NIH 1998 Almanac/The Organization/CC/
Warren Grant Magnuson Clinical Center: Major Programs
Unlike most hospitals, the CC does not offer general diagnostic treatment services. In
its beds and clinics are patients who consent to participate in one of the 1,000 studies
(protocols) sponsored by institutes conducting research on the NIH grounds.
The 13-story, 325-bed hospital logs about 7,000 inpatient admissions each year. Another
68,000 outpatient visits are made annually. Nearly 1,400 healthy people serve each year as
clinical research volunteers. Some 1,200 physicians and 650 nurses provide patient care.
Clinical Center departments specifically tailor their services to serve the unique
needs of medical research and patient care at NIH.
Clinical Pathology provides laboratory services for CC patients, develops new test
methods, conducts research in laboratory medicine, and offers subspecialty training
programs in the subdisciplines of clinical pathology. Five services make up the
department: clinical chemistry; hematology; immunology; microbiology; and phlebotomy. The
department performs about 3 million tests per year for CC patients. Research focuses on
lipoprotein disorders, mineral metabolism, thrombosis and hemostasis, characterization of
cells by flow cytometry and the identification of microorganisms causing human disease.
Further, the department is developing molecular diagnostic testing in each clinical
service.
Critical Care Medicine was established in November 1977 in response to a need
for a modern facility to care for increasing numbers of critically ill patients. Critical
care physicians, nurses, and technical staff working with highly advanced technology and
equipment provide care for any CC patient with serious but reversible medical problems.
The nine-bed unit performs clinical research in collaboration with other NIH institutes on
AIDS, sepsis, and pulmonary biology in addition to providing care.
Research in the Department of Diagnostic Radiology, as well as the Laboratory of
Diagnostic Radiology Research, encompasses computer-assisted imaging processing analysis
(including "virtual reality" imaging), image-guided therapies, and the
development of new molecular and physiologic imaging tools. Basic animal research focuses
on rodent genetic model imaging. Clinical imaging projects focus on new cancer diagnostic
and monitoring techniques, functional brain imaging, stroke and multiple sclerosis,
nonivasive angiography, and dynamic diagnosis of endocrine tumors.
Nuclear Medicine provides a broad scope of diagnostic and therapeutic services
for CC patients and engages in collaborative research with institute investigators on the
medical application of radionuclides. Nearly 5,000 patient studies were conducted last
year. A new, miniaturized, PET camera for animal studies was produced by the physics group
in collaboration with BEIP. Other research examines radiation effects on DNA by delivering
the radioactive atom on triplex-forming oligonucleotides directly to gene targets. Ongoing
studies with NCI laboratories have further developed radiolabeled monoclonal antibodies
for tumor diagnosis and therapy.
Positron emission tomography (PET) is a method of imaging the body’s
physiologic functions such as blood flow and metabolism. Patients receive a short,
half-lived radiopharmaceutical containing a radioactive atom that is produced by
cyclotrons.
As positrons encounter electrons in the body, they produce high-energy photons that can
be traced by radiation detectors surrounding the body. By evaluating the concentrations,
physicians can study blood flow, tissue receptors, and glucose metabolism.
The PET department is organized as a scientific core concentrating on radiochemistry.
Resources include two medical cyclotrons to produce radionuclides; six lead-lined
chemistry hoods where radiopharmaceuticals are formulated; laboratories for
radiochemistry; three PET tomographs and computer hardware; and software for generating
and analyzing the PET images.
Rehabilitation Medicine Department has six sections that provide services to
approximately 25,000 NIH patients. The medical section has continued to develop and
validate functional outcome measures to assess musculoskeletal abnormalities and the
impact of developmental delays on children with congenital problems (e.g., Beckwith
Weidemann syndrome and osteogenesis imperfecta). The speech-language pathology section has
developed quantitative measures to assess tongue motion and force and to characterize
tissue changes in the oral pharynx.
The biomechanics section has continued to develop software to assess balance and motion
in real time. The physical therapy section has developed and applied new techniques to
assess excercise capacity using a metabolic testing device. This allows NIH investigators
to correlate exercise performance with other biological measures such as cytokines and
hormone levels.
The occupational therapy section has continued its efforts to validate and apply an
instrument that evaluates motor and process skills in a variety of medical conditions such
as Alzheimer's and stroke. The recreation therapy section has initiated evaluations of
coping strategies for patients in clinical trials. Relaxation training and self-help
approaches to assist patients in adjusting to illness and treatments have been introduced
this year. The department continues a program in student training.
The Department of Transfusion Medicine (DTM) continues to provide safe and
effective blood and blood components for CC patients. This includes approximately 500
units of whole blood or red cells and approximately 1,800 units of platelets a month for
treatment of patients undergoing surgery, bone marrow transplantation or therapy for such
diseases as aplastic anemia, leukemia, or other malignant conditions. Projects include a
core facility for providing hematopoietic cells for transplantation, immunotherapy, and
gene therapy, expansion of molecular-level testing in the tissue typing (HLA) and
establishement of stem cell infusion services in an outpatient transfustion clinic. The
HLA lab was one of nine designated as a "lead laboratory" based on performance
in an international cell exchange. It is the only lab in the world to be so designated for
7 consecutive years. The department’s Blood Bank also acts as a reference center for
transfusion problems referred by labs and hospitals throughout the country.
The department investigates the relationship between blood transfusion and hepatitis.
DTM staff expanded their studies of hepatitis C to to look at blood donor risk factors and
instituted clinical sutdies of the newly reported agent, hepatitis G. The apheresis
activities included studies to stimulate the production of granulocytes and hematopoietic
stem cells in normal donors to collect more effective transfusion components.
In 1990 the DTM was the site of the first human gene therapy experiments involving
children with severe congenital immune deficiency disorders. Eight clinical research
protocols are now being carried out in such diseases as breast cancer, AIDS, Fanconi
anemia, Gaucher disease, and chronic granulomatous disease. Lymphocytes are harvested from
donors and patients for potential cellular vaccines. Innovative cellular therapies
complement the department’s traditional role in transfusion therapy.
Hospital Epidemiology Service (HES) includes a physician, an epidemiologist, and
four infection control specialists. HES has implemented an infection prevention and
control program that operates within the guidelines of several agencies: the Joint
Commission on Accreditation of Healthcare Organizations, the Centers for Disease Control
and Prevention (CDC), and the Occupational Safety and Health Administration. The HES seeks
to prevent occurrence and transmission of hospital infections by using ongoing educational
programs, infection surveillance, investigations of outbreaks, isolation procedures and
engineering controls, and employee health protocols.
Although tuberculosis historically has been a rare disease in the CC, with the
continued implementation of protocols to study multidrug resistant tuberculosis and the
issuance of revised guidelines from CDC, HES continues focus on development of a
comprehensive plan to minimize transmission of tuberculosis. The global emergence of
antibiotic-resistant organisms has also prompted HES to develop specific policies and
procedures to prevent transmission of these pathogens at the CC.
The Information Systems Department (ISD) manages the planning, development,
deployment, and maintenance of CC computer systems and applications. The largest
application, the medical information system (MIS), is a mainframe-based electronic patient
record used in all aspects of clinical care and research. MIS is used by more than 4,000
health-care providers and researchers. On a typical day 1,200 individuals access the
system 8,800 times, write 5,300 orders, and request nearly 20,000 pieces of data for 2,000
patients.
ISD also supports ancillary systems including those used by clinical pathology,
pharmacy, radiology, transfusion medicine, and others. The department maintains the
network infrastructure and provides user support for desktop systems throughout the CC. It
implements and maintains the Information Technology Center, an area where CC employees can
use current hardware and software to improve clinical research and productivity.
The department has several ongoing initiatives, including the creation of a clinical
data repository (CDR) and the promotion of telemedicine. The CDR will contain easily
accessible data on patients seen at the NIH for the past 20 years, and will allow the
invaluable resource represented by these data to be used much more effectively for
research. Telemedicine holds the promise of greatly expanding the number of patients and
providers who have access to NIH’s expertise and of increasing the number of patients
able to be included in NIH protocols.
Pharmacy provides a 24-hour comprehensive service for patients and NIH staff. The
clinical pharmacy service is staffed by pharmacists with advanced specialty training. They
provide advice in the design, monitoring, and evaluation of patient drug regimens to
assure rational drug therapy. The Drug Information Service is available to assist in
complex pharmacotherapy problems for commercial or investigational drugs.
The Clinical Pharmaceutical Research Lab conducts research on the pharmacodynamics of
drugs in clinical investigation. The pharmaceutical development section provides services
in formulation, contol, assay, dispensing, and monitoring of investigational drugs.
Pharmacy manufactures nearly 1 million investigational drug units and registers and has
more than 2,000 registered investigational drug projects. The inpatient pharmacy prepares
and dispenses I.V. admixtures and dispenses close to 1 million doses of medicine yearly.
The outpatient pharmacy fills approximately 500 prescriptions a day for hospital and
clinic patients in investigational protocols.
Other departments and offices supporting the research effort include anesthesiology;
housekeeping and fabric care, clinical bioethics, materials management; medical record;
nursing; nutrition; outpatient; social work; spiritual ministry; and surgical services.
