Published monthly for CC employees by Clinical Center Communications/ October 1997 Staff for new CC office announced CC leads local campaign train for annual CFC Doppman honored First CC Roundtable airs Flu shot schedule CCMD's work extends beyond CC walls JCAHO! From the director Disability awareness News briefs

Prototype The artist's rendering of the new Mark O. Hatfield Clinical Research Center features a sweep of new wings. The initial phase of construction, slated to begin at the end of October, includes the demolition of Building 20, several cottages, and approximately 200 trees. At press time, groundbreaking ceremonies had been scheduled for Oct. 31. Staff for new CC office announced The Office of the Director recently announced the creation of the Office of Administrative Management and Planning (OAMP), designed to integrate and coordinate the administrative management support provided within the Clinical Center while providing a career ladder for CC administrative officers (AOs). "Until recently there was limited growth potential for administrative officers in the Clinical Center," says Maureen Gormley, OAMP chief. In the new office, four senior-level administrative officers will work with department AOs to coordinate administrative management services, which include personnel operations, acquisitions management, and budget. The new senior administrative officers--Elaine Ayers, Bridget Macnamara, Lynda Ray, and William Rosano--will each receive primary departmental assignments. Linda Linko will continue to serve as the senior AO for nursing. The goal is a team able to create administrative efficiencies that will result in cost savings and service improvements in the CC, Gormley pointed out. Among the first efforts of the OAMP is the installation of Visual Status of Funds software, an automated budget tracking and monitoring system that downloads information from the NIH Central Accounting System. Other efforts will focus on creating consistent administrative policies and practices; developing "best practices" and sharing knowledge among AOs; providing training for career growth and technical expertise; implementing new initiatives such as use of credit cards; and ultimately to improve efficiency across the CC. "Our goal is to provide the administrative support necessary to assist the CC in its long-range goal of cost effectiveness and efficiency," says Gormley.  index

Foil the flu with help from OMS The Occupational Medicine Service (OMS) is once again offering flu vaccinations for all CC health-care workers. The flu, which can be debilitating even for healthy people, is particularly serious if transmitted to the elderly or to patients with certain chronic medical conditions. Here are some facts about the flu: It is very infectious and can be passed from person to person through casual contact, as well as through direct patient care; People infected with the flu are contagious before their own flu symptoms develop (usually 2 days before fevers, coughs, and aches begin); The Centers for Disease Control and Prevention has predicted that influenza B will be the predominant flu strain this year. Since it cannot be treated with drugs that are currently available, the only way to avoid it is to prevent it by being vaccinated. CC staff can "Foil the Flu" by receiving a vaccination during many convenient times and numerous locations throughout the hospital. Check the schedule for the site nearest you. More detailed information about the flu vaccine is available on the CC homepage and in brochures throughout the hospital. OMS schedule  First letter, last name Date  am pm  NOPQ Oct. 15 7:30-11 1-3  RS Oct. 16  7:30-11  1-2  TUV Oct. 21  7:30-11  1-3  WXYZ Oct. 23  7:30-11  1-2  AB Oct. 28  7:30-11  1-3  CD Oct. 30  7:30-11  1-2  EF Nov. 4  7:30-11  1-3  GH Nov. 6  7:30-11  1-2  IJK Nov. 12  7:30-11  1-3  LM Nov. 13  7:30-11  1-2  Open Nov. 20  7:30-11  1-2  Open Nov. 21  7:30-11  1-3 Evening clinics will be held Oct. 16-Nov. 20, Mondays and Thursdays, 4:30- 8 p.m. First come, first served. index

Critical Care Medicine's work extends beyond CC walls

Staff of the Clinical Center's Critical Care Medicine Department (CCMD) are applying their expertise outside the walls of the Clinical Center. Recently, staff members have been involved in updating guidelines for treatment of opportunistic infections in HIV-infected patients; developing guidelines for evaluating and treating fever in the intensive-care setting; and organizing the upcoming meeting of the Society for Critical Care Medicine. Said Dr. Henry Masur, CCMD chief, "The Clinical Center and the NIH are taking an important role in synthesizing NIH-funded research and industry-sponsored research into practice guidelines that both health-care providers and patients can translate into practical day-to-day management." One such effort is the 1997 revision of USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus. Preventing opportunistic infections (OIs), which take advantage of a weakened immune system, is key to prolonging survival and improving quality of life for HIV-infected patients. A task force co-chaired by Dr. Masur, Dr. Jonathan Kaplan of the Centers for Disease Control and Prevention (CDC), and Dr. King Holmes of the University of Washington, Seattle, and comprising members of NIH, the CDC, and the Infectious Diseases Society of America (IDSA), convened last fall here in Bethesda. The task force reviewed new data concerning the prevention of OIs and determined which recommendations needed to be changed. Their revised guidelines, which were originally published two years ago (see CC News, Aug. 1995), were published in June in Morbidity and Mortality Weekly Report, and will be reprinted in both Annals of Internal Medicine and Clinical Infectious Diseases. A July editorial in the Journal of the American Medical Association by the co-chairs drew attention to the guidelines for that journal's diverse audience. "The 1995 edition was the first time that all the opportunistic pathogens were included in one set of recommendations," said Dr. Masur. "For an individual practitioner to keep up with all this data is almost impossible, even if they make AIDS their full-time occupation. It was very important to try to consolidate this information so that it is available quickly and all in one place." What's new in the 1997 revision? Recommendations have changed for four main OIs: Pneumocystis carinii pneumonia Mycobacterium avium complex disease Tuberculosis Streptococcus pneumoniae infection The guidelines are presented in an easy-reference table format accompanied by full-text rationale for the recommendations. Single copies are available from the National AIDS Clearinghouse, 1-800-458-5231. Fever management is another area in which CCMD staff have weighed in with their expertise. "The Society of Critical Care Medicine (SCCM) is interested in establishing practice parameters in a variety of areas. One of these is how to evaluate fever in a cost-effective way," said Dr. Masur. Patients in intensive-care often develop fevers, and numerous tests are usually done to determine its cause. This gets expensive. Dr. Masur again chaired a group that compiled a report called "Practice Parameters for Initiating a Fever Evaluation in Critically Ill Adult Patients." CCMD senior fellow Dr. Naomi O'Grady was the group's executive secretary and lead author. The group also included former CC clinical specialist Debra Tribett, R.N., and former CCMD fellow Myung Nam, M.D. The team considered questions such as, What constitutes a fever? How best do we measure fever? What tests are most useful? What are the relative risks of various tests? and How much do they cost? Their report, initiated by SCCM, has been endorsed by the IDSA and the Society of Health Care Epidemiologists and will be published this coming winter in Critical Care Medicine. "This report should establish a consistent and logical approach that intensive-care units can modify to fit their practice situations," said Dr. Masur. The third recent area of influence by CCMD staff centers on the annual meeting of SCCM. Coming up in February 1998, in San Antonio, the meeting is being organized by Dr. Anthony Suffredini and Dr. Fred Ognibene. "We've worked for at least two years to develop a program that reflects the exciting new developments in the science and clinical practice of critical care medicine," said Dr. Suffredini. "Our clinical and research experience here at the Clinical Center gives us a broad perspective. We were able to apply that expertise to help revitalize the content of the annual meeting," he said. A heavy emphasis will be placed on interactions between basic science and clinical practice. The program has four tracks: pulmonary sepsis/multiorgan failure cellular and molecular biology patient care and professional development. "The topics within each track are timely, and the speakers are experts who can communicate with a diverse audience. In fact, several Clinical Center people are speaking," he said. They include: Dr. Robert Danner, Dr. Peter Eichacker, Dr. Charles Natanson, Dr. Naomi O'Grady, Dr. Henry Masur, Dr. James Shelhamer, and Dr. Alison Wichman. Drs. Suffredini and Ognibene will moderate several sessions. Dr. Masur sums up: "Critical care is a relatively new subspecialty compared to cardiology, pulmonary medicine, or gastroenterology. Technology is improving rapidly, and our understanding of the pathophysiology of life-threatening illness has improved dramatically. Clinical Center staff have an opportunity to contribute to advances in basic research and improvements in patient care and to the dissemination of these advances to practitioners at other centers. Taking a leadership role in professional societies in terms of producing practice parameters and organizing national meetings fits into the vision and goals our department has established." (by Sue Kendall)  index

Roundtable-- live from the CC The first CC Roundtable on Sept. 23 featured a panel of NIH experts discussing "New Strategies for the Diagnosis and Management of Kidney Cancer: Recent Advances in Molecular Genetics." It was broadcast live over the GE TiP-TV Healthcare Network and CenterNet-The Academic Health Center Network. Preparing for the broadcast were (left to right) Dr. Berton Zbar, chief of the Laboratory of Immunobiology, NCI Division of Basic Sciences; Dr. John Gallin, CC director; Dr. Peter Choyke, chief of the uroradiology section, CC Diagnostic Radiology Department; and Dr. W. Marston Linehan, chief of the Urologic Oncology Branch, NCI Division of Clinical Sciences.  index

From the director by Dr. John I. Gallin, CC director

October promises to be a busy and historic month for the Clinical Center. CC departments are working together and with the institutes to prepare for our accreditation survey by the Joint Commission on Accreditation of Healthcare Organizations, which is set for later this month. This top-to-bottom scrutiny offers us all the opportunity to spotlight what we do best, which is to provide the highest quality patient care in a clinical research environment. The survey team will review our policies and procedures, visit patient-care units, and talk with employees representing all aspects of CC operations. I am confident that the hard work of all involved in the preparations will result in a successful survey. As this issue of CCNews goes to press, groundbreaking ceremonies for our new Clinical Research Center (CRC) are scheduled for Oct. 31, the day after the Joint Commission survey ends. Senator Mark O. Hatfield, for whom our new facility will be named, will be on hand for this event. I hope that as many Clinical Center employees as possible are able to participate. Details about the ceremony will be available soon. The CRC design team is hard at work refining plans for our new facility. To ensure that the final design meets the needs of the NIH clinical research programs, the CC Advisory Council has coordinated a series of meetings to articulate the needs and visions of the individual institutes, centers, and divisions, which will be incorporated into the final plans. The results of these reviews will be presented to NIH Director Dr. Harold Varmus and the ICD directors this month. Finally, I'd like to extend a welcome to medical and dental students from across the country who make up the charter class of the new Clinical Research Training Program here at NIH. Patterned after the Howard Hughes Medical Institute-NIH Research Scholars Program, its primary goal is to provide the nation's medical students an NIH venue for exploring clinical research. The program was suggested last fall by the clinical research panel that advises Dr. Varmus about ways to stimulate interest in clinical research. Nine third-year students joined this first class and most will reside in the newly renovated NIH Director's House. Part of the students' experience will be participation in the fourth generation of the Clinical Center's introductory course in clinical research, which will run October 7, 1997-June 2, 1998.  index

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Clinical Center News, Building 10, Room 1C255, National Institutes of Health, Bethesda, Maryland 20892. (301) 496-2563. Fax: 402-2984. Published monthly for CC employees by the Office of Clinical Center Communications, Colleen Henrichsen, chief. News, articles ideas, calendar events, letters, and photographs are welcome. Deadline for submission is the second Monday of each month. Editor: LaTonya Kittles.