COOK COUNTY BUREAU OF HEALTH
SERVICES
GRANTS NEWSLETTER
Volume 6, Number 5 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~May,
1998
Back Issues
Published by
OFFICE OF RESEARCH DEVELOPMENT
Hektoen Building
627 South Wood Street
Chicago, IL 60612
FAX: 312-738-3102
Karen M. Smith, PhD, Director
312-633-4940
email: kmsmith@wwa.com
Bennetta Anderson, Administrative Assistant
312-633-4941
Lillian Hampton, IRB Administrator
312-633-7792
email: lhampton@hektoen.org
Funeka Sihlali, RN, Scientific Quality Coordinator
312-572-3506
email: fsihlali@hektoen.org
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COOK COUNTY BOARD
OF
COMMISSIONERS
John H. Stroger, Jr.,
President
|
Jerry
Butler
Allan C. Carr
Earlean Collins
John P. Daley
Gregg Goslin
Carl R. Hansen
Ted Lechowicz
Roberto Maldonado |
William R. Moran
Joseph Mario Moreno
Mike Quigley
Herbert T. Schumann, Jr.
Peter N. Silvestri
Deborah Sims
Bobbie L. Steele
Calvin R. Sutker |
COOK COUNTY BUREAU OF HEALTH
SERVICES
Ruth M. Rothstein, Chief
Affiliates
Ambulatory & Community Health Network
of Cook County
Cermak Health Services of Cook County
Cook County Department of Public Health
Cook County Hospital
Oak Forest Hospital of Cook County
Provident Hospital of Cook County
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GRANT PROFILE: QUALITY ASTHMA CARE IN AN EMERGENCY
DEPARTMENT OBSERVATION UNIT
Quality health care means achieving a balance among effective treatment,
efficiency in cost, and patient satisfaction. Health care systems which
emphasize one or another factor while disregarding the rest can be wasteful,
or ineffective, or insensitive to the needs of the patient. Obviously,
approaches to delivering care which demonstrably optimize all three factors
are highly desirable.
A study by investigators from Cook County Hospital's Emergency Medicine
Department has shown that a rapid diagnostic and treatment protocol in
the emergency department can achieve this balance for persons having severe
asthma attacks. The Observation Unit is a 20-bed facility staffed by nurses
and supervised by doctors, where patients undergo up to 12 hours of close
monitoring and treatment without being admitted to the hospital. About
98% of asthmatic patients treated this way could be discharged without
inpatient stays.
As an alternative to inpatient care, the Observation Unit was found
to cost, on average, $1,045 less per patient to treat, a 47% reduction.
Not only was the cost of treatment substantially less, but the relapse
rate after eight weeks was comparable between those who were hospitalized
and those who were treated in the Observation Unit. And finally, patients
who had been treated in the Observation Unit rated their quality of life
higher on 5 of 8 measurements: physical, emotional, social functioning,
mental health and vitality. Since patients were randomly assigned to either
inpatient care or Observation Unit care, these differences after treatment
may very well be related to their experiences while under medical care.
This research was funded in part by a grant from the federal Agency
for Health Care Policy and Research. These results were recently reported
in an article in Medical Care, with Robert J. Rydman, PhD, Co-Director
for Research in the Department of Emergency Medicine as the lead author.
The complete citation for this article is:
Rydman RJ, Isola ML, Roberts RR, Zalenski RJ, McDermott MF, Murphy DG,
McCarren MM, Kampe LM Emergency Department Observation Unit versus hospital
inpatient care for a chronic asthmatic population: a randomized trial of
health status outcome and cost. Med Care 1998 Apr;36(4):599-609
Here are some other recent publications by Cook County-affiliated investigators:
Akintorin SM, Kamat M, Pildes RS, Kling P, Andes S, Hill J, Pyati S:
A Prospective Randomized Trial of Feeding Methods in Very Low Birth Weight
Infants. Pediatrics 1997 Oct 1;100(4):E4
Ansell D, Schiff G, Dick S, Cwiak C, Wright K: Voting with their feet:
public hospitals, health reform, and patient choices. Am J Public Health
1998 Mar;88(3):439- 441
Freeman J, Loewe R, Benson J: Training family medicine faculty to teach
in underserved settings. Fam Med 1998 Mar; 30(3): 168-171
Gavagan T, Brodyaga L: Medical care for immigrants and refugees. Am
Fam Physician 1998 Mar 1;57(5):1061-1068
Gonzalez MH, Nikoleit J, Weinzweig N, Pulvirenti J: Upper extremity
infections in patients with the human immunodeficiency virus. J Hand Surg
Am 1998 Mar;23(2):348-352
Griffitt W, Glick RP, Lichtor T, Cohen EP: Survival and toxicity of
an allogeneic cytokine-secreting fibroblast vaccine in the central nervous
system. Neurosurgery 1998 Feb;42(2):335-340
Mason E, Rosene-Montella K, Powrie R : Medical problems during pregnancy.
Med Clin North Am 1998 Mar;82(2):249-269
McDermott SR, Scott KL, Frintner MP: Accessibility of cigarettes to
minors in suburban Cook County, Illinois. J Community Health 1998 Apr;23(2):153-160
Morales P, Rastogi A, Bez ML, Akintorin SM, Pyati S, Andes SM, Pildes
RS : Effect of dexamethasone therapy on the neonatal ductus arteriosus.
Pediatr Cardiol 1998 May;19(3):225-229
Mullai N, Khokha N, Shiomoto G: Case one. Bleomycin cutaneous toxicity.
J Clin Oncol 1998 Apr;16(4):1625
Schiff GD, Rucker TD: Computerized prescribing: building the electronic
infrastructure for better medication usage. JAMA 1998 Apr 1;279(13):1024-1029
Schwartz DN, Furumoto-Dawson A, Itokazu GS, Chinikamwala M, Levasseur
S, Weinstein RA: Preventing mismanagement of community- acquired pneumonia
at an urban public hospital: implications for institution-specific practice
guidelines. Chest 1998 Mar;113(3 Suppl):194S-198S
DO YOU HAVE A GRANT TO PROFILE? If you would like to see the
achievements of your grant-funded project profiled in this newsletter,
please send a 1 to 2 page summary, preferably on disk, to Karen Smith,
Hektoen 277, 627 S. Wood Street, Chicago, 60612.
NIH ANNOUNCES PROGRAM TO SUPPORT CLINICIAN-RESEARCHERS
Over the years, the National Institutes of Health has been criticized
for favoring basic biomedical research in its funding decisions, to the
detriment of proposals for clinically-oriented research. In 1995, a special
panel was appointed by Harold Varmus, Director of NIH, to study this widespread
perception, and to make recommendations about how to remedy the disparity
if it was found to exist.
In December, 1997, the panel submitted its report and recommendations,
which have now resulted in several new grant initiatives. While the panel
did not agree that clinical research was disproportionately underfunded,
it did recommend mandating more balanced composition of review groups and
new funding to train clinicians to do research.
The working definition of "clinical research" used by the panel was
in three parts:
(a) Patient-oriented research. Research conducted with human
subjects (or on material of human origin such as tissues, specimens and
cognitive phenomena) for which an investigator (or colleague) directly
interacts with human subjects. This area of research includes:
Mechanisms of human disease
Therapeutic interventions
Clinical trials.
Development of new technologies
(b) Epidemiologic and behavioral studies
(c) Outcomes research and health services research.
Excluded from this definition are in vitro studies that utilize human tissues
but do not deal directly with patients. In other words, clinical or patient-oriented
research is research in which it is necessary to know the identity of the
patients from whom the cells or tissues under study are derived.
Using this definition, the panel indexed all competing awards for FY
1996 according to the use of human subjects, classification as clinical
research and whether they fall into the subset of clinical trials. The
table below summarizes this data.
Category
# of Projects
Total dollars |
All Projects
10,493
$2,361,434,220 |
Human Subjects
3,665 (35%)
$1,139,061,717
(48%) |
Clinical Research
2,795 (27%)
$905,852,246 (38%) |
Clinical Trials
518 (5%)
$313,435,513 (13%) |
The panel also reported that the ratio of M.D. to Ph.D. applicants for
NIH support has progressively fallen over the past thirty years even though
success rates for the two types of applicants are similar. Importantly,
the absolute number of M.D. applicants has fallen further in the past three
years. Furthermore, M.D.s who fail to achieve fundable priority scores
from study sections following their initial applications are less likely
to reapply than Ph.Ds. The panel concluded that this represents a dispirited
attitude among M.D. faculty members that bodes ill for the future of academic
medicine and the public's health.
PANEL RECOMMENDATIONS
(A) Recommendations Concerning Data on and Review of Clinical Research
Recommendation #1. The NIH should continue to monitor and track the
percentage of NIH resources devoted to clinical research, as defined by
this Panel, and report these results annually to the Advisory Committee
to the NIH Director. The Panel views the current fraction of the extramural
portion of the NIH budget devoted to clinical research as reasonable at
the present time, although it should be subject to ongoing review and analysis.
In addition, however, based on the proliferation of rich opportunities
in medical research, the Panel strongly endorses efforts to increase the
NIH budget as a whole and believes that such overall increases should at
least include proportional increases for clinical research.
Recommendation #2. The NIH must ensure fair and effective reviews of
extramural grant applications for support of clinical research: panels
that review clinical research (a) must include experienced clinical investigators
and (b) at least 30-50% of the applications reviewed by these panels must
be for clinical research.
(B) Recommendations Concerning Training and Support for Clinical Investigators
Recommendation #3. The NIH should initiate training programs that will
enhance the attractiveness of careers in clinical research to medical students.
Recommendation #4. The NIH should improve the quality of training for
clinical researchers by requiring grantee organizations to provide formal
training experiences in clinical research and careful mentoring by experienced
clinical investigators.
Recommendation #5. The NIH should initiate substantial new support mechanisms
for young and mid-term clinical investigators, if possible in collaboration
with the private sector.
Recommendation #6. A loan repayment program for clinical investigators
should be instituted.
(C) Recommendations Concerning the General Clinical Research Centers
(GCRCs) and the Clinical Center
Recommendation #7. The scope of the GCRCs should be broadened to enhance
their leadership role in clinical research and research training and NIH
should significantly increase its financial support of these centers.
Recommendation #8. The NIH should continue to improve the quality of
clinical research and strengthen research management in the Warren Grant
Magnuson Clinical Center (CC) and extend the availability of its resources
and expertise, as well as those of the Institutes and Centers (ICs), to
extramural investigators.
(D) Recommendations Concerning Partnerships
Recommendation #9. The NIH should sustain a productive dialogue on enhancing
clinical research with its partners: the academic health centers, private
foundations, and the pharmaceutical and managed health care industries.
Recommendation #10. The NIH should expand efforts to educate the public
about the crucial importance of clinical research for the future health
of the nation.
NEW GRANT INITIATIVES
In response to the panel's recommendations, NIH has announced the availability
of several new special K award programs. These programs include:
* Clinical Research Curriculum Awards (K30, Grant Announcement RFA OD-98-007)
The NIH invites educational and research institutions to apply for the
new Clinical Research Curriculum Award (CRCA) (K30). The CRCA is an award
to institutions and addresses, in part, the NIH's initiative to improve
the quality of training in clinical research. This RFA is intended to stimulate
the inclusion of high-quality, multidisciplinary didactic training as part
of the career development of clinical investigators.
* Mentored Patient-Oriented Research Career Development Awards (K23,
Grant Announcement PA-98-052) The purpose of the Mentored Patient-oriented
Research Career Development Award (K23) is to support the career development
of investigators who have made a commitment to focus their research endeavors
on patient-oriented research. This mechanism provides support for a period
of supervised study and research for clinically trained professionals who
have the potential to develop into productive, clinical investigators focussing
on patient-oriented research.
* Midcareer Investigator Award In Patient- Oriented Research (K24, Grant
Announcement PA-98-053) The purpose of the Midcareer Investigator Award
in Patient-Oriented Research (K24) is to provide support for clinicians
to allow them protected time to devote to patient-oriented research and
to act as mentors for beginning clinical investigators. The target candidates
are outstanding clinical scientists engaged in patient-oriented research
who are within 15 years of their specialty training, who can demonstrate
the need for a period of intensive research focus as a means of enhancing
their clinical research careers, and who are committed to mentoring the
next generation of clinical investigators focussing on patient-oriented
research. The award is intended to further the research and mentoring endeavors
of outstanding patient-oriented investigators, enable them to expand their
potential to make significant contributions to their field of patient-oriented
research, and to act as mentors for beginning clinicians.
* New Clinical Associate Physician Award Guidelines (CAP) - The National
Center for Research Resources has consolidated the three career development
awards issued as competitive supplements to funded General Clinical Research
Centers into one Clinical Associate Physician (CAP) award. No new applications
for the Minority Clinical Associate Physician (MCAP) and Clinical Research
Scholar (CRS) will be accepted.
If you would like a copy of any of these grant announcements, or a copy
of the Executive Summary of the NIH panel's report, call Karen Smith at
312-633-4940. If you would like to see the entire report, go to:
http://www.nih.gov/news/crp/97report/index.htm
CALL FOR PAPERS: ORGANIZATION ETHICS IN HEALTH CARE
Papers for a conference to be held September 25-26 at the University
of Virginia are now being solicited. Topics in business, clinical or professional
ethics will be covered. Contact Patricia Werhane, PhD, Olsson Center for
Applied Ethics, UVA, Box 550 Darden, Charlottesville, VA 22906, phw2m@virginia.edu
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SEMINARS, CONFERENCES, WORKSHOPS, ETC
[A long-term calendar showing most of the major academic medical society
meetings can be found on the web at: http://www.aamc.org/meetings/mjmtgcal.htm]
Communicating Science will be held October 3-5 at Hamilton College in
Clinton, NY. Call 315-859-4716 for more information.
Women as Research Subjects is a workshop cosponsored by OPRR and UCLA.
It will be held July 30-31 in Santa Monica. For more information, call
310-825-8714.
Pressure Points in Human Subjects Research, cosponsored by OPRR, the
FDA and the University of Rochester, this workshop will be offered August
6-7 in Rochester, NY. For more information call 716-275-4111.
Management of Biomedical Research Laboratories, sponsored by the University
of Arizona, and the Office of Research Integrity, will be offered October
1-3, in Tucson. Call 520-626-9060 for more information.
Office of Research Development Workshops
These workshops are open to any County-affiliated investigator or grant-seeker.
Enrollment for some sessions is limited, so please register only for those
you will be able to attend.
Grant Writing Seminar:
Gives an overview of the entire process of developing a project
and applying for funding. Includes information on approaching both governmental
and private funders, describes an approach to developing grant budgets,
discusses stylistic and content issues that are frequent stumbling blocks
in writing grant applications.
Constructing a Grant Budget:
Covers many of the technical aspects of developing an accurate
time line and budget for a grant proposal.
What Are All These Forms? Interacting With the Scientific Committee:
Gives an orientation to procedures -- and the associated forms
-- used by the Scientific Committee to
ensure that patients are protected from undue risks in research. The
Bureau forms will be discussed, and new policies and changes in federal
regulations will be covered.
To register for any of these, call Bennetta Anderson at 312-633-4941.
If you would like to schedule one or more of these workshops in your Department
or at another site, please call Karen Smith at 633-4940.
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FUNDING OPPORTUNITIES
National Institutes of Health:
All NIH announcements from the past several years, including full
text versions of RFA's and PA's, can be reached on the web at: http://grants.nih.gov/grants/guide/index.html
To have the NIH Guide sent automatically to your e-mail address every
week, click on the LISTSERV link on this page and follow the instructions.
To ask specific questions about NIH grant programs, send e-mail to:
grantsinfo@nih.gov
NIH RFA'S AND RFP'S:
These are one time only opportunities. Call 312-633-4940 to check
for due dates or to get copies of full announcements
INTERNATIONAL COLLABORATIONS IN INFECTIOUS DISEASE RESEARCH (RFA AI-98-009)
National Institute of Allergy and Infectious Diseases
ACTIONS FOR BUILDING CAPACITY IN SUPPORT OF ICIDR PROGRAM (RFA TW-98-004)
Fogarty International Center
ADVANCED TECHNOLOGY RADIATION THERAPY CLINICAL TRIALS SUPPORT
(RFA CA-98-006) National Cancer Institute
HYPERACCELERATED AWARD/MECHANISMS IN IMMUNE DISEASE TRIALS (RFA AI-98-006)
National Institute of Allergy and Infectious Disease,s National Institute
of Arthritis and Musculoskeletal and Skin Diseases, National Institute
of Diabetes and Digestive and Kidney Diseases, National Heart, Lung and
Blood Institute, National Institute of Neurological Disorders and Stroke,
Office of Research on Women's Health
REGIONAL VARIATION IN BREAST CANCER RATES IN THE U.S. (RFA CA-98-017)
National Cancer Institute, National Institute of Environmental Health Sciences
CARDIOVASCULAR COMPLICATIONS FROM COCAINE ABUSE IN HIV INFECTION (RFA
HL-98-012) National Heart, Lung, and Blood Institute, National Institute
on Drug Abuse
STUDY OF SLOW, LATENT AND TEMPERATE VIRUS INFECTIONS OF THE NERVOUS
SYSTEM CAUSED BY CONVENTIONAL AND UNCONVENTIONAL VIRUSES; AND, MAINTENANCE
OF A BREEDING COLONY OF RHESUS MONKEYS FOR INTRAMURAL RESEARCH (RFP NIH-NINDS-98-10)
National Institute of Neurological Disorders and Stroke
COOPERATIVE CLINICAL TRIAL: PEDIATRIC RENAL TRANSPLANTATION (RFA AI-98-012)
National Institute of Allergy and Infectious Diseases
COMMUNITY CLINICAL ONCOLOGY PROGRAM (RFA CA-98-020) National Cancer
Institute
AUTOIMMUNITY CENTERS OF EXCELLENCE (RFA AI-98-010) National Institute
of Allergy and Infectious Diseases,
National Institute of Diabetes and Digestive and Kidney Diseases, National
Institute of Arthritis and Musculoskeletal and Skin Diseases, Office of
Research on Women's Health
HEALTH COMMUNICATIONS IN CANCER CONTROL (RFA CA-98-014) National Cancer
Institute
ENVIRONMENTAL JUSTICE: PARTNERSHIPS FOR COMMUNICATION (RFA ES-98-006)
National Institute of Environmental Health
STRUCTURE-FUNCTION RELATIONSHIPS OF ENVIRONMENTALLY RELEVANT GENETIC
VARIANTS (RFA ES-98-007) National Institute of Environmental Health Sciences,
National Institute on Aging
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NIH PROGRAM ANNOUNCEMENTS
(PA'S): These are ongoing funding priorities, with due dates usually
October 1, February 1 and June 1 of each year. Note that HIV-related applications
are due January 2, May 1 and September. Past PA's, many of which are still
open, can be searched at the NIH
Guide web site.
SMALL BUSINESS INNOVATION RESEARCH ADVANCED TECHNOLOGY: NIAID (SBIR-AT-NIAID)
(PAR-98-073) National Institute of Allergy and Infectious Diseases
INNOVATION GRANT PROGRAM: APPROACHES IN HIV VACCINE RESEARCH (PA-98-075)
National Institute of Allergy and Infectious Disease
BEHAVIOR GENETICS IN ADULTHOOD AND OLD AGE (PAS-98-076) National Institute
on Aging, National Institute of Mental Health
INNOVATIVE TECHNOLOGIES FOR THE MOLECULAR ANALYSIS OF CANCER: SBIR/STTR
INITIATIVE (PAR-98-066) National Cancer Institute
INNOVATIVE TECHNOLOGIES FOR THE MOLECULAR ANALYSIS OF CANCER: PHASED
INNOVATION AWARD (PAR-98-067) National Cancer Institute
NIDDK MENTORED RESEARCH SCIENTIST DEVELOPMENT AWARD (PAR-98-065)
National Institute of Diabetes and Digestive and Kidney Diseases
ENGINEERED ISOGENIC CELL LINES WITH RELEVANT CANCER TARGETS (PAR-98-068)
National Cancer Institute
CANCER PHARMACOLOGY AND TREATMENT IN OLDER PATIENTS (PA-98-069) National
Institute on Aging, National Cancer Institute
RESEARCH ON MICROBIAL BIOFILMS (PA-98-070) National Institute of Dental
Research, National Institute of Allergy and Infectious Diseases, National
Institute on Deafness and Other Communication Disorders, National Institute
of Arthritis and Musculoskeletal and Skin Diseases, National Institute
of General Medical Sciences, National Heart, Lung, and Blood Institute,
National Institute of Diabetes and Digestive and Kidney Diseases, Office
of Research on Women's Health
SMALL GRANTS IN DIGESTIVE AND NUTRITIONAL DISORDERS (PAR-98-071) National
Institute of Diabetes and Digestive and Kidney Diseases
RESEARCH SCHOLAR DEVELOPMENT AWARD (PAR-98-072) National Institute of
Allergy and Infectious Diseases
OTHER OPPORTUNITIES
July 10
REFUGEE RESETTLEMENT: COMMUNITY AND FAMILY STRENGTHENING, Administration
for Children and Families (202-401-1196)
June 19
COMMUNITY FOOD PROJECTS, US Department of Agriculture (202-401-1898)
August 1
DEAFNESS AND HEARING DISORDERS, American hearing Research Foundation
(312-726-9670)
August 15
CHILD WELFARE, American Legion Child Welfare Foundation ( http://www.legion.org/cwf.htm)
July 13
FOOD SAFETY RESEARCH, Food and Drug Administration (202-205-5053)
October 28
AIRBORNE PARTICULATE MATTER, Environmental Protection Agency (800-490-9194)
July 28
FACULTY DEVELOPMENT PROGRAM: SUBSTANCE ABUSE PREVENTION, Substance
Abuse and Mental Health Services Administration (301-443-5266, refer to
CFDA 93.274)
July 23
HEALTHCARE WORKER GLOVE PROTECTION EVALUATION, Centers for Disease
Control (404-639-1534, or http://www.cdc.gov.
Refer to announcement 98090)
August 15, December 15 and March 15
CANCER RESEARCG, Damon Runton-Walter Winchell Foundation (212-697-4950,
or http://www.cancerresearchfund.org)
June 30
VIOLENCE AGAINST WOMEN, Centers for Disease Control (404-842-6796,
or http://www.cdc.gov. Refer to
announcement 98036)
August 1
RESIDENT RESEARCH SCHOLARSHIPS, American College of Surgeons (312-202-5000)
December 15
SUICIDE RESEARCH, American Foundation for Suicide Prevention (212-363-3500,
or http://www.afsp.org)
July 1, November 1, and March 1
RESEARCH TRAVEL GRANTS, Burroughs Wellcome Fund (919-991-5100, or http://www.bwfund.org)
June 29
ANTIMICROBIAL RESISTANCE, Centers for Disease Control (404-639-2603,
or http://www.cdc.gov. Refer to
announcement 98039)
June 25
MINING OCCUPATIONAL SAFETY AND HEALTH RESEARCH , Centers for Disease
Control (404-639-3343, or http://www.cdc.gov.
Refer to announcement 98056)
June 26
SUSAN HARWOOD TRAINING GRANTS IN WORKPLACE SAFETY AND HEALTH, Occupational
Safety and Health Administration (847-297-4810)
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