The CC Pain and Palliative Care Consult Service, which opened in August, has already seen its 100th patient, Eugene Leverson (sitting, shown with his wife). The staff includes (standing, left to right) Dr. Adeline Ge, recreation therapy; Dr. Ann Berger, chief CC pain and palliative care; Dr. Jay Shah, rehabilitation medicine; Donna Pereira, pain and palliative care; Landis Vance, spiritual ministry; Karen Baker, pain and palliative care; and Dr Ann O'Mara, NCI.

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CC Pain and Palliative Care Consult Service debuts

The Clinical Center’s new Pain and Palliative Care Consult Service opened in August and already boasts more than 100 patients. The service uses a multidisciplinary approach to manage patient’s pain, and the associated symptoms.

"Our multidisciplinary team helps to address the quality of life, pain, and symptom management issues outside of a patient’s protocol," said Dr. Ann Berger, chief of the CC Pain and Palliative Care Consult Service. "This approach helps to treat the whole person and makes them feel better."

Patients are referred to the service by their physicians, and after an initial assessment, team members from various CC departments collaborate on the best approach. "We begin by looking at pain and how it affects a patient’s emotional state, and other symptoms," said Dr. Berger. "That way when we bring our team together we can work to pinpoint critical areas of care."

Dr. Berger, a former oncology clinical nurse specialist who received medical training at the Medical College of Ohio, initiated palliative care services at both Yale University, and Cooper Hospital/University of Medicine and Dentistry in New Jersey, before joining the CC. The core staff of the service includes Dr. Berger and nurse practitioners Donna Pereira and Karen Baker. The multidisciplinary team includes representatives from rehabilitation medicine, pharmacy, nutrition, anesthesia, spiritual ministry, social work, bioethics, and the CC patient representative.

According to Dr. Berger, educating health professionals in the field of pain and palliative care has increasingly received more emphasis in recent years. The American Medical Association has initiated a program to educate physicians on how to provide pain and palliative care, and questions can now be found on the internal medicine board exams. "The JCAHO made pain a fifth vital sign for its accreditation process," said Dr. Berger. "This shows that pain and palliative care is a growing field in the country." But education, says Dr. Berger, is a critical component. The staff has already initiated training for the multidisciplinary team and looks towards providing specialized training for the medical and nursing staff on each patient-care unit.

"It is critical for staff to understand and identify the possible components of one’s pain experience so that appropriate treatments can be implemented," said Dr. Jay P. Shah, a physiatrist in the Rehabilitation Medicine Department and a collaborator in the service. "We are integrating nonpharmacologic treatments, such as those we use in physical medicine and rehabilitation, with pharmacologic management," said Dr. Shah. "It’s a pyramid strategy: first we try to manage pain with physical and psychosocial modalities, and then introduce drugs as needed. Many patients have benefited tremendously."

Timing is everything when it comes to these issues, say the program planners. "We are here for patients from day one of their illness, not only for end-of-life issues," said Dr. Berger. Patients who are experiencing anything from fear and anxiety, to nausea and vomiting are encouraged to participate in the service. "It’s a patient's quality of life that makes all the difference. We not only have to cure the illness, we have to take care of the person," said Dr. Berger. "More and more patients are saying that they want both. That is our purpose, to give them both."

Outpatient clinics are held Mondays and Thursdays in OP3. Inpatients are seen all week. For more information, call 4-9767. (by LaTonya Kittles)

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Astute clinician lecture to be held Dec. 13

"The Patients Who Taught Me and Led to My Discoveries in Congenital Adrenal Hyperplasia" is the title of the Third Astute Clinician Lecture, which will be held on Wednesday, Dec. 13, at 3 p.m. in Masur Auditorium. The speaker is Dr. Maria I. New (left), professor and chairman of the Department of Pediatrics, and chief of the Division of Pediatric Endocrinology at New York-Presbyterian Hospital-Weill Medical College, Cornell University.

Congenital adrenal hyperplasia (CAH) is a family of inherited steroid production disorders. A mild form occurs in one in 100 live births and results in excess male hormone production. The severe form, which occurs in one in 14,000 live births, causes girls to be born with ambiguous genitalia, and can result in severe salt and hormone imbalances in boys and girls. Dr. New has pioneered major advances in the diagnosis and treatment of CAH, including the implementation of CAH newborn screening programs worldwide. She and her associates determined that the conditions result from the lack of essential enzymes of the adrenal gland. Through DNA analysis, they discovered specific mutations in the genes producing these enzymes and developed a DNA test to diagnose the most common forms of the disease prenatally. They then found that giving the hormone dexamethasone to a pregnant mother at risk can prevent ambiguous genitalia and a newborn salt-wasting crisis.

The adrenal gland is located near the kidneys and controls metabolism and sex hormone production.

Dr. New has also discovered new forms of high blood pressure and explained their genetic basis.

Dr. New obtained a BA from Cornell and an MD from the University of Pennsylvania School of Medicine. She completed an internship in Medicine at Bellevue Hospital and a residency in pediatrics at the New York Hospital. She fulfilled two NIH fellowships and was Research Pediatrician to the diabetic study group of the comprehensive care teaching program at Cornell Medical Center.

She has received the Robert H. Williams Distinguished Leadership Award in Endocrinology and the Rhone-Poulenc Rorer Clinical Investigator Lecture Award. Dr. New was elected to the National Academy of Sciences in 1996 and was president of the Endocrine Society in 1992. She has authored more than 500 articles in scientific publications.

The Astute Clinician Lecture was established through a gift from Haruko and Robert W. Miller, MD. It honors a U.S. scientist who has observed an unusual clinical occurrence, and by investigating it, has opened an important new avenue of research.

The Astute Clinician Lecture is an NIH Director’s Wednesday Afternoon Lecture Series event. It is hosted by the CC. For information and accommodations, call Hilda Madine at 4-5595.

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Cybercafe opens in the CC

Nine months after concluding his 6-year tenure as NIH director, Dr. Harold Varmus returned to campus Sept. 18 for a warm homecoming in which the new Cybercafé for graduate students in Bldg. 10 was officially opened and dedicated in his honor.

"I’m very pleased to see this project completed, and very grateful to have this honor bestowed on me, especially while I’m still alive," said Varmus. "I'm also grateful for the speed with which it has happened."

Dressed somewhat uncharacteristically in a suit and tie – a signal that this was indeed a special occasion – Varmus, who is now president of Memorial Sloan-Kettering Cancer Center, said he was pleased on three counts to open the café: first, he said he had been obsessed, in discussions of campus master planning, with creating focal points on campus – "places where significant interactions occur." When he was an undergraduate at Amherst, he recounted, Valentine’s Grill served that purpose, offering up a unique ambiance along with burgers and English muffins.

Medical school, sadly, lacked any special locus, he noted, but the University of California at San Francisco, where he spent most of his research career prior to coming to NIH, boasted the Courtyard Café, a "patch of green that had a bakery and coffee." NIH, he said, "is a fairly rambling place, but the Clinical Center is still its heart," so the new café has the advantage of location in its bid to acquire charisma.

The second pleasing factor, Varmus said, is that the café "is focused around graduate students primarily, but also trainees of all kinds including postdocs, and high school students. I hope that the faculty will gather to meet here, too."

Finally, he emphasized the "cyber" nature of the place, with its promise – via computers offering Internet connection – of "free access to research literature. The message that’s delivered to students is that the world could be at their fingertips." He hoped that authors using the space would contribute only to journals offering free access to their contents. He also acknowledged the importance of coffee: "Good coffee is essential to good science."

"This is a great idea – I’m very happy that (NIH) has finally decided to acknowledge graduate students and foster more of a sense of community among them," said Aviva Jacobs, a grad student with NIDDK, now in her fifth year of training. She predicted that veterans like herself will probably use the place less than newcomers, for whom it will represent a welcome chance to interact.

"Basically, graduate students hang out in their labs," said Rachel Politove, an NIDDK graduate student who first came as a summer trainee in 1993, then began graduate school in fall 1996. "They’re very isolated – the lab is their only interaction. The café will facilitate future graduate student activity."

Deanna Buck, a graduate student at NINDS, lauded the Cybercafé opening as a sign that "graduate students will know that there’s a place for them to go. So many people at NIH are unaware that we are here. This will give us a place to meet and share information."

The Cybercafé, an adjunct of the popular coffee bar in the Bldg. 10 lobby, is a short flight downstairs from the bar, and occupies what used to be the Visitor Information Center’s Nobel Terrace, which had featured brief biographies of NIH grantees who went on to become laureates. The café is furnished with comfy chairs and sofas arranged around small tables, and has a sequestered nook for more private gatherings. Anyone –not just grad students– can tote a steaming cuppa into the café, but grad students have first dibs on reserving the space for meetings.

"Harold Varmus has done an enormous amount for graduate education at NIH – not a day went by that we didn’t discuss some aspect of graduate education, and the need to do more for students here," said NIH Deputy Director for Intramural Research Dr. Michael Gottesman, who emceed the ceremony.

Also on the program were Charles Sanders, president of the board of the Foundation for the NIH, who came to honor Varmus’ contributions in support of the foundation, and Dr. Paul Montrone, FNIH treasurer, whose company, Fisher Scientific International, Inc., helped pay for furnishings within the café. The FNIH board voted unanimously last March to dedicate the facility to Varmus; Sanders unveiled a dedicatory plaque, stating, "We are very grateful for your services."

While a proposed degree-granting graduate school here was eventually rejected, NIH has established a Graduate Program Partnerships Training Award for people seeking Ph.D. and master’s degrees, and this fall launched the NIH Academy, a small cadre of postbaccalaureate research trainees who are motivated to focus on health disparities in the U.S. There are currently almost 200 graduate students on campus, a number that will slowly grow in coming years.

For more information on the partnerships program or graduate education, call 4-9605. (by Rich McManus, NIH Record)

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CC website addresses drug-nutrient interactions

Drugs and food can be uneasy partners when taken together. Foods may change the effect of a drug, or interact with the drug to cause serious, sometimes even life-threatening side effects.

So Clinical Center health professionals are taking special care to make sure their patients know about these serious drug-nutrient interactions.

In 1997, CC dietitians, nurses, pharmacists, and physicians formed the CC Drug-Nutrient Interaction Task Force. As part of their hospital-wide effort, members developed easy-to-read, web-based information sheets to educate patients who receive drugs on potentially serious drug-nutrient interactions. The patient’s dietitian, nurse, or pharmacist evaluates and educates the patient. All disciplines use the same factsheets that enable the patient to understand and prevent drug-nutrient interactions.

"Availability of these factsheets through the web makes it easy for the staff involved to deliver patient education using standardized, state-of-the-art information," said Denise Ford, chief of the Nutrition Department’s clinical nutrition service and task force chair. "The web site is well used; approximately 120 patients receive education using these materials on a monthly basis."

The drug-nutrient interaction factsheets are newly formatted and available on a redesigned website. For more information about the Drug-Nutrient Interaction Task Force, contact Ford at dford@nih.gov.

On the web:
http://www.cc.nih.gov/ccc/patient_education/drug_nutrient/

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CC personnel specialist dies

A long-time Clinical Center employee, Michael Pometto, Jr., passed away on Oct. 5 after a long illness.

During his tenure in the Office of Human Resources Management (OHRM), Pometto was promoted to leader, then supervisor, and most recently, headed the Delegated Examining Unit (DEU) as a personnel staffing specialist. In this position, he recruited nurses and other professionals for CC departments.

"Mike was a diligent professional who will be greatly missed," said Sue Fishbein, associate personnel officer in OHRM. "He deferred many vacations and devoted much personal time to work accomplishments. Even when his health was failing, he worried about deadlines and managed to arrive at work, concerned about applicants and management commitments," she said.

Throughout his career, Pometto received numerous awards and bonuses for his excellent performance. He was a recipient of the NIH Director’s Award, and also earned the CC OHRM much praise in the community for the meticulous manner in which he managed the DEU, which was audited and cited by the U.S. Office of Personnel Management as a model of excellence at NIH.

"Mike’s ability to motivate his staff and his relentless sense of humor were well known," said Fishbein. "Friends and clients spoke often about the way he not only worked tirelessly to solve their personnel problems, but also how he could make even the most serious person convulse in laughter in the midst of problem-solving."

Pometto was born and raised in Wheaton, MD, and graduated from Wheaton High School. He began his Federal career at NIH as a clinic clerk in the Nursing Department in 1979. He moved to the NIH Personnel Systems and Actions Branch, and in 1987, he returned to the Clinical Center as a personnel assistant in OHRM.

In OHRM he helped manage the Clinical Center health benefits open season and the Stay-in-School Program. He helped revise the OHRM orientation manual, developed a disability retirement manual for the personnel assistants, contributed to the development of the employee benefits statements, and assisted with the assimilation of the Department of Anesthesia and Surgical Services from contract to civil service status.

He is survived by his parents, Frances and Michael Sr.; brother, Gene of Rockville; and sisters, Darlene of Columbia, and Michele Gilfillan of Ellicott City.

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Present for the reception for the new clinic were (left to right) KaLea Kunkle, speaker; Renee Thomas, AJAO chair; Dr. Raphaela Goldbach-Mansky, NIAMS; Dr. Peter Lipsky, NIAMS; Dr. Robert Lipnick, clinic co-director; Dr. Janet Austin, NIAMS; Janet Jones, NIAMS; Ann Kunkel, juvenile arthritis advocate; and Dr. Barbara Mittleman, NIAMS.

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Pediatric rheumatology clinic opens in the CC

NIH officially opened its first pediatric rheumatology clinic during a reception held on September 21. NIAMS, which sponsored the reception, organized the specialty clinic at the CC.

The clinic offers diagnosis, evaluation, and treatment for children with arthritis and other chronic rheumatic diseases. It also serves as a specialty care facility for children through age 17 who are suspected of having or have a confirmed diagnosis of a rheumatic disease.

"This project represents a coming together of the community and the Clinical Center, and we thank everyone who was involved," said Dr. Peter Lipsky, NIAMS scientific director. "The clinic will help scientists gather research data we so badly need, especially since rheumatic diseases in children varyconsiderably from those in adults."

Dr. Lipsky also spoke on behalf of Dr. Stephen I. Katz, NIAMS director, saying, "Marking the opening of the NIH Pediatric Rheumatology Clinic means making a strong commitment to research for children with rheumatic diseases, which are costly, chronic, and, by nature, devastating. The research information that we gather will ultimately translate into meaningful information and data."

The youngest speaker at the reception, KaLea Kunkel, 16, from Oregon, Mo., has juvenile scleroderma. She, like her three siblings, including one who is adopted, all have a rheumatic disease. "I am here representing the more than 300,000 kids with a rheumatic disease, which may be invisible to the outsider. But the truth is that these irreversible diseases affect every aspect of a child’s life."

Other speakers included KaLea’s mother, Ann Kunkel, who also has a rheumatic disease, and is an advocate for the American Juvenile Arthritis Organization (AJAO). Another speaker, Renee Thomas, chair of AJAO, presented an award to Lipsky and NIAMS for ongoing work in juvenile rheumatic diseases. In speaking about the reception and clinic, Thomas said, "This is a wonderful celebration. Children walking through these doors will be very fortunate. Working together, we can make the dream come true to eventually cure our children who have arthritis."

During the ceremony, CC Director Dr. John Gallin, pledged to assist with the needs of the clinic. "As the clinic project evolves and needs become clear, ask us to help," said Dr. Gallin. "We are fully committed to this project."

The clinic will expose additional doctors to the subspecialty of pediatric rheumatology, an area of medicine that is greatly underserved. According to a 1999 report from the American Board of Medical Specialties, there are only 162 pediatric rheumatologists in the United States, and most are clustered around large cities.

Staffing the clinic are a host of medical professionals from NIH and the private sector, including pediatric rheumatologists, pediatricians, nurse practitioners, research nurses and fellows.

"Rheumatic diseases in children can compromise many developmental and educational tasks," said Dr. Barbara Mittleman, NIAMS director of scientific interchange. "Early and effective treatment can restore or improve the chances of kids with rheumatic diseases enjoying childhood."

"This is a dream come true," said Dr. Robert Lipnick, a pediatric rheumatologist in private practice in Bethesda, who helps staff the clinic along with Dr. Karyl Barron, an NIAID pediatric rheumatologist; and Dr. Raphaela Goldbach-Mansky, an NIAMS pediatrician. "I am extremely excited about this clinic," Dr. Lipnick said. "It will provide a tremendous opportunity for training young physicians to diagnose and treat children with rheumatic diseases and for conducting innovative and unique research studies. It also offers children all over the country the chance to participate."

Pediatric rheumatic diseases include juvenile rheumatoid arthritis, lupus, scleroderma, dermatomyositis, familial fever syndromes, and other chronic diseases that affect the joints, muscles, bones, and skin. (by Janet Howard, NIAMS)

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Alter honored at Lasker reception

The CC hosted a reception last month to honor Dr. Harvey Alter, chief of the Infectious Disease Section and associate director for research in the Department of Transfusion Medicine. The reception celebrated Dr. Alter’s receipt of the 2000 Albert Lasker Award for Clinical Medical Research. The Albert and Mary Lasker Foundation granted Dr. Alter the award to recognize his work to eliminate the presence of hepatitis C in the U.S. blood supply. The event included remarks from CC Director Dr. John Gallin; Dr. Harvey Klein, chief, Department of Transfusion Medicine; Dr. Michael Gottesman, deputy director for intramural research, NIH; and Dr. Ruth Kirschstein, principal deputy director, NIH. Dr. Alter was presented with a portrait by Al Laoang (right), Medical Arts and Photography Branch.

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NIH QWL fair hailed a success

The CC QWL Council would like to thank all of the staff involved in this year's NIH QWL fair, held last month. The CC Council provided a host of resources to the community, including handouts, health screenings, and information on the blood donor program at the CC. A "traveling suggestion box" was also available. Staff are reminded to drop any quality-of-work-life suggestions in the box near the B1 and 2nd floor cafeteria exits.

The Transhare program has had some positive changes recently. Anyone who qualifies will receive the benefit, and the upper level of the benefit amount for Metrochek vouchers has gone up to $65.

For more information call 6-6851 or e-mail: nihparkingoffice@ord.od.nih.gov

Volunteers needed

NINDS researchers seek adults with hypertension for a blood draw. Participants must have an NIH hospital identification number and have had a physical examination at the CC within the past year. Participants will be needed for approximately one hour, and will receive compensation. Appointments will be scheduled at 9:15 a.m. and 10:30 a.m. only. For more information, call Tereza at 6-1115.

The Pediatrics and Developmental Neuropsychiatry Branch of NIMH seeks children 6 to 13 years old, with and without an ADHD diagnosis, to participate in a movement study. Volunteers should have no other history of medical, psychiatric, or neurological disorders (including seizures and hearing problems), and should not be currently taking any prescribed medications. Participation requires a screening interview and neurological examinations. The study will take three to four hours, and participants will be compensated. For more information, call Chris Barker at 6-5323.

Winter blues study

During the winter, are you like a bear that wants to hibernate all the time? If you notice that you feel fatigued and down and that your sleeping and eating habits change in the winter, you may be eligible to participate in a research study on seasonal affective disorder. Diagnostic assessment and treatment consisting of light therapy, psychotherapy, or their combination will be offered. Interested volunteers, 18 or older, are invited to call the Uniformed Services University for more information at (301) 295-9718.

Stress hormones & depression

NIMH researchers seek people with current or past depression to participate in an evaluation study. Participants should be between 18 and 65 years old and otherwise medically healthy. They cannot have smoked within the last year and need to be able to stay at least one night at the CC. Eligible participants will receive a physical evaluation and metabolic studies, and will participate in studies for possible heart disease and osteoporosis in depression. Participants will be compensated. For more information, call 6-5831.

Awards ceremony announced

The Clinical Center Director’s Annual Address and Awards Ceremony will be held on Nov. 13 at 2 p.m. in Masur Auditorium.

Auction set

The CC Department of Laboratory Medicine (formerly Clinical Pathology) announces its 28th annual holiday fundraiser to benefit the Patient Emergency Fund and the Friends of the Clinical Center. Tickets will be on sale Oct. 30-Dec. 7 outside the 2nd floor cafeteria, and the event will be held on Dec. 8,

9 a.m.-2 p.m., in room 2C310. For more information, call Norma Ruschell at 6-4473, or Sheila Barrett at 6-5668.

Clinical research training

Applications for the 2001-2002 NIH-Duke Training Program in Clinical Research are now available in Room B1L403. Designed primarily for clinical fellows and other health professionals training for careers in clinical research, the program offers formal courses in research design, statistical analysis, health economics, research ethics and research management. Courses for this program are offered at the CC by means of videoconferencing from Duke or onsite by adjunct faculty. Students completing the required coursework are awarded a Master of Health Sciences in Clinical Research from Duke University School of Medicine. Prospective participants should consult with their institute or center regarding the official training nomination procedure. Applications must be received by March 1, 2001.

PI training announced

The required course for clinical principal investigators, Clinical Research Training, will be repeated on Dec. 12 from noon-4 p.m. in Lipsett Amphitheater. Topics include ethical issues in human subjects research, roles and responsibilities of the investigator and institution, regulatory issues, and clinical investigators and the mass media.

All principal investigators with a protocol approved through the Clinical Center are required to take the course and successfully complete an exam by March 1, 2001. Registration will be held from Nov. 1-30.

CRC to be discussed

The designers of the new Clinical Research Center, the Zimmer Gunsul Frasca Partnership, will discuss several of their recent design projects, including the CRC, on Nov. 13 from 6:30 to 8:00 p.m. at the National Building Museum in Washington, D.C. The cost is $10 for Museum members, and $14 for nonmembers. To register, call (202) 272-2448, or register online.

On the web:
http://www.nbm.org

Celebrate escort services

Join members of the escort team in celebrating patient escort services Nov. 6-9 from 9 a.m. to 2 p.m. outside the hospitality services office, 1C174. They will sponsor their sixth annual raffle to benefit the Patient Emergency Fund, and the winner will receive exclusive transport services for the patient-care area of their choice. Tickets can be purchased from any member of the patient escort team, and tickets will also be sold outside the second floor cafeteria during lunch hours.

Scrooge visits

The Performing Arts Ensemble will present a musical adaptation of "Scrooge" on Saturday, Dec. 2 at 7 p.m. in Masur Auditorium. Local actors and dancers will star in the extravaganza, and there will be a special appearance by Dale Solly from Channel 7 News. Proceeds from the event will support NIH patients and their families through the Friends of the Clinical Center. Admission is $8 for adults and $4 for children 12 and under. For tickets, call 4-5596.

No more receipts

The annual receipt drives to benefit the NIH School has new rules–no more receipts needed. To help the NIH School earn free educational equipment, shoppers at Safeway and Giant Foods need only register for a club card and give the school code: Giant #2983, and Safeway #0623. Then registered shoppers will automatically earn credit for the school every time they use their club cards. The NIH School can even earn double credit when customers purchase selected products which are clearly designated at the stores. Both the Safeway Club Card for Education Program, and the Giant A+ Bonus Bucks Program run until the end of March 2001. For more information call the NIH School at 6-2077, or e-mail: hmays@mail.cc.nih.gov.

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Acting Editor: LaTonya Kittles   Clinical Center News, 6100 Executive Blvd., Suite 3C01, MSC 7511, National Institutes of Health, Bethesda, MD 20892-7511. Tel: 301-496-2563. Fax: 301-402-2984. Published monthly for CC employees by the Office of Clinical Center Communications, Colleen Henrichsen, chief. News, article ideas, calendar events, letters, and photographs are welcome. Deadline for submissions is the second Monday of each month.

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For more information about the Clinical Center, e-mail occc@cc.nih.gov, or call Clinical Center Communications, 301-496-2563.

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