NIH Almanac (1995-1996) - Office of the Director

Institutes and Research Divisions
Warren Grant Magnuson Clinical Center

Mission

The Warren Grant Magnuson Clinical Center (CC) provides hospital services to patients who participate in clinical research conducted at NIH. The CC strives to be a model for clinical research by assuring quality patient care, delivering excellent support services, and recruiting and maintaining expert staff.

Authorized by Congress to provide patient care necessary to conduct biomedical research, the CC was specially designed to place patient care facilities close to research laboratories to promote the quick transfer of new findings of scientists to the treatment of patients. Institutes admit to their units and clinics only those patients (upon referral by personal physicians) who have the precise kind or stage of illness under investigation by scientist-clinicians.

CC departments are responsible for the hospital services, except for direct physician care, and conduct research in their own specialties.

In addition to biomedical research and patient care, the CC offers opportunities for advanced training to physicians, medical and nursing students, and members of the paramedical professions. This training includes a core curriculum in clinical research, a graduate and postgraduate program, a clinical electives program, and many lecture series. Monthly clinical staff conferences present the results of the cooperative biomedical research carriedout at the CC by the scientists and clinicians of the institutes and CC departments.

Important Events in CC History

November 1948--Construction of the Clinical Center was started.

June 22, 1951--The cornerstone ceremony was officiated by Oscar R. Ewing, Federal security administrator. President Harry S. Truman was the honored guest.

July 2, 1953--The CC was dedicated by DHEW Secretary Oveta Culp Hobby.

July 6, 1953--The first patient was admitted to the Clinical Center.

September 5, 1963--A new surgical wing for cardiac and neurosurgery was dedicated by Dr. Luther L. Terry, Surgeon General.

July 2, 1969--A dedication ceremony was held to name the CC's Jack Masur Auditorium.

April 1977--Construction of the ambulatory care research facility was started.

November 1977--The Critical Care Medicine Department was established.

October 22, 1981--The outpatient clinic facility was dedicated. The research hospital was renamed the Warren Grant Magnuson Clinical Center.

September 20, 1982--The NIA Laboratory of Neurosciences was dedicated.

March 22, 1984--The first magnetic resonance imaging unit became operational for patient imaging.

October 1984--NCI's Radiation Oncology Building was dedicated.

April 13, 1985--Two cyclotrons were delivered to the new underground facility operated by the Nuclear Medicine Department.

November 20, 1987--The Lipsett Amphitheater in the clinic was dedicated.

September 14, 1990--A 4-year-old patient with adenosine deaminate deficiency was the first to receive gene therapy treatment.

April 8, 1991--The Department of Transfusion Medicine opened its state of the art facility.

June 1992--The A-wing addition was completed, adding NCI and NIAID labs focusing on AIDS research.

July 1993--The hematology/bone marrow unit opened to improve transplant procedures and develop gene therapy techniques.

May 1994--First multi-institute unit designed and staffed for children opened.

CC Legislative Chronology

July 1, 1944--Public Law 78-410, the Public Health Service Act, authorized establishment of the Clinical Center.

July 8, 1947--Under P.L. 80-165, research construction provisions of the Appropriations Act for FY 1948 provided funds "For the acquisition of a site, and the preparation of plans, specifications, and drawings, for additional research buildings and a 600-bed clinical research hospital and necessary accessory buildings related thereto to be used in general medical research...."

Director's of CC

Name	Date of Birth	Dates of Office
		From	To
Jack Masur	June 12, 1908	1948 1956	1951 1969
John A. Trautman	March 30, 1902	1951	1954
Donald W. Patrick	.........................	1954	1956
Thomas C. Chalmers	1917	1970	1973
Robert S. Gordon, Jr.	.........................	1974	1975
Mortimer B. Lipsett	February 20, 1921	1976	1982
John L. Decker	June 27, 1921	1983	December 1990
Saul Rosen (Acting)	July 29, 1928	1990	1994
John I. Gallin	March 23, 1943	May 1, 1994	.........................

Biographical Sketch of CC Director

John I. Gallin, M.D.

Dr. Gallin became CC director and NIH associate director for clinical research on May 1, 1994. Prior to his appointment, he had served as director, Division of Intramural Research, NIAID, since 1985 and as chief of its Laboratory of Host Defenses since 1991.

A New York native, he graduated with honors from Amherst College, where he received an honorary doctor of science in 1988. He earned an M.D. degree at Cornell University Medical College in 1969. He was an intern, resident, adn senior chief medical resident at New York University-Bellevue Hospital Medical Center.

Dr. Gallin's primary research centers on how phagocytes--the body's scavenger cells--function. When the cells fail to produce the oxygen-rich chemicals that normally kill germs, a rare hereditary immune disorder--chronic granulomatous disease (CGD)--results.

His laboratory has actively pursued gene therapy for the treatment of CGD. He also has helped lead investigations demonstrating that the immune stimulant interferon-gamma reduces infections in CGD. Currently, he and his colleagues are pursuing the use of interferon-gamma in the treatment of other infectious diseases such as tuberculosis.

Dr. Gallin lectures internationally on inflammation and topics of host defense. Among his honors are the PHS Distinguished Service Award, the Young Investigator Award of the American Federation for Clinical Research, and the Squibb Award of the Infectious Diseases Society of America. In 1991 he received the PHS award for orphan product development, an honor that recognizes work in finding treatments for diseases and disorders that affect a small number of patients worldwide.

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 15 institutes conducting research on the NIH grounds.

The 13-story, 350-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 700 nurses provide patient care.

Clinical Center departments specifically tailor their services to serve the unique needs of biomedical 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 some 4 million tests per year for CC patients. Research focuses on lipoprotein disorders, mineral metabolism, thrombosis and hemostasis, identification of cell populations by flow cytometry and the identification of microorganisms causing human disease. Further, the department is developing tests using molecular biology in each of the four clinical services.

Critical Care Medicine

This department 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.

Diagnostic Radiology

Research focuses on rare diseases or those in which traditional imaging methods have presented major problems in diagnosis, detection, or followup. New areas of research in MRI (magnetic resonance imaging) have concentrated on developing "contrast" agents that improve image resolution and on defining and analyzing optimal strategies for rapid scanning. The ultrafast computerized tomography (CT) scanner can display diagnostic images of patients unable to hold still for more conventional scanners. This is especially valuable when treating infants, children, and extremely ill adults.

Nuclear Medicine

Provides a broad scope of diagnostic and therapeutic services for CC patients and engages in collaborative research with institute investigators on the safe application of radionuclides. Nearly 5,000 patient studies were conducted last year. A new, miniaturized, SPECT gamma camera for animal studies was produced by the physics group in collaboration with BEIP and institute investigators. This presentation was singled out for its excellence at the annual scientific meeting of the Society of Nuclear Medicine. Ongoing studies with NCI laboratories have further developed radiolabeled monoclonal antibodies for tumor diagnosis and therapy.

Positron emission tomography (PET)

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 a cyclotron. This substance, also called a radionuclide, emits positrons.

As the 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 or how the brain metabolizes glucose.

The PET department is organized as a scientific core concentrating on radiochemistry. Resources include two medical cyclotrons to produce the radionuclides six lead-lined chemistry hoods where the radiopharmaceuticals are formulated laboratories for radiochemistry three PET tomographs and computer hardware and software for generating and analyzing the PET images.

Rehabilitation Medicine Department

(RMD) has continued to provide comprehensive rehabilitation services to NIH research patients. Approximately 25,000 patients were seen by RMD staff in the medical, occupational therapy, physical therapy, speech-language pathology, recreation therapy, and biomechanics laboratory sections.

Recently, RMD developed new clinical programs to assess swallowing and tongue motion in children. These children had diagnoses of childhood dermatomyositis and Beckwith-Weidemann syndrome (BWS).

A comprehensive musculoskeletal evaluation was devised to determine the degree of abnormalities in children with BWS and their unaffected siblings. This evaluation was designed to provide pediatricians with a screening tool to identify abnormalities frequently associated with BWS (hemihypertrophy, macroglossia, and scoliosis).

The ultrasound laboratory developed programs that will help provide real time imaging of the oral pharynx without exposure to radiation and will permit quantitation and sequencing of swallowing events in real-time.

The biometrics laboratory has developed simulation models that will be used to predict outcomes of therapeutic intervention prior to treatment.

Undergraduate and graduate-level training are provided routinely in RMD, including summer programs and student interships.

The Department of Transfusion Medicine (DTM)

Continues to provide safe blood and blood products 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) lab to meet all CC service needs, 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 6 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 continues to investigate 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 in order 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 vacccines. Innovative cellular therapies complement the department's traditional role in transfusion therapy.

Hospital Epidemiology Service (HES)

Includes a physician, an epidemiologist, and five infection control specialists. HES has implemented a comprehensive infection 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 transmission of hospital infections by using ongoing educational programs, routine patient surveillance, investigations of outbreaks, isolation precautions, and employee health protocols.

Although tuberculosis historically has been a rare disease in the Clinical Center, with the recent implementation of protocols to study multidrug resistant tuberculosis and the issuance of revised guidelines from CDC, HES has focused on development of a comprehensive control plan to minimize transmission of tuberculosis. Similar to the hierarchy of controls used to control transmission of blood-borne pathogens, tuberculosis control has involved developing and implementing administrative (work practice) and engineering controls and using personal protective equipment.

Information Systems (ISD) Consolidates the planning, development, and maintenance of CC computing activities. ISD manages the CC medical information system (MIS), a large, online computerized system that provides access to patient records and allows users to retrieve and add data. The department operates the computer center, providing round-the-clock service to patient units, clinical pathology, pharmacy, radiology, admissions, and other departments engaged in administrative, diagnostic, and therapeutic activities. In addition, ISD provides advice and support to CC departments about micro- or minicomputers, or other computer hardware or software. MIS is used by over 4,000 physicians, nurses, and other hospital professionals. On a typical day, 1,200 different hospital staffers make 8,800 distinct accesses to the system write 5,300 orders and request nearly 20,000 online patient retrievals for 2,000 patients.

Pharmacy

Provides a 24-hour comprehensive service for patients. The clinical pharmacy service is staffed by pharmacists with advanced specialty training. They assist physicians in designing, monitoring, and evaluating patient drug regimens to assure proper, rational drug therapy. The clinical pharmacokinetic research lab monitors drug levels in patients and interprets patient response to drug therapy. The formulation, development, control, assay, dispensing, and clinical monitoring of investigational drugs make the CC's pharmacy program unique. Pharmacy manufactures nearly 1 million investigational drug units and registers and labels some 2 million units each year. The inpatient pharmacy mixes an average of 750 I.V. admixtures daily and dispenses close to 1 million unit doses of medicine yearly. The outpatient pharmacy fills approximately 400 prescriptions a day.

Other departments and offices supporting the research effort include anesthesiology; housekeeping and fabric care materials management; medical record; nursing; nutrition; outpatient; social work; spiritual ministry; and surgical services.