The Department of Laboratory Medicine and Pathology at the University of Minnesota Medical School is committed to bringing leading-edge basic and applied research and innovation to patient care.

The research-intensive faculty within the department have several major focus areas including cancer, immunology, cardiovascular disease, renal disease, diabetes, and genetics. The faculty consist of tenured associate and full professors, several of which currently hold endowed chairs or professorships. They interface with University of Minnesota departments and centers such as the Center for Immunology, Masonic Cancer Center, and the Institute for Translational Neuroscience.

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Finkelstein sees promising future for home telehealth

LMP professor Stan Finkelstein, who retired at the end of January, has been an integral research scientist in the fields of patient monitoring and home telehealth as they have evolved over the past three decades.  

Stan FinkelsteinAn electrical and biomedical engineer, Finkelstein teamed up with faculty in the fields of health informatics, biomedical engineering, biostatistics, and nursing to develop monitoring systems, decision-support systems, and home telehealth systems for managing patients with chronic illnesses.

“Initially there was very slow movement, but lately it’s been amazing in terms of how fast things are going,” Finkelstein said. Yet home telehealth is not emphasized in broader discussions of telemedicine.  “There’s been a lot of progress and lots of support for hospital-to-hospital, clinic-to-clinic, and clinic-to-provider, but much less support for provider-to-home or home-to-provider.”

Home telehealth is beginning to enter the telemedicine mainstream thanks largely to Finkelstein and his colleagues in the field.  “When we started, it was thought that patients were not capable of doing this work,” he said.  “Our studies have demonstrated that if you teach the right way and you put the system together appropriately, patients can do it, and do do it.  They comply frequently enough and well enough for investigators to get reasonably useful clinical data.”

When Finkelstein began his research in home telehealth, computers and smartphones were not available to patients. “Thirty years ago, we could not have predicted where we are now.  Devices have gotten cheaper, smaller, and easier to use.  Communications are well developed.  Computing between systems has become easier.  All these things are pluses.”

Another real plus, in his view, is that the younger generation is developing the critical skills to make home telehealth widely acceptable and practiced in the future.  “They are not fazed by using computers or Fitbits or taking on the challenge of computer games.”  These technologies are not typically used for clinical health purposes but they could be, Finkelstein said.  Whether they can be promoted and developed into something clinically useful remains to be seen.  What he and his colleagues have demonstrated over the years is that patients are capable of reporting information about their condition consistently to their provider.

In his phased retirement, Finkelstein found that the time that was freed up got used.  “I wasn’t sitting around thinking ‘What am I going to do in the next hour?’”  Finkelstein will continue a relationship with LMP as an emeritus professor.  

Medical education

Toward competency-based medical education (CBME)

Deborah PowellLMP professor Deborah Powell is lead author of “Toward Competency-Based Medical Education” published in the January 4th edition of the New England Journal of Medicine

In their review, Powell and coauthor Carol Carraccio of the American Board of Pediatrics write that competency-based medical education (CBME) “reconceives medical training by recognizing that not all students or trainees master all necessary skills at the same pace.” Rather than a medical school or residency class proceeding through medical education as a single, undifferentiated group, CBME focuses on all trainees demonstrating the competencies required for caring for a population by means of what they term “time-variable transitions from training to practice.”  Demonstration of practice competencies constitutes the key benchmarks or milestones, not time in the training program.

Powell is well known as a medical education innovator through her pioneering Education in Pediatrics Across the Continuum (EPAC) project, now in its eighth year.  The project tests students from early in medical school to residency and then to practice based on their ability to demonstrate competence rather than their time in the program.  Powell and Carraccio write that the next step is to compare EPAC student progress to that of their non-EPAC peers within their own participating institutions and at other undergraduate institutions.  A key element of EPAC, they write, is “the partnership in curricular design between clerkship and residency program directors, which prepares students for the transition to residency.”

Powell and Carraccio write that CBME promises to produce “a better-trained workforce — and for many physicians, this training could be accomplished within a shorter time frame.”  With continuing improvements in methods to assess comparative competencies, they believe CBME “now appears to be not only possible, but is also an innovative model that could create a learner-centric education system that, in turn, helps bring about a patient-centric care system.” 

Research Spotlight

Flanagan focuses on aging and dementia

LMP neuropathologist Maggie Flanagan specializes in investigating neurodegenerative diseases associated with aging.  She is the department’s lead investigator for the Nun Study of Aging and Alzheimer's disease, a longitudinal study of Catholic nuns who donated their brains to research. 

Margaret FlanaganThe study was launched in 1986 to determine the causes and prevention of Alzheimer’s disease, other brain diseases, and mental and physical disability associated with old age.  Nearly 700 School Sisters of Notre Dame have participated.

Flanagan and Laura Hemmy, Department of Psychiatry, spoke about the Nun study in a recent LMP Research Forum.  Since the study was initiated investigators have found:

  • Variability in correspondence between clinical state and brain pathology
  • A single copy of the APO e4 genetic allele is associated with a higher risk of dementia
  • Alzheimer’s disease together with vascular brain lesions have a compounding effect
  • High levels of linguistic ability earlier in life may protect against cognitive decline in old age

Flanagan said the Nun study is “fundamental to our knowledge of brain aging” in part because about 90 percent of study participants consent to brain autopsy following their death, making possible both anatomical and molecular studies of brain tissue. She said she is “extremely grateful for the ongoing contributions of the sisters.  I am just so lucky to have the opportunity to work with such an amazing and scientifically critical cohort of women.”

Flanagan and Hemmy are featured in Dr. Sanjay Gupta’s CNN story on aging and Alzheimer’s disease involving the Nun study. The story has been shown in Europe and will air in March in the US.  Flanagan appears at the 2:04 mark of the link below.