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.

The 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 centers.

This past year, many other members of the University's medical and nursing faculties received significant awards to support their work.

• 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 investigation projects.

• 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 growth.

• 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 undergraduate curriculum.

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.


Patient-Centered Care

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 Hospital Association.

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 inject--insulin.

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.
 

A 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.

A Challenging Environment

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.