seeking to cure disease and transform the way we deliver healthcare requires a direct connection to the people we serve," she says.

Health is a blessing

Billie says he appreciated this chance to participate in CE Studios. He hopes that the knowledge he and the other experts shared will give Dr. Rusk the context she needs to develop a tobacco intervention that will have a lasting impact. He looks forward to hearing from her upon completion of the study to see the results.

He encourages other people to consider participating in CE Studios to help advance research to improve the health of their communities. He connects his motivation for this work to a Navajo proverb that reminds his people to live their lives with purpose:

"Remember to walk in beauty. Beauty before you and beauty behind you."

If the community can improve the health of its people today, he says, they will pass that blessing on to future generations.

Get involved in CE Studios

A CE Studios community expert can be a person with any type of lived experience. Experts receive a small honorarium in exchange for their time. People interested in joining Mayo Clinic’s database of community experts should complete a Community Expert Enrollment Form.  

Mayo Clinic Community Engaged Research

Learn more about community outreach and engagement and community-engaged research at Mayo Clinic.

This work is supported by Mayo Clinic Center for Clinical and Translational Science and by Mayo Clinic Comprehensive Cancer Center.

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A study published in Menopause provides a comprehensive overview of the most common conditions diagnosed in clinical practice among women in the U.S. Upper Midwest during their critical midlife transition.

Overall, eight conditions increased by 45% or more between the ages of 40 and 59, and several conditions were more common in Black women and women living in more socioeconomically deprived neighborhoods.

Jennifer St. Sauver, Ph.D., the study's first author and professor of epidemiology at Mayo Clinic, says that the health of women in midlife is understudied, and comprehensive data about women between the ages of 40 and 59 are lacking.

"Most studies examine men and women together. However, we know that men and women age differently, so it's important to do separate studies to understand these differences," she explains.

Researchers know that hypertension and high cholesterol increase rapidly in both men and women during midlife. However, in this study, the researchers were surprised to see such a significant increase in sleep disorders, acid reflux and conditions related to joint and muscle pain in midlife women, according to Dr. St. Sauver.

Together, these data provide a picture of the most common health conditions that come to medical attention in midlife women and the most rapidly increasing, medically diagnosed conditions during the menopause transition.

Key findings

Eight conditions became significantly more common and increased in women during midlife (ages 40-59).

• Disorders of lipid metabolism (high cholesterol)
• Hypertension (high blood pressure)
• Sleep/wake disorders
• Thyroid disorders
• Esophageal disorders (especially acid reflux)
• Osteoarthritis (joint wear and tear)
• Tendon and synovial disorders (problems with joints and connective tissues)
• Menopausal disorders (especially hot flashes)

Black women and women living in socioeconomically deprived neighborhoods were more likely to have many of these conditions. Black women were more likely to have high blood pressure and esophageal disorders (especially acid reflux) compared to white women across all age groups. Women living in more deprived neighborhoods had a significantly higher prevalence of high cholesterol, high blood pressure, sleep disorders and esophageal disorders.

"Our data provide a comprehensive picture of the most common conditions coming to medical attention in midlife women. They are useful for understanding common diagnoses in women during the menopause transition and suggest that additional attention should be focused on Black women and women with lower socioeconomic status to ensure that common midlife conditions are identified and addressed," says women's health researcher and coauthor Stephanie Faubion, M.D., Mayo Clinic in Florida.

The findings also underscore the need for increased research to understand underlying biological changes in women at midlife and how these changes contribute to the development of many conditions throughout the aging process. Such research may suggest future treatments that could be beneficial for multiple conditions. In addition, the findings highlight the need for increased attention to the health needs of Black women and women with lower socioeconomic status to ensure early diagnosis and treatment of common midlife health conditions.

The study used data from the Rochester Epidemiology Project in Minnesota, including medical records from approximately 1.4 million people in the Upper Midwest. Researchers analyzed data from 86,946 women between the ages of 40 and 59. They examined diagnoses recorded in electronic health records between 2016 and 2019.

Review the study for a complete list of authors, disclosures and funding.

Related: Managing menopause symptoms

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A new study has revealed a significant link between a common pregnancy complication and early heart disease in women.

Researchers found that women with a history of hypertensive disorders of pregnancy (HDP) were at higher risk of developing coronary artery disease at an earlier age. In addition, they found that women with these disorders were at higher risk of myocardial infarction with non-obstructive coronary arteries (MINOCA) — heart attacks that occur when the coronary arteries appear normal. 

Hypertensive disorders of pregnancy (HDP) — such as gestational hypertension, chronic hypertension and preeclampsia — affect 15% of women during their reproductive years. Marked by high blood pressure, the effects of these disorders continue to impact the health of mothers and babies well after pregnancy.

Compared to women with a history of normotensive (normal blood pressure) pregnancies, women in this study with a history of HDP were at greater risk for:

• Early onset of coronary artery disease: Occurring on average seven years earlier among women with a history of HDP.
• More severe atherosclerotic coronary artery disease: Twice as likely among women with a history of HDP.
• Increased risk of MINOCA: Twice as likely among women with a history of HDP.

"This research highlights the need for earlier screening for heart disease among women with a history of high blood pressure in pregnancy, particularly for MINOCA, which is up to five times more common in women than in men," says Vesna Garovic, M.D., Ph.D., a Mayo Clinic nephrologist and senior author of the study.

To improve patient care and outcomes for women, the researchers say clinicians should not only screen for traditional coronary artery disease risk factors, but they should also screen for non-traditional risk factors associated with MINOCA and other non-obstructive types of coronary artery disease, such as stress, autoimmune diseases — and now, HDP.

How does high blood pressure in pregnancy lead to coronary artery disease?

According to the researchers, there are two related types of small vessel heart disease that may make it more likely for women to develop HDP and coronary artery disease:

1. Microvascular dysfunction: Women with a history of HDP often have this underlying problem, which occurs when the small blood vessels that feed the heart stop working as they should, decreasing blood flow to the heart.
2. Endothelial dysfunction: This is a problem common to both HDP and coronary artery disease. It occurs when the cells that line the inside of blood vessels malfunction, narrowing instead of dilating.

Together, these dysfunctions clog or narrow the arteries and small blood vessels that supply blood to the heart, which can lead to coronary artery disease without any physical blockage (non-obstructive). The researchers think it's possible that these processes may feed on one another, creating an environment where coronary artery disease is more likely to occur.

Further research, including large prospective studies, are needed to understand the mechanisms linking HDP to coronary artery disease, such as specific biomarkers and genetic factors that contribute to increased risk.

Read the paper to learn more about the study, including funding and disclosures.

A growing body of research on high blood pressure in pregnancy

Research led by Dr. Garovic, a Mayo Clinic nephrologist, has shown links between HDP and a greater risk for a wide range of health concerns including:

• Atherosclerosis and stroke
• Renal disease
• Brain cell damage and inflammation
• Accelerated aging and the markers of cellular senescence
• Early-onset hypertension in children

The overall goal of Dr. Garovic's research is to increase understanding of the causes and mechanisms that play a role in the process that leads to HDP. The potential to identify targeted therapies that address the underlying causes of disease may improve treatment options for diseases, such as preeclampsia, that have seen few therapeutic advances in recent decades.

Related:
Mothers with history of pre-eclampsia may encounter cardiovascular challenges later in life

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There is new hope in the fight against glioblastoma, the deadliest and most aggressive form of primary brain cancer.

Currently there is no cure, but results of a new study conducted at Mayo Clinic show patients experienced improved overall survival while maintaining quality of life after undergoing a novel approach to treatment.

Watch: Breakthrough in the fight against glioblastoma

Journalists: Broadcast-quality video (2:45) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Richard Casper was one of the study participants. The Arizona man enrolled in the clinical trial at Mayo Clinic in Phoenix after his diagnosis of glioblastoma in 2019. Richard was given only months to live, but his family says thanks to his strength, perseverance, and innovative medical care, he survived nearly double the amount of time.

"To be almost two and a half, three years in after being told you only have a few months, it's quite remarkable," says Susan Casper, Richard's daughter.

Richard succumbed to the disease in 2023. During the treatment, his family says he had little to no side effects. In the months before his passing, Richard stated, "I feel great. If someone didn't tell me I have the glioblastoma, I wouldn't even know it."

The clinical trial was led by Dr. Sujay Vora, a radiation oncologist at Mayo Clinic in Arizona. The small, single-arm study incorporated the use of advanced imaging technology combined with cutting-edge radiation therapy in patients over the age of 65 with newly diagnosed World Health Organization (WHO) grade 4 malignant glioblastoma.

"The patients lived longer than we expected. This patient population is expected to live six to nine months. Our average survival was 13.1 months. There were some patients that were out closer to two years. The results exceeded our expectations. We are very pleased," says Dr. Vora.

The study is published in The Lancet Oncology.

Why is glioblastoma so deadly?

Glioblastoma is among the most challenging cancers to treat. The disease is aggressive and invades healthy brain tissue with hairlike tentacles. "That is why doing a complete surgery is very difficult, as compared to say breast cancer, where a lumpectomy can be performed to remove not only the tumor, but a healthy rim of tissue around it," explains Dr. Vora.

Surgery for glioblastoma presents a different set of obstacles. "When it comes to glioblastoma, it is challenging to do that level of surgery. You try to surgically remove whatever you can safely without leaving the patient worse off after surgery."

Another factor that makes glioblastoma so lethal is that it can be fast- growing and unresponsive to treatment.

"These cancer cells are quite challenging to overcome," says Dr. Vora. "There are some patients we see after their surgery, and by the time we are ready to start their treatment, they've already had a recurrence of the disease."

An estimated 14,500 people will be diagnosed with glioblastoma in the U.S this year. "In the best of circumstances the average survival rates are in the 14-15 month range. But for patients 65 and older, the group that was the focus of our study, patients do even worse. The prognosis for this population is between six and nine months," says Dr. Vora.

Symptoms of glioblastoma

• Headache
• Nausea and vomiting
• Confusion or decline in brain function
• Memory loss
• Personality changes
• Vision changes
• Speech difficulties
• Trouble with balance
• Muscle weakness
• Seizures

Attacking glioblastoma with a triad

For the clinical trial, Dr. Vora and his team mapped out a plan that would allow them to be more intentional and precise with treating the location of the glioblastoma.

The imaging incorporated the use of ¹⁸F-DOPA PET and contrast-enhanced MRI. "¹⁸F-DOPA PET is an amino acid tracer that can cross the blood brain barrier, and it can accumulate within the glioblastoma cells itself," says Dr. Vora.

Researchers combined these images to determine the location of the most metabolically active "hot spots" of the cancer in the brain.

Taking aim with proton beam therapy

Study investigators used one of the most advanced forms of radiation treatment, called proton beam therapy.

"With standard radiation, the beams go through the brain tissue, so there's an entrance dose and the exit dose. But with proton beam therapy, we dial up how deeply we want the radiation to go," explains Dr. Vora. "It drops off its energy in the tumor, and then there's basically no radiation after that. It allows us to be more preferential into the delivery of radiation and protect more of the healthy surrounding tissue."

During proton beam therapy, a patient lies on a table while the machine rotates around the patient's head targeting the tumor with an invisible beam. The patient is awake for the procedure. It is painless with many patients reporting fewer to no side effects.

Unlike traditional radiation for glioblastoma, which is typically delivered over the course of three to six weeks, treatment with proton beam therapy for the study was conducted in one to two weeks.

"I am hopeful that this is the first step of many where we can continue to move the needle and allow patients to live longer and live well," says Dr. Vora. "The goal is to improve the outcomes for our patients allowing them to spend more time with their families."

Nadya's story

2022 was a tough year for Nadya El-Afandi. She was on the verge of celebrating a long but successful battle with breast cancer.

"Out of the blue, I had a seizure. I went to the hospital, they did an MRI. After additional tests they told me the news: 'You have a glioblastoma,'" recalls Nadya. She asked her doctor if she should continue her breast cancer treatment. "He said, 'No'-meaning the glioblastoma would kill me before the breast cancer."

Nadya was not about to give up.

Nadya is a wife and mother of four children. She lives just outside of Rochester, Minnesota. "My children said to me, 'Mom, you're a unicorn. Of course you'll live.' My mother has had a number of medical conditions and we never expected her to live this long. And she's still alive and with us," says Nadya. "My children have also said, 'You've got grandma's blood in you. You will live.'"

Nadya is receiving care at Mayo Clinic in Rochester. That's where she learned about a new clinical trial called SAGA, or stereotactic ablative radiation treatment for glioblastoma. The phase 2 clinical trial is building upon Dr. Vora's research and studying a larger group of patients. The study is being led by Dr. William Breen, radiation oncologist at Mayo Clinic in Rochester.

It has been 15 months since Nadya began treatment for glioblastoma. So far, there is no sign the glioblastoma has returned. "Nadya has already exceeded the time that's expected time to have a tumor recurrence, and she continues to do well," says Dr. Breen. "Nadya is beyond some measures of what the average, overall survival time would be."

While Nadya's progress in encouraging, Dr. Breen says it is important to note that it is too early to draw any conclusions about safety or efficacy of this approach to treatment until the study is completed.

Meanwhile, Nadya is focused on living her life to the fullest. Fifteen months after undergoing treatment, Nadya embarked on an adventure to Hawaii, where she spent time taking helicopter tours, snorkeling and hiking.

Related articles

• Breakthrough in treatment approach showing promise in the fight against glioblastoma, the deadliest and most aggressive type of brain cancer
• (VIDEO) Focus on hope: Brescia’s Story
• All-Star pitcher Liam Hendriks shares how he closed out cancer at Mayo Clinic in Arizona
• Cancer is tough. Evelyn Owens is tougher
• https://cancerblog.mayoclinic.org/2021/12/21/glioblastoma-in-older-adults-improving-survival-and-quality-of-life/
• https://cancerblog.mayoclinic.org/2024/05/15/technology-clinical-trials-offer-hope-after-glioma-diagnosis/

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At 20 years old, Brescia Dover was ready to take on the world.

She was on her way to achieving her dream of being a professional photographer.

Everything was going according to plan when her dream came to a halt. Brescia was diagnosed with cancer. With her plans for her future pushed aside, Brescia's focus was now on her health and hope.

It's an unexpected chapter facing an increasing number of adolescents and young adults diagnosed with cancer.

Watch: Focus on hope: Brescia's Story

Journalists: Broadcast-quality video (2:31) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Brescia's dream

At 4 years old, it was clear Brescia Dover had a flare for creativity. She readily admits she was never one to miss an opportunity to play dress-up, draw pictures, or tell a story.

"Being creative has always been at the core of what I do," she says. Early on she developed a love for photography and videography. Brescia's dream was to pursue a career that allowed her to put her creative energy to work.

After high school Brescia's passion led her to college to study film and media production. She even traveled to Italy to study abroad. After her Italian adventure, Brescia returned to the U.S. to finish college. First, she went to her doctor for her annual checkup.

"I lived a really healthy, balanced lifestyle," says Brescia. "My doctor found swelling on the side of my neck. I hadn't noticed the swelling and didn't have any symptoms." Brescia was sent for an ultrasound followed by a surgical biopsy.

The diagnosis - cancer

The surgical biopsy revealed Brescia had Hodgkin lymphoma, a rare type of blood cancer. "Being diagnosed with cancer at 20 years old was so scary and I wouldn't wish that on any 20-year-old," says Brescia. "I think about the young version of me who just found out she had cancer, and I just wish I could give her a hug."

Hodgkin lymphoma is a type of cancer that begins in the lymphatic system, which is part of the immune system. Brescia says the news came as a shock because she felt healthy and had no family history of cancer. "It felt like there was something I could have done to prevent it, but I learned that there's nothing I could have done," says Brescia.

Being a young adult with cancer

"When I was going through college and diagnosed with cancer it was not what I was expecting," says Brescia. "Being a young adult with cancer was very hard and challenging. It is scary and can be very frightening."

At 20 years old, Brescia falls into a group of patients referred to as adolescents and young adults with cancer. AYA patients are between the ages of 15 and 39. Experts says AYA patients face a distinct set of challenges.

"One of the reasons this age group is so important is based on their life stage; the things they uniquely face, like body image, disruption in school and work, financial challenges, feeling isolation," says Dr. Allison Rosenthal, with the Mayo Clinic Comprehensive Cancer Center.

Doctor and cancer survivor

Dr. Rosenthal knows firsthand the challenges AYA patients face. She was diagnosed with leukemia during medical school. "I had leukemia in medical school. There were a lot of missed opportunities in my care to recognize the issues that I might face as a 24-year-old woman," explains Dr. Rosenthal.

Putting her experience into action, Dr. Rosenthal championed Mayo Clinic's Adolescent and Young Adults with Cancer program. The program is tailored to meet the unique needs of AYA patients to include medical care, fertility concerns, social and relationship issues, school and work concerns, and the personal and emotional impact of cancer in this age group.

Brescia underwent about four months of chemotherapy treatment under the care of Dr. Rosenthal. "She did a beautiful job of explaining to me what the process was going to look like and what my treatment plan was going to look like. Because I'm so young, she walked me through the whole process," says Brescia.

Cancer-free and focused on the future

After her cancer treatments, Brescia returned to college and got her degree. She the started her own marketing agency providing social media management, videography, photography, and brand development with her personal creative touch. She also celebrated her five-year anniversary of being cancer-free.

"I also have a podcast called the Checkered Jaguar where I get to have incredible conversations with people, share their stories and connect people who may be going through similar challenges that I went through," says Brescia. "We're all in this journey together and just being open and vulnerable with my journey, as challenging as it may be, I feel like it connects me to people all around the world."

If you are someone you know would like to learn more about the Mayo Clinic Adolescent and Young Adults with Cancer Program please click this link or email us at arzayacancerprg@mayo.edu. You can also reach us at 480-574-1341.

Related articles:

• Mayo Clinic Cancer Center launches program for adolescents and young adults
• Meeting the unique needs of adolescents and young adults with cancer
• Adolescent & Young Adult (AYA) Cancer Support Group
• All-Star pitcher Liam Hendriks shares how he closed out cancer at Mayo Clinic in Arizona
• Cancer is tough. Evelyn Owens is tougher
• (VIDEO) Harnessing the power of innovation and a patient’s will to survive
• Jessie’s Journey

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At 27 years old, Shraddha Kalgutkar was told she had less than a year to live. Determined to prove everyone wrong, she turned to Mayo Clinic in Arizona.

Now Shraddha is living proof of the power of innovation combined with a patient's will to survive.

Watch: Harnessing the power of innovation and a patient's will to survive

Journalists: Broadcast-quality video (4:03) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script

Shraddha's Story

It was November 2022, just a month shy of her 28th birthday.

Shraddha was wrapping up another day at the medical clinic where she worked as an occupational therapist. Shraddha's job was to help patients regain the ability to perform day-to-day activities following a health challenge like a surgery.

Suddenly that afternoon, Shraddha became the patient who needed help.

"My co-worker looked at me and said, 'Why is your hand all purple and blue?'" Shraddha says. She admits she had been feeling exceptionally tired as of late, but attributed it to a thyroid condition.

Her co-worker checked Shraddha's vital signs and found her blood oxygen level was dangerously low. "I remember her saying, 'If this is right, you wouldn't even be standing.'" A repeat test showed the same result. "The next thing I remember was we were on our way to the hospital," says Shraddha.

At the hospital doctors began looking for the cause of Shraddha's low blood oxygen level. A series of tests traced Shraddha's condition all the way back to the day she was born.

"When I was born, doctors said I had fatty liver, but they didn't know why so they called it 'undiagnosed,'" says Shraddha. "The doctors thought it wouldn't be a problem because the liver has a tendency to heal itself." It didn't. Shraddha grew up seemingly in perfect health, unaware that her liver disease was silently doing damage to her body.

A little girl with a big dream

Shraddha was born in Mumbai, India which is often called the "City of Dreams." At a young age, Shraddha had big dreams of her own. She wanted to pursue a career in the medical field that would allow her to help others.

Every year Shraddha went to the doctor for her routine physical. Each time she was given a clean bill of health. "I used to do blood tests, but everything always looked good," says Shraddha. Still, the question of what caused her congenital liver condition lingered in her mind.

"I didn't have a family history of any liver condition. I've never had alcohol in my life," says Shraddha. "There was always a question mark. I needed to find out why this happened to me."

At 23, Shraddha became the first person in her family to leave India and go to the U.S. to attend college. She studied occupational therapy and got her master's degree at the University of Southern California. After college, Shraddha found her dream job at a medical clinic in California.

'You have less than a year to live'

All was going well until Shraddha began to noticed she was unusually tired. "When my sister came to visit she noticed I got tired after walking short distances. I went to the doctor and they thought maybe it was my thyroid," recalls Shraddha.

Then came the day her hands turned purple and her blood oxygen level mysteriously dropped. "My co-worker is a nurse so she got the oximeter and checked and it was 78%," says Shraddha. "And I was like, No, that's not possible because I wouldn't be alive." Shraddha's co-worker checked again, looked at the reading and said, "That's it, you have to go to the hospital."

A series of tests at the hospital revealed shocking results. Shraddha's liver condition had silently led to a more serious condition called hepatopulmonary syndrome.

Hepatopulmonary syndrome

Hepatopulmonary syndrome is caused when liver disease shunts blood away from the lungs preventing the body from getting the appropriate amount of oxygen. Doctors told Shraddha the only way she would survive is with a liver transplant. However, she says she was told her condition was so severe and the risk so high, that she would likely not survive a transplant.

She was denied the transplant and given less than a year to live.

"I told the doctors 'that just can't be. I can't have just one year with nothing to bring to this world. I have not served my purpose,'" recalls Shraddha.

Refusing to give up, Shraddha turned to Mayo Clinic in Arizona.

"More than 40% of her blood was being shunted away from her lungs. Because of that she had extremely low oxygen levels in her blood," explains Bashar Aqel, M.D., director of the Transplant Center at Mayo Clinic in Arizona. "Shraddha's case was one of the most severe cases of liver disease and hepatopulmonary syndrome."

Saving Shraddha

The liver transplant was Shraddha's only hope for survival. "Without a transplant, this disease was progressive and fatal. We don't like to use this word, but it is a very progressive disease," says Dr. Aqel. "There was no other cure than a liver transplant."

Dr. Aqel and his multidisciplinary team of experts at Mayo Clinic went to work on a strategy to save Shraddha. The team came up with a plan using a combination of some of the latest cutting-edge technologies in medicine.

"Liver in a box"

Transplanting any organ is a race agains the clock. Every second the donor organ is outside the body it begins to break down. Surgeons only have a limited time window to transplant the organ. Due to the complexity of Shraddha's case, Dr. Aqel's team knew they would need extra time. They decided to use one of the latest medical breakthroughs in transplant often referred to as "liver in a box."

Traditionally donor organs are kept cold until transplanted. "Liver in a box" uses a warm organ preservation method. The organ is placed in a container that pumps oxygenated, nutrient-rich blood through the liver simulating conditions in the human body. The innovative perfusion system gives surgeons more time to perform the transplant.

"Having the donor "liver in a box" allowed the donor liver to stay healthy while we performed this complex surgery," says Dr. Aqel.

Currently, this warm perfusion technology is primarily being used for heart, lungs and liver transplants.

Saving lives with mobile ECMO

The next challenge was how to keep Shraddha's blood oxygen levels stable after her transplant. Dr. Aqel's team turned to a device called extracorporeal membrane oxygenation, or ECMO. The device often is used when the lungs aren't working properly. ECMO helps with the appropriate gas exchange that must occur to keep the body's blood oxygen level safe.

"It helps in getting oxygen into the blood and carbon dioxide out of the blood through the machine," explains Ayan Sen, M.D., medical director of Mayo Clinic's Intensive Care Unit in Arizona. "It helped us while her lungs recovered after her transplant."

The Mayo team also used one of the newest advancements in ECMO where the device is mobile.

"The best part of the mobile ECMO was that we do it in a way where she could actually walk around with the machine so that we could continue with her physical therapy, which is so important for the healing process after such a complex surgery," says Dr. Sen.

Shraddha was in the ICU for nearly two months. With mobile ECMO she walked nearly every day.

Dr. Sen says mobile ECMO has proved to be a game-changer in critical cases like Shraddha's.

"It is technology that has really expanded from what surgeons do when they do heart surgeries and transplants where now we can do this to save lives at any place that is not a complex environment, like the ICU or the operating rooms," explains Dr. Sen.

Mobile ECMO has become a lifesaving medical breakthrough for many patients.

"It has enabled us to raise the bar when it comes to saving people, who, until now, could not have been saved in the absence of this heart-lung machine," says Dr. Sen.

A team of highly specialized experts escorted Shraddha on her daily walks, meticulously monitoring her vital signs. Each step required Shraddha to muster every bit of strength she had.

"From the first day, I thought even if it pains me, if it hurts, even if it feels impossible, I still need to put that step forward to do something better today than yesterday," recalls Shraddha.

'Mayo's mission is now my purpose'

Almost two years after her harrowing experience, Shraddha is healthy and back at work. She continues her daily walks, only now, at the beach, in solitude, reflecting on how her own experience can make her a better healthcare professional.

"Mayo Clinic doesn't like to say no. They set out to achieve the unachievable," says Shraddha. "My goal is to treat patients as they do, making them a priority."

Shraddha says words of thanks alone are not enough to convey her gratitude.

"Dr. Aqel and his team achieved something for me that everyone else thought was impossible," says Shraddha. "It was a gift. I will keep the mission of Mayo Clinic in mind when I am serving my patients. My purpose now is to put forward their purpose and help someone else."

Related articles:

• Heart Transplant Innovation: New ‘heart in a box’ technology provides gift of life to Arizona man, as couple prepares to celebrate 50-year anniversary
• Breaking barriers: Helping Native Americans in need get the gift of life
• Organ Transplant Innovation: Helping more people get the gift of life

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A recent Mayo Clinic study has linked frailty to poor outcomes for patients suffering from pulmonary embolism, a blood clot that blocks and stops blood flow to an artery in the lung. Frailty is a condition that often accompanies aging and is characterized by a reduced ability to cope with acute stressors, such as illnesses or injuries.

The findings underscore the importance of managing chronic health conditions among older people and countering those and other factors that contribute to frailty, when possible, the researchers say.

Researchers applied an assessment tool known as the Hospital Frailty Risk Score (HFRS) to sort patients into low, medium and high-risk groups. The study included 288,070 patients 65 years or older with a primary diagnosis of pulmonary embolism.

"We discovered that patients with higher frailty risk, as indicated by their HFRS, experienced significantly higher all-cause in-hospital mortality rates compared to those with lower frailty risk," says Pablo Moreno Franco, M.D., senior author of the study. He and his research team also learned that frailer patients needed more aggressive treatments.

Dr. Moreno Franco is chair of Critical Care Medicine at Mayo Clinic in Florida, and has a joint appointment in Transplantation Medicine. He chairs Mayo Clinic Quality in Florida and regularly collaborates with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, on research like the current study to improve or transform the practice of medicine.

Findings allow for improved, individualized care

"Working with our Acute Care Research Consortium M.D. trainees during their time at Mayo on this retrospective analysis was a pleasure," says Terri Menser, Ph.D., a Florida-based collaborative scientist in the Kern Center for the Science of Health Care Delivery and expert in mixed methods studies.

"By utilizing the National Inpatient Sample, the largest publicly available U.S. inpatient, all payer database, we were able to capture a much broader sample that yielded more generalizable findings."

The findings revealed that patients with high frailty risk were more likely to be older and female, with a higher frequency of comorbidities such as heart attack, congestive heart failure, cerebrovascular disease, dementia, diabetes and kidney diseases compared with those with medium and low frailty scores, the researchers say.

The investigators also discovered that frailty was associated with increased odds of needing invasive interventions for pulmonary embolism, such as thrombolysis, thrombectomy and mechanical ventilation, as well as a higher likelihood of complications like acute kidney injury and cardiogenic shock.

"These findings underscore the importance of considering frailty in the management and treatment of older patients with pulmonary embolism, as it can be a crucial predictor of adverse outcomes," says Dr. Moreno Franco.

The response, he says, should both include raising awareness in patients of the risks of frailty and encouraging them to make proactive changes to counter it where possible. Regular check-ups to monitor and manage comorbidities like heart disease, diabetes and kidney issues can help, he says.

"Preventative measures to counteract frailty include maintaining a balanced diet, engaging in regular physical activity and staying socially active," says Dr. Moreno Franco.

People also can do strength and balance exercises that can help improve resilience and reduce the risk of falls and other complications.

"It's all about taking proactive steps to maintain overall health and well-being," he says.

The study's authors further emphasize that by recognizing frailty early, healthcare teams can implement targeted interventions, such as more frequent monitoring, personalized treatment plans and proactive management of comorbidities, which ultimately leads to better patient outcomes.

Dr. Moreno Franco says that the collaborative efforts of the Kern Center and Mayo's Florida-based Acute Care Research Consortium team were invaluable to the success of the study.

Review the study for a complete list of authors, disclosures and funding.

About 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 collaborates with clinical areas across Mayo to create and evaluate data-driven solutions to transform the experience of health and healthcare for patients, staff and communities. It drives continuous improvement of Mayo Clinic as a learning health system, enabling safe, evidence-based, high-quality care.

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Research teams from Mayo Clinic in Florida and Carnegie Mellon University will work on a federally funded project to accelerate the development and testing of a new device to treat patients with type 2 diabetes and obesity.

The bioelectrical device, known as Rx On-site Generation Using Electronics, or ROGUE, is being developed at Carnegie Mellon University. It will act as a "living pharmacy" using engineered cells capable of producing therapy to treat patients with both conditions. At the conclusion of device development, Mayo Clinic will conduct a first-in-human clinical trial to test the viability of ROGUE in humans for wider applicability.

The goal for the device is to produce regulated levels of glucagon-like peptide 1 (GLP-1)-based therapies, which can improve glucose levels in patients with diabetes and also promote weight loss.

The Advanced Research Projects Agency for Health, or ARPA-H, made the award to Carnegie Mellon and the project's principal investigator, Itzhaq Cohen-Karni, Ph.D. The ROGUE collaboration also includes bioengineering faculty from Boston University, Georgia Institute of Technology, Northwestern University, Rice University, University of California Berkeley and Bruder Consulting and Venture Group.

"There is great potential for ROGUE to expand access and decrease the costs of these medical therapies for at-risk patients who may not otherwise be able to use these agents for diabetes and obesity," says Susan Samson, M.D., Ph.D., chair of the Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Mayo Clinic in Florida. Dr. Samson has a background in preclinical models and translational research in the use of GLP-1 receptor agonists for metabolic disorders and is the clinical team lead and principal investigator of the project at Mayo.

ROGUE is an implanted device designed to make biological drugs more accessible to patients by reducing development and manufacturing costs while making it easier for patients to follow their treatment plan. The device, implanted during a minimally invasive outpatient procedure, will be designed to deliver continuous therapeutic peptides.

"Our team will be engaged throughout the project to provide expertise from the clinical side to ensure that the device is usable, safe and comfortable for patients down the line," says Mayo physician-scientist and co-principal investigator Maria Daniela Hurtado Andrade, M.D., Ph.D. Dr. Hurtado Andrade brings basic science and clinical trial expertise to the project and also is an expert in the field of weight management.

A phase one clinical trial will be conducted at Mayo Clinic in Florida, the sole clinical site for testing the device in humans. The trial requires the recruitment of a diverse group of patients, including those most at risk for diabetes and obesity.

"Mayo Clinic in Florida, which is embedded within the Jacksonville community, is strategically positioned to recruit this diverse study population," says Dr. Hurtado Andrade. As part of the project, Mayo Clinic will provide diabetes educators to help educate patients on the device's use.

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Healthcare is evolving rapidly, demanding solutions to complex challenges. The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery is at the forefront of guiding a new generation of clinician-scientists to address these needs and improve patient care.

Meet Nadine Abdallah, M.D., Eleshia Morrison, Ph.D., and Yewande Odeyemi, M.B.B.S., who are completing the Kern Health Care Delivery Scholars Program. They join a growing group of clinician-scientists at Mayo who are conducting high-quality, practice-based health services research to enhance healthcare delivery. They are three of the four scholars that finished their program in 2024.

The Kern Health Care Delivery Scholars Program represents Mayo Clinic's commitment to innovation and excellence in healthcare. The program includes scholars from all Mayo Clinic campuses, fostering collaboration and a diverse perspective on healthcare delivery.

As Kern Scholars, Drs. Abdallah, Morrison and Odeyemi expanded their knowledge and capabilities while pursuing solutions to challenges within their own clinical practice. As alumni, they will continue their investigations while advocating for continuous improvement and transformational innovation.

"The goal of the Kern Health Care Delivery Scholars Program is to develop future leaders to advance practice innovation at Mayo Clinic," says Timothy Lyon, M.D., clinical director of the program.

The program provides protected time, mentored career development and specialized training in healthcare delivery research methodology to accelerate their careers and prepare them to tackle the clinical practice problems of tomorrow.

"In alignment with Mayo's Practice Priorities, we seek candidates with innovative ideas to improve clinical practice," Dr. Lyon says.

Learn more about how the three researchers are shaping the future of healthcare and how their experiences as Kern Scholars have prepared them for what is next in healthcare delivery.

Leveraging expertise from diverse fields

Dr. Abdallah, a senior associate consultant in the Division of Hematology and the Department of Internal Medicine focuses her research on tailoring treatment for multiple myeloma, a blood cancer that disproportionately affects older adults.

She explores how a patient's biology can influence treatment outcomes paving the way for more effective therapies for aging populations.

With the program's focus on equipping scholars with tools to translate research into real-world improvements, she was able to use large datasets and electronic health records to enhance her research.

She says the program created a collaborative environment for her to thrive and dive deeper into her research.

"The importance of interdisciplinary research was a key takeaway," says Dr. Abdallah. "Leveraging expertise from diverse fields is crucial for effective healthcare delivery research."

Championing healthcare equity

Dr. Morrison, a consultant in the Department of Psychiatry and Psychology, is a licensed psychologist whose research focuses on healthcare equity. She delves into the social determinants of health, medical morbidity and functional ability — factors that significantly affect a patient's health outcomes.

She says the program has provided a bridge to connect her past experiences with new approaches to healthcare delivery science, and that its equity commitment extends beyond fostering research interests.

"I have been fortunate to be able to access excellent mentorship, research collaborators and networking opportunities, and have a better understanding of the landscape of research resources available," says Dr. Morrison. "It's clear that these resources are in place to promote researchers' success."

Individualizing care with a data-driven approach

Dr. Odeyemi, a consultant in the Division of Pulmonary and Critical Care Medicine, is part of a multidisciplinary team that cares for critically ill patients in the intensive care unit (ICU).

Her research focuses on improving outcomes for patients admitted to the ICU, especially those with lung infections. She uses data analytics to individualize treatment for patients hospitalized with community-acquired pneumonia.

Through the program, Dr. Odeyemi says she has honed her ability to connect with researchers from diverse disciplines, fostering a collaborative approach central to her research.

"The program provides the unique opportunity to transform my daily clinical practice through high-quality research focused on improving patient-centered outcomes," says Dr. Odeyemi. "I have built on my research skills through expert mentoring and career development activities."

She emphasizes the program's holistic approach, which encourages scholars to develop scientifically sound skills and assess key outcomes in healthcare delivery research.

The three researchers endorse the Kern Scholars program, emphasizing its value to their practice-transforming research and careers. Collectively, they highlight the program's role in fostering collaboration, providing resources and cultivating a supportive environment. Their experiences underscore the program's success in training the next generation of healthcare innovators.

About 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 collaborates with clinical areas across Mayo to create and evaluate data-driven solutions to transform the experience of health and healthcare for patients, staff, and communities. It drives continuous improvement of Mayo Clinic as a learning health system, enabling always safe, evidence-based, high-quality care.

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