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.


National Institutes of Health