Luke Judge

The third year of medical school is a year of total clinical immersion. The experience is critically important, and transcends the acquisition of medical and patient care knowledge. It is a time for humanism, empathy, professionalism, service and resiliency in the face of personal, academic, and at times, emotional challenge. self reflection is paramount for a truly enriching and transformative experience.
As the director of the 3rd and 4th year Internal Medicine rotations at VCU, I have witnessed the clinical and professional growth of many students.
I thoughtful perspective can be found here.

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ROCHESTER, Minn.–(BUSINESS WIRE)–Mayo Clinic is making it easier for industry sponsors and investigators at sites across the country to collaborate with Mayo on complex and groundbreaking research studies and clinical trials.

“Like many other funders, NCI is very interested in better integration of clinical trials across the country”

In a move aimed at optimizing accuracy, speed and efficiency in clinical research, Mayo Clinic has implemented a front-line system of technology for electronic data capture and management, according to Gloria Petersen, Ph.D., Mayo Clinic associate dean for research informatics. “Mayo’s Clinical Trials Management System (CTMS) will eliminate the duplication, delays and errors caused by manual data entry and multiple, disconnected data management systems that don’t ‘talk’ to each other. When combined with Mayo Clinic’s impressive array of clinical laboratory services and outstanding clinician-investigators, this new CTMS makes Mayo an ideal coordinating site for drug and device trials and large clinical research studies of all kinds. We’re offering a full spectrum of new opportunities for Mayo investigators to work with sponsors and collaborators to conduct clinical research with Mayo Clinic — research that results in high-quality data that reliably support the development of new treatments for patients around the world.”

“With support from the National Cancer Institute, Mayo’s CTMS will be using an enterprise-wide clinical data management system — Medidata Rave® — to manage large, complex or multi-site clinical research studies,” says Daniel Sargent, Ph.D., Mayo Clinic biostatistician and chair of Mayo’s CTMS Oversight Committee. “While NCI is providing access to this data management system to NCI-supported not-for-profit organizations that conduct clinical research in the field of cancer, Mayo is taking it a step further by making our CTMS available to all researchers at Mayo, including both cancer and non-cancer studies.”

Early adoption of this clinical data management system keeps Mayo Clinic well aligned with the direction of NCI, a major supporter of clinical trials. “Like many other funders, NCI is very interested in better integration of clinical trials across the country,” says Dr. Sargent. “To facilitate integration, NCI is enabling all its cancer trial sites to adopt this clinical data management software package so multi-site trials can be managed efficiently. We see it as a win-win. Mayo was already well on the way to adopting this technology as the core of our CTMS; now this system can serve all our clinical research investigators, collaborators and sponsors, as well as supporting our role as a major cancer trial coordinating center.”

Mayo Clinic is a leader among academic medical centers in implementation of this electronic data management technology. Pilot studies using the Mayo CTMS for Alzheimer’s disease research, nicotine dependence research, and cancer clinical trials are scheduled through the remainder of 2010. Dr. Sargent anticipates implementing the Mayo CTMS across Mayo’s research enterprise and collaborations with industry and academia during 2011.

For more information, visit Mayo Clinic’s CTMS website.

About Mayo Clinic

For more than 100 years, millions of people from all walks of life have found answers at Mayo Clinic. These patients tell us they leave Mayo Clinic with peace of mind knowing they received care from the world’s leading experts. Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. At Mayo Clinic, a team of specialists is assembled to take the time to listen, understand and care for patients’ health issues and concerns. These teams draw from more than 3,700 physicians and scientists and 50,100 allied staff that work at Mayo Clinic’s campuses in Minnesota, Florida, and Arizona; and community-based providers in more than 70 locations in southern Minnesota, western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To best serve patients, Mayo Clinic works with many insurance companies, does not require a physician referral in most cases and is an in-network provider for millions of people. To obtain the latest news releases from Mayo Clinic, go to mayoclinic.org/news. For information about research and education, visit mayo.edu. MayoClinic.com (mayoclinic.com) is available as a resource for your general health information.

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SPECT brain imaging of the majority of the few celiac disease patients studied reveals abnormalities that are usually most severe in the frontal areas of the brain. Improvement of these abnormalities are seen on a gluten-free diet. The frontal area of the brain is important in brain function that controls attention, impulse control, organization, and problem solving. Problems in this area of the brain result in short attention span, disorganization, procrastination, short-term memory problems, anxiety and depression.

Not surprisingly these are common symptoms reported by Sprue patients and in non-celiac gluten sensitivity that improve with a GFD. ADD, schizophrenia, alcohol and drug addiction problems and depression, all associated with gluten in some studies, are also associated with functional disturbances in the frontal area of the brain seen on SPECT scans. Though the reports of SPECT imaging in celiac disease are limited there have been some very interesting findings that make sense to those of us familiar with the effect of gluten on the brain.

The most dramatic report I have found comes from a 1997 report of a newly diagnosed celiac diease patient with established schizophrenia whose symptoms and abnormal SPECT scan reversed on a gluten-free diet. He presented with an established diagnosis of schizophrenia, diarrhea and weight loss. Endomysial antibody was positive and villous atrophy was present on intestinal biopsy. SPECT scan was performed before and after gluten free diet. Before GFD, the scan confirmed abnormal decreased blood flow to the frontal lobe of the brain. With a GFD schizophrenia symptoms resolved, the intestinal lesion resolved and the SPECT scan became normal. More recently in 2004, Usai et al. reported 34 celiac patients in whom 70% had abnormal SPECT scans. Again the abnormalities were most pronounced in the frontal areas of the brain and were less severe on a gluten free diet.

SPECT is single photon emission computerized tomography. It is a combined nuclear medicine CAT scan of the head performed by injecting a radioisotope material that is taken up by the brain according to blood flow and metabolism. A scan is produced that is a color-coded 3-D representation of brain metabolism or activity. Daniel Amen MD is one of the countries foremost experts on SPECT brain imaging. You can take a free online brain system quiz at amenclinic.com that may be helpful. His detailed and well-researched recommendations for nutritional interventions for the brain are also worth reviewing. More collaboration with neuroscientists and gastroenterologists is definitely needed to look further into the association of poor brain function and gluten. SPECT imaging technology appears to be one exciting tool available to us if we can get the research funded. We will continue to explore the gut-brain connection further.

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