Adult stem cell infusion to treat MS - collaboration trial between Cleveland Clinic and Case

Cleveland Clinic, University Hospitals Seidman Cancer Center and Case Western Reserve University are collaborating on a clinical trial designed to treat the debilitating effects of multiple sclerosis by using a patient's own adult stem cells.

Mesenchymal stem cells, or MSCs, are found in the bone marrow. More than 150 clinical trials are currently testing MSCs' ability to encourage tissue repair as a way to treat a variety of conditions such as osteoarthritis, diabetes, emphysema and stroke.

In this trial, a patient's MSCs are harvested at Case's University Hospital, cultivated in a special laboratory and then injected intravenously back into the patient at the Cleveland Clinic.

See the two videos below that describe the project - the first is from the Cleveland Clinic and shows one of the patients, the second is from Case and focuses on the researchers:





Multiple Sclerosis Overview - Mayo Clinic YouTube http://bit.ly/181FCi4



References:

Clinical trials using adult stem cells to treat MS. Cleveland Plain Dealer.
Anti-CD20 monoclonal antibody ocrelizumab helps patients with relapsing-remitting multiple sclerosis (MS) (Lancet, 2011).

Related:

Ads for Target in-store clinic

Target pushes hard the ads for its in-store clinics - 4 of them in the Sunday edition of The Chicago Tribune:



Walmart is also entering the field of NP-staffed clinics in a major way, followed by CVS Pharmacy:



Walmart has been adding health clinics to its stores during the last 3 years as part of its drive for "one-stop shopping." There were 100 in-store clinics in 21 states in 2010.

In fact, Minute Clinic is the largest retail clinic chain in the country, with 600 clinics in CVS stores in 24 states. Almost half of Minute Clinic's clientele don't have a primary-care doctor of their own.

Comments from Twitter:

@napernurse: Pharm son works for #Walgreens. Costs them $5 to be seen by NP for whatever :) Can just walk-in & now WAG on "Blue Button" campaign.

Related:
"The Clinic" at Walmart - Operated by "Family Medicine Specialists"
Minute Clinics: The McDonalds version of healthcare?

Are you addicted to social media? Cleveland Clinic video

Clinical Pearls in Gastroenterology from Mayo Clinic (video)

The social media department of Mayo Clinic combines journal articles and videos by the lead authors. This is a useful approach that should be followed by other journals, in addition to Mayo's own journal, Clinic Proceedings.



Dr. Amy Oxentenko, Assistant Professor of Medicine at Mayo Clinic, discusses "Clinical Pearls in Gastroenterology" (article abstract). Here is the 2009 edition of the same project.

References:

Clinical Pearls in Gastroenterology 2011. Amy S. Oxentenko, MD, John B. Bundrick, MD, and Scott C. Litin, MD

Cleveland Clinic calls "Code Lavender" to improve patient satisfaction

From the WSJ:

How patients feel they were treated has always colored their opinions of a hospital. Now, those feelings are being factored into how hospitals get paid.

The Cleveland Clinic CEO, Dr. Cosgrove, says that in his own days as a top cardiac surgeon, he focused so intently on reducing complications from cardiac procedures that he gave little thought to the feelings or experiences of patients.

Times have changed dramatically since then. The Cleveland Clinic has launched a program known as HEART - for hear the concern, empathize, apologize, respond and thank—that empowers employees to handle patient concerns from the moment they arise.

It developed a Healing Services team to offer complimentary light massages, Reiki—a laying on of hands—aromatherapy, spiritual care from a clergy person or lay practitioner and other holistic services, and it will call a "Code Lavender" for patients or family members under stress who need immediate comfort.

Since 2008, the Cleveland Clinic's overall hospital ratings have increased by 89%.

"Code Lavender" has a Twitter account too (@CodeLavender), managed by the former Cleveland Clinic Chief Experience Officer who popularized the term.

From the Cleveland Clinic Twitter account: Efforts to improve patient satisfaction were featured in a NBC Nightly News story (see the video below).



References:

A Financial Incentive for Better Bedside Manner. WSJ.
Image source: Lavender Farm, Wikipedia, public domain.

Disclaimer: I was an Assistant Professor of Medicine at Cleveland Clinic from 2005 to 2008.

Comments from Twitter:

@TanyaPRpro (Tanya R. Walton): Clever and meaningful hospital care

@scottRcrawford: Brand medicine

@gruntdoc: How sad. Condolences. RT @DrVes: Cleveland Clinic calls "Code Lavender" to improve patient satisfaction goo.gl/X4Jtt

@MGastorf (Melissa Gastorf): concerns about satisfaction basis for payment- i.e. if you refuse to write narcotic and patient angry, physician payment suffers.

iPad app tests athletes for concussion - Cleveland Clinic video

An iPad app tests athletes for concussions (a Cleveland Clinic video). The players perform a series of balance, memory, vision, and reaction time experiments to obtain a baseline reading. If they receive a blow to the head during a game or practice, these tests can be redone to determine when it is safe for the athlete to return to action.

References:

Concussion Center - Cleveland Clinic.
Cleveland Clinic Treats Concussions With iPad App. Fox News.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.

Comments from Twitter:

@DrVes: Why are some doctors and nurses giving back their iPads? http://j.mp/Hq15aD - Easy: iPad works great for pt education, NOT for data entry. Only 10% of doctors currently use an iPad at work http://j.mp/Hq15aD - I use iPad daily to discuss these diagrams: http://j.mp/Hq1k5v

iPad is a great teaching tool @CraigCCRNCEN was able to explain to Vietnamese family AFib and clots by showing them animation from YouTube.

Brian S. McGowan PhD @BrianSMcGowan: so is the best option for docs still a touch screen laptop? teach w/ touch screen, work w/ full keyboard? #hcsm

@DrVes: iPad works well for discussing DDx, Tx options with pts. Much more portable than laptop. Full-keyboard COWs best for typing.

Jeff Bray @jeffkbray: I have been scanning all my medical reference books and store them on my iPad for quick use and no weight - great tool and mobile

Risk of heart attack and stroke goes up during holidays - Mayo Clinic video

From the Mayo Clinic YouTube channel: Are you at an increased risk of heart attack and stroke? Studies show the incidents rise during December and January, but particularly on Christmas Day and New Year's Day. Stay safe.

Jon Lord (70), a Hammond organ player, and a founding member of Deep Purple, who is currently recovering from cancer, says it very well: "Party hearty but look after yourselves. I wish you success and happiness, and above all I wish you health."



Jon Lord - Child In Time, 4 March, 2009, Palace of Arts (MÜPA), Budapest, Hungary.

Happy New Year!

References:

Jon wishes you a Happy New Year

Why Mayo Clinic is a power user of social media: "Our patients are doing it, so this is where we need to be"

Mayo Clinic's first-ever Social Media Residency took place October 20-21, 2011. At the end of the first day, the attendees went out on a video interview assignment. Check out some of the videos they returned with.

The best interest of the patient is the only interest to be considered

The Mayo Clinic CEO, John Noseworthy, M.D., pointed out recently that Mayo intends to be the leader in social media in healthcare but this is not about competitive advantage, it is about the patient. The best interest of the patient is the only interest to be considered. Social media makes the union of forces more broadly practical than at any time in human history.

Social Media and Medicine is a Good Marriage, says Mayo Clinic director for social media: We're judged more by how well we listen, than by what we say (http://goo.gl/0ECin).

If you work for Mayo Clinic, social media is not an option, it's a job requirement http://bit.ly/IHf3lM - Others will follow.

References:

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

Running Marathons and Staying Injury Free - Mayo Clinic Video

Mayo Clinic Florida sports medicine physician Daniel Montero, M.D., provides tips on avoiding injuries while running in a marathon. He also addresses tips on:

- safely keeping up when running in large crowds
- staying hydrated
- dressing for weather conditions
- running the way you were trained to do

March Madness Vasectomies: Postop period is "a perfect situation for television", says Cleveland Clinic urologist

Vasectomy is a surgical procedure for male sterilization, and consequently, birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed. This prevents sperm from entering into the seminal stream (ejaculate). You can watch a video how the procedure is done here.



From Cleveland Clinic YouTube channel: A urologist talks about the increase in the number of vasectomies he does this time of year. "Guys get it done, then watch the NCAA Basketball tournament all weekend long." The procedure takes 5-10 minutes. Patients need to ice the area for 2-3 days.

The NCAA Men's Division I Basketball Championship is a single-elimination tournament held each spring in the United States, featuring 68 college basketball teams, to determine the national championship in the top tier of college basketball. The tournament, organized by the National Collegiate Athletic Association (NCAA), was created in 1939 by the National Association of Basketball Coaches, is held mostly in March, and it is known informally as March Madness (source: Wikipedia).



Private urology practices advertise on TV their "Vasectomy Madness" campaigns:



CNN RidicuList with Anderson Cooper: Vasectomy and free pizza (video):

What are Yips? (Mayo Clinic video)

Yips are involuntary wrist spasms that occur most commonly when golfers are trying to putt. However, the yips can also affect people who play other sports - such as cricket, darts and baseball.

It was once thought that the yips were always associated with performance anxiety. However, it now appears that some people have yips that are caused by a focal dystonia, which is a neurological dysfunction affecting specific muscles.



Charles H. Adler, M.D., neurologist at Mayo Clinic in Arizona, discusses study findings related to the yips, a condition affecting a significant number of already anxious golfers during putting or chipping.

References:

Yips. Mayo Clinic.

iPad App for Education of Heart Patients After Surgery - Mayo Clinic Video

From Mayo Clinic YouTube channel: "Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That's not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They're giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying."



Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:

PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318

A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.

Background:

During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.

Methods:

8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p≥0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.

Conclusion:

Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.

Source:  Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.

http://www.annallergy.org/supplements

Mayo Clinic Offers Dietary Supplements, Stress Management, Massage and Acupuncture in the Mall of America

Cleveland Clinic has a Wellness Institute. In another push to the realm of wellness, Mayo Clinic now offers one-on-one consults with Complementary and Integrative Medicine physicians on campus and where the customers are - right in the Mall of the America. See this 3-part video series below:



Brent A. Bauer, M.D. Dr. Bauer is a physician in the Department of General Internal Medicine and supervisor of the Complementary and Integrative Medicine Research program at Mayo Clinic.



Nancy Drackley, a physical therapist, massage therapist, and supervisor of massage therapy at Mayo Clinic.



Tony Chon, M.D, a physician in the Department of General Internal Medicine and a member of the Complementary and Integrative Medicine team at Mayo Clinic, discusses acupuncture.

Dermatology Art Contest by Mayo Clinic shows that art can be seen in every aspect of life

A Mayo Clinic dermatology art contest shows beauty really is skin deep. From Mayo Clinic News blog:

A hair follicle or skin specimen that doesn’t look like much of anything to the naked eye can become a complex, colorful work of art under a microscope. The winner of the Mayo dermatologists’ first art contest in 2011 was “Hair Follicle Triplet”. Alexander Meves, M.D., used fluorescent dyes to highlight proteins. The inaugural winners of the art contest appeared in the May issue of the Journal of Cutaneous Pathology.

“Every single day, dermatopathologists get to see beautiful images under the microscope, and most people never have the opportunity to see that. So I thought it would be a nice way to show not only the science of dermatopathology, but also the art,” says the contest’s creator, Dr. Lehman, a Mayo Clinic dermatopathologist.



Dr. Lehman hopes medical societies will run with the idea and hold similar competitions to highlight aesthetics in their specialties. People in other lines of work can also celebrate the beauty of what they do each day, she says.

Editor's note: Allergists should do something similar. We already highlight beautiful pollen allergens on the monthly covers of the ACAAI journal.

“Art can be seen in every aspect of life,” Dr. Lehman says. “You just have to have an open mind and be looking for it.”

References

Dermatology Art Shows Beauty Really Is Skin Deep. Mayo Clinic News.

Mayo Clinic now offers Patient App: access to personal medical record, appointment schedule and more

The Mayo Clinic Patient app allows access to the latest news, publications, and health information from Mayo Clinic. Mayo Clinic patients also have access to their personal medical record, appointment schedule and other services using their Patient Online Services account.

The Mayo Clinic Patient app provides local community information, including directions to local restaurants, entertainment, and more. http://youtu.be/UAymmf5ZUNo

Social media FTW: Mayo Clinic offers preferred early access to journalists and bloggers to health news

The newly launched "Mayo Clinic News Network" is billed as the journalists' multimedia source for health, science and research information: http://newsnetwork.mayoclinic.org

The no cost, password-protected site for journalists offers the latest breaking medical news, videos, graphics, links for background, animation, experts and patient interviews. Journalists from TV, radio, newspaper, blogs, and mobile platforms are invited to visit our site http://newsnetwork.mayoclinic.org and register. Pending approval, you will have access to this rich source of multimedia content.



I feature high-quality videos from Mayo Clinic on CasesBlog 2-3 times per month, and after some brief consideration I registered and applied for access. I will let you know if a medical blog with 7 million page views qualifies for access to the Mayo Clinic News Network or not (update: the application was approved).

The flagship journal of ACP, Annals of Internal Medicine, already includes medical bloggers in their embargoed news release before each new issue.

The ACP Internist website took a step further and includes guest posts from hand-picked medical bloggers (disclaimer: I am one of the selected authors). Many of the posts are quite interesting and cover a wide variety of topics. You can see for yourself here: http://blog.acpinternist.org

Kudos to the ACP editor Ryan DuBosar who is leading the medical blog initiative there: http://blog.acpinternist.org/2012/05/qd-news-every-day-nearly-1-in-8-doctors.html

Mayo Clinic latest computer toy: "YES" Board patient tracking system

From Mayo Clinic YouTube channel:

Vernon Smith, M.D., an emergency room physician at Mayo Clinic in Arizona, discusses the benefits of the computerized YES Board patient tracking system which he developed over the course of several years and input from hundreds of doctors, nurses and emergency room staff while he worked at Mayo Clinic in Rochester, Minn.



According to Mayo Clinic, "the YES board reduces the time required to translate data, allowing physicians to forecast the needs of their patients and track progress. It has the capacity to walk physicians through current and past information for each patient — in addition to all patients collectively. Additionally, the YES Board helps to secure usable space and resources and detect the most at-risk patients and also helps forecast the needs of the patients in the emergency department. Plus, the YES Board can be viewed through any approved computer with an internet connection."

Mayo Clinic uses smartphone images to evaluate stroke patients in remote locations through telemedicine

A new Mayo Clinic study confirms the use of smartphones medical images to evaluate stroke patients in remote locations through telemedicine. The study, the first to test the effectiveness of smartphone teleradiology applications in a real-world telestroke network, was recently published in Stroke, a journal of the American Heart Association.

Bart Demaerschalk, M.D., neurologist and medical director of Mayo Clinic Telestroke, shows us how the smartphone technology works:

Physician Communication PEARLS from Cleveland Clinic

The video features my former colleagues and hospital medicine stars Drs. Moises Auron and Vj Velez:



Some key messages:

- Establish rapport and plan an encounter with the patient

- Elicit the patient perspective using FIFE (function, ideas, fears and
expectations)

- Apply PEARLS (partnership, empathy, acknowledgment, respect,
legitimation and support) to convey empathy

- Incorporate the patient into decision making and education using ART
(ask, respond, tell)

References:

Relationship-Centered Communication for Physicians (PDF) from Cleveland Clinic Academy

Empathy and patient experience - video from Cleveland Clinic

CEO Toby Cosgrove, MD, shared this video, titled "Empathy," with the Cleveland Clinic staff during his 2013 State of the Clinic address on Feb. 27, 2013. The video relates to any person - not only patients and physicians. It's so worth it 4 minutes of your time:



Physician Communication PEARLS from Cleveland Clinic

- Establish rapport and plan an encounter with the patient

- Elicit the patient perspective using FIFE (function, ideas, fears and
expectations)

- Apply PEARLS (partnership, empathy, acknowledgment, respect,
legitimation and support) to convey empathy

- Incorporate the patient into decision making and education using ART
(ask, respond, tell)

References:

Relationship-Centered Communication for Physicians (PDF) from Cleveland Clinic Academy

Comments from Twitter:

Dr Kelly Sennholz @MtnMD: This is JUST how I see the hospital. Magic place

PracticeMatch @PracticeMatch: Wow...great video!

Wouter van Furth @wvfurth: Take 4 min to watch this video. Worth it.

Mary Maier MD @MaryMaierMD: The Cleveland Clinic - it was/is a great place to train