Department of Medicine
Connecting Tec h n olog y, Educ ation a n d D iscov e r y w i t h H u m a n i s m i n M e d i ci ne
Vol. 2 Issue 1 Jan. 2013
Alzheimer’s Disease: What’s in a Name?
Dementia is a clinical syndrome marked emotional damage by the insidious onset and slow progression in work lost, careers of cognitive impairment. Alzheimer’s disease abandoned and lives is the most common dementia and the fifth put on hold. The leading cause of death in Americans over age cost of medical and 65. It affects more than 5 million Americans institutional care and millions more worldwide. Based on for patients with the aging population, these numbers are Alzheimer’s disease is predicted to double every 20 years. estimated in billions of John Dougherty, M.D., associate dollars per year. professor of Medicine and the director of Identifying the the University of Tennessee Medical Center problem at an early Cole Neuroscience Center, along with his stage is pivotal to clinical and research colleague, Monica realistic management John Dougherty, M.D., and Monica Crane, M.D., are investigating many aspects of Crane, M.D., clinical assistant professor, and meaningful Alzheimer’s disease. are part of a very active multidisciplinary, research. “Up to multi-institutional team investigating many aspects of 60 percent of patients with early indicators of Alzheimer’s disease go Alzheimer’s disease. undiagnosed in the primary care setting” says Dougherty. The symptoms of Alzheimer’s usually begin with short-term To facilitate earlier diagnosis, Dougherty has developed a memory problems that eventually affect job skills and daily life at computerized test that may be self-administered or administered home. Problems with using and understanding language develop. by physicians, caregivers or family members to screen for cognitive Further complicating the illness are confusion about time and place, deficits. He and his research team recently completed a project problems with abstract thinking, personality changes such as apathy correlating driving skills and cognitive function that resulted in a poster and withdrawal from social situations, mood swings and behavioral presentation at the International Alzheimer’s Conference in July 2012 difficulties. entitled “Turning the Keys Over in Alzheimer’s Disease.” Some medical researchers believe Alzheimer’s disease is caused or According to Crane, accurately diagnosing Alzheimer’s also is complicated by amyloid, a proteinaceous material that forms hair-like important but can be difficult. Diffuse Lewy Body, Vascular Dementia, fibrils that deposit in the brain causing devastation and eventual death. Frontotemporal Dementia and Parkinson’s Dementia may be confused The devastation is not confined to the person with the disease. Since with Alzheimer’s disease. the disease gradually renders patients unable to care for themselves, Depression, vitamin deficiencies, hypothyroidism and chronic the burden of caregiving usually falls on the spouses or other family subdural hematoma can cause symptoms easily mistaken for dementia. members. These unpaid caregivers suffer unmeasured financial and “It is important to diagnose these accurately since they are treatable,” continued on page 2
Points of View
Rajiv Dhand, M.D., Chair
Academic medical centers are at the core of scientific innovation and discovery. Mankind has immensely benefited from scientific discoveries that have improved health care. Vaccines have eradicated dreaded diseases, such as small pox; others such as polio are at the brink of eradication; and antibiotics effectively treat highly fatal infections. We also have an unparalleled ability to diagnose diseases at an early stage with biochemical tests, ultrasound, x-rays, magnetic resonance and radiopharmaceutical imaging.
Exciting findings of the ENCODE project provide a vast wealth of knowledge about gene regulation that could unlock vexing mysteries of common diseases that have remained resistant to all scientific inquiry. Society expects academic medical centers not only to train excellent physicians but also provide new knowledge and discoveries to enhance human health. We embrace this responsibility, because through our efforts trainees will receive instruction in the latest technology and the most up-to-date, advanced scientific knowledge. If the past is our guide, we can imagine the day when dedicated efforts of medical researchers will lead to lasting cures for cancer and other diseases that currently take an enormous toll on human life. The health and well-being of future generations depends on our ability to build on the achievements of our predecessors in academic medicine. 1
Clinical Research Department of Medicine
Lauren Davis, coordinator, and Carol Ellis, M.D., director, are leading clinical research for the Department of Medicine.
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she says. Crane presented a poster at the 2012 International Conference on Frontotemporal Dementias entitled “Differentiating Frontotemporal Dementia from Early Alzheimer’s Disease with the Cognitive Self Test.” In collaboration with members of the UT Graduate School of Medicine basic science research division, Dougherty and Crane have tested imaging biomarkers in Alzheimer’s, a project that resulted in the Food and Drug Administration’s approval of Amyvid™ for use in PET imaging. Decades ago all renal failure was labeled as Bright’s Disease. Today, books have been written on the many types and subtypes of renal pathology. Now, the diagnosis of Bright’s is only historically significant. Someday, the same will be true of Alzheimer’s. For more information visit http://www.utmedicalcenter.org/brainand-spine-institute/diseases-and-conditions/alzheimers-disease/.
Presentations, Publications, Awards
Carol Ellis, M.D., director of Clinical Research for the Department of Medicine, is moving quickly to incorporate research trials in a variety of clinical areas. Her goal is to study new drugs for a variety of indications and evaluate therapies for conditions and populations where they have not been used. There are plans to participate in multicenter Phase III studies sponsored by pharmaceutical companies as well as investigator-initiated studies within the department. “There are potential opportunities for research in any area where we have both investigator expertise and a large pool of potential patient participants,” Ellis says. “Dr. Dhand [chair of the Department of Medicine] brings a wealth of experience to the department in conducting trials in pulmonary medicine, so the first studies are likely to involve inhaled bronchodilator medications in COPD and asthma.” Lauren Davis recently joined the department as Clinical Research coordinator. Davis worked in South Carolina initiating clinical trials for oncology research. She will be responsible for shepherding protocols through the Institutional Review Board process, budgeting, enrolling patients and processing the trials. Ellis encourages those interested in participating in clinical research to contact her or Davis at 865-305-9340. Likewise, they welcome information on Phase III clinical trials in which the department might participate.
Department of Medicine faculty, residents and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.
Thank You for Your Support For information about philanthropic giving to the UT Graduate School of Medicine Department of Medicine, please contact the development office at 865-305-6611 or development@utmck.edu. If you would like more information about any of the information in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm. We look forward to your input. Thank you.
Stay in Touch! Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340. Thank you!
Resident Spotlight: Water Safety in the Smokies
Combining his passion for hiking and scholarly activity, Brian Reed, M.D., PGY-1 Internal Medicine resident, is working with Mark Rasnake, M.D., to study water quality along the Appalachian Trail. “I most often hear along the trail, ‘Is this water safe to drink?’” Reed said. “Using sampling sites we Brian Reed, established in the Great Smoky Mountains National M.D. Park, we culture water and monitor it for coliform growth.” A Physician Medical Education and Research Foundation grant allows them to collaborate with scientists from Oak Ridge National Laboratory to detect the presence of other organisms that can be identified using 454 DNA pyrosequencing. The results will be available soon.
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Basic Science Research: Collaborations, Programs advancing understanding of the pathogenesis of primary (AL) amyloidosis and developing innovative diagnostic and therapeutic methods. This program, directed by Alan Solomon, M.D., is internationally known for Solomon’s work using monoclonal antibodies to treat and detect amyloid. Valerie Berthelier, Ph.D., director of the Conformational Diseases and Therapeutics Research Laboratory, works on understanding the mechanisms of protein folding and misfolding to decipher how these processes are related to normal physiology and disease. Among other goals, Berthelier is studying mechanisms of protein aggregation in patients with Huntington’s disease and alpha-1 antitrypsin deficiency. “The Basic Sciences division collaborates widely,” says Wall. “We work with scientists from Oak Ridge National Laboratory, the departments of Surgery, Pathology and Radiology, UT College of Veterinary Medicine and others and have several active clinical trials under way.” Those trials include melanoma imaging and therapy, tumor growth inhibition by odontogenic ameloblast associated protein (ODAM) and the ability of heparin-binding peptides to inhibit the infection of cells by enveloped viruses.
The Department of Medicine’s Basic Science Research enterprise is a collaborative effort comprised of three active programs with overlapping and complementary areas of research. It is directed by Jonathan Wall, Ph.D. “The Preclinical and Diagnostic Molecular Imaging Laboratory is a small animal imaging facility dedicated to the study of Jonathan Wall, Ph.D., directs the disease and the evaluation collaborative and diverse basic science research and development of novel at the UT Graduate School of Medicine. treatments and diagnostic techniques,” Wall says. “Our focus is on amyloid-associated disorders, cancer, atherosclerosis and diagnostic veterinary imaging.” The Human Immunology and Cancer Program, he says, is a multifaceted basic and clinical scientific endeavor devoted to
Faculty Announcements and Honors
Richard Obenour, M.D., (right) received the inaugural Beasley Pylon Award. Joining him are Rajiv Dhand, M.D., (center) and Alfred Beasley, M.D.
John Lacey, III, M.D., (left) received the inaugural R.A. Obenour, M.D., Distinguished Alumnus Award from Rajiv Dhand, M.D.
At the Department of Medicine’s annual faculty awards reception in December, Rajiv Dhand, M.D., presented several awards, including two new awards in honor of the department’s original chair, Alfred Beasley, M.D., and long-time leader, Richard Obenour, M.D. The Beasley Pylon Award is aptly named, indicating the recipient has been a pillar of support to the department. This inaugural award was presented to Richard Obenour, M.D., professor and vice chairman. In addition to serving for 50 years, Obenour has acted as interim chair for the department on two occasions. The inaugural R.A. Obenour, M.D., Distinguished Alumnus Award was presented to John W. Lacey, III, M.D., assistant professor, Department of Medicine, and senior vice president and chief medical officer, University of Tennessee Medical Center. Lacey was recognized for outstanding career achievement in the field of medicine. In recognition of excellence in teaching, Ronald Lands, M.D., associate professor, was honored as the recipient of the London Award, and Dale Wortham, M.D., professor, Division of Cardiology, and program director of the Cardiovascular Disease Fellowship, received the R.A. Obenour, Jr., Award.
Service Awards
Ronald Lands, M.D., received the London Award.
Dale Wortham, M.D., received the R.A. Obenour, Jr., Award.
50 Years Richard A. Obenour, M.D.
40 Years Alan Solomon, M.D. Robert Overholt, M.D. Clark Julius, M.D.
25 Years Daniel Ely, M.D.
Resident Awards
Congratulations to these residents in the Department of Medicine: Eric Edwards, M.D., PGY-2, won first place with his oral presentation, and Andrew Dake, M.D., PGY-2, claimed second place for his narrative medicine entry “Still Kickin’” at the 2012 Tennessee Chapter of the American College of Physicians annual meeting. Asha Pathak, M.D., PGY-1, won second place for her recent poster presentation at the 2012 Southern Hospital Medicine Meeting in Atlanta. Eric Edwards, Andrew Dake, Asha Pathak, Jonathan Jonathan Suther, M.D., PGY-1, received a Guardian Angel award from a grateful M.D. M.D. M.D. Suther, M.D. patient and family. 3
Finn, Fassler, Khanna Present at Grand Rounds
In Touch
Volume 2, Issue 1: January 2013 Publishers James Neutens, Ph.D., Dean Rajiv Dhand, M.D. Managing Editor Amanda F. Johnson, APR Editor Ronald Lands, M.D.
Cheryl Fassler, M.D.
Department of Medicine welcomed special speakers recently for its active Grand Rounds series. In September, William Finn, M.D., Department of Medicine, University of North Carolina, presented “Hyperuricemia and Gout: A Neglected Component in the Care of the Patient with Chronic Kidney Disease,” and Cheryl Fassler, M.D., UT College of Medicine, Baptist Hospital, Nashville,
Ramesh Khanna, M.D.
gave a presentation titled “Management of Hyperglycemia in the Hospitalized Patient: 2012.” Ramesh Khanna, M.D., the Karl D. Nolph, M.D., Chair in Nephrology at the University of Missouri Health Sciences Center, presented “AcidBase Analysis” in October. For information about Grand Rounds, visit http://gsm.utmck.edu/cme/boards.cfm.
Continuing Education Opportunities The University of Tennessee Graduate School of Medicine offers the following educational courses this winter and spring. To register or for more information, call 865-305-9190 or visit www.tennessee.edu/cme.
Department of Medicine Grand Rounds
January 8: Transcutaneous Aortic Valve Insertion February 12: Primary Immune Deficiency February 26: ID Cases from the Archives March 12: 2013 Update on the Diagnosis, Treatment and Prevention of Breast Cancer March 26: Interstitial Lung Disease 8:00-9:00 a.m. Morrison’s Conference Center, University of Tennessee Medical Center, Knoxville Approved for AMA credit Visit www.tennessee.edu/cme for a complete schedule.
Ninth Annual Hematology Conference: An Update on Selected ASH Topics January 19, 2013 University of Tennessee Conference Center, Knoxville Approved for AMA, AAPA, ACPE credits and CEUs www.tennessee.edu/cme/Hematology2013 The annual update occurs as soon as possible after the American Society of Hematology (ASH) international conference, while allowing time for the
featured speakers to develop unique presentations combining their areas of expertise with new information garnered from the ASH presentations.
Annual Medicine Conference: Optimizing Patient Care for a Changing Population
March 1-2, 2013 University of Tennessee Conference Center, Knoxville Approved for AMA, AAPA, ACPE credits and CEUs www.tennessee.edu/cme/Medicine2013 Primary care providers are faced with caring for an aging and changing population with increasing rates of obesity, diabetes, cancer and drug use. They and other healthcare professionals manage progressively complex medical issues using new guidelines and techniques. The Annual Medicine Conference will equip healthcare professionals with strategies and skills to provide care for today’s changing population. Topics will include patient-centered medical home; HIV; diabetes and obesity; complications of drug use; sleep-related breathing disorders; guidelines for screenings, vaccines, anticoagulation techniques and more.
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Administrative Director Susan Burchfield, CAP-OM Contributors Susan Burchfield, CAP-OM Rajiv Dhand, M.D. Amanda F. Johnson, APR Ronald Lands, M.D. Design J Squared Graphics In Touch iproduced by the University of Tennessee Graduate School of Medicine Department of Medicine. The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities. Contact Us In Touch UT Graduate School of Medicine Department of Medicine 1924 Alcoa Highway, U-114 Knoxville, TN 37920 Telephone: 865-305-9340 E-mail: InTouchNewsletter@utmck.edu Web: http://gsm.utmck. edu/internalmed/main.cfm The University of Tennessee is an EEO/AA/Title VI/ Title IX/Section 504/ADA/ ADEA institution in the provision of its education and employment programs and services.