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Recipients of the award, given annually since 1985, are recognized for their excellence as a mentor and teacher and their contributions to clinical research. Dr. Brian Porter, who chaired this year’s award committee, noted that they had a record 16 nominees this year. Reading a few comments from fellows during the introduction, Porter called Gallin "one of the strongest mentors and advocates of clinical fellows at NIH." As the 2007 DCTA award recipient, Gallin will deliver the annual John Laws Decker Memorial Lecture during a CC Grand Rounds in June 2008. The finalists for the 2007 DCTA award were Dr. Richard Childs, NHLBI Hematology Branch, and Dr. Roberto Machado, NHLBI Pulmonary and Vascular Medicine Branch.
Institute of Medicine selects Rehabilitation Medicine chief
IOM membership, now totaling 1,538, is considered one of the highest honors in the fields of medicine and health. The criteria for election are: distinguished professional achievement in a field related to medicine and health; demonstrated and continued involvement with the issues of health care, prevention of disease, education, or research; skills and resources likely to contribute to the Institute’s tasks of assessing current knowledge, conducting studies, and considering policy issues; and willingness to be an active IOM participant. Unique for its structure as both an honorific membership and advisory organization, IOM was established in 1970 by the National Academy of Sciences and is recognized as a resource for independent, scientifically informed analysis and health recommendations. With their election, members make a commitment to devote a significant amount of volunteer time as members of IOM committees, which engage in a range of studies on health policy issues.
"Let food be your medicine and your medicine be your food."
Not every Clinical Center patient can eat their meals with utensils. Some patients must be fed with IVs or tubes, can’t eat solid foods, or need special ways of receiving nutrition because of digestive issues. Sara Bergerson, clinical nutrition support dietitian and Commander in the U.S. Public Health Service, specializes in finding unique solutions to ensure CC patients’ proper nourishment, comfort, and tolerance of treatment side effects. "Food is so important to us all. It’s a quality of life issue," Bergerson said. Her role in the Pain and Palliative Care Service reflects her commitment to these issues. The team’s chief Dr. Ann Berger notes that "Sara goes above and beyond to get anything for every patient. When all a teenage patient would eat was noodles, Sara made sure to provide them." Bergerson thinks working at the CC is the "most exciting and dynamic way to be a dietitian" because of the close team work required. She interacts with doctors, nurses, and pharmacists to review patients’ nutritional status, which can change significantly during the course of treatment. Bergerson is responsible for the nutrition of critically ill patients, including those in the ICU, radiation oncology, and hematology units. Dr. Margaret Bevans, senior nurse specialist with nursing’s Research and Practice and Development Service, calls Bergerson a team player with a clear focus on patients’ nutritional outcomes. After rounds, Bergerson frequently remains with the patient and family to discuss the nutritional implications of their treatment at the CC. She is a strong advocate in ensuring that not only patients’ physiological nutrition needs, but also their psychological and emotional needs, for food are met. She is always challenging teams to consider creative strategies to dovetail patient preferences with clinical needs. When a new nutritional supplement for cancer patients was introduced, Bergerson provided samples for staff to try before using it with patients. Bergerson also meets patients’ diverse food needs and cultural preferences. The CC’s room service menu allows patients the freedom to make food choices at meals, such as a hamburger for breakfast or an omelet for dinner. But if the menu won’t work for a patient for any reason, nutrition technicians will "Visit In Person" before every meal to find out what the patient wants. "Everyone is a V.I.P.," Bergerson said. Madeline Michael, chief of clinical nutrition services for the Nutrition Department at the CC, said Bergerson embodies Hippocrates' saying, "Let food be your medicine and medicine be your food." She demonstrates during her interactions with patients how important nutrition and food are in healing and recovery and recognizes the special significance that food holds for those who are ill and for their families. "What sets Sara apart is that rare combination of excellence in clinical care, commitment to duty, and her dedication to the whole patient," Michael said. "The patients give to me as much as I give to the patients," Bergerson said. "I have a lot of fond memories and amazing experiences I would never have gotten anywhere else."
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DCRI’s Tim Maloney and Susan Houston stand behind a palette stacked with 128 disk drives from MIS. |
On Sept. 21, the Clinical Center surplused the Medical Information System (MIS) mainframe, which had served the hospital since June 1976. The CC was the nation’s fifth hospital to install the system and the first to configure and enhance it to support protocol-based clinical research. MIS allowed physician order entry, result reporting, medication administration, and nursing documentation long before others began using electronic medical records—and provided access to patient data at rates difficult to match even after 30 years.
CRIS replaced most of MIS in 2005. MIS continued to be used for patient registration and for managing admission, discharge, and transfers until last November.
Dr. Jon McKeeby, CC CIO, marked the historic transition by lauding the enduring efforts of Dr. Thomas Lewis—the “heart and soul of MIS" since the beginning. Lewis, former associate director of information systems and currently a consultant to DCRI, led the original MIS selection and implementation team.
“As you might imagine,” said Lewis, “the step from a billing-oriented, community hospital to the complex research-oriented CC environment was large and with significant risk.” It was a risk work taking. Lewis credits staff involved in clinical programs—even for brief periods—during MIS’s lifespan who “worked hard to use, contribute to, critique, explore, and expand the use and advancement of information technology for better patient care and clinical research. This is a group of literally thousands of individuals, many of whom may not even realize how much they contributed, to patients, the CC, the NIH, and beyond.”
Other DCRI staff involved in retiring the historic mainframe included Steve Bergstrom, John Franco, Susan Houston, John Kocher, Murali Kumar, Tim Maloney, and Steve Moore.
(from left): Jenny Haliski, Dr. Norka Ruiz Bravo, and Dr. Michael Gottesman judge the CFC dance championship. |
ORS Director Dr. Alfred Johnson won the first—and possibly last—Combined Federal Campaign dance championship trophy for his rendition of the cowboy boogie during a country line dance competition in front of Building 1.
NIH Director Dr. Elias Zerhouni took second place and NINDS Director Dr. Story Landis came in third.
The event was part of this year’s CFC campaign with the theme, "Have a heart, be a star." For more information, see http://cfc.nih.gov/ .
(from left) ORS Director Dr. Alfred Johnson accepts his trophy from NHLBI Director and 2007 CFC Vice Chair Dr. Elizabeth Nabel; NIH Director and runner-up Dr. Elias Zerhouni; and NINDS Director and third place finalist Dr. Story Landis. |
NHLBI’s Dennis Askwith, who teaches weekly country line dancing classes with R&W taught both the audience and the IC directors a 24-count beginner line dance called the cowboy boogie. |
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Dr. Jacques Bolle, clinical thanatologist with the CC Pain and Palliative Care Service, gives a presentation at the conference. |
Some call pheo "the great mimic" because its symptoms resemble many other conditions. It’s so misunderstood and underdiagnosed that it was the subject of an episode of the TV show "House." Pheos are tumors of the chromaffin cells, which produce, store, metabolize, and secrete catecholamines, such as norepinephrine or epinephrine. The diagnosis depends on evidence that the tumor is overproducing catecholamine.
Although the disease’s signs and symptoms can include bouts of rage, more common are anxiety, headache, severe hypertension, and nausea. Symptoms, caused by the body’s response to catecholamine secreted by pheos, may last from few minutes to several hours and may occur daily or once every few months.
Presentations at the conference, hosted by NICHD, were a collaborative effort between NIH institutes and centers to pull together the entire spectrum of care involved in the rare disease. CC contributions included Dr. James Reynolds, chief of the Clinical Studies Section of the Nuclear Medicine Department, who discussed internal radiation as a treatment for pheo; Brad Wood, chief of interventional radiology research in the Diagnostic Radiology Department, who discussed the potential application of tumor ablation; and Dr. Jacques Bolle, clinical thanatologist—a specialist who helps people live a fuller life and maintain meaning as they face serious illnesses that could lead to death—with the CC Pain and Palliative Care Service, who discussed the emotional impact of a life-challenging illness on individuals and families.
Much of Bolle’s presentation about the emotional responses to pheo pertains to life with any chronic or life-challenging disease, especially those that are rare. The multiple complex emotions experienced by pheochromocytoma patients include: uncertainty, fear, powerlessness, depression, and anger. Bolle also shared his "pearls of wisdom" for how to cope with illness: pace your day according to your biological clock; lose the word "should," which leaves little room for flexibility; restrict how large a part of your life the disease becomes in relation to other aspects of your identity; ask care providers questions and consider them partners in your treatment; share feelings with loved ones; and use humor and laughter.
Several conference participants echoed Kauffman’s sentiments on the benefits of becoming proactive in learning about and seeking support for their disease. After the initial astonishment of wondering, "How can something this rare happen to me?" one woman expressed her frustration when, after multiple misdiagnoses, her instincts that something was physically wrong with her turned out to be correct. Others described difficulties responding to questions about a disease with few external signs and symptoms that mimic other conditions.
Some participants found comfort in the universality of health concerns. "Everyone has 'something' in their lives, whether it’s heart disease, diabetes, Parkinson’s, or cancer. Mine happens to be pheo, which is rare and new. But the development of treatments gives us some hope. Life isn’t always fair and you have to decide how you are going to deal with it." Bolle quoted the title of an article one physician wrote about his own illness: "We are all patients. Some of us also become physicians as well."
'We are all patients': One physician's story of life with pheo
Dr. Edward Kauffman (at right) reviews his nuclear medicine scan taken earlier in the day at the Clinical Center with Dr. Karel Pacak. The fluorodopamine positron emission tomography technology highlights Kauffman’s three small pheochromocytoma tumors. |
Many physicians don’t think of checking for pheo when their patients describe these symptoms and prescribe medications appropriate to the symptoms but not the underlying condition while the potentially fatal metastatic disease goes unchecked, according to Kauffman. Because death from hypertension and heart attacks are common and usually don’t trigger autopsies, studies indicate that up to 50 percent of all cases remain undiagnosed until death, he said.
Kauffman experienced anxiety, night sweats, and heart palpitations. His wife noticed personality changes and angry episodes that could be triggered by anything, and kept escalating.
Eventually, Kauffman’s son, who is also a physician, put his father on a path that led him to Dr. Karel Pacak, head of NICHD's unit on clinical neuroendocrinology, and an expert on the condition. About 2,000 patients are diagnosed with pheo in the U.S. every year.
Pacak, together with NINDS' Drs. David Goldstein and Graeme Eisenhofer, developed a biochemical diagnosis for the disease using plasma-free metanephrines that changed the method of diagnosis worldwide. They also developed the use of 18F-fluorodopamine positron emission tomography to successfully take images of tumors. "Hope at NIH comes from the research. It’s not just about doing the clinical work, but also incorporating research into daily clinical practice through better ways of diagnosing and treating patients," Pacak said.
(from left) Dr. Edward Kauffman and Dr. Karel Pacak discuss Kauffman's treatment at the Clinical Center. |
Pacak says another "huge breakthrough" in the disease came with the discovery that pheo susceptibility is associated with mutations of the succinate dehydrogenase (SDH) gene family. As between 30 to 35 percent of tumors have a hereditary basis, he now recommends that all patients with identified tumors be tested for the presence of possible underlying genetic mutations, regardless of family or clinical history.
"I thought I had a death sentence," Kauffman recalled. "Now I know pheo is treatable, although not cureable." The tumors may never go away, but for a third of patients, they won’t grow and might even shrink. Pacak and his team are still seeking other therapeutic options for patients with metastatic tumors who don’t respond to current treatments. Curiously, Pacak says patients with minimal symptoms often have an extensive, aggressive form of pheo that requires a different treatment than those with differentiated tumors and more symptoms.
At NICHD’s first worldwide conference last year, Kauffman met other patients, most of whom are enrolled in Pacak’s protocols, and learned that what he experienced was common. "When you have a rare disease, you think you’re alone. There are no local support groups for pheo." Instead, email contact with fellow patients across the country provides a lifeline on new information and advances. Kauffman said the care he and others receive at the CC provides "feeling of security, knowing there’s a place that deals with this problem on a routine basis."
For Kauffman, who was first a physician and then a patient, moderating a session at the conference about patient and family dynamics is his way of adapting to his condition and giving back to the pheo community and NIH. "I thank my lucky stars that I found NIH," Kauffman said.
(from left) NHLBI’s Eleni Footman; Steven Mosley; Ihsan Rogers of the CC Social Work Department; Althea Burey; Erika Fonseca; Emily Hershenson, also from SWD; NHLBI’s Nona Coles; Alexander Gibson; and Curtis Robinson work on the Team NIH banner for the Stomp Out Sickle Cell (SOS) Walk during a sickle cell support group meeting at the Clinical Center.
Rogers said that the CC sickle cell support group members’ enthusiasm for the SOS Walk spread to CC staff and motivated them to participate. "Patients want people to know what it’s like to live with sickle cell and how severely under-funded it is compared to other chronic illnesses. They also want to encourage genetic testing so people will know if they carry the sickle cell trait," Rogers said. |
CC respiratory therapist Kevin Cole meets Gabriel George, the Sickle Cell Disease Association of America’s 2007-2009 sickle cell poster child, at the organization’s 35th annual conference. The event, which was sponsored by NHLBI in September, focused on sharing information and building partnerships between medical, scientific, and public health professionals with the ultimate goals of finding a cure and improving the quality of life for patients living with sickle cell disease. |
Team NIH at the Stomp Out Sickle Cell Walk on Sept. 22 included: (front row, from left) Ijeuru Uzoma; Jim Nichols, head research nurse; Carole Tremonti, former CC nurse; Dr. Mark Gladwin, senior investigator with the CC’s Critical Care Medicine Department and the chief of NHLBI’s Vascular Medicine Branch, holding his son Rowan; Dietrich Ames; Darlene Allen, medical technologist, holding her granddaughter Kennedy; Ayana Rowley, ambulatory care and pharmacotherapeutics research fellow; Carissa Haney, CRNP; and Ihsan Rogers holding her daughters, Faith and Amirah Rogers. (back row, from left) Monica Tremonti; Tammy Gladwin, holding her son Brenden; Victor Doherty; Amy Chi, CCMD senior clinical research nurse; Annie Brown; Dr. James Taylor; Eleni Footman; Mary Hall, CCMD protocol manager; Chris Chi; and Sean Haney. |
On Saturday, Sept. 29, workers delivered the new cyclotron on three tractor trailers, attached it to the crane, and lowered the 28-ton machine into an access shaft that connects to the B-3 level. |
A 300-ton crane arrived at the CC to lift out the old cyclotron and lower the new one. |
The new cyclotron weighs about half as much as the old JSW-1710 machine and is computer-controlled rather than manually operated. It is identical to a machine installed in 2002 and complements the remaining large CS-30 cyclotron installed in 1985.
Staff conducted soil compression tests to ensure that the soil between the playground and the CC could support the weight of the crane and the trucks that would move the machines.
Functional genomics symposium
The fifth annual Symposium on the Functional Genomics of Critical Illness and Injury, "Forging a Critical Alliance: Are We Meeting the Need?" will be held at Natcher Conference Center on Nov. 14 and 15. The event will assemble multidisciplinary acute and critical care specialists, microbiologists, immunologists, cell biologists, molecular biologists, experts in high-throughput technologies, and computational scientists to discuss the application of functional genomic approaches to critical illness and injury. The Clinical Center’s Critical Care Medicine Department is one of the symposium’s sponsors, and CCMD’s Drs. Robert Danner and Anthony Suffredini served on the organizing committee. For more information, visit www.strategicresults.com/fg5.
The following new clinical research protocols were approved in September:
A Phase I Study of Sunitinib (SU11248), an Oral Multi-Targeted Tyrosine Kinase Inhibitor, in Children With Refractory Solid Tumors, 07-C-0220, Elizabeth Fox, MD, NCI
Pilot Trial of the NK1 Receptor Radio-Ligand [18F]SPA-RQ: Imaging Pancreatic Ductal Adenocarcinoma, 07-C-0222, Richard E. Royal, MD, NCI
Phase I and Pharmacokinetic Study of Vorinostat for Solid Tumors and Lymphomas in Patients With Varying Degrees of Hepatic Dysfunction, 07-C-0228, Shivaani Kummar, MD, NCI
A Phase II Study of Hypofractionated Highly Conformal Radiation With Helical Tomotherapy for Extra-Cranial Oligometastases, 07-C-0230, Deborah E. Citrin, MD, NCI
A Pilot Study of the Safety and Activity of Escalating Doses of ON 01910.Na in Patients with Myelodysplastic Syndrome (MDS), 07-H-0225, Aarthi G. Shenoy, MD, NHLBI
A Double-Blind, Randomized, Placebo-Controlled Cross-Over Study Assessing the role of Pathogen-Specific IgE and Histamine Release in the Hyper-IgE Syndrome and the Effect of Ranitidine on Laboratory and Clinical Manifestations, 07-I-0218, Steven M. Holland, MD, NIAID
Influenza in the Immunocompromised Host, 07-I-0229, Matthew J. Memoli, MD, NIAID
A Nutrigenomics Intervention for the Study of the Role of Dietary Sitosterol on Lipid, Glucose and Energy Metabolism, 07-DK-0219, Francesco S. Celi, MD, NIDDK
PET Imaging of Brain mGluR5 Receptors Using [18F]SP203, 07-M-0082, Amira K. Brown, PhD, NIMH
PET Imaging of Peripheral Benzodiazepine Receptors in Patients with Neurocysticercosis Using [C-11]PBR28, 07-M-0208,
PET Imaging of Peripheral Benzodiazepine Receptors in Patients with Neurocysticercosis Using [F-18]FBR, 07-M-0209,
Clinical Center Grand Rounds and Great Teachers Lectures
November 7, 2007
No Grand Rounds
Astute Clinician Lecture at Masur Auditorium, 3 p.m.
From the Rivers of Babylon to the Coronary Blood Stream
Barry S. Coller, M.D., David Rockefeller Professor of Medicine
Head, Laboratory of Blood and Vascular Biology, The Rockefeller University Hospital
For more information visit
www.cc.nih.gov/researchers/lectures/astuteclin07.shtml
November 14, 2007
Great Teachers
Contemporary Clinical Medicine: Great Teachers
Contemporary Management of Acute Coronary Syndromes
Eugene Braunwald, M.D.
Distinguished Hersey Professor of Medicine
Harvard Medical School
Chairman, TIMI Study Group, Brigham and Women’s Hospital
Lecture will be videocast, http://videocast.nih.gov
November 21, 2007
No Grand Rounds
November 28, 2007
TBA
John Barrett, M.D.
NHLBI
TBA
Katayoun Rezvani, M.D., Ph.D.
NHLBI
Clinical Center News, National
Institutes of Health, Building 10, 10 Center Drive, Room 12C440, Bethesda, MD 20892-1504. Tel: 301-496-6787.
Fax: 301-402-2984. Published monthly for CC employees
by the Office of Communications, Patient Recruitment, and Public Liaison. News, article ideas,
calendar events, letters, and photographs are welcome.
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This page last reviewed on 06/9/11
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