PROMISING ERA IN MEDICINE
In 2001, the centennial of both the University Hospital and the
School of Nursing provided the opportunity to take stock of advances
in medical science and health care over the past 100 years. Never
in human history have scientists been confronted with such clear
evidence of the daunting complexity of human biology, but never
have they had such sophisticated tools at their disposal as they
promote the flow of new discoveries from the laboratory to the bedside.
In the University Health System, medical researchers have harnessed
these resources by creating multidisciplinary teams of basic and
clinical scientists who focus on specific diseases, organs, and
systems. This approach draws on the strengths of our basic science
departments, three of which--microbiology (second), cell biology
(eleventh), and molecular physiology and biological physics (eleventh)--ranked
among the top fifteen in funding from the National Institutes of
Health in 2000.
stature of these programs was demonstrated this fall when the School
of Medicine received a $38 million grant, one of the largest in
its history, to support the study of cell movement. Cell migration
plays many positive and negative roles in the body, from enabling
white blood cells to attack bacteria and viruses to allowing malignant
cells to spread via the blood. Learning more about this basic cellular
mechanism will be critical to understanding diseases such as cancer,
arthritis, and osteoporosis, as well as wound repair, embryonic
development, and tissue engineering.
Awarded by the National Institute of General Medical Science, part
of the National Institutes of Health, and called a Glue grant because
it brings a large group of scientists together to tackle a major
problem, the funding will support a five-year, multidisciplinary
program involving eleven institutions. Alan F. "Rick"
Horwitz, professor of cell biology, and J. Thomas Parsons, chairman
of the Department of Microbiology, are co-principal investigators
for the consortium, which includes leading researchers at Harvard
University, the Massachusetts Institute of Technology, The Johns
Hopkins University, and Northwestern University, among other medical
This past year, many other members of the University's medical
and nursing faculties received significant awards to support their
James R. Brookeman, professor of radiology and biomedical engineering,
and John P. Mugler III, associate professor of radiology and biomedical
engineering, received a $3.7 million grant from the Commonwealth
Technology Research Fund and Nycomed Amersham Imaging to continue
pioneering work on magnetic resonance imaging using hyperpolarized
noble gases. The procedure can detect subtle changes in the lung
that are not revealed by other imaging techniques.
A team of researchers led by Dr. Jerry L. Nadler received a five-year,
$9.3 million grant from the National Heart, Lung and Blood Institute
of the National Institutes of Health to study the link between diabetes
and heart disease. Diabetics are up to four times more likely than
others to develop heart problems.
Pediatric physicians just entering practice at the University can
extend their research training, thanks to a $1.7 million Child Health
Research Career Development Award from the National Institutes of
Health. The award is designed to enhance the research capabilities
of junior faculty members by allowing them to spend more time on
With a $1.1 million grant from the Fogarty International Center
of the NIH, scientists from China and India will receive training
at the University in such areas as gene cloning and protein sequencing.
The grant also enables faculty from the University to conduct workshops
and deliver lectures at universities in these two countries and
to establish collaborative research programs to study population
The NIH awarded two five-year grants totaling almost $4.2 million
to the School of Nursing's Center for the Study of Complementary
and Alternative Therapies. The purpose of these awards is to train
nurses and other health care providers to design and conduct clinical
research on novel treatments, such as herbal remedies, therapeutic
touch, and magnet therapy.
Across the Health System, basic medical science is pointing the
way to new approaches in clinical care. In microbiology, researchers
Sarah J. Parsons and Michael J. Weber are both working to understand
the events that make prostate cancer cells grow, even when the normal
growth signals are absent. Their goal is to find ways to prevent
slow-growing tumors from becoming malignant. At the Beirne B. Carter
Center for Immunological Research, Young Hahn led a team that discovered
how the hepatitis C virus undermines the immune system. Their work
sets the stage for the development of new vaccines and treatments.
Other researchers provide the groundwork for this translational
research, uncovering key cellular processes that underlie all efforts
to find new cures and treatments. C. David Allis, the Harry F. Byrd,
Jr., Professor of Biochemistry and Molecular Genetics, is one of
the premier researchers in the world who is breaking the code that
explains gene expression. Mr. Allis studies how proteins called
histones, around which DNA is coiled, form a structure called chromatin
and appear to provide a master switch for turning genes on and off.
"Our research is attempting to understand what we have referred
to as a 'histone code'--how chemical changes affecting
the histone proteins affect gene expression--and could eventually
lead to the development of highly targeted and highly effective
therapies for disease control through gene regulation," Mr.
Allis explains. "For example, we could turn off genes that
promote tumor growth to help prevent cancer development, and turn
on other genes that suppress tumors."
Extending the Reach of the Classroom
In U.S. News & World Report's survey of the top fifty medical
schools, the University's School of Medicine placed twenty-eighth
in research and twenty-eighth in primary care. The school continues
to strive for improvement and innovation. This year, first-year
medical students took a curriculum that had been substantially reorganized
to include a course on the practice of medicine, revamped science
courses, and hands-on experience making diagnoses with standardized
patients, volunteers who have been trained to mimic the symptoms
of different illnesses. In the School of Nursing, a new subspecialty
in advanced practice nursing--wound, ostomy, and continence
nursing--was added to its graduate curriculum. Additionally,
the Nursing School will use a $75,000 grant from the Helene Fuld
Health Trust to integrate leadership development into the school's
Both schools also increased the use of information technology in
teaching, a new emphasis that is being supported by improvements
to the Claude Moore Health Sciences Library. With the completion
of the third phase of a $5.5 million renovation and expansion project,
the library has been able to increase computer access to online
resources and provide more group study space.
The University Medical Center maximizes its ability to deliver care
by providing treatment in convenient, multidisciplinary centers
and clinics that are designed to meet patients' particular
needs. The results of a number of nationwide surveys this year show
the merits of this approach:
U.S. News & World Report's 2001 issue on "America's
Best Hospitals" judged eight medical specialties at the University
Medical Center among the finest of their kind in the nation.
The Medical Center was ranked for the third year in a row as a Top-100
hospital in the country by Solucient, a health information and benchmarking
company. This ranking recognizes hospitals' quality of care,
efficiency of operations, and sustainability of overall performance.
In two other benchmarking studies, the same organization named the
Medical Center among the nation's top 100 orthopedic hospitals
and top 100 intensive care units.
Forty-two doctors from the University were listed in the 2001 edition
of America's Top Doctors.
The University Health System was named one of the nation's
100 Most Wired hospitals and health care systems in the July 2001
issue of Hospitals & Health Networks, the journal of the American
The University Medical Center is often among the first to offer
the latest medical advances from laboratories at the University
and around the world. An example is the Division of Pediatric Endocrinology.
Under the direction of Dr. William L. Clarke, it is one of only
twenty research centers in the nation that is testing a new device
used by diabetic children in which they inhale--rather than
The University is also leading the way in the development of anticancer
vaccines. A vaccine for melanoma, a potentially deadly form of skin
cancer, is in Phase II clinical trials at the University. This groundbreaking
work is the result of an interdisciplinary collaboration involving
surgical oncologist Dr. Craig L. Slingluff, Jr., microbiologist
Victor H. Engelhard, and chemist Donald F. Hunt. Also promising
is a vaccine developed by Dr. William P. Irvin, associate professor
of clinical obstetrics and gynecology, to prolong remission in women
who have completed treatment for ovarian cancer. Tests of the vaccine
are expected to begin this fall.
Century of Care
This was the centennial year for both the University Hospital
and the School of Nursing. Since 1901, the hospital has grown
from 150 beds to 541 and now accommodates nearly 28,000 patient
admissions and well over 500,000 outpatient visits annually.
The School of Nursing, created in 1901 to supply qualified
nurses to the new hospital, is now ranked in the top 9 percent
by U.S. News & World Report, offers master's, doctoral,
and nurse practitioner programs in addition to the baccalaureate
degree, and is home to a well-rounded research effort in fields
such as HIV, rheumatoid arthritis, alternative therapies,
and the history of health care.
Changes in health care funding, the aging population, and the increased
cost of new medical procedures over the last decade have placed
great pressures on academic medical centers, and it is unlikely
that this situation will be resolved soon. The University Medical
Center is rare among its peers in that its costs currently do not
exceed its revenues. In response to these and other issues, the
University has taken a number of steps. R. Edward Howell has been
appointed vice president and CEO of the Medical Center and will
assume overall management responsibility for operation of our hospitals
and clinics in February 2002. In addition, the University is merging
the positions of the dean of medicine and the vice president and
provost for the Health System into a single position to oversee
academic quality, planning, and medical school finance.
Other management innovations include adapting parts of the Six Sigma
quality program developed by Motorola and General Electric, integrating
central business systems, and implementing more flexible scheduling
and compensation for nurses, enabling the Medical Center to make
considerable progress in addressing staffing issues.
In response to recent incidents in the hospital's psychiatric
unit, the University has redoubled its efforts to ensure patient
safety and to uphold the highest standards in every area of the
Medical Center. The scrutiny from inspection agencies prompted by
these episodes has revealed a relatively small number of deficiencies,
but we are taking them seriously, and we are moving quickly and
resolutely to address them. There should be no doubt in the minds
of our patients that the University and its Medical Center can be
entrusted with their care.