Lt. Cmdr. Lucienne Nelson and her colleagues face the realities of anthrax. They aren't wearing contamination suits and testing for spore traces in legislative buildings and post offices, but they are calming nerves, wiping tears and comforting the thousands of people affected by the deadly bacteria.
A group of 27 Clinical Center nurses and pharmacists were deployed to the Washington, D.C. area, to educate and test postal workers and congressional staff, and dispense antibiotics to anyone who may have come in contact with the anthrax spores. "It's what I train for," said Lt. Cmdr. Nelson, R.N., research nurse, Pediatric Oncology Branch. "We just came to try and help."
Nelson was called to the Hart Senate office building two days after returning from New York City, where she was among the 43 people on the Commissioned Corps Readiness Force, an immediate response team sent to Ground Zero to assist rescue workers. "It was like being in a foreign country looking at ancient ruins. All you could do is stare in total disbelief," said Nelson. "I needed those two days just to regroup and get my bearings."
At the Hart Senate office building, Nelson helped set up a treatment area for Capital Hill employees from Senator Tom Daschle's (D-South Dakota) office, where one of several anthrax-laced letters was mailed. Nelson worked two 17-hour days taking nasal swabs and educating employees about the nature of anthrax before being sent to the main Capital building.
"Most people were more concerned about whether or not they were going to bring this home to their kids," said Nelson. "We were trained in infectious diseases, so we knew that you couldn't get the disease from casual contact, however, we had to ease the minds of these individuals. They were concerned for their lives and for their families lives."
Anthrax is an illness caused by bacteria called bacillus anthracis. The bacteria can form a protective coat around themselves called spores. When actively multiplying, the bacteria release poisonous substances into the bodies of infected people. According to the Centers for Disease Control and Prevention (CDC), anthrax is not easily transferable. An infected person cannot pass the disease on by coughing or touching another person. The skin form, or cutaneous anthrax, can only be harmful if the bacteria enter through a cut in the skin. A sore develops and in a few days turns into a blister with a black scab in the center. Skin anthrax is more easily treated than inhalation anthrax. Inhalation anthrax is the most serious form of the disease and is caused by inhaling the anthrax spores. The spores begin to nest in the lymph nodes where the bacteria multiply, creating toxins. The body responds to the toxins by creating flu-like symptoms. The increase in toxins is what eventually causes death.
"This is what gets people confused. They come in to the hospital and tests are negative, so they think they have the flu. However a couple of days later, when the toxins begin to take over the body, the individual thinks that it couldn't be anthrax because the initial test was negative," said Nelson. "By then, unfortunately, the person may die and the problem wasn't that they had a bad doctor or that they went to a poor hospital, it's just the nature of the organism."
It's that nature that sent thousands of postal workers and others who work in the Washington, D.C. area to D.C. General Hospital to be tested and receive antibiotics. The hospital, which was downsized and taken over by a private company earlier this year, reopened portions of the building to handle the barrage of people.
"There were some angry people," said Lt. Felicia Andrews, R.N., unit coordinator on 13 West. "They were afraid and would come into the hospital and have panic attacks because they were so upset."
Andrews spent two days at D.C. General Hospital and saw nearly 2,000 people each day. The first two days that the hospital was open, nasal swabs were taken from each individual. Afterwards, no swabs were taken, but most individuals were given a 10-day supply of antibiotics.
"People were under the impression that they were going to be swabbed, because they thought it would determine if they had anthrax," said Andrews. "When we told them that we weren't doing anymore swabs, and the person knew that their buddy was swabbed the day before, they became upset and wondered why they couldn't be swabbed."
Since there is no type of screening for anthrax, no test exists to determine if an individual has been exposed to the bacteria. Based on a CDC report, the only way exposure can be determined is through a public health investigation. Nasal swabs and environmental tests are done to determine the extent of exposure in a given building or workplace, not to determine whether an individual should be treated. Even the use of a home test kit cannot determine if a person has been infected with the bacteria, but rather is a device to test environmental samples.
By the second day, workers at D.C. General Hospital had swabbed enough people to determine what areas in Greater Washington were of high risk. "We were answering questions and dispensing antibiotics to anyone who walked in the door," said Lt. Cmdr. Katherine Berkhousen, R.N., B.S.N., clinical research nurse, HIV/AIDS Outpatient Research Clinic.
Postal officials were bringing employees by the busload, while concerned citizens lined up to receive antibiotics. "Their main concern was that they wanted to be treated," said Lt. Cmdr. Scott Dallas, senior staff pharmacist. "We had exactly what they needed, but we wanted to make sure that they got the maximum beefit from it." Dallas evaluated individuals and then dispensed Ciprofloxacin or Doxycycline, two antibiotics used to fight the anthrax bacteria. Berkhousen spoke with people one-on-one to ease their concerns, and in some cases made phone calls to parents and guardians of employees with disabilities and special needs. "We didn't turn anyone away. Our main concern was dispensing antibiotics to people not at risk. We didn't want to say no and turn them away, because we really did not know."
New information about the infected letters, and a continuous stream of buildings that tested positive for the bacteria was constantly changing. With no bathroom breaks and shortened lunch breaks, Berkhousen said it was like being cut off from the world. "When you are seeing 2,000 patients a day it's hard to keep up with what is happening. When the patients came in they were almost more up-to-date and educated than we were."
Despite the never-ending workdays, just to be able to help is reward enough. "I was on a mission and I was going to do whatever it took to accomplish that mission," said Nelson. "If all I get is a couple of hours of sleep each day, then I appreciate it. I'm just honored to be able to do my job."
by Tanya C. Brown
Nurses and allied health professionals hired under the General Schedule (Title 5) now have the opportunity to convert to Title 42, an alternative personnel system that gives managers flexibility in salary negotiation and allows employee promotion based on job performance without a waiting period.
Conversion is optional and solely dependent upon the individual. However, once the switch is made, an employee cannot go back into Title 5.
"If people don't perceive it to be advantageous to move into Title 42, then there is no pressure to make a change," said Tom Reed, director, Office of Human Resources Management. "I think that the trend toward Title 42 allows the Clinical Center to be successful in recruiting more people, faster. Title 42 make us more competitive and encourages people to come here instead of going to other places."
More than 93 nurses and allied health professionals have been hired under Title 42 since its inception last May. In fact, the nursing department has hired 48 nurses within six months, creating a low one percent vacancy rate.
"Title 42 has been incredibly helpful because it has enabled us to reduce our vacancy rate quickly, while also dramatically reducing the time from inquiry to offer," said Clare Hastings, chief, Nursing and Patient Care Services. "It has also allowed us to offer more competitive salaries at the senior staff levels."
Hiring under Title 42 does not require the General Schedule rating and ranking system that selects the top three candidates, passing their applications along to the hiring official. Instead, all qualified applications are submitted to the hiring official, creating a larger pool of applicants.
The General Schedule follows job grades and steps, that limit employees to a set salary and generally require a one-year in-grade waiting period before being promoted. With Title 42 employees can be promoted at any time based on their performance. Salary is based on pay bands that use competency and not longevity to determine the amount of individual pay increase or supplemental pay (awards, bonuses), given to employees.
The Council was highlighted at the Nov. 5 CC Director's Awards Ceremony as a CC activity benefiting employees. This year, membership was expanded with an increased emphasis in diversity appreciation and education.
CC Director Dr. John Gallin expressed his support of council undertakings, particularly the Employee Suggestion Program. There are two suggestion boxes for QWI and/or Diversity suggestions: one is outside the second floor cafeteria, near the vending machines; the other is in the B1 cafeteria, on the wall near the B1 level entrance. Employees may also contact Sue Fishbein 301-435-0031 or Jacques Bolle 301-594-9768 for comments.
At the Director's Awards Ceremony Dr. Gallin not only underscored his interest in responding to feasible suggestions that bring about positive changes, but mentioned the new plan to expand the Building 10, 14th floor exercise facility so employees and patients can use it. For facility availability, contact George Patrick at 301-496-2278.
Celebrating American Indian/Alaska Native Heritage Month
The first observance of the American Indian/Alaska Native Heritage Month, on Nov. 16, was sponsored by the NIH American Indian/Alaska Native Employee Council. The theme was "Leading the Way to Good Medicine." Speakers included Dr. Jared Jobe, Cherokee, NHLBI; Dr. Clifton Poodry, Seneca, NIGMS; Leo Nolan, M. Ed., St. Regis (Akwesasne) Mohawk, IHS; and Dr. Everett Rhoades, Kiowa, former Director, IHS and currently Director, Native American Prevention Research Center, College of Public Health, University of Oklahoma and Adjunct Professor of Medicine, University of Oklahoma. All currently work in the fields of health, health policy, and/or medicine.
American Indian and Alaskan native contributions have been numerous and significant. These contributions range from the use and development of herbal medicines to participation in research studies which lead to the development of vaccines for Hepatitis B and influenza. The program included the presentation of award-winning artwork, flute and drum music, and dancing, and emphasized the themes of healing, spirituality, and reverence for nature and for the community.
A number of common misperceptions about American Indians were dispelled simply, and with humor. For example, the term "Chief" was first used by early Europeans who thought the feather war bonnets American Indians wore resembled the hats of "chefs." For more information about the program or the organization, e-mail the NIH American Indian/Alaska Native Employee Council at: WebO@od.nih.gov, or call 301-402-3681.
The Clinical Research Information System (CRIS) Project Management Team has scheduled a series of educational sessions. These sessions are targeted to all interested personnel. The sessions will present real-life examples of the challenges and risks of similar system installations in the hope that realistic expectations will be developed for the CRIS implementation. For more information about the sessions, call 301-496-3825.
January 7, 2002, 1:30-3 p.m. Lipsett Amphitheater
Case Study Reductions of Medical Errors
February 7, 2002, 1:30 Ã? 3 p.m. Lipsett Amphitheater
Implementation: The Good, The Bad & The Ugly
March 11, 2002, 1:30-3 p.m Lipsett Amphitheater
Clinical & Process Outcomes
When Dr. Norberto Soto sought out people to receive an experimental vaccine for shingles he thought it would be a difficult task. But it wasn't. Within two years, Dr. Soto's team at the Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases (NIAID) recruited 1,741 individuals from the Washington metropolitan area and more than 38,000 people nationwide.
"I don't think there's ever been a vaccine study of this magnitude done in older adults at the Clinical Center," said Dr. Soto, principal investigator for the Shingles Prevention Study. "It's just really been amazing to be able to enroll this many people."
The goal of recruiting a large test group was met through a mass media campaign, mailings and community outreach programs that involved going to senior communities to educate residents about the study.
The Patient Recruitment and Public Liaison office reports that the Clinical Center screened 3,515 participants, and referred 3,063 of them to the study team. Of those who were referred, 1,741 were selected to participate in the five-year study. Participants had to be healthy adults over age 60, who have never had shingles.
The Clinical Center was one of 22 recruitment centers nationwide. The study is being conducted in collaboration with the Department of Veterans Affairs, NIAID and Merck & Company, Inc., the vaccine producer.
An estimated 600,000 to 1 million people develop shingles annually. The disease generally strikes people over the age of 50, but anyone who has had chickenpox is at risk of developing the disease. When a person gets chickenpox the bumps and scarring go away, but the virus causing the chickenpox lies dormant in nerve cells and can be reactivated as a person gets older, causing shingles.
The shingles vaccine is a modified version of the current chickenpox vaccine and is used to boost the immune system to protect people from developing shingles later in life. Shingles produces a painful outbreak on the skin. It usually occurs on one side of the body and a rash of fluid-filled blisters generally form on the face, chest or waist, according to Dr. Soto.
"It can be very painful," said Rosemary McCown, R.N., who along with Marilyn Kelly, R.N., M.S., served as study coordinators for the trial. "You may get a rash for two to three weeks, but the pain may never go away. It can stay with you the rest of your life."
Prolonged pain caused by shingles, affects 20 percent of people with the condition. That rate increases to 40 percent in people over the age of 60. Other complications from shingles include irreversible hearing and vision loss, or permanent blindness if the disease develops on the face.
" We want to improve the health quality in these individuals," said Dr. Soto. "Preventive measures and health maintenance is more effective than treating people once they are sick."
Need to change your computer password, have a question about your Parachute account, or just want to know how to change your desktop telephone service? If so, look no further than the new online service from the NIH Center for Information Technology (CIT). Available 24-hours a day, seven days a week, CIT can provide expert assistance when users need it.
The new Customer Support online service not only provides answers to basic Information Technology (IT) questions using the CIT Knowledge Base, it displays up-to-the-minute IT news and frequently asked questions. If none of these options provides the solution, an electronic "Help" request ticket can be issued. Customers may also submit tickets via the web interface when the Technical Assistance Support Center (TASC) is open. TASC will respond to all electronic requests the following business day. The new website even lets users review the status of their existing service calls online.
Also debuting is CIT's emergency after-hours live telephone support. The new service, staffed from 6 p.m. to 7 a.m., is intended for emergencies and problem reports only. A call to the TASC helpline 301-496-6248, allows users the option of leaving a voice message for non-emergency issues, or speaking with the on-call technician. TASC will contact users the next business day after a call. The TASC help desk is open from 7 a.m. to 6 p.m., Monday through Friday. The hours of operation will change during the holidays.
TASC Holiday Schedule
The TASC help desk resumes its regular schedule on Wednesday, Jan. 2, 2002. TASC holiday hours are also available at http://support.cit.nih.gov.
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Family lodge support
Support NIH School
Healthy adults needed
Post-traumatic stress study
Bipolar disorder study
African American men and women
more information about the Clinical Center,
Grant Magnuson Clinical Center
This page last reviewed on 09/9/09