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Country: USA
City: Rochester, Minnesota
IHTC:
Mayo (Rochester) Comprehensive Hemophilia Center and IHTC (WFH)
Mayo Clinic/Foundation and Mayo Medical School
Hilton 1, 200 First St. SW
Rochester , MN 55905 USA
Tel.: 507 284 8634; 507 284 5978 (IHTC)
Fax: 507 284 8286
Email: nichols.william@mayo.edu;
pruthi.rajiv@mayo.edu
Website: Under development
Director: William L. Nichols (IHTC Director), Rajiv K. Pruthi, (CHC Director), Vilmarie Rodriguez, (Director, Pediatric Hemophilia Program), John A. Heit, (Director, Mayo Coagulation Labs & Thrombosis/Vascular Training Centre Director)
Responsible for training: William L. Nichols, (overall), Drs. Rajiv K. Pruthi, Vilmarie Rodriquez, John A. Heit,, Aneel A. Ashrani, Michelle A. Elliott, C. Christopher Hook, Dennis A. Gastineau, Alexandra P. Wolanskyj, Laynalee K.; Cardel, MT, (ASCP), Jeffrey A. Slaby, RN, Kirstin A. Schmidt, RN, and James E. Langworthy, MS, LICSW.
Fellowship logistics coordinator: William L. Nichols, Rajiv Pruthi
Year of IHTC designation: 1974
Areas of specialty: General hemophilia care, pediatrics, orthopedic surgery, laboratory diagnosis, genetic diagnosis, psychology and social work.
DESCRIPTION OF TRAINING PROGRAM
Clinical activities: The strengths of the Mayo ( Rochester) IHTC and its programs mainly reflect:
1) the truly comprehensive availability at Mayo Medical Center of compassionate expertise in all recognized medical, surgical, dental, and laboratory specialty services for patients of all ages;
2) the experience of managing a broad range of pathology conditions as encountered in a very large referral centre;
3) the collaborative nature of Mayo’s academic medical practice, education and research; and
4) the integrated interactions of Mayo’s coagulation diagnostic and research laboratories, and coagulation clinical centres including the Coagulation Clinic, Comprehensive Hemophilia Center and Thrombophilia Center.
Mayo’s Hemophilia Center annually provides comprehensive evaluations and care for approximately 200 patients with hereditary bleeding disorders, in addition to assisting in the management of an additional 100 such patients encountered annually for initial or sporadic visits. The patients are mainly of regional residence, but also include many of distant and international origins.
The coagulation consulting staff includes seven hematologists, one pediatric hematologist, and three vascular medicine specialists, supplemented by hemophilia centre staff including two nurses and a social worker, and secretarial support. Other adult and pediatric specialists are available to assist with hemophilia patient care (e.g., orthopedic surgery, physical medicine, dental specialties, psychiatry, infectious diseases, etc.). Mayo’s Medical Genetics Department assists in evaluating individuals and families with hereditary hemostatic disorders. Laboratories within the Special Coagulation Laboratories or in the Division of Laboratory Genetics provide DNA diagnostic testing for hereditary bleeding disorders such as hemophilia A and B, and certain variants of von Willebrand disease, as well as hereditary thrombophilias.
Outpatient coagulation clinic consultations and evaluations are provided for more than 500 patients annually with bleeding or thrombotic problems, with a larger number of hemostasis-related consultations provided in the outpatient Thrombophilia and Vascular Centers, and in the Mayo hospitals. A hemostasis educational coordinator and teaching technologist assists with hemostasis-related trainee education. Mayo also has been designated since 1990 as a Thrombosis and Vascular Training Center (TVTC) by the International Society for Thrombosis and Haemostasis (ISTH), such that trainees can also be better exposed to thrombosis and anticoagulation teaching when indicated.
Laboratory activities/research: Mayo’s Coagulation Laboratoriesare directed by Dr. J.A. Heit, supervised by Ms. B.L. Meyers, and staffed by more than 30 laboratory technologists, aides and secretaries. In addition to Mayo’s internal practice, the laboratory has a very large national and international referral practice via Mayo Medical Laboratories, such that esoteric coagulation test volume now exceeds 300,000 tests yearly, with emphasis on “consultative coagulation testing” (reflexive testing panels and interpretive reporting) for diagnosis and management of virtually all inherited and acquired bleeding and thrombotic disorders.
Mayo’s Comprehensive Hemophilia Center (CHC) is one of five national hemophilia centres in the U.S. participating in a CDC-sponsored study of outcomes associated with comprehensive models of care for women with bleeding disorders and menorrhagia. Other recent or current research activities of the Mayo CHC include participation in cooperative group clinical trials of coagulation factor concentrates, such as ongoing surgical studies of recombinant factor VIIa or a von Willebrand factor (vWF) factor VIII concentrate.
Mayo’s Special Coagulation Laboratory served as the central clinical laboratory for the latter study. The Mayo CHC also initiates or participates in other research studies such as a recent protocol to examine the immunomodulatory efficacy of anti-CD20 monoclonal antibody therapy for patients with factor VIII inhibitors.
Additional information: Through the WFH, the Mayo IHTC had its first twinning 1997-2002 with a Moscow hemophilia and hemostasis centre, and so far has provided training for 6 IHTC fellows from Russia, as well as two others. Mayo’s IHTC and director played a major role in planning and conducting the first WFH-sponsored Russian Hemophilia Workshops (March 1999). Other recent IHTC fellows have come from Kenya and China. Thrombosis/Vascular Training Centre ( TVTC) fellows have come from Hungary, Lithuania, Georgia, Russia and Macedonia. Many other international hemostasis trainees have also been accommodated for training, recently including those from Taiwan, Greece, Argentina and the Dominican Republic. The Mayo CHC staff are actively involved in both the WFH and the National Hemophilia Foundation (NHF, US.), as well as our regional hemophilia association. James Langworthy of the Mayo CHC is currently Vice Chair of the WFH Psychosocial Committee, and recently served as chair of the NHF Social Work working group. The centre has the capacity to train one or two fellows annually. There are no calendar restrictions for training, but requires advance coordination.
DESCRIPTION OF IHTC FACILITIES
Location:
Rochester , Minnesota (north central U.S.)
Climate: Continental – pleasant summers and cold winters
Accommodation (residence, meals, etc...): Available in Mayo-affiliated facilities at subsidized rates
Transportation: Assistance, not routinely available
Language: Mayo’s Language Department routinely supports interpretation in more than 50 languages to facilitate interactions with visitors from throughout the world. However, adequate English language capability is fundamental for Mayo IHTC trainees.
Financial assistance: Dependent on WFH funds.
Cost of living (per week): 250-300 USD
Communications tools for trainees: Computer, Internet access
RELEVANT PUBLICATIONS BY IHTC STAFF
Sadler JE, Budde U, Eikenboom JCJ, Favaloro EJ, Hill FGH, Holmberg L, Ingerslev J, Lee CA, Lillicrap D, Mannucci PM, Mazurier C, Meyer D, Nichols, WL, Nishino M, Peake IR, Rodeghiero F, Schneppenheim R, Ruggeri ZM, Srivastava A, Montgomery RR, Federici AB. Update on the pathophysiology and classification of von Willebrand disease: a report of the subcommittee on von Willebrand factor. J Thromb Haemost 2006 Oct;4(10):2103-14.
Pruthi RK. A practical approach to genetic testing for von Willebrand disease. Mayo Clin Proc 2006 May;81(5):679-91.
Pruthi RK. Hemophilia: A practical approach to genetic testing. Mayo Clin Proc 2005 Nov;80(11):1485-99.
Rodriguez V, Schmidt KA, Slaby JA, Pruthi, RK. Intracranial haemorrhage as initial presentation of severe haemophilia B: case report and review of Mayo clinic comprehensive hemophilia center experience. Haemophilia 2005 Jan;11(1):73-7.
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