Health Sciences Report (2004)

UNIVERSITY OF UTAH S U M M E R HEALTH SCIENCES REPORT UNIVERSITY OF UTAH Vol. 28, No. 2 Published by the Office of Public Affairs, University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, Utah 84132. Telephone 801 - 581 - 7387. Articles may be reprinted with permission. University of Utah Health Sciences School of Medicine College of Pharmacy College of Nursing College of Health University Hospitals & Clinics University of Utah Medical Group Eccles Institute of Human Genetics Huntsman Cancer Institute John A. Moran Eye Center Spencer S. Eccles Health Sciences Library Editor: Susan Sample Editorial Consultant: Anne Brillinger Contributing Writers: Cindy Fazzi, Phil Sahm Photographers: Sean Graff; Tim Kelly; Steve Leitch, Medical Graphics and Photography Visit the University of Utah Health Sciences Center Web site at: www. uuhsc. utah. edu. HEALTH SCIENCES R E P O R T FEATURES Here, There, Everywhere 8 Linda Amos's name is seen on memos and heard in meetings across the health sciences center, but her passion is still nursing education. Domino Effect in Trauma 12 Two School of Medicine researchers investigate the biochemical events that can be just as life- threatening as the traumatic injuries they follow. The Art of Healing 14 Sculptures featured in this photo essay reflect the creativity and compassion that accompany the science of medicine. Degrees That Add Dimension 16 Ranked sixth- best in the country, the medical school's Public Health Program draws health- care professionals back to the classroom. Organ Transplantation 18 Kidney, heart, and lung transplants give patients futures full of promise and unpredictability- and continuing care from University Hospital's Solid Organ Transplant Program. When the Doctor Becomes the Dad 26 Pediatric nephrologist Joseph Sherbotie, M. D., speaks from personal experience when he talks to parents of young kidney transplant recipients. DEPARTMENTS Headlines 2 Research Update 4 In Memoriam 6 People 7 Research in Brief 29 Gift of Health 31HEALTH SCIENCES REPORT The Promise- and Unpredictability- of Living with an Organ Transplant "It's a big scar," Vanessa said, lifting the hem of her halter- top. She looked at the TV camera, then at the girl sitting next to her at the picnic table." The liver's a big organ." " Yeaah." Mariela nodded as she showed off her own scar. The beads on Brittany's corn rows bobbed in agreement from across the table. " We're best friends now!" the 13- year- old told the reporter last July. Scars unite teenagers at the Youth Transplant Kamp, sponsored the past four summers by the National Kidney Foundation of Utah. Liver, kidney, heart, pancreas: the shape of the scar will tell you which trans-plant each has survived- so far. Teens have the lowest survival rates of any kidney transplant recipients because of noncompliance. " I don't even think it's always intentional," said Joe Sherbotie, a pediatric nephrologist interviewed for this issue's cover story. " They just don't remember if they took their meds." They do remember the words of kids at school. Like the girls in Talysa's P. E. class who have lockers across from hers. " One of them," the ninth- grader told me at a camp reunion last spring, " says my scar makes her want to puke." My adult friends weren't as graphic in their comments after we watched Sean Penn portray a heart transplant recipient in the movie 27 Crams. But as we drove home from the theatre, their response was just as visceral. No, they said, wincing as they shook their heads, they just couldn't be organ donors. But what if my friends knew Talysa or Mariela or Brittany? What if they heard the depth of the teens' gratitude, their humility when someone, even their own mom, donates a portion of her liver to them? " My mom must love me enough/ to give me something like that," Kelton wrote in his poem on losing his diseased liver. " So I found something:/ my mom is very giving." What if my friends heard the resilience of these young organ recipients? Although Talysa was too young to remember the actual surgery, she can't forget it. Pills to take every day; lab tests and biopsies for the rest of her life. And the thick scar crisscrossing her abdomen. " It looks like white railroad tracks going/ from New York to California./ But they take me to camp/ where scars are popular." I don't think about how their scars look when I'm working with the teens. Later, when I'm driving home on the freeway and I slow down on the exit ramp, I remember. But it's their voices I also recall: so full of life and hope for a future they almost didn't have. " Still, it wasn't my time/ to go away from this earth," J. D. wrote. " I have too much to live up to./ l want to get married, have kids, go to college./ My time is now,/ and I am here." n SUSAN SAMPLE Recent ceremonies honored employees and community members who contributed to the Eccles Critical Care Pavilion project and the new John A. Moran Eye Center under construction. HEADLINES 2 Departments Rank in Top 10 for NIH Grants T he medical school's Department of Family and Preventive Medicine ( DFPM) ranked third and the Department of Obstetrics and Gynecology ( OB- GYN), ninth in research funding from the National Institutes of Health ( NIH) in fiscal year 2003. The DFPM received $ 3.4 million, the third highest total among peer departments nationwide. This marks the third consecutive year that the U department has been ranked in the top 10. The high ranking reflects not only the department's commitment to research, but also " the diversity of work in this multidisciplinary department from large epidemiologic investigations to clinically oriented research," noted Michael K. Magill, M. D., professor and department chair. The OB- GYN department made the top 10 list for the third straight year with $ 4.4 million in funding. It ranked above programs at the University of Michigan; University of California, Los Angeles; New York University; Johns Hopkins University; and the University of Washington, according to Eli Y. Adashi, M. D., presidential professor and chair of the U department. Radiology Residency Rated # 1 e're taking the American Board of Radiology at its word: you can't find a better radiology training program in North America than the one at the U of U School of Medicine. In its latest rankings, the board once again rated the U's diagnostic radiology residency curriculum No. 1 out of 191 programs from 1999- 2003. During that five- year period, 100 percent of the U radiology residents passed their oral examinations on the first try. This is the third consecutive year the U program- under the mentorship of direc-tor Kevin R. Moore, M. D., assistant professor of radiology- has ranked first in the United States and Canada. Word about the program has gotten out: 319 medical school graduates applied for only five slots in the latest class, according to E. A." Steve" Stevens, M. D., professor and department chair. He credits the program's top ranking to David A. Bragg, M. D., former chair and professor emeritus, for establishing an environment in which education is paramount. The U radiology faculty includes 23 physicians and seven individ-uals with doctorates in basic science disciplines. Hoidal Named Internal Medicine Chair John R. Hoidal, M. D., was appointed chair of the medical school's Department of Internal Medicine last April. He had been serving as interim chair. Professor and chief of the Division of Respira-tory, Critical Care, Occupational, and Pulmonary Medicine, Hoidal holds the Attilio D. Renzetti Jr., M. D., Presidential Endowed Chair. He also is profes-sor and chief of the pediatric pulmonary division. The internal medicine department is the largest in the U School of Medicine with 360 faculty members and 105 residents. It also is the largest teaching department at the U of U. Hoidal was born in San Francisco and raised in Minneapolis. He received a bachelor's degree from Jamestown College, Jamestown, N. D., and his medical degree from the University of Minnesota. John R. Hoidal, M. D. Gross Cuts Medical students in human gross anatomy courses worldwide will know how to make the cut, thanks to experts in the U Department of Neurobiology and Anatomy who wrote Dissection Guide for Human Anatomy. Published last spring by Churchill Livingstone, an imprint for the noted medical textbook publisher, Elsevier, the 466- page guide takes students step- by- step through 35 different labs as they learn the structures of the back and thorax; abdomen, pelvis, and perineum; neck and head; and limbs. Authors are: David A. Morton, Ph. D., an instructor whose work on the proj-ect was his doctoral dissertation; Kerry D. Peterson, L. F. P., director of the Body Donor Program; and Kurt H. Albertine, Ph. D., director of the human gross anatomy course. Exercise for Parkinson's A group of patients, ages 60- 85, with mild to moderate Parkinson's disease are pedaling away to help determine whether eccentric exer-cise can strengthen their muscles and improve their balance and gait in a clinical trial under way at the College of Health. Lee Dibble, P. T., Ph. D., assistant professor of physical therapy, was awarded a $ 40,000 grant last January from the Foundation for Physical Therapy to evaluate and compare the effectiveness of eccentric exercise with traditional exercise training on Parkinson's patients. Parkinson's is a neurolog-ical disorder that is characterized by tremors, rigidity, and the loss of spontaneous movements, which amplify the effects of aging, according to Dibble. Patients who have been referred for neurological rehabili-tation participate in a 12- week exercise program of endurance, flexibility, and upper- trunk train-ing. Those in the experimental group use an eccentric ergometer, powered by a motor that moves Mark Munger, Pharm. D. the pedals in a backward rotation, for lower- trunk resistance training. Those in the control group use free weights and machines for traditional resistance weight train-ing of their lower extremities. Following the trial, participants will be evaluated for any signifi-cant increase in muscle size and strength; improvements in balance, gait, and fall- risk; and marked improvements in quality of life. New Duties for Munger Mark Munger, Pharm. D., professor of pharmacy, takes on new responsibilities as associate dean for academics at the College of Pharmacy July 1. He will be instrumental in the college's upcoming accreditation and complet-ing the final transition to the entry- level doctor of phar-macy program, according to John W. Mauger, Ph. D., professor and dean of the college. Munger, who received his Pharm. D. from the University of Illinois at Chicago, joined the U pharmacy faculty in 1991. He also is an adjunct professor of cardiol-ogy in the School of Medicine. He will serve a three- year term as associate dean. Her Heart Matters Here University Hospital doesn't miss a beat when it comes to caring for women's hearts. The Edwin L. & Grace G. Madsen Pre-ventive Cardiology Program and Cardiovascular Risk Reduction Center ranked among the nation's 44 " best of the best" cardiac centers for women, according to Good Housekeeping magazine. Honors for the U- the only Utah organization recognized for women's cardiac care in the February 2004 issue- included an " exceptional practitioner." David A. Bull, M. D., associate pro-fessor of cardiothoracic surgery at Utah's School of Medicine, was listed as one of the country's top docs for specialized heart care ( see pg. 30). 2 Health Sciences Report Summer 2004 Marion Bradford Bart Chournos, R. N. Linda Schmidt Award- winning Trio Three health sciences center employees were honored with 2004 University Presidential Staff Awards last May. They were: Marion Bradford, University Hospital case manager; Bart Chournos, R. N., who works in the hospital's Newborn Intensive Care Unit and with AirMed; and Linda Schmidt, senior research spe-cialist in the Department of Dermatology at the School of Medicine. The three were among six winners selected from 91 employees nominated from the entire University. In addition to a plaque, pre-sented at a special luncheon at the University president's residence, the awardees received a $ 3,000 honorarium. U Teams Up with NFL, USADA A Model Library Plan In an effort to help eliminate doping in sports, the U of U has joined with the U. S. Anti- Doping Agency ( USADA) and the National Football League ( NFL) to develop a new drug- testing laboratory in Salt Lake City. The Sports Medicine Research and Testing Laboratory ( SMRTL) will be an independent testing facility located at the U. It has contracted with the College of Pharmacy's Center for Human Toxicology, renowned for its foren-sic analytical toxicology expertise. Scheduled to begin operations this year, the new lab will conduct state- of- the- art research into the use of and detection of prohibited and performance- enhancing sub-stances. SMRTL will seek certifica-tions from the World Anti- Doping Agency and the International Organization for Standardization. Funding is provided by the NFL, USADA, the Salt Lake Organizing Committee, and the United States Olympic Committee. " This laboratory demonstrates the strong anti- doping efforts in the United States and further enhances the development of our research program," said Terry Madden, USADA chief executive officer. " We look forward to having the new laboratory complement the world- class facility at UCLA. Given the plans for expanded test-ing, it's important to re- establish a second World Anti- Doping Agency-accredited lab in the U. S." It was an invitation they couldn't refuse: the Board of Regents of the National Library of Medicine ( NLM) at the National Institutes of Health asked the Spencer S. Eccles Health Sciences Library to present its new regional model in Bethesda last May. Wayne J. Peay, M. S., director of both the Eccles library and the Midcontinental Regional Medical Library Program, and Claire Hamasu, M. L. S., associate director of the regional medical library, discussed how the new plan has " revitalized and enhanced" the services of the regional medical library program. " We decentralized services," explained Peay. The Utah library has subcontracted with academic health sciences libraries in each of the other five states that com-prise the midcontinental region: Colorado, Wyoming, Kansas, Nebraska, and Missouri. The contracts support a liaison for outreach as well as two special project coordinators, all of whom are connected to Eccles through new technologies. The Eccles library was awarded a $ 5.8 million five- year contract from the NLM in 2001 to serve as a regional medical library. Its role is to coordinate library resources and services to both health professionals and consumers in the region, and to facilitate access to the NLM's many Web- based information services. Virtual Tours No need for an appointment to visit the University's new Huntsman Cancer Hospital open-ing in July on the health sciences campus. Go to the Web site: uuhsc. utah. edu/ virtualtour. Floor plans and simulated tours are offered for: the Ortho-pedic Center, scheduled to open in the University's Research Park in early October; the Emma Eccles Jones Medical Research Building, to be completed in November 2005; the Health Sciences Education Building, anticipated to open for students in fall 2005; and the new John A. Moran Eye Center, sched-uled for completion in July 2006. Getting a Grip on Health Contaminated water is a major cause of disease in Mali, where Michelle Korth, shown above right, spent two weeks last January as a part of a six- member team from the U of U Public Health Program. Led by Stephen Alder, Ph. D., assistant professor of family and preventive medicine, the team from the School of Medicine assessed public health systems and the health needs of villagers in Ouelessebougou. " The students addressed the challenges of coming up with workable solutions in a real- life, hands- on setting," said Alder. Same- day Appointments Patients who call one of University Hospital's community clinics usually can see their health- care provider that same day, or when it's convenient for them, with the new Advanced Access program. Initially offered at the South Jordan Health Center that opened last March, Advanced Access has been implemented in all seven clinics, according to Rob Lloyd, executive director of the U commu-nity clinics. " Our patients' time is valuable, and we want to make the best use of each minute the patient is with us," he noted. To help maximize the time patients spend with their health-care provider, the South Jordan Health Center also offers a patient-escort system. Medical assistants meet patients when they arrive and help them with blood samples and X- rays. The assistants will update medical records, while the patient and provider discuss health- care needs and treatment, as well as help with referrals or follow- up appointments. Lloyd expects to offer this novel patient- escort system at all community clinics this fall. What to Expect in the Event of an Unexpected Death Media coverage was extensive, but that wasn't surprising last winter when three College of Nursing faculty members announced the publication of their book, Dealing with Sudden and Unexpected Death: A Handbook for Survivors. The first of its kind, the book offers practical tips about coping in the first few hours and days after the sudden and unexpected death of a loved one. The college's Caring Connections: A Hope and Comfort in Grief Program distributed complimentary copies to law enforcement officials. A companion pamphlet includes valuable information for victims' advocates, medical professionals, and others who notify families and survivors about a death. Authors are: Beth Vaughan Cole, Ph. D., A. P. R. N., Caring Connections director; Jan Harvey, R. N., U Hospital bereavement coordinator; and Leslie Miles, a nurse and graduate student in psychiatric nursing. Copies of the book can be ordered through the College of Nursing for $ 8.99 plus shipping and handling. Call 801- 585- 9522 or e- mail sherry. poulson@ nurs. utah. edu. Health Sciences Report Summer 2004 RESEARCH UPDATE The Gene Reaper T wo " death activator" genes are essential for cell death when fruit flies ( Drosophila) metamorphose from larvae to adults, according to Carl S. Thummel, Ph. D., professor of human genetics at the University's Eccles Institute of Human Genetics, and doctoral student Virabuth P. Yin. Their recent finding opens the possibility that someday death- inducing genes could be unloosed to specifically kill unwanted cells, such as tumors. Thummel, an investigator with the Howard Hughes Medical Institute at the U of U, and his colleague published their findings in the May 25th edition of the Proceedings of the National Academy of Sciences. It also appeared in the May 17th on- line edition. The two genes- reaper ( rpr) and hid ( head involution defective)- act by overcoming the protective efforts of a death inhibitor, DIAP1. Once it is disabled, larval tissues like the salivary glands are rapidly destroyed, explained Thummel. Death of obsolete larval tissue is critical in insect metamorphosis. Cell death ( apoptosis) begins when ecdysone, a steroid hormone, binds to its receptor, EcR/ USP. The binding allows the receptor to activate three key regulatory genes: E93, BR- C, and E74A. These genes turn on reaper and hid, which then deactivate the death inhibitor DIAP1. When it is no longer functioning, cell death is unleashed in the salivary glands, leading to the destruction of larval tissue and their replacement by adult structures. Ecdysone already was known to regulate a number of genes; reaper and hid were known as death activators. But it had not been proved that those two genes are essential for salivary gland cell death to occur, and no roles were known for DIAP1 in preventing premature larval cell death. Ecdyone is the critical signal in starting the process. " This hormone is the trigger that changes Drosophila from its larval to adult form," said Thummel. Reason to Smile When pediatri-cians educate and provide guidance to parents, children's oral health signifi-cantly improves, reported Karen A. Ortiz, M. D., assistant professor of pediatrics at the U School of Medicine. Parents were surveyed at the University's South Main Clinic before and after the checklist for patient visits was revised to include prompts on oral health habits. Resident pediatricians were encouraged to advise parents on brushing their children's teeth and reducing toddlers' consumption of juice, soda, and other sugared beverages. " Poor oral health habits, which are known to be a contributing factor to dental disease, are common in underserved populations," said Ortiz. South Main, operated by the U medical school and the Salt Lake Valley Health Department, provides health care to underserved women and children, many of whom are Hispanic immigrants. " Our goal is to find ways to prevent early childhood cavities." Results showed that parents who received guidance were significantly more likely to brush their children's teeth- and to brush them often. Ortiz presented her findings at the Pediatric Academic Societies Conference in San Francisco May 2. Quality and Quantity Both length and quality of life improve with implantable cardiac resynchronization therapy defibrillators, according to results from the national Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure ( COMPANION) study. The prospective, randomized trial looked at 1,520 patients with advanced heart failure at 128 centers, including the University of Utah Health Sciences Center. Patients had diminished function of the left ventricle, the heart's main p