Regenerative Medicine aims not only to repair or restore the function of cells, tissues or organs, but also the whole person. The latter is particularly important amid the COVID-19 pandemic. Regenerative approaches draw on the body’s natural abilities to heal, focus on establishing the healing environments and building new, healthy ways of functioning. These aspects of regenerative medicine may nurture healing in people who’ve contracted the virus, those who treat it and the broader community whose lives have suddenly been changed by the pandemic.

Creating safe, trusting environments

When people are diagnosed with COVID-19, their illness may go beyond physical afflictions to a breakdown of the mind and spirit. Some Coronavirus patients are immediately isolated, separating them from the people they love. That may trigger confusion, fear, anxiety and mistrust.

In a normal health care environment, patients might be soothed by welcoming faces and warm touches of medical professionals. But in the new world of a virus to which no one is immune, caregivers must wear personal protective equipment for their own safety. The face masks that allow patient and clinician to come together safely may also be a barrier that increases isolation and fear.

“It creates a new population of people who are traumatized,” says Victor Montori, M.D., an endocrinologist at Mayo Clinic and expert leader for the Mayo Clinic Center for Regenerative Medicine. “This trauma is a response to the difficult and unbearable aspects of COVID-19. It manifests itself as emotional and physical responses. In addition to fostering conditions to prevent trauma, the regenerative approach to healing in this case might mean that as people recover from COVID, they go on to receive additional care from psychologists and social workers that would help them build trust to overcome their trauma.”

Health care professionals who are on the forefront of care may themselves suffer trauma, particularly if they witness death, see colleagues become ill or have to make difficult decisions about prioritizing care.

Dr. Montori says creating a safe, trusting environment is a good antidote to trauma.  He suggests an effective platform for healing may be trauma-informed care, a way to prevent and care for people with post-traumatic stress disorder. Trauma-informed care creates a safe environment in which trauma is noticed and a caring response developed that fosters recovery. The emphasis for caregivers is on organizational safety, trustworthiness, cultural sensitivity and collaboration.

For the patient, trauma-informed care seeks to build coping skills and foster resiliency through:

• Managing emotions
• Connecting with others
• Finding hope, purpose and meaning

“To build back health, they’ll need to rehab their muscles and ability to breathe. Equally important is to regenerate the psyche and the way they trust and feel safe in the world.  Teamwork across clinical disciplines and collaboration with community partners is necessary, therefore, to work with affected patients and clinicians, so they can be supported in their healing,” says Dr. Montori.

Tapping the human mind to heal

Emotional trauma may extend beyond patients suffering with COVID-19 and those on the front lines of treating it, according to Craig Sawchuk, Ph.D., L.P., chair of Mayo Clinic Division of Integrated Behavioral Health. Fear, anxiety and stress also may be prevalent in otherwise healthy people who are overwhelmed by the societal and economic fallout of the pandemic. Psychological healing may be needed among people who fear contracting COVID-19 as well as those experiencing social isolation, job loss or financial pressures.

“The amount of uncertainty related to COVID-19 is unprecedented,” says Dr. Sawchuk. “There has been a complete disruption of day-to-day routines. No one is certain how long it is going to last. We see stress-related problems like sleep disruption, fatigue, physical tension, irritability and worry.”  

One key way to foster psychological healing, Dr. Sawchuk says, is by taking charge of things you can control and letting go of things you can’t.

“It is important to come to a level of acceptance with the situation. That doesn’t mean you have to be OK with it,” says Dr. Sawchuk. “But, we must be aware some people will have trouble and get stuck in conditions similar to post traumatic stress disorder or significant depression. They may need ongoing treatment.”

Dr. Sawchuk recommends several pathways to healing:

• Limiting exposure to COVID-19 related news.
• Finding support from family, faith and friends.
• Developing a structured daily routine that includes proper nutrition, exercise and sleep.
• Exploring self-help resources such as mental health apps that offer coaching for stress management, worry management, positive attitude and goal setting. Psyberguide.com is a free service that provides ratings of mental health apps.
• Seeking face-to-face counseling, including behavioral therapy and other coping strategies.
• Making an appointment for psychiatric evaluation or medication management.

In a world that has changed dramatically in just three to six weeks of time, healing mind, body and spirit may take time.

“It’s not like a light switch in which we can instantly turn back on the economy or return to our normal social routine. It’s probably going to be more like a gradual dimmer switch. For a while, people are going to feel like they are living life walking in a minefield. They’re likely to be extra cautious about reclaiming their usual activities,” Dr. Sawchuk says.

Rebuilding health

The regenerative medicine notion of building something new to restore health may also be applied to COVID-19 healing.

“Already, we see a lot of building and creating in the way that people live with COVID-19,” according to Ian Hargraves, Ph.D., a scientist and author of a regenerative medicine position paper. “People are creating new types of social interactions based on social distancing, and they are remaking schooling through online learning. They are redefining work and family life. People are making masks and creating new senses of who they are and what their world is.”

Those recovering from the trauma of COVID-19 may not be able to go back to the way things were before the pandemic, Dr. Hargraves says. For example, they may need to continue the practice of social distancing or may need to take their temperature daily. Although the virus was thrust upon hundreds of thousands of people, those who care for people with COVID-19 can help with healing by supporting people as they rebuild their lives, relationships and outlook, he adds.

Dr. Sawchuk predicts that personal and community healing will eventually come when COVID-19 infections, hospitalizations and deaths subside. Until that time, a regenerative approach of creating an environment of trust to ease trauma, tapping the human psyche for healing and focusing on creating something new may be the catalyst for recovery and preparation for a post-COVID-19 world.

The Mayo Clinic Center for Regenerative Medicine supports programs and practices that transform the focus of health care from treating disease to one of restoring health and healing.

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ROCHESTER, Minn. -- As COVID-19 testing becomes more widely available, it's vital that health care providers and public health officials understand the limitations of COVID-19 testing and the impact that false results can have on public safety and efforts to curb the pandemic.

A special article published in Mayo Clinic Proceedings calls attention to the risk posed by over-reliance on COVID-19 testing to make clinical and public health decisions. The sensitivity of reverse transcriptase–polymerase chain reaction (RT-PCR) testing and overall test performance characteristics have not been reported clearly or consistently in medical literature, the article says.

As a result, health care officials should expect a "less visible second wave of infection from people with false-negative test results," says Priya Sampathkumar, M.D., an infectious diseases specialist at Mayo Clinic and a study co-author.

"RT-PCR testing is most useful when it is positive," says Dr. Sampathkumar. "It is less useful in ruling out COVID-19. A negative test often does not mean the person does not have the disease, and test results need to be considered in the context of patient characteristics and exposure."

Even with test sensitivity values as high as 90%, the magnitude of risk from false test results will be substantial as the number of people tested grows. "In California, estimates say the rate of COVID-19 infection may exceed 50% by mid-May 2020," she says. "With a population of 40 million people, 2 million false-negative results would be expected in California with comprehensive testing. Even if only 1% of the population was tested, 20,000 false-negative results would be expected."

The authors also cite the effects on health care personnel. If the COVID-19 infection rate among the more than 4 million people providing direct patient care in the U.S. were 10% — far below most predictions ­­— more than 40,000 false-negative results would be expected if every provider were tested.

This poses risks for the health care system at a critical time. "Currently, CDC (Centers for Disease Control and Prevention) guidelines for asymptomatic health care workers with negative testing could lead to their immediate return to work in routine clinical care, which risks spreading disease," says Colin West, M.D., Ph.D., a Mayo Clinic physician and the study's first author. Victor Montori, M.D., a Mayo Clinic endocrinologist, also is a co-author.

While dealing with the enormity of the growing COVID-19 pandemic, it's important for public health officials to stick to principles of evidence-based reasoning regarding diagnostic test results and false-negatives. Four recommendations are outlined in the Mayo Clinic article:

• Continued strict adherence to physical distancing, hand-washing, surface disinfection and other preventive measures, regardless of risk level, symptoms or COVID-19 test results. Universal masking of both health care workers and patients may be necessary.
• Development of highly sensitive tests or combinations of tests is needed urgently to minimize the risk of false-negative results. Improved RT-PCR testing and serological assays — blood tests that identify antibodies or proteins present when the body is responding to infections such as COVID-19 — are needed.
• Risk levels must be carefully assessed prior to testing, and negative test results should be viewed cautiously, especially for people in higher-risk groups and in areas where widespread COVID-19 infection has been confirmed.
• Risk-stratified protocols to manage negative COVID-19 test results are needed, and they must evolve as more statistics become available.

"For truly low-risk individuals, negative test results may be sufficiently reassuring," says Dr. West. "For higher-risk individuals, even those without symptoms, the risk of false-negative test results requires additional measures to protect against the spread of disease, such as extended self-isolation."

At Mayo Clinic, RT-PCR testing is "one of many factors we take into account in deciding whether the patient meets criteria for COVID-19," Dr. Sampathkumar says. If the RT-PCR test is negative but chest X-ray or CT scan results are abnormal, or there has been close contact with a person who has confirmed COVID-19, the recommendation is to continue caring for the patient as if he or she has COVID-19.

"We need to continue to refine protocols for asymptomatic patients and exposed health care workers," says Dr. Sampathkumar.

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About Mayo Clinic Proceedings
Mayo Clinic Proceedings is a monthly peer-reviewed medical journal that publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research, and clinical epidemiology. Mayo Clinic Proceedings is sponsored by the Mayo Foundation for Medical Education and Research as part of its commitment to physician education. It publishes submissions from authors worldwide. The journal has been published for more than 90 years and has a circulation of 127,000.

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

Media contact:

• Bob Nellis, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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You can see it in the doctor who passes a precious keepsake on to a boy in a hospital bed; in a care team that dances for a woman facing radiation alone; in the couple that grows acres of gladiolas to give away. Love. Love is there in so many of the stories that find their way to us here at In the Loop, motivating the gestures, silly and solemn, that make such a difference to patients at Mayo Clinic.

But it's not a word that gets used much in medical circles. Victor Montori, M.D., believes that needs to change. "The health system I envision is one of kindness, elegance and love," Dr. Montori, an endocrinologist and director of the Knowledge and Evaluation Research Unit at Mayo Clinic, tells Lown Institute. "We don't often use the word 'love' to describe the doctor-patient relationship, but when we take the time to be fully present and emotionally available with each other, this type of love is healing for both parties. We laugh with each other, we talk and connect, we cry. With love, clinicians can better understand their patient's situation and can begin to see the patient in high definition."

Dr. Montori is leading a charge to help create that high-definition view, with the goal of improving care for patients everywhere (in other words, all of us). In addition to his work as a physician and researcher, he serves as co-founder and chair of the board of The Patient Revolution, a nonprofit that got its start at Mayo Clinic and continues to partner with Dr. Montori's research unit. The Patient Revolution is "working to develop tools, programs and resources that help patients, caregivers, communities and clinicians work towards health care that is careful and kind."

Read the rest of the story.

________________________________________________

This story originally appeared on the In the Loop blog.

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To improve quality and reduce health care spending at a population level, state and federal agencies have begun requiring shared decision making tools for certain procedures and tests. With legal and financial incentives, the Centers for Medicare and Medicaid Services and others aim to move the industry toward value-based care.

But do shared decision making tools, which involve educating patients so they can work with clinicians to make decisions about their care, improve care? Mayo Clinic is helping answer that question.

Researchers in the Mayo Clinic Knowledge and Evaluation Research Unit published an editorial in JAMA on Aug. 15 on shared decision making. The researchers advocate for tools that promote a conversation during the visit (called conversation aids), and not simply provide information to the patients beforehand for them to make a decision themselves (referred to as patient decision aids). The researchers contend that patient decision aids can burden patients with having to decline their clinicians’ recommendations, but conversation aids directly encourage patient-clinician dialogue and a joint decision.

“While some organizations simply distribute decision aids to patients and consider the job done, we believe that patients are best served by an unhurried consultation,” says senior author Juan Brito Campana, M.B.B.S., medical director of the Mayo Clinic Shared Decision Making National Resource Center. Read the rest of the article on Advancing the Science.

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Other Mayo Clinic medical research websites:

• Advancing the Science
• Discovery’s Edge
• Forefront
• Mayo Clinic Center for Individualized Medicine
• Mayo Clinic Center for Innovation
• Mayo Clinic Center for Regenerative Medicine
• Research at Mayo Clinic

The post Science Saturday: Shared decision making should encourage conversations appeared first on Mayo Clinic News Network.

The Food and Drug Administration has recently approved the new class of drugs for patients with high LDL-cholesterol who also have familial hypercholesterolemia or with clinical cardiovascular disease who are seeking secondary prevention or cannot tolerate statins. The Mayo experts are predicting four situations that will fuel abandoning statins in favor of the PCSK-9 inhibitors:

• Patients who have muscle problems or other symptoms suggestive of statin intolerance.
• Patients who have a heart attack or a stroke while using a statin.
• Patients who may not to be taking statins every day.
• Patients who have cholesterol levels that remain high despite statins.

Media Contact: Bob Nellis, Mayo Clinic Public Affairs,
507-284-5005, newsbureau@mayo.edu

Journalists: Sound bites with Drs. Montori and Rodriguez-Gutierrez are available in the downloads.

In each of these cases, switching from statins to PCSK-9 inhibitor – agents that can be used once-a-week, are 280 times more expensive than generics, and that can achieve reductions in cholesterol levels of more than 50 percent - may leave patients unprotected given that we do not yet know that these drugs reduce the risk of heart attacks or strokes.

The message to physicians: Use caution and prescribe proven and safe, such as statins, while waiting for more evidence about the impact of PCSK-9 inhibitors on the risk of heart attacks and strokes. If necessary, discuss the uncertainty about their impact on important outcomes with patients before prescribing them.

The message to patients: Talk with your clinician about this and any new drug or treatment to determine if using it addresses your situation. New drugs do not necessarily work or work better than existing alternatives. It is possible that these new drugs in fact are highly effective in preventing heart attacks and strokes, but the point is that we do not know that yet. Be cautious.

The commentary “Predicting overuse of PCSK-9 inhibitors” is co-authored by Rene Rodriguez-Gutierrez, M.D., Nilay Shah, Ph.D., and Victor Montori, M.D., of Mayo Clinic.

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Here's the Podcast: MayoClinicRadio 10-03-15 PODCAST

The post Varicose Veins/Peripheral Artery Disease/Patient Revolution/Restless Legs Syndrome: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

Myth or Matter-of-Fact: Wearing compression stockings is often the first approach to try before moving to other treatments for varicose veins.

Click here to listen to the program at 9:05 a.m. CT Saturday, October 3, and follow #MayoClinicRadio.

Mayo Clinic Radio is available on iHeartRadio.

To find and listen to archived shows, click here.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio appeared first on Mayo Clinic News Network.

Myth or Matter-of-Fact: Wearing compression stockings is often the first approach to try before moving to other treatments for varicose veins.

Miss the show?  Here's the podcast: MayoClinicRadio 10-03-15 PODCAST

Follow #MayoClinicRadio and tweet your questions.

Mayo Clinic Radio is available on iHeartRadio.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

To find and listen to archived shows, click here.

The post Mayo Clinic Radio: Varicose Veins/Peripheral Artery Disease/Patient Revolution/Restless Legs Syndrome appeared first on Mayo Clinic News Network.

Here's the podcast: MayoClinicRadio 08-22-15 PODCAST

The post Quality Health Care/Enlarged Prostate/Thumb Arthritis: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

Myth or Matter-of-Fact: The number of a particular procedure done each year by a provider can be one indicator of the quality.

Mayo Clinic Radio is available on iHeartRadio.

Click here to listen to the program at 9:05 a.m. CT, Saturday, August 22 and follow #MayoClinicRadio.

To find and listen to archived shows, click here.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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