>> HELLO, EVERYBODY.
IT'S GOOD TO SEE ALL OF YOU, WE
ARE A MIX OF SOME LONG STANDING
FOLKS HERE AND SOME NEW MEMBERS
MORE ON THAT IN JUST A FEW
MINUTES.
I'M LAURA FORESE, I'M THE CHAIR
OF THIS BOARD AND DELIGHTED TO
SEE ALL OF YOU.
WE ARE VERY EXCITED BY THE
PROSPECT THAT OUR JULY MEETING
WILL BE IN PERSON SO EVERYBODY
KEEP YOUR FINGERS CROSSED ON
THAT 1.
WE'VE NOT BEEN ABLE TO GATHER AT
THE CAMPUS LO THESE MANY
MULTIPLE YEARS NOW SO IT WOULD
BE TERRIFIC PARTICULARLY AS WE
HAVE SOME NEW MEMBERS.
I'M GOING TO TURN IT OVER TO
LARRY IN HIS ROLL AS ACTING
DIRECTOR IN DR. TAWAK IN JUST A
MOMENT.
I ALSO WANT TO WELCOME DR. TARA
SCHWETZ, AS ACTING DEPUTY
DIRECTOR, AND SHE WILL BE WITH
US FOR PART OF THE MEETING AND
THEN AS SHE--NEW ROLE SINCE
WE'VE ALL BEEN TOGETHER LAST.
THE ONLY BOARD MEMBER WHO
COULDN'T MAKE IT TODAY WAS
DR. JULIE [INDISCERNIBLE] SO WE
HAVE A QUORUM AS I SAID AND
WE'VE BEEN WORKING ON THE
MEMBERSHIP OVER THE LAST COUPLE
OF MONTHS, I WOULD SAY, JIM,
TARA, LARRY AND MYSELF AND THE
FIRST THING WE HAVE TO DO IS
THAT WE'RE GOING TO SAY GOODBYE
AFTER THIS MEETING TO OUR LONG
STANDING MEMBER ELEN BERG WHO'S
BEEN WITH US THE ENTIRE 6 YEARS,
FOR ANYBODY WHO'S NEW TO ELEN
YOU MUST NOW PICK UP THE MANTEL
OF THIS FABULOUS COSTUMES AND
ELEN DO YOU WANT TO UNMUTE AND
SAY A FEW WORDS, WE ARE SURE
GOING TO MISS YOU.
YOU'VE BEEN A WONDERFUL BOARD
MEMBER.
>> S WHY, I WOULD LIKE TO SAY
THAT I HAVE TRULY ENJOYED AND
LEARNED SO MUCH FROM BEING A
MEMBER OF GROUP AND I WANT TO
SAY ON BEHALF OF PATIENTS
EVERYWHERE IN THE WORLD, THANK
YOU, EACH 1 OF YOU FOR ALL YOU
DO.
THANK YOU.
>> THANK YOU SO MUCH.
THANK YOU SO MUCH ELLEN, YOU
HAVE
BEEN A STALWART--RUTH
BRINKLEY AND RICK AND I ARE ALSO
GOING TO BE LEAVING THE BOARD
THIS YEAR, ALSO MEMBERS FROM THE
VERY BEGINNING.
WE WILL STAGGER THAT A LITTLE
BIT SO THAT WE WILL BE ABLE TO
DO A SMOOTH TRANSITION AND IT
LOOKS LIKE RICK AND I WILL BE
HERE FOR THE JULY MEETING AGAIN,
HOPEFULLY IN PERSON.
ONE OTHER NOTE IN TERMS OF
MEMBERSHIP, BILL HEIGHT LET US
KNOW THAT UNFORTUNATELY HE WAS
GOING TO NEED TO WITHDRAW DUE TO
SOME OTHER COMMITMENTS SO WE
THANK HIM.
I GOT A CHANCE TO SPEAK TO HIM
JUST A LITTLE WHILE AGO AND I
KNOW HE ALSO APPRECIATED THE
SERVICE.
SO WITH THAT, AGAIN, I WANT TO
WELCOME ALL OF OUR NEW MEMBERS
AS WELL AS ALL OF OUR ONGOING
MEMBERS.
WE'RE EXCITED ABOUT EVERYTHING
THAT'S TO COME.
YOU'VE SEEN THE AGENDA.
WE WILL HEAR ABOUT A NUMBER OF
EXCITING THINGS, SOME OF WHICH
IS NEW AND SOME OF WHICH IS A
CONTINUATION OF WHAT WE'VE BEEN
DOING AND WITH THAT, LARRY, I
WILL TURN IT OVER TO YOU.
THANK YOU.
>> GREAT.
THANK YOU SO MUCH LAURA AND GOOD
MORNING TO ALL OF YOU.
SO AS LAURA MENTIONED, THE LAST
TIME I SPOKE TO YOU BACK IN JULY
OF 21, I WAS SERVING AS THE
PRINCIPAL DEPUTY DIRECTOR OF NIH
AND I WAS FILLING IN FOR FRANCIS
WHO WAS UNABLE TO ATTEND.
SO NOW AS YOU'VE HEARD, FAST
FORWARD, TODAY I'M HERE IN THIS
NEW ROLE AS ACTING DIRECTOR OF
NIH BUT MY ROLE WILL BE PRETTY
MUCH THE SAME.
I'M JUST GOING TO GIVE YOU A
QUICK UPDATE ON NIH AND A FEW OF
ITS ACTIVITIES.
BUT FIRST, I ALSO WANT TO THANK
ELLEN.
YOU KNOW, AS I FOUNDING MEMBER
AND AS A FORMER NIH RESEARCH
PARTICIPANT, REALLY, YOU HAVE
PROVIDED US WITH SUCH IMPORTANT
INSIGHT OVER THESE YEARS AND I
JUST--WE REALLY OWE YOU A DEBT
OF GRATITUDE SO PERSONALLY I
WANT TO EXTEND MY THANKS AND I
KNOW THAT FRANCIS WOULD ALSO
LIKE TO SEND THOSE THANKS TO YOU
AS WELL.
SO ELLEXER EN, THANK YOU SO VERY
MUCH.
>> YOU'RE VERY WELCOME.
>> WE DO HAVE AS LAURA
MENTIONED, NEW MEMBERS OF THE
BOARD AND I'M GOING TO INTRODUCE
THEM AND I BELIEVE 3 OF THE 4
HAVE BEEN ABLE TO JOIN US.
THE FIRST DR. CRAIG SAMUT,
MANAGING DIRECTOR OF ITO
ADVISORS WHICH IS A HEALTHCARE
ADVISORY AND INVESTMENT FIRM.
CRAIG IS A NATIONALLY RECOGNIZED
THOUGHT LEADER ON INDUSTRY
TRANSFORMATION, CARE DELIVERY
AND HEALTHCARE POLICY, SO CRAIG,
WELCOME, THANK YOU SO MUCH FOR
BEING WITH US.
DR. DAVID CHIN, DIRECTOR OF
EXECUTIVE EDUCATION AND
CO-DIRECTOR OF THE MPH MBA
PROGRAM AT THE HOPKINS BLOOMBERG
SCHOOL OF PUBLIC HEALTH.
DAVID IS ALSO CHAIRS THE BOARD
OF THE NATIONAL COMMITTEE FOR
QUALITY ASSURANCE.
SO DAVID, WELCOME.
THANK YOU SO MUCH FOR DOING
THIS, WE HAVE 2 PATIENT
REPRESENTATIVES.
ANTWON ETICS ROYSTER IS WITH US
TODAY, SHE'S A CIVIC MINDED
ACTIVIST BORN AND RAISED IN
WASHINGTON D. C. AND LIVES IN
ALLEGEHENY COUNT
NEUROECTODERMAL, MARYLAND.
ANTOINETTE IS--WELCOME AND THANK
YOU SO MUCH FOR BEING WILLING TO
DO THIS.
OUR FINAL MEMBER, ALSO A PATIENT
REPRESENTATIVE IS DAVID
[INDISCERNIBLE] ON WHO
UNFORTUNATELY IS NOT ABLE TO BE
WITH US, I WAS TOLD EMPLOY SO AT
THE NEXT MEETING WE WILL GIVE
HIM A PROPER INTRODUCTION BUT
JUST FOR ALL OF YOUR AWARENESS,
HE IS MANAGING DIRECTOR OF THE
QX GROUP, HE HAS EXTENSIVE
PUBLIC AND PRIVATE SECTOR
EXPERIENCE WITH INNOVATIST
TECHNOLOGY AND CROSS FUNCTIONAL
TEAMS TO ACHIEVE MISSION
REQUIREMENTS.
AND SO, I'M SURE YOU WILL ALL
AGREE JUST BY LISTENING TO THESE
VERY, VERY BRIEF BIOS OF THESE
VERY ACCOMPLISHED PEOPLE THAT WE
ARE VERY FORTUNATE TO HAVE ALL
OF THEM COME TO SERVE ON THE
BOARD AND TO PROVIDE US WITH
THEIR UNIQUE INSIGHTS.
YES, ELLEN,.
>> ANTOINETTE, I WOULD LIKE TO
SAY, I WILL BE WILLING TO LOAN
YOU ANY COSTUME ACCESSORYS YOU
MIGHT BE NEEDING.
>> [LAUGHTER]
>> THANKS, ELLEN.
>> OKAY.
WELL, WE LOOK FORWARD TO THAT
JULY MEETING NOW, ANTOINETTE, WE
CAN'T WAIT.
[LAUGHTER]
SO LET ME JUST COVER A FEW
THINGS.
SO WE ARE NOW IN A TRANSITION
PERIOD IN TERMS OF LEADERSHIP AT
NIH AND OF COURSE FOR MANY OF
YOU, YOU HAVE NEVER EXPERIENCED
THIS BEFORE BECAUSE FRANCIS'
TENURE AS NIH DIRECTOR SPANNED
12 YEARS WHICH WAS
UNPRECEDENTED.
MULTIPLE ADMINISTRATIONS AND SO,
YOU WOKE UP EVERY DAY KNOWING
THAT FRANCIS WAS THE NIH LEADER
AND THEN THIS DECISION OF HIS TO
STEP BACK SEEMINGLY ONLY FOR A
FEW WEEKS TO HIS LABORATORY
BECAUSE HE IS NOW THE ACTING
SCIENCE ADVISOR TO THE
PRESIDENT.
IT IS ALSO UNIQUE IN THAT WE ARE
COMING UP TOWARDS MIDTERM
ELECTIONS AND THAT ALWAYS ADDS A
LITTLE INTRIGUE AND FRANKLY SOME
UNCERTAINTY, PARTICULARLY VIS A
VIS THE BUDGETARY PROCESS, AND I
THINK THAT, YOU KNOW THOSE OF US
WHO HAVE BEEN HERE LONGER THAN
THE 12 YEARS OF FRANCIS' TENURE,
KNOW THAT EVERYTHING WILL BE
FINE.
WE WILL ORDERLY, SEE THE
APPOINTMENT OF A NEW PERMANENT
NIH DIRECTOR IN DUE COURSE AND
HE OR SHE WILL INHERIT A
SPECTACULAR LEADERSHIP TERM WHO
WILL WORK VERY CLOSELY WITH THEM
AS THEY BEGIN TO THINK THROUGH
THEIR OWN NEW PERSPECTIVE, NEW
AGENDA AND OBVIOUSLY, WE AT NIH
LOOK FORWARD TO THAT, FOR THE
NEW MEMBERS OF THE BOARD WHO MAY
NOT BE AS FAMILIAR WITH THIS AS
OTHERS, WHAT THIS ENTAILS IS A
NOMINATION BY THE PRESIDENT TO
THE SENATE AND THEN THE SENATE
NEEDS TO HAVE A CONFIRMATION
PROCESS FOR THE NIH DIRECTOR
POSITION.
SO IT IS A PRESIDENTIAL
APPOINTEE WITH SENATE
CONFIRMATION.
THE TIMING TONY FAUCI SAID TO
ME, ANYONE WHO TELLS YOU THEY
KNOW, DOESN'T.
IT'S THE SORT OF THING THAT YOU
JUST HAVE TO LET THE PROCESS
WORK ITSELF THROUGH AND YOU KNOW
I AM VERY CONFIDENT THAT THE
PRESIDENT WILL NOMINATE A
SPECTACULAR CANDIDATE AND
HOPEFULLY THE SENATE WILL IN
VERY DUE COURSE CONFIRM HIS
NOMINEE.
AGAIN AS LAURA ALLUDED TO DURING
THIS INTERIM PERIOD, I AM
REALLY, REALLY FORTUNATE TO HAVE
3 SPECTACULAR LEADERS WHO HAVE
STEPPED INTO ACTING ROLES,
DR. TARA SCHWETZ, WHO IS WITH US
ON THE CALL NOW, TARA WAS ON
DETAIL TO ASTP WHERE SHE WAS
ARCHITECTING WHAT HAS BECOME
ARPA-H.
AND I WAS VERY FORTUNATE TO HAVE
HER COME BACK.
I'M NOT SURE HOW SHE FEELS ABOUT
IT BUT THIS IS REALLY BEEN AN
ENORMOUS HELP TO ME BEING ABLE
TO COUNT ON TARA FOR ALL MATTER
OF THINGS.
IN TURN, DR. COURTNEY ACKLAND
WHO WILL BE JOINING YOU LATER IN
THE DAY--CARRY WOLLENETZ, WHO IS
THE HEAD OF SCIENCE POLICY IS ON
DETAIL TO OSTP AND SO DR. LYRIC
JOGGERRENSON IS ACTING DIRECTOR
OF THE OFFICE OF SCIENCE POLICY,
SO AGAIN, I AM VERY GRATEFUL TO
THESE 3 LEADERS AND THEY ARE
MAKING MY LIFE A WHOLE LOT
EASIER.
ONE MORE APPOINTMENT TO NOTE AND
THAT IS ON MARCH 1st, THE
FOUNDATION FOR NIH, THE FNIH
ANNOUNCED THE APPOINTMENT OF
FORMER CDC DIRECTOR AND MERK
EXECUTIVE DR. JULIE
[INDISCERNIBLE] AS ITS NEXT
CHIEF EXECUTIVE OFFICER.
JULIE HAS ALREADY ASSUMED A
BOARD ROLE WITH THE FOUNDATION
BUT SHE WILL NOT BECOME THE CEO
OFFICIALLY OF THE FOUNDATION
UNTIL MAY 16th AS SHE FINISHES
UP SOME OBLIGATIONS IN HER
CURRENT ROLE.
SO WE'RE LOOKING FORWARD TO
BEING ABLE TO WORK WITH THE
DOCTOR.
A NUMBER OF US HAVE WORKED WITH
HER IN THE PAST AND HER PREVIOUS
GOVERNMENTAL SERVICE ROLES AND
SO, OBVIOUSLY WE ARE CERTAINLY
LOOKING FORWARD TO THAT.
FUNDING, LOTS GOING ON, WE HAD
THIS FASCINATING NEXUS OF BEING
FORTUNATE TO GET THE FY22 BUDGET
IN THE FORM OF AN OMNIBUS OF NOT
TOO LONG AGO AND THEN VERY
SHORTLY THEREAFTER, THE RELEASE
OF THE PRESIDENT'S PROPOSED FY23
BUDGET.
AND WHEN THESE THINGS COME CLOSE
TO 1 ANOTHER, IT CAN LEAD TO A
LITTLE CONFUSION, BUT WE ARE
FIRST, IN TERMS OF THE FY22
BUDGET WHICH WE NOW HAVE, AS IT
HAS PASSED TO CONGRESS, WE ARE
EXTREMELY GRATEFUL TO THE
CONGRESS FOR THEIR SUPPORT.
THE TOTAL BUDGET FOR FY22 IS
45.18 BILLION DOLLARS.
THAT'S AN INCREASE OF 2.24
BILLION OVER FISCAL YEAR 21 AND
THAT'S A 5.2% INKRES.
SO THAT'S RATHER SPECTACULAR IN
MY OPINION GIVEN THE STATE OF
THE WORLD AFFAIRS AND SO FORTH.
THE GENERAL INCREASE TO
INSTITUTES AND CENTERS WAS 3.4%.
A NUMBER OF SPECIFIC INCREASES
WERE INCLUDED, ALZHEIMER'S
DISEASE, AN ADDITIONAL
$289 MILLION.
CANCER RESEARCH AN ADDITIONAL
150 MILLION.
RESEARCH FOR OPIOID USE
DISORDER, AN ADDITIONAL
75 MILLION, THE BRAIN
INITIATIVE, AN ADDITIONAL
60 MILLION AND THEN FINALLY AN
ADDITIONAL $50 MILLION TO
SUPPORT HEALTH DISPARITIES
RESEARCH.
AND SO THAT IS MUCH APPRECIATED.
IN ADDITION WITHIN THIS BUDGET,
CONGRESS APPROPRIATED 1 BILLION
DOLLARS TO ESTABLISH THE
ADVANCED RESEARCH PROJECTS
AGENCY FOR HEALTH OR ARPA-H
WITHIN THE DEPARTMENT OF HEALTH
AND HUMAN SERVICES JUST A COUPLE
DAYS AGO, THE SECRETARY
ANNOUNCED THAT HE IS USING HIS
AUTHORITY TO TRANSFER ARPA-H
AUTHORITIES AND FUNDS TO THE
NIH.
THE ARPA-H DIRECTOR WILL BE A
PRESIDENTIAL APPOINTEE NOT
REQUIRING SENATE CONFIRMATION
BUT WILL BE A PRESIDENTIAL
APPOINTEE.
SO THIS IS EQUIV LEAPT TO THE
CANCER CENTER DISTRICTOR.
SO SOME OF YOU KNOW AT NIH WE
ONLY HAVE 2 POLITICAL
APPOINTEES, THE NIH DIRECTOR
WHICH IS A POLITICAL APPOINTEE
REQUIRING SENATE CONFIRMATION
AND THE NCI DIRECTOR WHO IS A
POLITICAL APPOINTEE, THERE WILL
NOW BE A THIRD AND THAT WILL BE
THE ARPA-H DIRECTOR.
HOWEVER WHAT IS UNIQUE ABOUT
THIS POSITION IS IT THAT THE
ARPA-H DIRECTOR WILL REPORT TO
THE HHS SECRETARY.
HE OR SHE WILL HAVE A DIRECT
REPORT TO THE SECRETARY AND WILL
HAVE AUTHORITY FOR
ADMINISTRATION AND OPERATIONS OF
ARPA-H.
NIH IS POISED TO HELP PROVIDE
ADMINISTRATIVE AND OPERATIONAL
SUPPORT FOR THIS NEW ENTITY.
TO GET IT UP AND RUNNING, AS RAN
EDUCATIONALLY AND EFFICIENTLY AS
POSSIBLE.
AND AGAIN WE LOOK FORWARD TO
WORKING WITH THAT INDIVIDUAL TO
FACILITATE THE STAND UP OF THIS
NEW ORGANIZATION.
AS I MENTIONED THE PRESIDENT'S
FY23 BUDGET PLAN WAS RELEASED ON
MONDAY.
WE NOW HAVE APPROPRIATIONS
HEARINGS SET.
THE HOUSE APPROPRIATIONS HEARING
WILL BE ON MAY 11th, THE
SENATE HEARING WILL BE ON MAY
18th GIVEN THE TIMING FOR THE
APPOINTMENT OF THE NEW PERMANENT
DIRECTOR, I'M IT AND SO IT WILL
BE MY PRIVILEGE TO REPRESENT NIH
IN THIS MANNER TOGETHER WITH A
NUMBER OF INSTITUTE AND CENTER
DIRECTORS WHO ARE SELECTED BY
THE RESPECTIVE BODIES OF
CONGRESS.
SO I JUST WOULD LIKE TO CLOSE
WITH A PIECE OF GREAT NEWS FOR
THE FUTURE OF NIH RESEARCH.
I WANT TO CONGRATULATE THE
CLINICAL CENTER ON THE RECENT
AWARD OF A CONTRACT FOR THE NEW
SURGERY RADIOLOGY AND LABORATORY
MEDICINE WING.
NOW FOR THOSE OF YOU ON THE
BOARD YOU KNOW THIS IS A BIG
DEAL.
OF COURSE, THE BOARD IS ONLY 6
YEARS OLD.
THIS HAS GONE WAY BEFORE THAT IN
TERMS OF PLANNING AND ASPIRATION
AND SO FORTH AND SO WE'RE REALLY
VERY, VERY EXCITED TO SEE THIS
FRUITION OF THIS.
I GUESS AT THE PRESENT TIME THE
BUILD OUT DATE IS 2028.
SO MOST OF YOU WILL BE ABLE TO
SEE THIS AND BENEFIT FROM IT BUT
REALLY LOOKING FORWARD TO THIS
FOR SURE.
AND SO WITH THAT, I AM VERY
PLEASED TO TURN THINGS OVER TO
JIM AND WISH YOU ALL THE BEST
FOR TODAY'S DISCUSSIONS AND
DELIBERATIONS.
>> HEY, LARRY JUMP BACK IN, THAT
IS FABULOUS NEWS.
YES, WE'VE BEEN TALKING ABOUT
THAT FOR AT LEAST 6 YEARS AS YOU
SAID AND MANY PEOPLE FOR PLANE
YEARS BEFORE THAT, IT'S
FANTASTIC.
BEFORE WE LET YOU GO, I JUST
WANT TO SEE IF THERE ARE ANY
QUESTIONS FOR YOU.
ANYTHING ANYBODY WANTS TO RAISE?
YOU CAN JUST UNMUTE YOURSELF IF
YOU WANT TO ASK LARRY A
QUESTION.
>> SO LARRY, THIS IS STEPHANIE,
JUST ACTUALLY MORE OF A
CURIOSITY AND IF TIME DOES NOT
PERMIT, CAN TAKE IT OFFLINE BUT
CURIOUS ABOUT ARPA-H AND THE
DECISION TO HAVE IT HOUSED SORT
OF IN 2 DIFFERENT PLACES AND
JUST WONDERING IF YOU HAVE A
PERSPECTIVE AS TO WHAT THAT WILL
MEAN, WHAT ARPA-H WILL
ULTIMATELY BE ABLE TO ACCOMPLISH
THAT IT WILL BE HOUSE INDEED 2
DIFFERENT PLACES?
>> WELL, I WILL ASK TARA TO
RESPOND AS WELL, BUT FROM MY
PERSPECTIVE, I THINK WE HAVE,
YOU KNOW THE BEST OF THE BOTH
WORLDS.
EVERYBODY IN CONTEMPLATING THIS
NEW ORGANIZATION, INDICATE THAD
IT NEEDED TO BE UNENCUMBERED AND
INDEPENDENT BUT WE HAVE CERTAIN
EQUITIES HERE AT NIH THAT I
THINK WILL INSURE A VERY RAPID
AND ROBUST START FOR THE
ORGANIZATION.
SO I THINK WE HAVE THE BEST OF
BOTH WORLDS BUT TARA WHO
ARCHITECTED THIS WHILE AT OSTP
AND HAS CONTINUED TO WORK VERY
HARD ON THESE ISSUES HAS JOINED
US, TARA WHAT ARE ARE YOUR
THOUGHTS ON THIS, PLEASE?
>> YES.
THANKS.
I THINK YOU'RE RIGHT.
YOU HIT THE NAILOT HEAD THERE.
I MEAN, THERE ARE LOTS OF VERY
OPERATIONAL AND STRUCTURAL
FUNCTIONALITIES THAT HAVE TO BE
BUILT WHEN YOU'RE BUILDING UP A
BRAND NEW ORGANIZATION AND WE
GET THE BENEFIT OF BEING ABLE TO
LEVERAGE THOSE AT NIH AS WELL AS
YOU KNOW HAVING A CLOSE
CONNECTION TO MANY OF THE
SCIENTISTS HERE AT NIH AND TO
BENEFIT FROM SOME OF THEIR
SCIENTIFIC KNOWLEDGE AND
EXPERTISE, WHILE ALSO
MAINTAINING AN ESSENTIAL
ELMETROPOLITAN OF WHAT THEY CALL
THIS ARPA-H MODEL WHICH, YOU
KNOW KIND OF 1 OF THE
FUNDAMENTAL TENANTS IS AUTONOMY.
SO HAVING THAT DIRECT CONNECTION
TO THE SECRETARY WILL SORT OF
CHECK THAT BOX.
IT'S ALSO SIMILAR TO HOW IN THE
ENERGY SECTOR THERE'S AN ARP A-E
AND SIMILAR TO HOW THEY ARE
STRUCTURED WITHIN THE DEPARTMENT
OF ENERGY.
>> THANK YOU, TARA, I WILL ADMIT
MY IGNORANCE, I DIDN'T KNOW
THERE WAS AN ARP A-E.
OKAY, THANK YOU.
>> YEAH, THERE'S BEEN A
PROLIFERATION--TO SHARE THIS
INFORMATION.
>> LEARNING EXPERIENCE FOR ME.
>> THANK YOU.
>> GREAT.
ANYONE ELSE, QUESTION FOR LARRY?
HAD.
>> KD--SALLY HA.
>> CAN YOU REPEAT THAT PLEASE?
>> WHAT ARE THE ACRONYMS OR HOW
DO YOU SPELL THE ARPA-H.
>> IT'S--
>> GO AHEAD TARA.
>> IT'S THE ADVANCED RESEARCH
PROJECTED PS AGENCY FOR HEALTH.
A-R-P A- H.
>> ONE MORE TIME?
>> A-R-P-A-H.
>> OKAY, THANK YOU.
ADVANCED RESEARCH PROJECT AGENCY
FOR HEALTH.
>> THANKS.
>> IT'S A RIFF OFF OF DARPA,
WHICH IS THE PROTOTYPICAL MODEL
BUT THERE'S ALSO--NOW I'M OUT OF
MY ELEMENT, ARP A E, ARPI,.
>> ARPI IS ALSO THERE'S HS ARPA.
THERE'S A LITTLE GROUP OF THEM,
BUT DARPA IS THE DEFENSE VERSION
BEEN AROUND SINCE THE 60S AND
HAD A ROLE IN CREATING A BUNCH
OF THINGS WE APPRECIATE TODAY
INCLUDING INTERNET AND
SELF-DRIVING CARS AND GPS.
>> WE ARE NOT GOING TO HAVE A
QUIZ AT THE END OF ALL OF THESE,
BUT WE WILL HAVE THOSE IN THE
MINUTES.
SO WE CAN KEEP TRACK OF THEM.
OKAY, NOT SEEING ANYONE ELSE
JUMP IN, LARRY, THANKS SO MUCH
FOR BEING HERE TODAY AND THANKS
FOR EVERYTHING YOU'RE DOING AND
YOU'RE RIGHT, YOU'RE ABLY
ASSISTED BY A GREAT TEAM.
>> INDEED.
THANK YOU.
>> AND WITH THAT, JIM, WE WILL
HEAD OVER TO YOU FOR THE CEO
REPORT.
>> BEFORE YOU PUT UP THE SLIDES,
TAKE THE SLIDES DOWN FOR JUST A
MINUTE, WITH SO MANY NEW
MEMBERS, I WANT TO INTRODUCE THE
FOLKS HERE FROM THE CLINICAL
CENTER WHRO SOME OF YOU MAY OR
MAY NOT KNOW.
FIRST OF ALL, FROM HERE IN THE
CLINICAL CENTER, BUT SOMEBODY
WHO'S A REGULAR AT THESE
MEETINGS, HAS BEEN THROUGHOUT IS
DR. MICHAEL GOTTESBE MAN, AND
DR. GOTTESMAN IS THE DEPUTY
DIRECTOR OF THE NIH FOR
INTRAMURAL RESEARCH AND THE
CLINICAL CENTER SITS SQUARELY IN
THE MIDDLE OF THE INTRAMURAL
RESEARCH PROGRAM.
THE SECOND PERSON I WANT TO
INTRODUCE IS COLLEEN HADIGAN,
COLLEEN IS THE CHIEF MEDICAL
OFFICER OF THE CLINICAL MEDICAL
CENTER IF YOU REMEMBER BACK AT
OUR OCTOBER MEETING, COLLEEN
SIGNED THE AGREEMENT ACCEPTING
THE POSITION IN THE OCTOBER
MEETING WHICH WAS QUITE
EVENTFUL.
PIAS, [INDISCERNIBLE] IS THE
CHIEF OPERATING OFFICER OF THE
CLINICAL CENTER OF NIH, PIAS HAS
BEEN HERE A BIT MORE THAN A YEAR
OR LESS THAN I HAVE BEEN AND
BARBARA JORDAN IS THE ACTING
CHIEF NURSING OFFICER OR THE
CLINICAL CENTER AND YOU WILL SEE
THAT WE'RE IN THE PROCESS OF THE
NATIONAL RECRUITING EFFORT TO
FIND THE NEXT CNO FOR THE
CLINICAL CENTER THERE ARE 3
PEOPLE ON THAT YOU WILL HEAR
FROM A BIT, AND I WON'T
INTRODUCE THEM, THAT'S DAVID
LANG, CHEF OF THE PATIENT SAFETY
AND CLINICAL QUALITY, AND
MARILYN FARINRE, WHO IS THE
CHIEF OF PHARMACY OPERATIONS WHO
YOU WILL HEAR ABOUT IN A LITTLE
BIT AND LAST BUT NOT LEAST, I
WANT TO ACKNOWLEDGE THE EFFORTS
OF NATASHA POINTER AND PAT
PURRINGER, THERE ARE A LOT OF
HOUSEKEEPING ISSUES TRANSFERRED
FROM SORT OF THE NIH CENTRAL TO
THE CLINICAL CENTER AND PAT AND
NATASHA HAVE BEEN IN
COMMUNICATION WITH ALL OF YOU, I
THINK.
I THINK YOU ALL HAVE THEIR
E-MAIL ADDRESSES AND THEY HAVE
BEEN VERY DILIGENT IN TRYING TO
MAKE SURE THIS FIRST EPISODE OF
THE CLINICAL CENTER RESEARCH
HOSPITAL BOARD FOR WHICH THEY
HAVE A GREAT DEAL OF
RESPONSIBILITY HAS BEEN PULLED
TOGETHER PRETTY WELL AND SO I
WANT TO ACKNOWLEDGE THEM.
AND NOW, I THINK WE CAN GO TO
THE SLIDES.
GO AHEAD AND GO TO THE NEXT
SLIDE.
SO AGAIN, WELCOME TO ALL THE NEW
MEMBERS.
>> BOARD BUT ALSO CONNECTED ME
WITH OTHER PEOPLE INCLUDING
DR. SA MITT, WHO ALSO AGREED TO
BE A MEMBER OF THIS BOARD.
WE GOT A REGRET YESTERDAY FROM
DAVID BAUM, I'M VERY SORRY HE
CAN'T BE HERE TODAY BUT DAVID
WILL BE A REGULAR PARTICIPANT
AND WE'RE VERY HAPPY TO HAVE
ANTOINETTE, ROYSTER, THOSE WHO
HAVE BEEN ON THE CLINICAL CENTER
RESEARCH BOARD FOR A WHILE WILL
REMEMBER ANTOINETTE AND THEY
CAME FROM THE SAME RESEARCH
POPULATION OR PATIENT POPULATION
AND IT WAS VERY INTERESTING BUT
JUST ABOUT THE TIME WE CELTED ON
ASKING ANTOINETTE TO JOIN US,
SHE WAS RECEIVING REQUESTS FROM
BEEs FAMILY AND WONDERING WHAT
WOULD HAPPEN WITH BEE'S SPOT,
NOW ELLEN IS LEAVING THE CCRHB
BUT SHE'S NOT LEVELS INCREASING
THE PATIENT CENTER OR THE
PATIENT ADVISORY GROUP.
SO ELEN WE HAVE A MEETING COMING
UP IN A COUPLE WEEKS, I EXPECT
TO SEE YOU THERE AND AND I CAN'T
WAIT TO SEE LAWN MOWER YOU'RE
GOING TO WEAR FOR US ON THAT
DAY.
BUT ELLEN IS 1 OF THOSE SPECIAL
PEOPLE WHO MAKE ITS MORE FUN TO
GET UP AND COME TO THE MEETING
AND THAT AND EVERY GROUP THAT'S
INVOLVED IN SERIOUS BUSINESS
NEEDS AT LEAST 1 PERSON WHO WILL
DO THAT FOR THE GROUP AND
ELLENOIR HAS BEEN THAT PERSON AT
THE SAME TIME PROVIDING PROFOUND
PATIENT INSIGHTS AND ASKING
QUESTIONS THAT WERE IMPORTANT.
NEXT SLIDE.
SO WE USUALLY BEGIN THESE BY
ACKNOWLEDGING THE CONTRIBUTION
OF THE CLINICAL CENTER STAFF AND
THIS ITERATION, WE WANT TO
INDICATE HOW PROUD WE ARE OF OUR
2 BOARD MEMBERS LISTED IN THE
2022 CLASS OF TOP WOMEN LEADERS
IN HEALTHCARE AND THAT'S OUR
CHAIR DR. FORESE AND ALSO RUTH
WILLIAMS-BRINKLEY.
1 OTHER NOTE ABOUT RUTH IS
RIEWGHTD WILL BE LEAVING THE
BOARD AS LAURA WILL BE LEAVES
OVER THE COURSE OF THE NEXT FEW
MONTHS.
RUTH IS 1 OF THE HEALTHCARE EXEC
TIEVERS WHO BROUGHT A NURSING
BACKGROUND TO THE CLINICAL
CENTER RESEARCH HOSPITAL BOARD,
THE OTHER WAS JANET ERICSON, AND
NOW WITH RUTH LEAVING WITH THAT
LEFT A VOID IN THE--WITH
SOMEBODY WHO COULD BRING THE
VOICE OF THE NURSE TO THE
CLINICAL CENTER RESEARCH
HOSPITAL BOARD AND THAT AND IT'S
A LITTLE EARLY BUT I WOULD SAY
THAT I HAD A VERY GOOD--I HAD A
VERY GOOD CONVERSATION YESTERDAY
WITH A NURSE EXECUTIVE, NOT A
NURSE EXECUTIVE BUT A CEO OF A
HOSPITAL THAT YOU WOULD ALL
RECOGNIZE AND VERY EXCITED ABOUT
THE POSSIBILITY OF JOINING THE
BOARD AND SO HOPEFULLY BY JULY,
WILL HAVE THAT TAKEN CARE OF AND
WILL AT LEAST BE ABLE TO HAVE AN
INITIAL ANNOUNCE NLT OF A NEW
BOARD MEMBER WHO WILL WHO WILL
REPRESENT THE VOICE OF A GREAT
HEALTHCARE EXECUTIVE AND A PREOF
THEIGEIOUS ORGANIZATION, BUT
ALSO WILL BRING THE NURSING
BACKGROUND TO THE BOARD AND I
THINK THAT THAT'S VERY IMPORTANT
IN THE CLINICAL CENTER.
WHERE ABOUT A THIRD OF OUR STAFF
ARE NURSES AND THEY ARE THE 1
WHO IS ARE WITH OUR PATIENTS ALL
THE TIME AND ARE VERY, VERY
IMPORTANT FOR OUR PATIENTS
SAFETY EFFORTS, EXTREMELY
IMPORTANT FOR THE PATIENT
EXPERIENCE EFFORTS AND HAVE BEEN
GREAT SUPPORTERS OF THE CHANGES
WE'VE BEEN MAKING SINCE 2017.
OKAY, NEXT SLIDE.
SO NOW, THEN, THAT GIVES ME A
CHANCE TO BRAG ABOUT THE
CLINICAL CENTER NURSING
DEPARTMENT.
SO THE PRESS GANEY AWARD FOR
NDNQI FOR METRICS IN 2021 IS
HERE IN THE CLINICAL CENTER AND
WE ARE VERY, VERY PROUD OF THIS
AND MANY HOSPITALS PARTICIPATE
IN THIS EFFORT AND YOU CAN SEE
THE PATIENT SAFETY METRICS THAT
ARE INVOLVED HERE AND I WOULD
SAY I HAVE 2 FOLKS FROM NCQA--IT
IS SOMETHING WE'RE CELEBRATING
AND IT IS 1 OF THE 6 HEGHT CARE
ORGANIZATIONS TO RECEIVE THE
AWARD AND WE RECEIVED THE AWARD
FOR THE TOP TEACHING HOSPITAL
AND JUST AS WE DID A FEW YEARS
AGO WHEN WE HAD AN AWARD FROM
THE NATIONAL RESEARCH NRC,
NATIONAL RESEARCH GROUP OUT OF
BOSTON WE WANTED TO MAKE SURE
THAT EVERYTHING THAT HAD
ANYTHING TO DO WITH THIS AWARD,
WHICH BASICALLY MEANT ALL OF THE
NURSING STAFF HAD A CHANCE TO
SEE THE AWARD, HAD A CHANCE TO
TOUCH IT AND HAD A CHANCE TO TO
HAVE THEIR PICTURE TAKEN WITH IT
AND THESE ARE A COUPLE OF THE
PICTURES THAT ARE FROM THE TOUR.
SO FOR THOSE WHO ARE SPORTS
FANS, THIS IS SORT OF THE
STANLEY CUP OR THE--OR THE
[INDISCERNIBLE] FOR WINNING THE
BRITISH OPEN AND IT'S OUR JOB TO
MAKE SURE THAT ANYBODY WHO KNOWS
AND HAD ANYTHING TO DO WITH THIS
GRAND ACCOMPLISHMENT IT'S A
CHANCE TO FEEL LIKE THEY'RE PART
OF THIS AWARD RECEPTION.
THANKS.
NEXT SLIDE.
WE ALSO HAVE SINCE THE LAST TIME
WE MET, WE'VE HAD NIH DIRECTORS
AWARDS, MORE THAN--AND THE NIH
PROBABLY 40,000 STAFF MEMBERS
WHO ARE ELIGIBLE FOR AWARDS AND
YOU CAN SEE THAT THE CLINICAL
CENTER WAS WELL REPRESENTED IN
BOTH THE INDIVIDUAL AND GROUP
AWARD CATEGORIES IN DECEMBER, WE
DO THE CLINICAL CENTER CEO
AWARDS AND I DESCRIBE THIS EVERY
YEAR AND IT PERSISTS AS THE BEST
DAY I HAVE IN THE CLINICAL
STRRKS CAN YOU SEE THE NUMBER OF
CLINICAL CENTER STAFF MEMBERS
WHO ARE HONORED WITH INDIVIDUAL
AND GROUP AWARDS AND THERE'S A
NEW AWARD THAT'S BEEN DEVELOPED
BY HHS, WHICH IS SORT OF
SOMETHING BIGGER CALLED THE PART
OF SOMETHING BIGGER AWARD AND IT
WILL INVOLVE--IT BASICALLY
INVOLVES THE ACTIVITIES OF NIH
STAFF MEMBERS OR HHS STAFF
MEMBERS WHEN THEY'RE AWAY FROM
THE WORKPLACE BUT THEY'RE STILL
CONTRIBUTING TO THE GOALS OF OF
HEALTH AND HUMAN EVERYBODY'SS
AND THIS GOES TO A COUPLE OF OUR
STAFF MEMBER WHO IS IN THEIR OWN
TIME WORKED WITH SOME OF THE
MASS IMMUNIZATION SITES FOR
COVID-19 VACCINES.
AND SO, WE'RE--THERE ARE STILL
SOME GLITCHES IN THIS AWARD AND
THE RECOGNITION BUT WE HAVE
WORKED OUT THE INDIVIDUAL
RECOGNITION AND AGAIN, THERE
WILL BE A WEBSITE AT HHS WHERE
THEIR NAMES WILL LIVE FOR AS
LONG AS THE WEBSITE'S THERE.
NEXT SLIDE.
IF YOU LOOK AT OUR STRAY --STRATEGIC
PLAN, YOU WOULD KNOW THAT WE
NEED TO DID A LOT OF RECRUITING
TO REPLACE SENIOR RETIREMENT AGE
STAFF MEMBER WHO IS ARE LEAVING
THE CLINICAL CENTER AND IN
ADDITION TO THAT, THERE ARE A
COUPLE OF OTHER POSITIONS THAT
HAVE OPENED UP THAT WE REALLY
DIDN'T THINK WE WERE GOING TO
HAVE TO DEAL WITH SO SOON BUT BE
THAT AS IT MAY, WE HAVE TO.
WE HAVE A NUMBER OF LEADERSHIP
VACANCIES THAT WE'RE ACTIVELY
RECRUITING FOR.
THE USA JOBS HAS JUST POSTED THE
ANNOUNCEMENT FOR THE CHIEF
NURSING OFFICER.
MARIE JOYCE AS RETIRED SINCE THE
LAST TIME WE GOT TOGETHER, SHE
WAS THE CFO FOR THE CLINICAL
CENTER FOR A LONG TIME AND
[INDISCERNIBLE] HAS ASSUMED THE
RESPONSIBILITIES IN THE INTERIM
BUT WE'RE IN THE PROCESS OF
BEGINNING THE SEARCH FOR A NEW
CFO.
DR. RICK [INDISCERNIBLE] HAS
DONE A GREAT JOB AS INTERIM
CHIEF OF PHARMACY FOR 3 YEARS
BUT IT'S NOW TIME TO BEGIN
RECRUITING FOR THE PERMANENT
POSITION.
WE HAVE FILLED NOW THE CHIEF OF
MATERIALS MANAGEMENT THAT
ENVIRONMENTAL SERVICES AND THAT
CAME FROM A PROMOTION IN HOUSE
AND WE HAVE BOB LIMBO WHO RAN
OUR OFFICE OF CLINICAL TRAINING
AND MEDICAL EDUCATION FOR THE
LAST SEVERAL YEARS THAT HAS
RETIRED AND WE ARE IN THE
PROCESS OF THAT SEARCH AS WELL.
WE HAVE COMPLETED A SEARCH FOR
THE DESIGNATED INSTIEWTIONZAL
OFFICIAL AND ALL OF YOU KNOW
THAT'S THE PERSON WHO INTERFACES
WITH THE ACCREDITATION COUNCIL
FOR GRADUATE MEDICAL EDUCATION
FOR THOSE FELLOWSHIPS THAT WE
HAVE HERE IN THE CLINICAL CENTER
THAT ARE ACG ME RECOGNIZED.
WE HAVE AN AWFUL LOT OF
FELLOWSHIPS THAT ARE FAIRLY
SPECIFIC--WE SPEND A LOT OF TIME
WORKING ABOUT HOW WE WILL WORK
IN THE NEW ENVIRONMENT, IN THE
CLINICAL CENTER IT'S NOT AS MUCH
AS SOME AREAS OF THE NIH WHERE
PEOPLE REALLY CAN DO REMOTE WORK
AN AWFUL LOT OF THE TIME.
WE WILL BE DOING TELEWORK AND
REMOTE WORK MORE.
AND MORE STAFF MEMBERS WILL BE
DOING IT FROM THE CLINICAL
CENTER BUT MOST OF OUR WORK IS
HERE IN THE BELLING AND SO THIS
IS--IS ACTUALLY MORE I THINK OF
AN ISSUE OF DISCUSSION AND
DEBATE IN THE REST OF THE NIH
THAN IT IS HERE.
NEXT SLIDE.
SO WE--ALL OF THAT YOU HAVE BEEN
PART OF THIS GROUP FOR THE LAST
5 YEARS, TO KNOW THAT I HELD A
TOWN HALL WITHIN THE FIRST WEEK
OF TAKING THE JOB IN 2017.
WE HAD TO GO TO VIRTUAL TOWN
HALLS DURING THE PANDEMIC AND WE
ARE STILL IN A VIRTUAL TOWN HALL
ENVIRONMENT.
WE DID CHANGE THE FORMAT IN A
PRETTY SIGNIFICANT WAY THIS
QUARTER, SO IN JANUARY, WHICH
WAS THE LAST TIME WE DID A TOWN
HALL, AND WE INCORPORATED MORE
OF THE EXECUTIVE LEADERSHIP FROM
THE CLINICAL CENTER IN THE
PRESENTATION.
THAT WAS VERY WELL RECEIVED, WE
DO SOLICIT QUESTIONS AHEAD OF
TIME AND WE DO MAKE EVERY EFFORT
TO RESPOND TO THOSE.
AND SO I THINK IT WAS WELL
RECEIVED.
WE WILL USE THIS FORMAT FOR THE
NEXT YEAR OR SO AND SEE HOW IT
GOES.
THE NEXT TOWN HALL WILL DEAL
MOSTLY WITH DIVERSITY, EQUITY
INCLUSION AND ACCESSIBILITY
ISSUES.
I MAY HAVE A LITTLE BIT MORE OF
A SPEAKING PART AT THAT 1 THAN I
HAD AT THE 1 IN JANUARY, BUT
THESE ARE ISSUES THAT ARE VERY
MUCH ON THE RADAR SCREEN AT THE
CLINICAL CENTER OF THE THE NIH
AND WE WILL BE WORKING ON THOSE.
NEXT SLIDE.
WE HOSTED--WE CO-HOSTED WITH
NCATS THE RARE DISEASE, AGAIN
THIS USED TO BE HELD IN-PERSON
IN OUR LARGE AUDITORIUM HERE AND
THEN IT GOT TOO BIG FOR THAT,
AND MOVED OVER TO THE NATCHER
BUILDING AND THE LARGER VENUE
THAT WAS THERE AND THEN LAST
YEAR AND THIS YEAR IT HAD TO BE
A VIRTUAL CONFERENCE WHICH MADE
SOME OF THE LOGISTICS EASIER, IT
USED TO BE THE HARDEST DAY TO
GET ON CAMPUS AT THE NIH BECAUSE
WE HAD HUNDREDS OF PEOPLE TRYING
TO DRIVE ON CAMPUS WHO WERE NOT
USED TO COMING ON CAMPUS, AND
SO, THE VIRTUAL MEETING HELPED
US A LOT IN THAT REGARD BUT IT
IS SOMETHING THAT THE CLINICAL
CENTER HAS BEEN VERY PROUD TO
CO-HOST FOR A NUMBER OF YEARS
AND WAS A BIG SUCCESS.
AGAIN, I THINK 3 OR 4 MEMBERS OF
CONGRESS WHO ARE PART OF THE
RARE DISEASE CAUCUS MADE
APPEARANCES.
IT'S REALLY BECOME QUITE AN
EVENT.
NEXT SLIDE.
I WILL SHOW YOU A COUPLE SLIDES
THAT SHOW YOU SOME CHANGES THAT
OUR OFFICE OF COMMUNICATIONS AND
MEDIA RELATIONS AND PATIENT
RECRUITMENT OR OCMR HAVE MADE
AND THESE HAVE TO DO WITH
LEVERAGING SOCIAL MEDIA TO--IN
AN EFFORT TO ADVERTISE OUR
STUDIES TO GET AND FIND PATIENTS
WHO MIGHT BE INTERESTED IN
PARTICIPATING IN STUDIES AND
IT'S MORE ACTIVE BUT STILL
INTEREST BASED.
PEOPLE CAN GO BY IT VERY QUICKLY
IF THEY WANT TO AND WE ARE ABLE
TO TARGET OUR FACEBOOK ADS AND
OTHER SOCIAL MEDIA EFFORTS TO
POPULATIONS THAT WE THINK MIGHT
BE ENRICHED FOR THE KINDS OF
INTERESTS WE'RE LOOKING FOR.
THIS IS AN INCREDIBLY COST
EFFICIENT OR LOW COST EFFORT AND
WE--ALL OF THIS ACTIVITY FOR ALL
OF THE INSTITUTES THAT ARE ON
THEIR, I THINK IS COSTING US
LESS THAN $5000 PER YEAR AND
AGAIN WE CAN NARROWLY TARGET OR
WE CAN GO MUCH, MUCH MORE
BROADLY.
WE HAVE--WE'VE HAD AT LEAST A
HALF MILLION PEOPLE SEE OUR
FACEBOOK POSTS AND WE HAVE A
NUMBER OF POST ENGAGEMENTS AND
WE ARE NOW TRACKING THOSE
PATIENTS WHO ACTUALLY CALL US,
MEDIA EFFORTS TO TRY TO IMPROVE
OUR OUTREACH AND PATIENT
RECRUITMENT EFFORTS.
NEXT SLIDE.
AND AGAIN, WE LIKE FOR PEOPLE TO
KNOW THAT THE CLINICAL CENTER
IS
AT THE HOSPITAL AND IS AT THE
NIH AND WE'RE VERY PROUD OF WHAT
WE DO AND WE WANT PEOPLE TO KNOW
ABOUT IT.
WE HAVE A BIT OF AN IDENTITY
ISSUE IN THAT WE'RE A CENTER AND
WE'RE FOCUS ON THE CALLED A
HOSPITAL, SO THESE EFFORTS AGAIN
ARE ALSO LOW COST BUT THEY'RE
TRYING TO GET OUR PRESENCE AND
OUR EFFORTS OUT INTO THE
COMMUNITY.
NEXT SLIDE.
THIS IS OUR AVERAGE DAILY CENSUS
AND AS YOU MIGHT IMAGINE, WE
HAVE A 200 BED HOSPITAL.
WE'VE BEEN OPERATING AT A MUCH
LOWER CENSUS THROUGHOUT THE
PANDEMIC AND WITH THE OMICRON
VARIANT AND THE USUAL DROP IN
DECEMBER HIT AT THE SAME TIME,
WE ARE RECOVERING FROM AND WE
ARE IN A RECOVERY MODE.
OUR PATIENT POPULATION IS GOING
UP, YOU WILL SEE ON THE NEXT
SLIDE THAT OUR OUTPATIENT
NUMBERS ARE GOING UP AND OUR NEW
PATIENT NUMBERS ARE GOING UP
WHICH IS REALLY, REALLY
IMPORTANT TO US.
OBVIOUSLY 2021 WAS ALSO A
PANDEMIC YEAR AND WAS WELL BELOW
OUR 3 YEAR AVERAGE, IT'S SPOTTY.
OUR CANCER UNITS AND BONE MARROW
TRANSPLANT UNITS HAVE BEEN VERY
BUSY AND VERY FULL.
SOME OF THE OTHER UNITS THAT
TAKE CARE OF PATIENTS WHO CAN
WAIT FOR A LITTLE BIT MORE OF
THE RESOLUTION OF THE COVID-19
ACTIVITY ARE NOT AS BUSY.
WE JUST HEARD THIS MORNING THAT
IN MARCH, OUR O. R.s HAD THE
BUT BUSIEST MONTH WE'VE EVER
RECORDED.
SO OUR ACTIVITY IS COMING UP AND
WE LOOK FORWARD TO BEING BUSIER
DURING THE SUMMER MONTHS.
NEXT SLIDE.
SO THESE ARE IN PATIENT
ADMISSIONS, STILL DOWN ON 21,
BUT IF YOU GO DOWN AND LOOK AT
OUTPATIENT VISITS YOU CAN SEE
WOO HAVE A 20% INCREASE IN THE
NUMBER OF OUTPATIENT VISITS AND
ANOTHER--AND OUR NEW PATIENTS,
THE LAST SLIDE, THE LAST LINE ON
THE SLIDE THERE A 10% INCREASE.
NEXT SLIDE.
AS MANY OF YOU MAY BE AWARE
BEFORE THE PANDEMIC WE HAD NO
TELEHEALTH PRESENCE AND WE HAD
VERY LIMITED AND I WOULD SAY,
OUR VISION FOR THE USE OF
TELEHEALTH WAS SORT OF FOCUSED
ON THE RESEARCH ENVIRONMENT, BUT
WITH THE PANDEMIC, WE'VE FOUND
THAT WE NEEDED TO USE TELEHEALTH
TO A MUCH GREATER EXTENT.
OUR HEALTH INFORMATION
MANAGEMENT FOLKS AND THE
DEPARTMENT OF CLINICAL RESEARCH
INFORMATICS DEVELOPED A
PLATFORM.
WE DEVELOPED POLICY, AND YOU CAN
SEE AT THIS TIME, A YEAR AGO, WE
WERE SEEING OVER 1200
PATIENTS A
MONTH.
YOU CAN'T DRAW BLOOD IN A
TELEHEALTH VISIT, YOU CAN'T DO
AN IMAGING STUDY IN A TELEHEALTH
VISIT.
SO THERE ARE--CAN YOU DO A LOT
OF FOLLOW UP, BUT THERE ARE SOME
THINGS THAT YOU CANNOT DO AND
SO, AFTER THAT INITIAL SURGE,
THINGS DROPPED OFF A LITTLE BIT
BUT WE'RE STILL VERY MUCH IN THE
800-THOUSAND VISITS A MONTH
TELEHEALTH WORLD AND IT'S BEEN
VERY IMPORTANT TO US DURING THE
PANDEMIC.
NEXT SLIDE.
YOU'RE GOING TO HEAR A LOT FROM
CLIFF LANE A LITTLE BIT WHO WILL
TALK AND GIVE THE COVID-19
UPDATE, WE REMAIN AND OUR BASIC
POSTURE DURING THE PANDEMIC.
WE HAVE A HIGH PERCENT OF
PATIENT WHO IS ARE IMMUNO
SUPPRESSED AND IMMUNO
COMPROMISED AND WE HAVE A NUMBER
COME TO US THAT WAY BECAUSE OF
THEIR DISEASE AND WE HAVE A
NUMBER OF THEM THAT WAY BECAUSE
OF THE TREATMENTS WE RECEIVE
HERE IN THE CLINICAL CENTER.
AND SO, WE ARE ALWAYS--WE HAVE A
VERY HIGH FOCUS ON INFECTION,
CONTROL AND PREVENTION OF THE
SPREAD OF INFECTION FROM STAFF
TO PATIENT--COMMUNITY AND WE'RE
BEGINNING TO PEEL BACK ON THOSE
A LITTLE BIT NOW AND WE'RE DOING
THAT NOT BECAUSE WE THINK THE
PANDEMIC IS OVER, BUT BECAUSE WE
THINK FOR THE LAST 2 YEARS WE
DEMONSTRATED THAT WE CAN TAKE
CARE OF PATIENTS SAFELY DURING
THIS PANDEMIC AS LONG AS WE PAY
ATTENTION TO SOME FAIRLY BASIC
TENANTS.
SINCE 2 APRIL SO EXACTLY 2 YEARS
WE'VE ALL BEEN MASKED, EVEN WHEN
OTHERS BEGAN UNMASKING, WE KEPT
OURS ON AND WE'VE--WE STILL GIVE
YOU A CLEAN MASK WHEN YOU COME
IN THE HOSPITAL.
IT'S BEEN A LONG TIME SINCE
WE'VE--AND WE HAVE MAINTAINED
VERY DETAILED CAREFUL CONTACT
TRACING THROUGHOUT THE PANDEMIC.
BOTH TARA P A LMORE WHO IS OUR
CHIEF OF HOSPITAL EPIDEMIOLOGY
AND BROOK BECKER WHO IS
CURRENTLY OUR CHIEF OF HOSPITAL
EPIDEMIOLOGY AND THEIR STAFFS,
THEY HAVE DONE VERY METICULOUS
CONTRACT TRACING WITH THE
OCCUPATIONAL MEDICINE SERVICE
AND IT'S BEEN ALMOST 2 YEARS
SINCE WE'VE DOCUMENTED OUR
PATIENT TO STAFF TRANSMISSION
AND WE HAVE YET TO DOCUMENT A
SINGLE STAFF TO PATIENT
TRANSMISSION.
IT'S A TRACK RECORD, WE'RE VERY
PROUD OF BUT WE--IT'S ONLY
THROUGH THE DEDICATION OF THE
STAFF AND THEIR WILLINGNESS TO
PUT UP WITH ALL OF THE EXTRA
EFFORT INVOLVED IN TRYING TO
MAINTAIN THAT RECORD.
BUT NOW, WE ARE THE NIH AND IN
ORDER TO PROVE PATIENT TO STAFF
TRANSMISSION, IT REQUIRES
GENOMIC ANALYSIS TO INDICATE
THAT WE ARE DEALING WITH, YOU
KNOW THE SAME VIRUS.
BUT STILL, WE THINK OUR TRACK
RECORD IS PRETTY GOOD AND IT'S
BECAUSE THE STAFF HAVE BEEN
WILLING TO DEAL WITH ALL OF
THESE ISSUES AND PERIODICALLY,
WE HAVE LAPSES BUT, FOR THE MOST
PART, EVERYBODY'S BEEN VERY
COOPERATIVE.
NEXT SLIDE.
>> THESE ARE JUST SOME NUMBERS,
THE SCREENING WE'RE RAPIDLY
APPROACHING 3 MILLION PERSONS
WHO HAVE COME THROUGH THE DOOR
AND ASYMPTOMATIC TESTING AND
DURING THE OMICRON, THE DAYS OF
OMICRON, MAYBE 1 OUT OF 20 THAT
WE WERE TESTING WERE EITHER
ASYMPTOMATIC SITE WERE TESTING
POSITIVE, WE'RE NOW DOWN TO
ABOUT 1 OUT OF 700 OR 1 OUT OF A
THOUSAND.
NNEXT SLIDE.
AND THESE ARE STILL THE THINGS
WE DO AND WE EMPHASIZE REGULARLY
AND WE I WOULD SAY THE FACE
SHIELDS AND THE GOGGLES ARE THE
THING WE HAVE TO REMIND FOLKS
ABOUT THE MOST OFTEN.
NEXT SLIDE.
AS ALL OF YOU ARE AWARE, THIS
IS--THIS IS AN ISSUE FOR ALL OF
US AND IT'S AN ISSUE, IT'S A
NATIONAL ISSUE.
IT'S NOT LIMITED TO US IN
HEALTHCARE BUT IT'S A REALLY
IMPORTANT ISSUE TO THE NIH, IT'S
REALLY IMPORTANT ISSUE TO THE
CLINICAL CENTER AND SO, WE HAVE
LAUNCHED A COMPREHENSIVE
DIVERSITY EQUITY INCLUSION AND
ACCESSIBILITY PROGRAM WITH AN
ANOWNTMENT IN JANUARY.
WE HAVE--WE LOG OUR ACTIVITYS ON
A SPECIAL WEBPAGE AND WE HAVE
FORMED AN ADVISORY COMMITTEE
THAT REPORTS DIRECTLY TO ME ON
THESE ISSUES.
NEXT SLIDE.
WE POSTED A VIDEO THAT INCLUDED
A NUMBER OF OUR STAFF AND WE
HAVE SET ASIDE RESOURCES TO
SUPPORT THESE EFFORTS.
WE HAVE DONE SOME--HAVE REGULAR
ASSESSMENTS OF OUR CLINICAL
CENTER WORKFORCE DEMOGRAPHICS
AND IN ADDITION WE HAVE
COMPLETED A SURVEY THAT ABOUT A
THIRD OF THE CLINICAL CENTER
STAFF RESPONDED TO THAT WE HAVE
SEEN THE RESULTS OF AND WE KNOW
IT CLEARLY INDICATES THAT
THERE'S SOME AREAS WE NEED TO
WORK ON.
AND THAT SURVEY IS BEING
FOLLOWED UP WITH FOCUS GROUPS OR
WHAT I THINK IS HAS BEEN TERMED
LISTENING SESSIONS TO TRY TO
GAIN MORE INSIGHTS INTO
PERCEPTIONS AND AS WELL AS
REALITY AND WHAT IS BEHIND THEM.
TODAY IS 1 APRIL AND TODAY WAS
OUR DAY TO TURN IN OUR INITIAL
EFFORT AT NIH RACIAL AND ETHNIC
EQUITY PLAN OR REEP AND I'VE
BEEN WORKING DALE WEB CONNECTED
THE GROUP FROM THE CLINICAL
CENTER OVER THE COURSE OF THE
LAST 2 WEEKS TO GET THAT INTO
FINAL FORM AND WE'RE PRETTY
HAPPY--PLAN SO FAR.
IT'S A LIVING DOCUMENT.
WE'RE CERTAINLY NOT DONE.
IF WE DO EVERYTHING THAT WAS IN
THE PLAN, WE STILL WOULDN'T BE
DONE, THERE WILL BE MORE
INITIATIVES ADDED OVER TIME BUT
THIS WAS TURNED IN, ACTUALLY
IT'S DR. SCHWETZ, AND DR. TABAK
WHO ARE THE ARBITERS OF WHETHER
OUR PLAN MEETS THE MARK.
AND WE LOOK FORWARD TO THEIR
FEEDBACK AND I'M SURE THEY'LL
HAVE SOME AND WILL NEED TO GO
BACK AND MAKE SOME CHANGES.
AND WE'RE ALREADY RECEIVING SOME
FEEDBACK FROM OUR STAFF, BUT IN
GENERAL MOST OF THE FEEDBACK'S
BEEN PRETTY GOOD.
NEXT SLIDE.
WE HAD BLACK HISTORY MONTH LAST
MONTH AND THIS IS--WE JUST
FINISHED WOMEN'S HISTORY MONTH
AND THESE MONTHS, I THINK WE ARE
DOING A BETTER JOB OF
ACKNOWLEDGING AND RECOGNIZING AS
PART OF OUR OVERALL EFFORT, THIS
IS THE STUFF THAT'S EASY TO DO
WITH OUR RACIAL AND ETHNIC
EQUITY PLAN.
WE REALLY TRY TO GET TO THE
SUBSTANCE OF WHAT THE ISSUES
ARE, WE DID NOT LOOK FOR LOW
HANGING FRUIT.
WE TACKLED--WE DID A CAREFUL GAP
ANALYSIS WHERE THE BIGGEST
PROBLEMS WERE AND WE DESIGNED
INITIATIVES TO ADDRESS THE GAPS,
NOT JUST LOOK AT ACTIVITIES THAT
WOULD BE NONCONTROVERSIAL AND
EASY TO DO.
NEXT SLIDE.
FOR THE--THIS IS ESPECIALLY FOR
THE NEWER MEMBERS OF THE BOARD
BUT IN TWEBT 19 WE PUBLISHED
THIS DOCUMENT CALLED THE
STRATEGIC PLAN WHICH WAS THE NIH
CLINICAL CENTER AT 65 YEARS OF
EXISTENCE.
PEOPLE, PLACES, CAPABILITIES, IT
WILL BE THE FOCAL POINT FOR OUR
JULY PRESENTATIONS TO THE
CLINICAL CENTER RESEARCH
HOSPITAL BOARD.
AND I THINK IT WILL BE A GREAT
WAY FOR THE NEWER MEMBERS TO
FIND OUT WHAT WE'VE BEEN DOING
EVEN DURING THE PANDEMIC TO TRY
TO GET AT THE STRATEGIC ISSUES
AND AS WELL AS SOLICIT YOUR
THOUGHTS ON WHAT THE NEXT
DOCUMENT THAT'S GENERATED FOR
THE STRATEGIC DIRECTION SHOULD
LOOK LIKE.
NEXT SLIDE.
OKAY, THIS IS FOR TODAY'S AGENDA
AND WE'RE PRETTY MUCH ON TIME
WHICH GOOD.
THE NEXT PRESENTATION WILL BE
DAVID LANG CHIEF OF OFFICE
PATIENT SAFETY AND CLINICAL
QUALITY, AND DAVID WILL GIVE AN
UPDATE ON THE CLINICAL METRICS.
THESE ARE ALSO POSTED ON THE
CLINICAL CENTER WEBSITE.
AFTER DAVID PRESENTED LAST TIME,
HE'S PRESENTING THIS TIME, FOR
THE JULY MEETING, THE CHANCES
ARE THAT THESE WILL BE PROVIDED
TO YOU IN A PRESENTATION, BUT
MAY BE NOT ON THE AGENDA.
THIS HAS BEEN A ROUTINE
PRESENTATION AT JUST ABOUT EVERY
CLINICAL CENTER RESEARCH
HOSPITAL BOARD.
AND THEN WE WILL HAVE A
PRESENTATIONOT COVID-19 UPDATE.
I KEEP THINKING THIS SHOULD BE
THE LAST 1 OF THOSE, BUT YOU
NEVER KNOW.
WE'RE VERY GRATEFUL IN THE
CLINICAL CENTER TO HAVE
DR. CLIFF LANE WHO IS THE
CLINICAL DIRECTOR FOR NIAID WHO
WILL PROVIDE THAT FOR US.
AFTER DISCUSSION REGARDING THAT
PRESENTATION, MARILYN FARINRE HO
IS THE CHIEF OF PHARMACY FROM
THE PHARMAC SKPE BAKUGAN WE ARE
WITHIN THE PROCESS, WE ARE
WITHIN WEEKS OF MOVING BACK INTO
THE PERMANENT HOME OF THE
PHARMACY AND FOR THOSE OF YOU
THAT HAVE BEEN HERE FOR 5 OR 6
YEARS YOU WILL KNOW IT'S JUST
ABOUT HOW THE RED TEAM STARTED
BUT IT WASN'T JUST ABOUT THE
PHARMACY BUT IT WAS ABOUT THE
PHARMACY SO WITH THE MOVE BACK
WE BEGIN THE PROCESS OF REALLY
HAVING PHARMACY FACILITIES AND
PHARMACY OPERATIONS THAT THE
CLINICAL CENTER REALLY NEEDED.
THIS HAS BEEN--THIS HAS REALLY
BEEN--IF YOU COUNT THE PLANNING,
IT'S BEEN 7 YEARS IN THE
PLANNING, THE PHARMACY STAFF HAS
BEEN OPERATING OUT AT SWING
SPACE AND DOING A GREAT JOB OVER
THE COURSE OF THE LAST 3 OR 4
YEARS AND THEY'RE LOOKING
FORWARD TO GETTING BACK IN 1
LOCATION SO MARILYN WILL
DESCRIBE THAT FOR YOU.
AFTER THE BREAK, THEN DAN
WHEELAND WILL UPDATE YOU ON
IMPORTANT CLINICAL CENTERS
FACILITIES PROJECTS AND THEEN
WILL VERMEN INFECTED A
RERESEARCH PRESENTATION BY
DR. MARSTON LINEHAN KOOH IS THE
CHIEF OF THE UROLOGIC SURMINGRY
AND THE UROLOGIC ONCOLOGY
BRANCH, CENTER FOR CANCER
RESEARCH, NCI.
AND OVER A PERIOD OF YEARS WAS
THE LARGEST IN THE CLINICAL
CENTER AND HIS PRESENTATION
ILLUSTRATES WHAT THE CLINICAL
CENTER CAN DO WITH THE ABILITY
TO SUSTAIN THESE PROGRAMS OVER
LONG PERIOD OF TIME AND BRING
PATIENTS IN WITHOUT HAVING TO
WORRY ABOUT WHETHER THEIR
INSURANCE WILL HELP PAY THE
BILLS.
SO THAT'S WHAT WE HAVE BY THE
WAY FOR AGENDA TODAY.
SO LAURA I WILL NOW OPEN FOR
QUESTIONS AND/OR COMMENTS.
>> PERFECT.
THANK YOU JIM.
LET'S TAKE THE SLIDES DOWN IF WE
COULD.
LET ME SEE IF ANYBODY HAS A
QUESTION FOR JIM, I THINK IT
WILL BECOME OBVIOUSLY OVERTIME
AND I SEE JOHN GALLEN JOINED US,
GOOD TO SEE YOU AS ALWAYS.
ANTOINETTE, I SEE YOUR HAND IS
UP.
>> DR. GILMAN, I THINK YOU MAY
HAVE ALREADY ANSWERED THE
QUESTION BUT YOU MENTION TD ON
FACEBOOK THAT THAT'S ANOTHER
MEDIUM WHEREBY WE'RE TRYING TO
RECRUIT MORE PATIENTS.
AND ON THERE, I THOUGHT IT SAID
REMOTE CLINICAL STUDY?
WHAT EXACTLY IS THAT AGAIN?
AND--AHEAD.
>> SO REMOTE CLINICAL STUDIES
COULD VOLVE STUDIES WHERE THE
PATIENTS DON'T EACH HAVE TO COME
TO THE HOSPITAL.
>> SO WHAT IF THEY NEED BLOOD
WORK OR ULTRA SOUND OR JUST
STUDIES THAT DON'T REQUIRE BLOOD
WORK.
>> YEAH, SO IT COULD BE SURVEY
INFORMATION, OKAY AND YOU KNOW
THERE IS THE ABILITY TO HAVE OR
THE ABILITY FOR SOME STUDIES FOR
PATIENTS WHO NEED TO HAVE LAB
WORK GO TO LABCORP OR ANOTHER
COMMERCIAL PROVIDER AND HAVE
THEIR BLOOD DRAWN.
AGAIN, THIS IS NOT JUST AT THE
CLINICAL CENTER, THIS IS
BECOMING A THING AT LOTS OF
PLACES TO HAVE THE ABILITY TO DO
STUDIES OF THIS KIND AND AGAIN,
YOU HAVE TO HAVE THE RIGHT
DOCUMENTATION, YOU HAVE TO--I
MEAN, THEY HAVE TO MEET
INCLUSION CRITERIA, THEY HAVE BE
CAREFULLY SCREENED.
THEY HAVE TO FILL OUT AN
ELECTRONIC CONSENT, BUT THIS IS
STUDIES PATIENTS AND THEIR
ENVIRONMENT RATHER THAN OUR
ENVIRONMENT.
>> ALL RIGHT.
THANK YOU.
>> RICK?
>> JIM, THANKS FOR A TERRIFIC
UPDATE, 2 COMMENTS.
AS YOU THINK ABOUT THE DNI ANDA
WORK, AND LOOKING AT THE
DEMOGRAPHICS OF THE NIH CLINICAL
CENTER, I HOPE WE WILL DO THAT
BY JOB CLASS.
THE AGGREGATE PICTURE IS 1 THING
BUT WHAT WE SEE OFTEN IS THAT
PEOPLE OF COLOR TEND TO BE
RELEGATED TO THE LOWER RANKS OF
THE INSTITUTION SO I THINK THAT
WILL BE HELPFUL AND OBVIOUSLY
WE'RE ALL KEENLY AWARE OF THE
GREAT WORK YOU AND JOHN GALLAN
HAVE DONE IN CREATING PIPELINES
FOR INVESTIGATORS FROM HBCUs
AND OTHER ORGANIZATIONS, SO I
WOULD BE VERY INTERESTED IN
SEEING HOW THAT WORK TRANSLATES
INTO THE DEMOGRAPHIC OF CERTAIN
JOB CLASSES.
>> YEAH, LET ME MAKE A COUPLE OF
COMMENTS, FIRST OF ALL WE HAVE
THAT INFORMATION BY THE KIND OF
JOB AND THE LEVEL.
AND THERE IS AN INITIATIVE THAT
IS FOCUSED SPECIFICALLY ON THE
ISSUE YOU POINTED OUT THAT IS IT
ISN'T ENOUGH JUST TO HAVE PEOPLE
OF COLOR OR HISPANIC STAFF IN
THE CLINICAL CENTER BUT YOU HAVE
TO LOOK AT NOT ONLY THE JOB
SERIES BUT ALSO THE LEVEL.
AND THAT'S WHERE WE COME UP
SHORT AND I DON'T THINK THAT
MAKES US UNIQUE, I THINK THERE
ARE AN AWFUL LOT OF GROUPS THAT
ARE LIKE THAT AND SO THERE IS 1
INITIATIVE WHERE WE ARE TRYING
TO TO GETTA THAT.
THAT'S NUMBER 1.
NUMBER 2 TARA IS IN THE MEETING
AND SHE'S HEARD LARRY TALK
ABOUT, YOU KNOW WE CAN'T BE
SATISFIED WITH PIPELINE INIT
WHYATIVES.
WE HAVE TO--PIPELINE INITIATIVES
ARE FINE--NO MORE THAN 5 OR 6
INITIATIVES TO BETO BEGIN WITH
BECAUSE THESE ARE THINGS WE'RE
REALLY GOING TO DO, THESE ARE
NOT THINGS WE ARE GOING TO TALK
ABOUT DOING SO IT WON'T BE A
BUNCH OF MOTION, WE WILL
ACTUALLY DO--WE ACTUALLY HAVE
THE SURPRISING THING TO ME IS WE
HAVE A LOT OF BASE LINE DATA AS
YOU KNOW, THE HARDEST PART OF
TRYING TO MAKE SOMETHING BETTER
IS BEING PATIENT WHILE YOU
FIGURE OUT WHAT THE BASE LINE
IS, BUT IT'S NOT PERFECT DATA,
IT'S NOT ALL THE DATA WE WOULD
WANT TO HAVE BUT WE HAVE PRETTY
GOOD DATA DISP AND WE HAVE DATAS
ABOUT REALITY AND WE HAVE DATA
ABOUT PERCEPTIONS AND SO, BUT I
SAID, LET'S LIMIT THE PIPELINE
INITTIAIVE ITS TO 1 BECAUSE
OTHERWISE WE WILL SPEND ALL OF
OUR TIME TALKING ABOUT THE
PIPELINE AND I'M NOT SAYING THE
PIPELINE ISN'T IMPORTANT, I'M
JUST SAYING, WORKING ON THE
PIPELINE ISN'T SUFFICIENT AND
THAT'S WHAT WE'VE DONE AND IT
DOES FOCUS A LITTLE BIT ON OUR
RELATIONSHIP HBCUs AND OTHER
MINORITY SERVING INSTITUTIONS
AND AMONG OTHER THINGS DOES A
BETTER JOB OF TRYING TO FIGURE
OUT WHETHER THAT IS WORKING.
AND SORT OF THE PROGRAM
EVALUATION PIECE BY BEING ABLE
TO TRACK THE CONTACT WE MAKE
WITH HBCUs AND MINORITY
SERVING INSTITUTIONS.
WE SPENT A LOT OF TIME TALKING
TO STUDENTS AND OTHERS IN THOSE
INSTITUTIONS BUT WE HAVE NO DATA
TO SHOW WHETHER THOSE FOLKS
ACTUALLY APPLY FOR NIH
OPPORTUNITIES OR ARE ACCEPTED
FOR NIH OPPORTUNITIES AND WE
NEED TO FIGURE THAT OUT.
HEY, CRAIG, THANKS.
>> LET'S GO TO CRAIG AND THEN
JOHN.
>> MORNING JIM AND LAURA, THANKS
FOR HAVING ME, I HAVE--I HAVE A
QUESTION ABOUT CENTER OCCUPANCY
FOR MANY HEALTH SYSTEMS AND
THERE ARE OTHERS ON THE CALL
THAT CAN ADDRESS THIS MORE
SPECIFICALLY.
WHEN YOU EXTRACT COVID RELATED
VOLUMES OF ADMISSIONS, IT LOOKS
LIKE HEALTH SYSTEMS ARE SETTLING
IN AT OCCUPANCY RATE THAT'S
LOWER THAN PRECOVID.
ANYWHERE FROM 10-15%.
SO HOW ARE YOU THINKING ABOUT
THAT FROM THE CENTER
PERSPECTIVE?
O. R.s ARE CLEARLY BUSY, NEW
MEMBERSHIP IS UP BUT DO YOU
PREDICT YOU'RE GOING TO SETTLE
INTO A NEW NORMAL WHERE
OCCUPANCY PER PATIENT OR PER
MEMBER IS LOWER THAN WE SAW
BEFORE COVID?
>> WHAT I THINK WILL HAPPEN,
CRAIG, IS THAT FIRST OF ALL, OUR
COVID-19 OCCUPANCY NEVER WAS
THAT OF A COMMUNITY HOSPITAL.
EVERY COVID PATIENT WAS ON A
RESEARCH PROTOCOL.
WE DID TAKE A VERY SMALL NUMBER
OF PATIENTS FROM THE STATE OF
MARYLAND WHEN THEY WERE OVERRUN
ESPECIALLY IN THE DECEMBER TIME
FRAME OF 2020.
SO THAT--BUT I THINK OUR
OCCUPANCY HAS BEEN DOWN BECAUSE
OF LIMITATIONS ON TRAVEL AND THE
FACT THAT YOU KNOW 50% OF OUR
RESEARCH PROTOCOLS ROUGHLY ARE
NATURAL HISTORY PROTOCOLS.
THEIR PATH ARE INTERVENTIONAL
PROTOCOLS, AND HALF ARE NATURAL
HISTORY PROTOCOLS, SO IF YOU ARE
ENROLL NOTHING AN NIH STUDY
WHICH WAS MORE OF A NATURAL
HISTORY PROTOCOL AND YOU--AND
YOU HAD TO TRAVEL A LONG WAY
INCLUDING INTERNATIONALLY, THEN
MAYBE THAT'S BEST TO PUSH THAT
OFF.
SO I THINK WE WILL GET BACK TO
WHERE WE ARE AS A RESEARCH
HOSPITAL.
WE WILL NEVER OCCUPY 80-85% OF
THE BEDS BECAUSE WE HAVE A
NUMBER OF SPECIALTY BEDS THAT
YOU CAN'T--IT'S NOT A GENERAL
MED SURGE POPULATION, BUT I
THINK WE WILL GET BACK TO THAT 3
YEAR AVERAGE OVER THE COURSE OF
THE NEXT YEAR OR SO GREAT, THANK
YOU.
>> THANK YOU.
>> THANK YOU, I JUST WANTED TO
EXPAND A LITTLE BIT ON THE
COMMENT ABOUT DIVERSITY ACROSS
THE RESEARCH PROGRAMS WE VIEW
OUR JOB AS MORE DIVERSITY WITHIN
THE CLINICAL CENTER ACTIVITIES
BUT REALLY ACROSS THE WHOLE
INTRAMURAL PROGRAM FOR CLINICAL
RESEARCH AND THE APPROACH OF
ESTABLISHING REGIONAL
PARTNERSHIPS WITH NOW 9
INSTITUTIONS IS HELPING,
PARTICULARLY OUR PARTNERSHIP
WITH HOWARD UNIVERSITY--THE
HEART LUNG AND BLOOD INSTITUTE,
THE CHILD HEALTH INSTITUTE AND
OTHERS AT NIAID HAVE REALLY
ESTABLISHED NEW PROGRAMS THAT
ARE BRINGING A WHOLE SPECTRUM OF
INVESTIGATORS TO THE NIH FROM
UNDERGRADUATE STUDENTS TO
MEDICAL STUDENTS TO DENTURED
TRACKS, ET CETERA AND SO I THINK
WHEN WE HAVE AN OPPORTUNITY TO
PRESENT HOW WE'VE DONE, YOU WILL
BE PLEASED, AT LEAST WE'RE
PLEASED THAT PROGRESS IS BEING
MADE THROUGH THESE PARTNERSHIPS
WITH OTHER INSTITUTIONS.
>> THANK YOU.
GOOD TO HEAR AND LOOK FORWARD TO
HEARING MORE OVER TIME.
I DON'T SEE ANYONE ELSE WITH A
HAND UP SO I THINK WE WILL TURN
IT OVER TO DAVID LANG.
>> HI, GOOD MORNING, I WILL
SHARE MY SCREEN REAL QUICK.
AND OKAY, THAT SHOULD DO IT.
ALL RIGHT.
>> ALL RIGHT, SO GOOD MORNING
EVERYBODY, I AM DAVID LANG, I AM
THE OFFICE OF PATIENT SAFETY AT
THE CLINICAL CENTER, I WOULD
LIKE TO THANK THE COLLEAGUES
ACROSS THE CLINICAL CENTER WHO
PROVIDED THIS DATA AND WHO ALSO
MORE IMPORTANTLY EVERY DAY ARE
WORKING HARD TO MAKE SURE THAT
THESE METRICS GO IN THE RIGHT
DIRECTION.
AS DR. GILMAN ALLUDED TO EVEN IF
WE ARE AT OR WHERE WE WANT TO BE
WITH OUR BENCHMARKS OR GOAL IS
ULTIMATELY 0 HARM SO WHETHER
HUNDRED PERCENT OR 0% DEPENDING
ON WHICH WAY THE METRIC IS
GOING.
THE FIRST TOPIC I WILL TALK
ABOUT IS EFFECTIVE CONTROL
METRIC.
WE SEE OUR HAND HYGIENE DATA
THESE ARE WHERE STATE REGULATOR
OF ARE ASKED TO JUST OBSERVE AS
YOU SEE ANYBODY GOING IN THE
ROOM, DID THEY WASH THEIR HANDS,
USE HAND HYGIENE AND THE SAME
WHEN THEY COME OUT AND TO ENTER
THESE IN AND WE ENCOURAGE STAFF
TO DO THIS, YOU KNOW AGAIN
WITHOUT OTHERS KNOWING SO IT'S
NOT A MATTER OF OH THEY'RE HERE,
LET'S TAKE A ELECTRIC AT IT AND
AND AS CAN YOU SEE, WE HAVE BEEN
CONSISTENT IN THE 95% AREA AND
OF COURSE WE WOULD LIKE TO BE A
AIAN HUNDRED PERCENT FOR THAT.
LOOKING AT RATES, AFTER HAVING
SEEN A REDUCTION IN THE PREVIOUS
5-QUARTERS WE DID SEE AN
INCREASE IN THE PAST 2.
I WOULD LIKE TO POINT OUT THAT
THIS INCREASE, THESE ARE LOW
NUMBERS, THE INCREASE REPRESENTS
1 ADDITIONAL CLABSI EACH QUARTER
COMBINED WITH DECREASED LINE
DAYS SO THAT THE PERCENTAGES YOU
KNOW SEEMS A LOT HIGHER, NOW
THAT SAID WHAT OUR HOSPITAL
ADVICES FOR EVERY CLABSI,
THERE'S INVESTIGATION, INCLUDING
NURSING AND HOSPITAL
EPIDEMIOLOGY SERVICE TO SEE BOTH
WHAT HAPPENED DURING THAT EVENT
AND ALSO SEE IF WE'RE SEEING
TRENDS.
AND WE HAVE IDENTIFIED
OPPORTUNITIES WHICH HAVE ALREADY
BEEN PLACED TO REEDUCATE AND
REDEDICATE THROUGH THE BEST
PRACTICES OF LINE CARE AND THESE
DATA, ALBEIT LOW, HELP US KNOW
THAT WE NEED TO KEEP PUSHING AND
MAKING SURE THOSE PRACTICES ARE
ALWAYS BEING USED.
OT NEXT SLIDE WE WILL SEE THE
IACU NUMBERS AND THESE AGAIN
WITH A SMALLER POPULATION, MORE
VARIABILITY, THEY HAD GONE UP A
BIT AND THEN CAME BACK DOWN, THE
BENCHMARK USED FOR THIS IS THE
NHSN NATIONAL HEALTHCARE SAFETY
NETWORK, WHICH YOU SEE ENDED
HERE, THERE'S NEW DATA COMING
OUT FOR 2022, BUT THOSE HAVEN'T
BEEN PUBLISHED YET, SO WE WILL
HAVE A NEW BENCHMARK COMING UP
FOR THAT.
STAYING IN THE ICU, WE SEE OUR
[INDISCERNIBLE] WHICH IS THE
URNANNY TRACT INFECTION RIGHT
AND THIS HAS GONE DOWN TO 0 AND
REMAINED AT 0 FOR 3-QUARTERS
WHICH IS OF COURSE WHAT OUR GOAL
IS.
AND SIMILARLY THE CAUTI, ON THE
SURGICAL ONCOLOGY UNITS HAD ALSO
COME DOWN TO 0.
AND STAYING WITH SURGERY FOR A
MINUTE, LOOKING AT SURGICAL SITE
INFECTIONS USING AS A COMPARISON
CLINICAL CENTER AVERAGE OVER THE
COURSE OF A COUPLE YEARS 2019 AS
A MARKER OF WHERE WE WERE AND
YOU SEE THAT AGAIN WITH LOW
NUMBERS HAD HAS BEEN MOVING
AROUND THE AVERAGE THERE FOR
WHERE WE ARE WITH THE SURGICAL
SITE AND AGAIN WITH EACH OF
THESE EVENTS, THERE'S
INVESTIGATION BOTH OF THE
INDIVIDUAL EVENTS AND THEN OF IF
THERE ARE ANY [INDISCERNIBLE] TO
SEE WHAT WE DO WITH THAT.
--AND WE ALSO LOOK AT FALLS OR
INJURIES.
THE RATES HAVE REMAINED AT OR
AROUND THE BASE LINE, SO THESE
SORT OF GRAY AND BLACK ARE THE
NDNQI BENCHMARKS AND THEN YOU
WILL SEE OUR RATES.
AGAIN IN VARIABILITY IN OUR RATE
AND BELOW THE BASE LINE THERE
AND PLEASE SAY WE'VE REMAINED
LOW AND FALSE WITH INJURIES.
AND EACH OF THOSE ARE LOOKED AT.
NOW OUR ORGANIZATION IS LOOKING
AT STRATEGIES TO EVEN OF COURSE,
REDUCE THESE FURTHER AND
SOMETHING THAT'S BEEN NEWLY
IMPLEMENTED IS SOMETHING CALLED
THE BEDSIDE MOBILITY ASSESSMENT
TOOL, THE AIM OF WHICH IS TO
REDUCE OCCUPATIONAL INJURIES AS
WELL AS HAVING POTENTIAL
REDUCING IN PATIENT INJURIES AND
PATIENT FALLS.
SO WE'LL HOPE TO SEE THESE
NUMBERS CONTINUE TO STAY LOW AND
GO EVEN LOWER.
AND THEN THE PRESSURE INJURY
PREVALENCE, YOU WILL SEE SORT OF
AGAIN, SORT OF EBBING AND
FLOWING RIGHT AROUND THE NDNQI
MEAN AND PLEASE TO SAY THAT FOR
MANY QUARTERS IN A ROW, THE MORE
SEVERE STAGE 3 AND 4 PRESSURE
INJURIES HAVE BEEN AT 0 WHICH IS
OF COURSE WHERE WE WANT THEM TO
BE.
OKAY, THIS IS A METRIC OF
PROCESS, MEANING IS THE PROCESS
OF MEDICATION ADMINISTRATION BAR
CODING BEING USED WHICH IS A WAY
TO INSURE PATIENT, THE CORRECT
MEDICATION IS GOING TO THE
CORRECT PATIENT.
OUR GOAL IS 100% USE OF WHAT'S
CALLED KBMA WHICH IS THE NAME OF
OUR BAR CODING SYSTEM AND YOU
WILL SEE WE'RE CONSISTENTLY UP
AROUND 90, 99%, SO IT'S A
HANDFUL OF IERK TEMS, THERE ARE
A SMALL NUMBER OF CIRCUMSTANCES
WHERE THE KBMA CAN NOT BE USED
AND THOSE ARE KNOWN AND THE
STAFF TAKE ADDITIONAL CARE IN
THOSE CIRCUMSTANCES BUT AGAIN,
WHATEVER IS NOT USED OUR NURSING
QUALITY OF PEOPLE ARE ALERTED TO
THAT AND SEE WHAT THE
CIRCUMSTANCE WAS TO INSURE THAT
IT'S BEING USED, ALWAYS OR
ALWAYS WHEN POSSIBLE.
I'M SWITCHING NOW TO EMERGENCY
RESPONSE DATA WHICH IS A RAPID
RESPONSE SYSTEM AND I WILL
REMIND THE PANEL FOR THE MEMBERS
AND NEW MEMBERS YOU KNOW WE
DON'T HAVE AN EMERGENCY ROOM SO
OUR CODE BLUE TEAM IS CALLED TO
ALL TYPES OF EMERGENCIES IN
ADDITION TO CARDIAC AARREST.
WHEN WE WILL SEE HERE AND THIS
ALSO WOULD INCLUDE PATIENTS BUT
VISITORS AND EMPLOYEES.
SO SORT OF ANYBODY WHO'S FOUND
WHO NEEDS ACUTE EMERGENCY CARE
IF SOMEBODY CALLS A CODE BLUE
THAT'S WHO WOULD COME.
SO I'M LOOKING HERE AT THE
NUMBERS FOR THE YEAR AND EACH
QUARTER OF 2021 AND AGAIN, THESE
ARE ABSOLUTE NUMBERS RATHER THAN
A RATE, SO THERE WOULD BE
VARIABILITY BASED ON THE CENSUS
THAT WE HAVE HERE.
AS WE'VE BEEN ABLE TO WELCOME
MORE PEOPLE BACK TO THE CLINICAL
CENTER, THERE HAVE BEEN SOME
SHIFT IN PROPORTIONS ABOUT YOU
TO GET A COMPARISON, I THINK I
MENTIONED THIS LAST TIME, I
LOOKEDDA THE 4-QUARTERS FOR
CALENDAR YEAR OF 2019, THAT
BEING THE LAST FULL YEAR BEFORE
THE PANDEMIC AND ACTUALLY THE
TOTAL NUMBER OF CODE BLUES
CALLED IN 2021, VERSUS 2019 WAS
ALMOST IDENTICAL.
IT WAS OFF BY 1 AS WAS WE WILL
SEE ON THE NEXT 1 THE TYPE OF
CODE.
BUT WE WILL SEE THAT HALF OF
THEM ARE FOR IN-PATIENTS AND
THEN ANOTHER THIRD MAY BE IN
OUT-PATIENTS AND THEN VISITORS
AND EMPLOYEES MAKING UP THE REST
OF THEM.
AND HEAR THE NUMBERS ARE BROKEN
UP BY TYPE OF EVENT AND AS I
MENTIONED, THE CARDIAC ARREST
RATE IS ABOUT 15%.
SO ABOUT 15% ARE, YOU KNOW A
CARDIAC ARREST BUT MANY ACUTE
EMERGENCIES AND MANY ACTUALLY
ARE WHERE THEY DEEMED TO BE
STABLE EVENTS, MAYBE SOMEBODY
SAW SOMEBODY TRIP AND FALL AND
THOUGHT THEY NEED ASSISTANCE AND
THE CODE TEAM COMES, EVALUATES
THEM OF COURSE AND DEEMS THEM TO
BE STABLE EVENT.
THE CODE BLUE DISPOSITION AS WE
SEE ABOUT A QUARTER OF THEM GO
TO THE ICU AFTER THE CODE BLUE
AND ABOUT A THIRD WIND UP
STAYING ON THE UNIT.
THE BLUE IS A TRANSFER TO THE
OUTSIDE HOSPITAL THAT WOULD BE
MOST--THE ALMOST EXCLUSIVELY
GOING TO BE A VISIT ON OR AN
EMPLOYEE WHO THE CODE TEAM
EVALUATES AND THEN DEEMS TO NEED
MORE CARE RATHER THAN GOING TO
AN OUTSIDE HOSPITAL FOR THAT.
JUMPING FROM CODE BLUE TO RAPID
RESPONSE, I THINK WE
KNOW--RESPONSE TEAM AND THAT'S
SOMETHING ANYBODY CAN CALL FOR
BUT LOOKING AT WHAT HAPPENED TO
THE PEOPLE FROM THE RAPID
RESPONSES, WHICH SOMETIMES CAN
BE AN INDICATOR OF MAYBE A CODE
BLUE SHOULD HAVE BEEN CALLED
INSTEAD, WE SEE HERE THAT MOST
DO GET EVALUATED AND CARE FOR
RECOMMENDATIONS ARE GIVEN, MAYBE
GO TO ANOTHER UNIT OR SWITCH TO
ANOTHER AUTOPSY SERIES, THIS
MIGHT BE A OUT PATIENT, HEY, YOU
SHOULD BE ADMITTED BUT WE'RE NOT
GOING TO HAVE TO NECESSARILY
ADMIT YOU TO THE ICU, YOU WILL
GO TO AN IN-PATIENT UNIT AND
THEN LIKE I SAID, ABOUT 20% ARE
GOING TO THE--ABOUT 15% ARE
GOING TO THE ICU.
ONE OF THE THINGS WE LOOK AT AS
A TEAM AFTER EACH CODE BLUE IT'S
DEBRIEFED BY THE CODE TEAM IN
THE ICU AND THEN IT'S LOOKED AT
A MULTIDISCIPLINARY GROUP IN
ADDITION TO THAT 1 LOOKED AT AS
THE GROUP OF CODE BLUES ARE
LOOKED AT, BY A MULTIPLE CODE
BLUE COMMITTEE, THOSE THINGS ARE
LOOKED AT AGAIN, NOT JUST FOR
TRENDS BUT ANY PROCESS ISSUES
AND THEN WITH RAPID RESPONSE,
ONCE AGAIN WE ASKED IS THIS
SOMETHING THAT MAY BE THEY
SHOULD HAVE CALLED A CODE BLUE
FOR AND MAYBE AN OPPORTUNITY TO
DO THAT AND WE WOULD SEE, YOU
KNOW WHY ARE PEOPLE CALLING,
CHOOSING TO PICK THE KIND THAT
THEY DO.
MOVING NOW TO TRANSFUSION
MEDICINE METHODS INVOLVING BLOOD
PRODUCTS.
LOOKING AT THE CROSS MATCH TO
TRANSFUSION RATIO, THIS WOULD BE
THE LOWER IS THE BETTER BECAUSE
THAT WOULD MEAN THAT THE BLOOD
THAT WAS CROSS MATCHED WAS
INDEED USED SO IT'S A MATTER OF
HOW MUCH AND HOW TO RESERVE
VERSUS GOING TO THE PATIENT AND
WE SEE THAT OUR GOAL IS A RATIO
OF 2-1 AND WE'RE WELL BELOW
THAT, AND THOSE NUMBERS HAVE
BEEN PRETTY STABLE OVER THE
COURSE OF THIS PAST YEAR.
LOOKING AT TRANSFUSION REACTIONS
BY CLASS, THIS IS OVERALL BEEN
ABOUT 1% OR BELOW 1% FOR THE
YEAR.
MAJORITY OF THESE ARE FEVER
WITHOUT HEMOLYTIC REACTION AND
YOU WILL SEE WE ACTUALLY DO NOT
HAVE ANY OF THE GRAY WHICH WOULD
BE SOME OF THE MORE SEVERE
REACTIONS THAT MAY INDICATE THAT
THE PERSON GOT AND NOT PROPERLY
MATCHED UNIT AND WE DON'T HAVE
ANY OF THOSE IN THESE--YOU KNOW
WITH SMALLER NUMBERS, THERE'S A
LITTLE BIT OF A JACKED LINE BUT
PRETTY CONSISTENT AND ALWAYS
BELOW 1% TURNOVER.
SO LOOKING AT UNACCEPTABLE BLOOD
BANK SPECIMENS, THIS JUST IS AN
INDICATOR IF THE TYPE AND SCREEN
IS SENT AND THERE'S SOMETHING
SUCH THAT IT CANNOT BE USED,
THAT WOULD ALWAYS BE THEN
DECLINED BECAUSE OF COURSE, THE
TYPE AND SCREEN OF HAVING THE
PROPER LABELING ON IT AND
MATCHING WITH THE PATIENT IS 1
OF THE CRUCIAL STEPS OF INSURING
THAT A PERSON DOES NOT
INADVERTENTLY RECEIVE MISMATCHED
BLOOD.
BUT WE ALSO WANT TO SEE, EVEN,
ARE THESE UNACCEPTABLE PESMENS
COMING.
THREE% BEING THE GOAL, WE'VE
BEEN WELL BELOW THAT AGAIN,
EVERY SINGLE 1 OF THESE WOULD
THEN BE DISCARDED AND ASKED FOR
A NEW SPECIMEN.
FOR THE NEXT SLIDE WE WILL TALK
ABOUT SOME OF OUR CLINICAL COCK
DOCUMENTATIONS, OUR THE NEXT SET
OF SLIDES ARE CLINICAL
DOCUMENTATION METRICS.
LOOKING AT DELINQUENT RECORDS
WHICH IS DEFINED AS GREATER THAT
KNOW 30 DAYS POST DISCHARGE
UNTIL THE DOCUMENTATION IS IN
ORDER.
WE RUN AROUND 5, 6, 7%, WITH
ACTUALLY THE JOINT COMMISSION
BENCHMARK BEING 50% SO OBVIOUSLY
WE HAVE THAT, ABOUT YOU WE DO
WANT TO STAY STABLY DOWN HERE AS
CLOSE TO 0 AS POSSIBLE
ESPECIALLY AS WE GO TO A POINT
WHERE PEOPLE MIGHT BE BEING
TRANSFERRED, THERE MIGHT BE SOME
CARE THAT'S AT VARIOUS DIFFERENT
PLACES, WE WANT TO BE SURE THAT
THE DOCUMENTATION IS ALL IN
ORDER.
AND LOOKING FOR AGENT 4 COUNTER
PROCEDURES.
SO WE HAVE A STRICT POLICY ON
WHAT TYPES OF THINGS CAN HAVE A
VERBAL ORDER OR AN AGENT FOR
ORDER WHERE 1 PERSON PRESENTS
THE ORDER AND WITH THE
PHYSICIAN'S APPROVAL AND SHOWING
IT HAS TO BE SIGNED BUT THEN IT
HAS TO BE SIGNED WITHIN 72
HOURS, OUR GOAL IS 100% MEETING
THAT AND WE SORT OF KEEP UP IN
THAT MID90S.
SOME OF THE STEPS THAT ARE TAKEN
IS THAT THE PERSON FOR WHOM THE
ORDER WAS PLACED GETS AN E-MAIL
ALERT AND EVERY TIME THAT PERSON
LOGS ON TO OUR COMPUTER ENTRY
SYSTEM CALLED C RES, THEY WILL
BE TOLD YOU HAVE UNSIGNED ORDERS
SO GO AHEAD AND DO THAT.
IFINEALLY DO NOT USE
ABBREVIATION ADHERENCE, THIS IS
SOMETHING THAT
WOULD--UNACCEPTABLE
ABBREVIATIONS WHERE THERE COULD
BE CONFUSED GRAPHICALLY LIKE A U
FOR UNITS LOOKING LIKE A 0,
MEANING WHICH MAKES IT 10 FOLD
ERROR OR SOMETHING, YOU KNOW
SHORT ABBREVIATION THAT BEING BE
MULTIPLE THINGS.
SO WE HAVE OUR DO NOT USE, AGAIN
WITH THE GOAL OF 100% IN OUR
ORDER ENTRY, THESE THINGS YOU
WON'T BE ABLE TO PLACE MOST OF
THESE THINGS BUT IN SOME OF THE
FREE CHECKS AREAS, SOMETIMES
PEOPLE ARE ABLE TO SO WE NEED TO
BE VIGILANT ABOUT THAT ASK
KEEPING THIS NUMBER AS CLOSE TO
100% OR IN THAT CASE, 0% USE OF
THEM RATHER I SHOULD SAY AS
POSSIBLE.
AND THEN THE ACCURACY OF RECORD
CLEARING, THIS IS DONE BY AUDIT,
BY HEALTH INFORMATION MANAGEMENT
SYSTEM, AND ACCURACY OF CODING
HAS BEEN IN THE MID TO HIGH 90S
WITH THE HOSPITAL SETTING A GOAL
OF AT LEAST 90% AND WE'VE
REMAINED BOTH STABLE AND ABOVE
THAT.
THE LAST TOPIC, LAST BUT NOT
LEAST IS EMPLOYEE SAFETY.
TALKING ABOUT OCCUPATIONAL
INJURIES AND ILLNESSES,
COMPARING TO OTHER U.S.
HOSPITALS.
SO AT THE LAST MEETING WHEN I
SHOWED DATA THERE WAS A REQUEST
FOR SOME BENCHMARKS AGAINST U.S.
HOSPITALS, I WILL SAY THAT THE
BURRO OF LABOR AND STATISTICS
WHO PROVIDES THIS DATA, THE 2021
DATA ARE NOT FULLY COMPILED,
EXCUSE ME, SO THE BLUE IS THE
DATA FOR U.S. HOSPITALS ACROSS
THE LAST SEVERAL YEARS I WILL
SAY IT'S USUALLY PRETTY STABLE
BUT WE DON'T KNOW WHAT THE 21
WOULD BE BUT THAT SAID, WHERE
ARE WE WITH TOTAL REPORTABLE
CASES AND OTHER REPORTABLE CASES
FREQUENTLY AND CERTAINLY THIS
YEAR AND THE LAST YEAR'S BELOW
THE NATIONAL AVERAGE FOR A
HOSPITAL OUR SIZE.
AND AS WE WILL MOVE ON TO SOME
OF THE OTHER THINGS, DAYS OF JOB
TRANSFER, RESTRICTION OR DAYS
AWAY FROM WORK.
WHERE WE ARE.
AND LOOKING AT A COMBINED CALLED
DAYS AWAY OR RESTRICTED OR
TRANSFERRED.
I WILL SAY THAT THE MAJORITY OF
OUR DARTS, DAYS AWAY OR
RESTRICTED OR TRANSFERS ARE E
LIEWCIALLY DUE TO
MUSCULOSKELETAL INJURIES AND
THIS GOES BACK TO SOMETHING I
MENTIONED EARLIER THAT OUR
HOSPITAL IS TAKING STEPS TO PUT
IN PROCESSES THAT WOULD HELP
REDUCE SOME OF THOSE ERRORS, I
MENTIONED THE BEDSIDE MOBILITY
ASSESS WILL TOOL, 1 OTHER THING
THEY PUT INTO PLACE IS AN AIR
MATTRESS SYSTEM FOR MOVING
PATIENTS FROM BED TO BED.
THIS CAN HELP REDUCE STAFF
INJURIES, IT CAN ALSO HELP
REDUCE PATIENT INJURIES AND
DISCOMFORT, YOU KNOW A PATIENT
MOVE FRIDAY 1 BED TO ANOTHER
RATHER THAN SOMEBODY LIFTING
THEM OR MAYBE GETTING TWISTED A
LITTLE BIT, THE AIR MATTRESS
JUST LIED THAT PERSON OVER.
SO 1 OF THE THINGS WE WANT TO DO
IS INSURE THIS IS USED AS MUCH
AS POSSIBLE IN ANY OF THESE
STEPS, BOTH TO KEEP OUR PATIENTS
SAFE BUT ALSO TO KEEP OUR
EMPLOYEES SAFE FROM INJURY.
THAT WAS THE FINAL METRIC I HAD.
AND I WILL SEE IF THERE'S ANY
QUESTIONS?
I WILL GET MY--TRY TO STOP
SHARING.
>> THANK YOU DAVID AND RIGHT NOW
I FEEL PAUL O'NEIL SMILING DOWN
ON US FOR NEW MEMBERS OF THE
BOARD.
PAUL O'NEIL WAS 1 OF OUR
ORIGINAL BOARD MEMBERS AND WAS
VERY FOCUSED THROUGHOUT HIS
CAREER ON TEAM MEMBER SAFETY.
AND SO AS WE'VE TALKED ABOUT
PATIENT SAFETY, HE WOULD ALWAYS
RIGHT THERE.
SO IT'S GREAT TO SEE THE FOCUS
ON THAT.
LET ME SEE IF ANYBODY WANTS TO
ASK A QUESTION, MAKE A COMMENT?
ANTOINETTE.
>> JUST A QUICK QUESTION
DR. LANG, YOU SAID THERE WAS A
0% UTI INFECTION RATE.
HOW WERE YOU ALL ABLE TO
ACCOMPLISH THAT?
WAS IT DUE TO THE NURSES WERE
DOING OR IS IT SOME SORT OF THE
CATHETER TYPE DEVICES THAT ARE
USED NOW DAYS?
>> YEAH THAT'S A GREAT QUESTION.
THE 0% UTI ASSOCIATED WITH A
CATHETER AND I THINK IT'S
CERTAIN PRACTICES, CERTAIN
NURSING PRACTICES THAT ARE PUT
IN AND IN FOLLOWING THOSE BEST
PRACTICES ARE THE THINGS THAT
HELP KEEP THAT VALUE LOW.
SO THANK YOU FOR ASKING.
>> VERY IMPRESSIVE.
>> I WOULD LIKE TO ASK 1 OTHER
QUESTION AND I'M NOT SURE TO
WHICH TEAM MEMBERS I'M DIRECTING
THIS TO BUT PERHAPS SEVERAL,
VANDERBILT JUST 10 DAYS OR SO
AGO, I KNOW IN MY AREA, IT'S
BEEN A HUGE TOPIC OF
CONVERSATION AROUND SUPPORTING
OUR STAFF, I THINK THE STORY
ITSELF IS COMPLICATED, WE'VE
TRIED TO STAY AWAY FROM THAT BUT
SUPPORTING OUR STAFF AND FOR
BARBARA OR DAVEED COLLEEN,
SOMEWHERE IN THERE, IS THERE
CONVERSATION NOW GOING ON WITH
YOUR TEAM AND HOW ARE YOU THINK
BEING APPROACHING SOME OF THAT?
>> YEAH, SO, THANK YOU FOR THAT
QUESTION.
I SHARED WITH THE NURSES,
THROUGHOUT THE NURSING
DEPARTMENT AS WELL AS OUR EXTRA
DEPARTMENTMENTAL NURSES,
FORWARDED THE STATEMENTS FROM
THE MARYLAND NURSE'S ASSOCIATION
AND THE AMERICAN NURSE'S
ASSOCIATION ALONG WITH MY
COMMENTS TO CONTINUE TO SUPPORT
1 ANOTHER AND TO REACH OUT.
AND I RECEIVED VERY FAVORABLE
RESPONSES BUT IT IS A CONCERN
AND WE WANT PEOPLE TO NOT FEAR
RETALIATION, BUT OVER THE PAST
SEVERAL YEARS WE'VE FOCUSED ON A
JUST CULTURE, THE OPEN
DISCUSSION OF EVENTS AND WORK TO
RESOLVE ISSUES AND OUR FOCUS ON
SAFETY.
HOPEFULLY PEOPLE FEEL THAT
SUPPORT AND CAN COME FORWARD IF
THEY HAVE CONCERNS OR ISSUES.
WE HAVE TO REALLY FOCUS ON A
NONPUNITIVE ENVIRONMENT AND WE
HAVE TO MODULATE OUR RESPONSES,
YOU KNOW WHEN EVENTS OCCUR BUT
AGAIN TO BE VERY SUPPORTIVE OF
THE STAFF.
>> THANK YOU.
STEVE, I SEE YOUR HAND GOING UP
THERE.
>> YEAH, I WOULD JUST COMMENT,
WE ACTUALLY STARTED THE DISTRICT
ATTORNEY AT 6:30 THIS MORNING
WITH A MEETING ON THIS SUBJECT.
THERE ARE PECULIARITIES OF THE
TENNESSEE LAW WHICH OBVIOUSLY
PLAY INTO THIS AND THE ISSUE OF
OVERRIDE PICKS US PARTICULARLY
WHEN WHAT YOU HAVE RECEIVED, IF
THE LOOK AT THE FACTS OF THE
CASE THAT HAS WARNINGS ON IT
THAT WERE IGNORED.
SO I--THAT LED US TO DO IS TO
ACTUALLY FORM A GROUP
PREDOMINANTLY COMPRISED OF
NURSES THAT ARE LOOKING WITH OUR
RCA SYSTEM AROUND THE ISSUES OF
WHETHER OR NOT THERE ARE CHECKS
AND BALANCES THAT NEED TO BE
INITIATED FURTHER THAT WILL
ENHANCE THE ABILITY OF A STAFF
MEMBER NOT TO MAKE A MENTAL
ERROR AT AN IMPORTANT TIME
BECAUSE THESE THINGS, AS WE KNOW
THESE THINGS WILL HAPPEN.
NOW THERE'S NO CASE LAW IN
NEW YORK STATE THAT WE'VE HAD
OTHER CASES AND IF FACT WE
COULDN'T FIND ANY OTHER CASES
NATURALLY BUT THIS IS VERY
PARTICULAR AND I DO THINK IT
GOES TO THE ISSUE OF OVERRIDE,
OF [INDISCERNIBLE] AND HOW DO
YOU RECEIVE THE CHECK OF WHAT
YOU WANTED AND THEN YOU GET INTO
A WHOLE ISSUE OF PATIENT
MONITORING, ET CETERA.
SO IT'S REALLY--I DON'T KNOW
THIS GOES BACK TO 2017 SO I
DON'T KNOW THE RESPONSE OF
VANDERBILT AT THAT TIME AND
WHERE THEY CHOSE TO PURSUE IT
THE WAY THEY DID.
>> YES, JUST TO BE VERY CLEAR, I
DIDN'T WANT TO GET INTO THAT, I
REALLY WAS JUST WANTING TO HEAR
AND BARBARA I THINK YOU SHARED
IT AND I KNOW YOU ARE SUPPORTING
YOUR STAFF SO I KNOW PEOPLE ARE
TALKING ABOUT IT.
GOOD, THANK YOU.
I SEE STEPHANIE AND THEN RICK.
>> THANKS, LAURA.
SO MY COMMENT IS ALSO JUST
DIRECTED, I GUESS AT THE WHOLE
TEAM OR MAYBE IN GENERAL
COMMENT.
IT SEEMS AS THOUGH WE'RE SEEING
LEVELS OF FATIGUE, ALL KINDS OF
FATIGUE AMONG OUR TEAMS, MENTAL
HEALTH ISSUES BUT PERHAPS NOT
QUITE THAT SERIOUS ISSUES JUST
INCREDIBLE FATIGUE AND I CAN'T
HELP BUT THINK IT HAS AN IMPACT
ON EVERYTHING WE DO,
SAFETYENTIOUS SPECIALLY OR AT
LEAST IT HAS THE POTENTIAL OF
THAT SO WONDERING, ARE
YOU--THERE'S BEEN SO MUCH
OPTIMISM SHARED TODAY WHICH IS
SO HELPFUL FOR ALL OF US AND OUR
MENTAL HEALTH BUT I WONDER, ARE
YOU ALSO SEEING JUST THIS
INCREDIBLE LEVEL OF FATIGUE THAT
WE SEEM TO BE SENSING ELSEWHERE?
>> I WOULD SAY YES THAT WAS A
TOPIC OF CONVERSATION AT OUR
NURSE EXECUTIVE COMMITTEE
MEETING YESTERDAY IS JUST, WE
HAVE TO KEEP FOCUSING ON MAKING
SURE WE ARE OUT AND AVAILABLE
WITH OUR WITH SCHEDULING AND
STAFFING AND JUST MAKING
SURE--YOU KNOW WE HAVE PEOPLE
THAT WORK HERE AND LIVE PRETTY
FAR AWAY AND THEY LIKE TO BUNCH
ALL THEIR SHIFTS TOGETHER AND
IT'S LIKE, WE LOOK AT THINGS
FROM PATIENT SAFETY AND THE
STAFF SAFETY PERSPECTIVE BUT WE
ARE SEEING THE SIGNS OF FATIGUE
AS ELSEWHERE ACROSS THE COUNTRY
AND SO, YOU KNOW WE'RE VERY
FOCUSED ON WHAT WE DO AND THE
CLINICAL CENTER AND DR. GILMAN
MAY WANT TO SPEAK MORE TO AGAIN,
WE'VE--WE HAD REOPENED THE
CRISIS LINE, THE HOT LINE FOR
PEOPLE TO CALL TO GET SUPPORT TO
HAVE SOMEBODY TO SPEAK WITH
BECAUSE, YOU KNOW WE'RE STILL
FEELING IT AS OUR PEOPLE BUT
ALSO AS HEALTHCARE INSTITUTIONS.
YEAH, I THINK LIKE DR. FORESE,
WITHOUT GETTING INTO THE DETAILS
OF THE VANDERBILT CASE, 1 THING
WE LOOK AT IS 1 MAKING SURE WE
HAVE PROCESSES THAT HELP PREVENT
PEOPLE FROM DOING ERRORS BUT
THEN IF PEOPLE DON'T FOLLOW
THOSE, THE QUESTION IS WHY ARE
THEY NOT FOLLOWING THEM?
AND GIVING THE ASSUMPTION IT'S
GOING TO BE EXTREMELY, EXTREMELY
OUTLYING CASE WHERE SOMEBODY'S
INTENTIONALLY TRYING TO HARM
SOMEBODY SO WE'RE SETTING THAT
ASIDE, WHY ARE THEY NOT
FOLLOWING THESE?
IT'S INTERFERING WITH SOME OTHER
THING WHETHER IT'S THE NEED--THE
PERCEIVED NEED FOR RUSHING OR
FEELING SO FATIGUED THAT IT'S
LIKE, WELL I HAVE 17 MEDICINES
TO USE SO I'M JUST GOING TO--I
DIDN'T MEAN TO GRAB THE FIRST 1
THAT WAS THERE BUT I HAD TO THAT
KIND OF THING, I THINK ALL THOSE
THINGS TIE IN TOGETHER.
>> YEAH, THANK YOU.
THANK YOU.
>> OKAY, WE WILL TAKE 1 MORE AND
THEN WE WILL GET OVER ON CLIFF,
GREAT CONVERSATION, GREAT
REPORT, DAVID.
>> RICK?
>> YES, THANK YOU DAVID AND
MAYBE THIS IS FOR BARBARA,
OBVIOUSLY THE FATIGUE AT THE
CLINICAL CENTER ISN'T DUE TO
COVID, MEANING YOU DON'T HAVE
COVID CASES.
YOUR CENSUS IS WAY DOWN SO THE
IDEA OF BEING OVERBURDENED ALSO
AT LEAST FROM THE NUMBERS ISN'T
THE ISSUE.
MY QUESTION IS WHAT ABOUT
TURNOVER?
AND ARE YOU SEEING THE SAME
CHALLENGES EITHER WITH RESPECT
TO STAFF SHORTAGES OR WITH
RESPECT TO TURNOVER AND NEW
NURSES CAN WHICH LEAD TO DRIFT
ASK THEREFORE MORE SAFETY
EVENTS?
>> YES, TO ALL OF THE ABOVE.
SO WE'VE HAD--WE'VE HAD TURNOVER
JUST AS ANY OTHER ORGANIZATION
HAS HAD AND ALSO WHAT WE SAW, WE
DO USE SOME CONTRACT STAFF TO
SUPPLEMENT BUT WE HAD GREAT
DIFFICULTY IN FILLING THOSE
NEEDS BECAUSE OF THE EXORBITANT
COSTS AND/OR THE MONEY THAT
PEOPLE CAN MAKE EITHER GOING TO
THE HIGHLY HIT PANDEMIC AREAS.
BUT THE FATIGUE, THE PATIENTS AS
DR. GILMAN PRESENTED, THE 1S
THAT CONTINUE TO COME DURING ALL
THIS TIME ARE VERY ACUTE, VERY
COMPLEX.
OUR PATIENT ACUITY IS VERY HIGH
AND SO THAT AGAIN, THE
DAY-TO-DAY, BUT OUR, THE FATIGUE
JUST COMES FROM LIVING IN THIS
DIFFERENT WORLD AND TAKING CARE
OF PATIENTS BUT THEN HAVING TO
GO HOME AND, YOU KNOW HOME
SCHOOL YOUR CHILDREN THAT YOU
WEREN'T PLANNING TO DO ALL THOSE
KINDS OF THINGS SO WE'VE SEEN
THE SAME THINGS HERE AS OTHERS,
YOU KNOW IN THE COUNTRY.
>> ABSOLUTELY, I THINK WE ALSO
HAVE--YOU KNOW PEOPLE NEEDING TO
MASK, PEOPLE NEEDING TO NOT BE
ABLE TO EAT TOGETHER, PATIENTS
NONAPOPTOTIC THE HAVING
VISITORS, SO THINGS THAT ARE
COVID SECOND ORDER OF
CONSEQUENCES EVER COVID ARE
DEFINITELY AFFECTING OUR STAFF
IN ADDITION TO THE COVID
PATIENTS THEMSELVES.
SO, YEAH.
JUST I DO THINK COVID IS PART OF
IT.
>> SO EVERYTHING THAT BARBARA
JUST SAID.
WE HAVE EXPERIENCED THE IMPACT
OF THE GREAT RESIGNATION AS WE
TALKED ABOUT IN OUR OCTOBER
MEETING AND WE DO OPERATE IN A
PERSONNEL SYSTEM THAT MAKES IT
EASY TO LEAVE IN A COUPLE WEEKS
AND VERY HARD TO COME AND IT
TAKES MONTHS TO BRING THE NEW
STAFF ONLINE.
AND THERE A INFLEXIBILITIES THAT
I THINK MANY OTHER PLACES DON'T
HAVE TO DEAL WITH.
WE DO WORK UNDER--WE DO
EMPHASIZE THE JUST CULTURE, WE
ALSO EMPHASIZE REPEATEDLY THAT
HELP SEEKING IS A SIGN OF--AND
WE'VE DONE A FAIR AMOUNT OF
THAT.
WE ARE--WE DO AT THE PRESENT
TIME DEAL WITH SORT OF THE PUSH
AND THE PULL OF INVESTIGATORS
WHO WANT TO REENERGIZE THEIR
CLINICAL PROGRAMS THAT
HAVE--THAT HAVE BEEN ON LOW
SPEED FOR THE LAST COUPLE OF
YEARS AND WHO WANT TO--WE HAVE
INVESTIGATORS THAT ARE ON
TENURED TRACK WHEN THERE'S A
CLOCK TICKING AND DR. GOTTESMAN
DOESIS BEST TO REASSURE THEM
THAT THEY WILL GET THE EXTRA
TIME THEY NEED BUT I KNOW THEY
ARE STILL FEELING, THEY NEVER
ARE SURE WHEN THEIR EXTRA TIME
WILL BE UP AND SO THERE'S A LOT
OF STRESS IN AND AMONG THE
INVESTIGATORS AND I THINK IN THE
PAST, IT MIGHT HAVE LED TO MAYBE
TOO MANY--MORE PATIENTS THAN WE
CAN REALLY TAKE GOOD CARE OF IN
THE CLINICAL CENTER, I
THINK--WHILE IT'S A BALANCING
ACT EVERY DAY, TRYING TO TAKE
CARE OF AS MANY PATIENTS AS WE
CAN SAFELY, THEN I THINK--BUT
IT'S A CONSTANT TOPIC OF
DISCUSSION AND SOMETIMES THE
DISCUSSIONS GET A LITTLE WARM
BUT I THINK WE'RE DOING THE BEST
WE CAN.
>> GREAT.
WELL, THANK YOU.
RICK JUST PUT A LINK INTO THE
CHAT AS WELL.
THANK YOU RICK.
WELL, THANK YOU ALL.
THIS IS A GREAT CONVERSATION AND
THERE'S SOME THINGS THAT ARE
UNIVERSAL HERE THAT WE CAN
CERTAINLY ALL RELATE TO ALL
RIGHT.
WE'RE GOING TO SWITCH GEARS NOW,
A BIT.
AND GO OVER TO CLIFF.
CLIFF SORRY TO KEEP YOU WAITING.
THANKS VERY MUCH FOR BEING HERE
AND WE'RE LOOKING FORWARD TO
HEARING YOUR COMMENTS.
>> GREAT.
THANKS, VERY MUCH.
ARE MY SLIDES SHOWING ALL RIGHT?
AND GOOD, YOU CAN HEAR ME?
OKAY.
SO THANKS FOR THE OPPORTUNITY TO
PROVIDE WHAT I THINK MUST BE NOW
THE THIRD UPDATE TO THE GROUP ON
SOME THINGS GOING ON HERE AND
OBVIOUSLY GLOBALLY WITH REGARD
TO COVID-19.
I KNOW YOU HAVE COPIES OF THE
SLIDES AND I KNOW WHERE YOU ARE
IN TERMS OF SCHEDULE SO SOME OF
THE STUFF I WILL GO THROUGH
PRETTY QUICKLY, SO THIS IS JUST
SORT OF THE OUTBREAK AS A COUPLE
OF DAYS AGO, I WILL COME BACK TO
THIS LAST PEAK IN A MINUTE
BECAUSE IT OBVIOUSLY REPRESENTS
OMICRON, IT DOESN'T SHOW ANY
IMPACT YET IN THE U.S. OF THE
BA.2 VARIANT.
SOPHISTICATED I WILL TALK ABOUT
THE NORG OZIOMATION AT THE
NATIONAL LEVEL AND THEN TALK
ABOUT PATHOGENESIS, DIAGNOSTIC,
THERAPEUTICS, PREVENTION AND
POST ACUTE SEQUELAE.
SO ANDY CANNED WHAT WAS THE
SENIOR ADVISOR AT WHITE HOUSE,
HE HAS LEFT.
JEFF ZIENTS, WHO IS CURRENTLY
THE CORONAVIRUS RESPONSE
COORDINATOR WILL BE LEAVING IN A
FEW DAYS.
HE WILL JEFF WILL BE REPLACED
BY--WHOOPS, S
ORRY--DR. ASHISH JHA, AND
NOUNSING HIS APPOINTMENT THE
PRESIDENT NOTED HE IS 1 OF THE
LEADING PUBLIC HEALTH EXPERTS IN
AMERICA AND WELL KNOWN FIGURE TO
MANY AMERICANS FROM HIGHS
WEDNESDAY AND CALMING PRESENCE
STRESSING THE LAT LATTER PHRASE
THERE.
I KNOW THOSE OF YOU WHO KNOW HIM
AND SEEN HIM ON CNN WILL
PROBABLY AGREE WITH THAT
SENTIMENT.
THERE ARE TRANSITIONS THAT BEEN
TAKING PLACE AT THE LEVEL OF
HHS, REGARDING THE COVID-19
RESPONSE VENLT THE INITIAL
RESPONSE KNOWN AFFECTATELY AS
OPERATION WARP SPEED WAS REALLY
A COMBINED EFFORT BETWEEN THE
DEPARTMENT OF DEFENSE AND THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES THAT WAS UNDERAN MOU
THAT EXPIRED AT THE END OF LAST
YEAR AND OPERATION WARP SPEED
THEN TRANSITIONED OVER TO
SOMETHING CALLED H-CORE, OR HHS
ACCORD NATION OPERATIONS AND
RESPONSE ELEMENT.
THIS COMES OUT OF THE OFFICE OF
SECTIONAL ANALYSIS FOR
PREPAREDNESS AND RESPONSE WHICH
IS DON O'CONNELL, AND ITS LED BY
DR. JASON ROOS, CHIEF OPERATING
OFFICER AND DR. DAVID KESSLER
WHO WAS THE HHS CHIEF SCIENCE
OFFICER FOR COVID-19.
I MENTION THESE THING BECAUSE
IT'S HELPFUL TO KNOW WHO THE
PLAYERS ARE AND WHERE THE
DECISIONS ARE BEING MADE.
THE WHITE HOUSE RELEASE THE
NATIONAL COVID-19 PREPAREDNESS
PLAN ON MARCH 2nd.
IT HAS 4 MAIN ELEMENTS.
THE FUNDING WAS IN THE COVID-19
SUPPLEMENT THAT DID NOT GET
PASSED.
SO AGAIN, THERE'S A LOT OF
UNCERTAINTY RIGHT NOW ABOUT WHAT
ELEMENTS OF THIS PLAN IN FACT
ARE GOING TO COME INTO BEING OR
NOT.
SO JUST TO GIVE A FEW COMMENTS
ABOUT PATHOGENESIS, THIS IS A
SLIDE I USED IN THE EARLIER
PRESENTATION TO THE GROUP
UTALKING ABOUT SORT OF THE
CONVENTIONAL WISDOM ABOUT THIS
DEC THAT THERE'S, YOU KNOW
RANGING FROM ASYMPTOMATIC TO
MECHANICAL VENTILATION AND
DEATH.
THAT THAT EARLY PHASE APPEARS TO
BE DRIVEN LARGELY BY THE VIRUS
FOR WHICH ANTIVIRAL STRATEGIES
SEEM TO HAVE THE BIGGEST IMPACT,
THE LATTER STAGES PERHAPS THE
IMMUNE RESPONSE TO THE VIRUS AND
ASSOCIATE ANY INFLAMMATION WHERE
IMMUNO MODLATTORY STRATEGY VS
THE BEST EFFECT AND THEN AGAIN
LOOKING AT THE ROLE OF
COAGULATION THROUGHOUT.
SOME MORE RECENT DATA THAT'S
EMERGING IT'S REALLY NOT OUT
THERE VERY MUCH BUT I WANTED TO
MENTION IT TO THE GROUP, HAS
SUGGESTED THAT THERE MAY BE
VIRAL LOGIC ELEMENTS THROUGHOUT
THE COURSE OF ILLNESS AND IN
PARTICULAR, NOW THAT WE'RE USING
SUCH IMOWN O SUPPRESSION IN THE
ADVANCED STAGES THAT THE VIRUS
ACTUALLY MAY BE PLAYING A ROLE
THROUGHOUT THE COURSE OF
INFECTION.
WE'RE USING THIS TECHNOLOGY
DEVELOPED BY QUANTERIX, IT'S A
NANO TECHNOLOGY USING TINY
MAGNETIC BEADS CODED WITH
ANTIBODIES TO THE CORE PROTEIN
OF SARS-COV-2 SO CAN YOU MEASURE
DOWN TO THE PICOGRAM LEVELS OF
CIRCULATING SARS-COV-2 NUCLEOCAP
SID PROTEIN IN THE PLASMA OR
SERUM OF INFECTED INDIVIDUALS.
AND HERE WE'RE LOOKING AT THE
COHORT OF PATIENTS WHO ARE
ENROLLED IN THE ACTIVE 3
THERAPEUTIC TRIALS, THESE ARE
PATIENTS WHO ARE HOSPITALIZED
WITH COVID-19 AND WHAT YOU SEE
AS YOU GO FROM PATIENTS WITH
MILD DISEASE, ONLY ON ROOM AIR
THROUGH PROGRESSIVE LEVELS OF
OXYGEN SUPPORT UP TO NONINVASIVE
VENTILATION OR HIGH FLOW, CAN
YOU SEE THAT THE PLASMA LEVELS
OF ANTIGEN ACTUALLY
PROGRESSIVELY INCREASE
SUGGESTING THAT THESE MORE
SEVERELY ILL PATIENTS ACTUALLY
HAVE HIGHER LEVELS OF
CIRCULATING PLASMA ANTIGEN, HOW
THIS PRECISELY RELATES TO VIRAL
REPLICATION, WE'RE NOT SURE BUT
I THINK IT DOES RAISE THE
QUESTION ABOUT WHETHER OR NOT WE
MIGHT BE FOCUSING ADDITIONAL
ANTIVIRAL THERAPIES IN THIS
ADVANCED GROUP AS I MENTIONED
EARLIER, PARTICULARLY GIVEN THE
AMOUNT OF IMMUNO SUPPRESSION
WE'RE CURRENTLY GIVING THEM SO
BEAN IT MAY BE THAT WE NEED TO
ELECTRIC AT ANTIVIRAL STRATEGIES
THROUGHOUT THE COURSE OF
COVID-19.
YOU KNOW WOOF THE BIG WORRIES
AND--1 OF THE BIG WORRIES AND
AREAS OF FOLK SUS LOOKING AT THE
NEW VARIANTS AS THEY COME UP,
THE MOST RECENT 1 BEING OMICRON,
THAT I THINK MOST OF YOU ARE
PRETTY AWARE AS A WHOLE ARRAY OF
ADDITIONAL CHANGES FROM ITS
PREDECESSOR DELTA AND EVEN MORE
SO FROM THE ANCESTRAL STRAINS.
AGAIN THIS HAS BIG TIME
IMPLICATIONS IN TERMS OF
PATHOGENESIS, WHERE IT DOESN'T
APPEAR TO BE AS PATHOGENIC AS
SAY DELTA, BUT ALSO IN TERMS OF
THE ABILITY OF COUNTERMEASURES
PARTICULARLY THE MONOCLONAL
ANTIBODIES TO EXERT THEIR
EFFECT.
THIS JUST SHOWS THE MOST RECENT
DATA FROM CDC LOOKING AT THE
EVOLUTION OF DIFFERENT VALID AND
RELIABLE YABTS, WITHIN THE U.S.
POPULATION, THE FIRST BARS UP TO
THE LAST 2 ARE ACTUAL DATA, THE
LAST 2 BARS ARE WHAT CDC
PROJECTIONS WILL BE THE CASE IN
THE NEXT 2 WEEKS.
ONCE THE DAILY BASIS AT FROM THE
PRIOR 2 WEEKS ARE AVAILABLE, AND
YOU CAN SEE GOING BACK HERE
THIS, IS JUST GOING BACK TO
DECEMBER, THE END OF DECEMBER OF
2021, WHERE YOU STILL HAD SOME
ELEMENT OF DELTA, AND YOU HAD
BA.1 JUST SHOWING UP AS 1 OF THE
VARIANTS WITHIN OMICRON, AND
OMICRON, RANGING FROM DARK
PURPLE TO LIGHT PURPLE AND YOU
CAN SEE IT TOOK OVER IN A
MONTH'S TIME AND THE TREND IS
NOW FOR THE EMERGENCE OF BA.2,
SUBVARIANT OF OMICRON IS, THE
REASON THIS IS IMPORTANT IS
BECAUSE THIS DOES REFLECT
CHAIMPLES AND THE ABILITY OF THE
MONOCLONAL ANTIBODIES TO WORK.
[INDISCERNIBLE] THE MAIN
ANTIBODY OUT THERE WITH EFFICACY
AGAINST OMICRON, DOES NOT SEEM
TO HAVE EFFICACY AGAINST BA.2.
THE ONLY THING AVAILABLE IS
METRICS TIEWZ MAB.
BUT THIS I THOUGHT WAS AN
INTERESTING THING TO LOOK AT AND
THIS ISN'T IN THE SLIDE DECK.
I JUST PUT THIS TOGETHER EARLIER
TODAY, LOOKING AT THE CHANGES IN
NEW CASES IN FRANCE COMPARED TO
THE U.S., AGAIN THIS IS TRYING
TO GET UNDERSTANDING OF WHAT'S
GOING TO HAPPEN IN THE U.S. WITH
BA.2.
I THINK MOST PEOPLE ARE
ANTICIPATING WE WILL SEE A SURGE
WITH BA.2.
WE ARE CERTAINLY SEEING A SHIFT
TO BA.2, BUT THUS FAR THERE
AREN'T A LOT OF DATA TO SUPPORT
THAT AND THAT LOOKS LIKE THAT
EPIDEMIOLOGY MAY BE END UP BEING
DIFFERENT IN THE U.S. THAN IT IS
SHOWN HERE IN FRANCE.
AGAIN, I THINK THIS MOST LIKELY
REFLECTS DIFFERENCES SOMETHING
THAT NCATS SUPPORTS AND IT'S A
VERY NIFTY COMPILATION OF DATA
THAT ALLOWS YOU TO LOOK AT THE
EFFICACY OF ALL DIFFERENT
COUNTERMEASURES, SERUM FROM
VEHICLEINATED INDIVIDUALS,
DIFFERENT MONOCLONAL ANTIBODIES,
THE DIFFERENT ANTIVIRALS, OR
CONVALESCENT PLAZ MIDS PLACENTA
OR SERUM, AND IF YOU CLICK ON
OMICOON, CAN YOU GET WHAT YOU
SEE ON THE RIGHT AND YOU SLEEP
APNEA AND OBESITYY ALL THOSE
YELLOW DOTS OVER THE TO RIGHT
FOR MONOCLONAL SHOWING THAT THEY
ARE NOW MUCH LESS ACTIVE AGAINST
TD OMICRON VARIANT.
IN EMERGINGS OF DIAGNOSTICS
THINGS HAVEN'T CHANGED SO MUCH,
RTPC R REMAINS THE MOST
SENSITIVE TOOL AND IT REMAIN
POSITIVE FOR A PROLONGED PERIOD
OF TIME AND LOOKING AT WHETHER
OR NOT YOU'RE GETTING
AMPLIFICATION OF THE S-GENE AND
TO IDEPT BIFY VARIANTS AND
SUBVARIANTS OF OMICRORKS ON,
ANTIGEN TESTING WHILE LESS
SENSITIVE IT DOES TYPICALLY
REPRESENT A HIGHERVILLEERAL LOAD
AND IT'S VERY EASILY USED IN THE
HOME, THESE ARE ALL AVAILABLE
UNDER EMERGENCY USE
AUTHORIZATION, BUT IF WE DO GET
TO THE END OF THE PUBLIC HEALTH
EMERGENCY, THEY WILL NEED TO
HAVE SOME SORT OF MORE FORMAL
FDA APPROVAL TO CONTINUING USE.
IN TALKING ABOUT THERAPEUTICS
AND THE REMAINS A VERY EXTENSIVE
CLINICAL TRIALS INFRASTRUCTURE
THAT'S BEEN PUT TOGETHER TO LOOK
AT DIFFERENT THERAPEUTIC
STRATEGIES AND AMPLATTORY AND
HOSPITALIZED PATIENTS, THE
ACCELERATING COVID-19
THERAPEUTIC INTERVENTION
VACCINE, PUBLIC PRIVATE
PARTNERSHIP IS DOING MUCH OF
THIS WORK FOR NIH.
ACTIVES 1, 3, 4, A AND 5, LOOK
AT HOST DIRECTED THERAPIES AND
ANTIVIRALS AND HOSPITALIZED
PATIENTS.
ACTIVE 2 LOOKING AT AMBULATORY
PATIENTS AND ACTIVE 6 LOOKING AT
REPURPOSES DRUGS SUCH AS
IVERMECTIN AND [INDISCERNIBLE]
IN PATIENTS.
IT'S AN AMAZING LABD SCAPE WHEN
YOU LOOK AT WHAT'S REPORTED AND
WHAT'S AVAILABLE FOR TREATING
PATIENTS WITH COVID-19.
IF YOU DO A SEARCH OF
CLINICALTRIALS.GOV, YOU GET OVER
4000 HITS.
IF YOU LOOK FOR ARTICLES ON
PUBMED IT'S OVER 5000 HITS AND
IF YOU DO A GOOGLE SEARCH IT'S
OVER 4 BILLION HITS
SOPHISTICATEDY TRYING TO KEEP
TRACK OF ALL OF THIS IS
EXTREMELY DIFFICULT.
FORTUNATELY THERE ARE A SEER OF
DIFFERENT TREATMENT GUIDELINES,
WE HAVE 1 THAT COMES OUT OF NIH
THAT BEBAN, ORIGINS WERE IN
MARCH, IT WAS A REQUEST FROM THE
WHITE HOUSE TASK FORCE AND THEN
FROM SECRETARY AZAR TO PUT
TOGETHER A GROUP TO ISSUE A
LIVING SET OF GUIDELINES THE
FIRST RELEASE CAME OUT IN APRIL
OF 2020 FOR THAT TYPO, AS OF
JUST THIS WEEK, WE'VE HAD 48
UPDATES, THERE MAY BE ANOTHER 1
TODAY OR MONDAY AND OVER
34 MILLION PAGE VIEWS.
THE LIED LINES PROVIDE 2 TYPES
OF RATINGS.
ONE IS THE STRENGTH OF THE
RECOMMENDATION, STRONG, MODERATE
OR WEAK AND THE SECOND IS THE
STRENGTH OF THE EVIDENCE SUPPORT
THAGOREAN RECOMMENDATION, 1
BEING DATA FROM ROBUST, OR
RANDOMIZED CONTROL TRIALS,
SECOND BEING DAT FROM OTHER
TRIALS OR OBSERVATIONAL STUDIES,
OR SUBSET OF RANDOMIZED TRIALS
AND THEN THE THIRD BEING EXPERT
OPINION.
SO WITHIN THE GUIDELINES WE
BREAK IT OUT INTO
RECOMMENDATIONS FOR
NONHOSPITALLIZED PATIENTS, THIS
IS IN THE PROCESS OF BEING
UPDATED, THE BOTTOM LINE FROM
THE CURRENT RECOMMENDATION, THAT
WE FEEL IS PROBABLY THE GO TO
THERAPY FOR PATIENTS WHO ARE
PATIENTS WHO ARE AMPLATTORY WITH
PILED MODEL CITIZEN MODERATE
COVID-19 AT HIGH RISK FOR
DISEASE PROGRESSION.
IN TERMS OF MONOCLONALS AS BA.2
COMES INTO PLACE, THE ONLY 1 IS
BEBTELOVIMAB AND THAT WILL BE
REFLECTED IN THE NEXT UPDATE,
REMDESIVIR CAN BE GIVEN LOOKING
GOOD BUT IT'S A INFUSION, IT'S
REQUIRED FOR 3 CONSECUTIVE DAYS
AND VERY IMPORTANT IN AMBULATORY
PATIENTS WHO DO NOT NEED
STEROIDS, IT'S THE DATA ARE
CLEAR THAT GIVING STEROIDS TO
THIS POPULATION RESULTS IN WORSE
OUTCOMES THAN NOT GIVINGSTER
OITDS.
NERMALS OF HOSPITALIZED
PATIENTS, THERE ALSO IS AN
ENORMOUS AMOUNT OF DAT AAGAIN IF
THEY DON'T REQUIRE SUPPLEMENTAL
OXYGEN, IF AVOID STEROIDS IF
THEY DO REQUIRE OXYGEN AMONG THE
DRUGS THAT HAVE SHOWN EFFICACY,
REMDESIVIR, DEXAMETHA SEWN,
BARICITINIB, AND USE THESE ALONE
OR IN COMBINATION AND WE TRY TO
PROVIDE THAT TYPE OF GUIDANCE
AND GUIDE LINES WITH THE
ASSOCIATED CAVEAT.
THE CLINICAL TRIALS DAILY BASIS
THEA SHOULD SUGGESTS THAT
EVERYONE SHOULD BE
[INDISCERNIBLE] AND THEN PLUS OR
MINUS BARI CITINIB, BLOCKADE, SO
THE U.S. GOVERNMENT HAS BEEN
INVOLVED HEAVILY IN THE
DEVELOPMENT OF 6 OF--THERE AN
EUA ON THE PFIZER VACCINE FOR
AGES 5-15.
JOHNSONS & JOHNSONS ADENO 26
PLATFORM AS BEEN AVAILABLE UNDER
EMERGENCY USE IN THE U.S., IT'S
NOT CLEAR WHERE ASTRAZENECA,
WHETHER OR NOT THEY'RE GOING TO
BE PURSUING OPERATION IN THE
U.S. AND THEN TO RECOMBIN ANT
PROTEIN AND ADJUVANT VACCINES
HAVE UA REQUESTS IN AND THEY
PROBABLY WOULD BE USED MORE
LIKELY IN BOOSTER REGIMENS.
THOSE 6 ARE JUST A SUBSET OF THE
10 VACCINES THAT HAVE BEEN
APPROVED FOR USE BY W. H. O.
AGAIN, W. H. O. HAS APPROVED 2
OR AUTHORIZED 2 PROTEIN
VACCINES, 2 RNA VACCINES, 3 ADEN
O VIRUS BASED VACCINES AND THEN
3 ENACTIVATED VIRUS VACCINES.
JUST TO TALK FOR A FEW MOMENTS
OF THE EFFICACY FROM THE
VACCINES FROM THE U.S.
POPULATION, THESE I THINK ARE
EXTRAORDINARILY COMPELLING
DATAOT IMPACT OF VACCINATION,
THIS IS LOOKING AT AGE ADJUSTED
RATINGS OF CONFIRMATION 19
HOSPITALIZED BY VACCINE STATUS
OCTOBER 21st TO JANUARY OF
2022.
YOU CAN SEE THOSE, FULLY
VACCINATED THAT MEANS 1 DOSE OF
J& J OR 2 DOSES OF RNA, 9.8 PER
HUNDRED THOUSAND WITH A BOOSTER,
WITHOUT A BOOST ARE 35.2 AND
WITHOUT ANY VACCINE, 145.
SO THE ABILITY OF THESE VACCINES
TO PREVENT HOSPITALIZATION IS
PRETTY SECURE.
THE QUESTION ABOUT A BOOSTER AND
NOW WE'RE TALKING ABOUT A SECOND
BOOSTER, OR A FOURTH DOSE OF
RNA, IS A VERY HOT TOPIC AT THE
MOMENT.
THERE ARE REALLY, REALLY GOOD
DATA, I THINK ON THE THIRD SHOT
OR THE FIRST BOOSTER FOR RNA,
THESE ARE RANDOMIZED CONTROL
TRIAL DATA FROM PFIZER TAKING
THEIR INITIAL PHASE 3 COHORT AND
RANDOMIZING THEM TO AN
ADDITIONAL SHOT OR BOOSTER AS
ARE OPPOSE TO NOT GETTING
ADDITIONAL SHOT WHICH IS THE
RED.
YOU CAN SEE THE IMPACT OF THAT
ADDITIONAL SHOT ON INCIDENCE OF
NEW CASES, IT REALLY IS THE
THIRD SHOT AS A LOT IN TERMS OF
EFFICACY.
THOSE DISA OF COURSE ARE
GENERATED PRIOR TO OMICRON, SO
THE QUESTION IS WELL, YOU KNOW I
WAS VOCINATED WITH ANCESTRAL
STRAIN, SPIKE PROTEIN, WHAT WILL
THAT DO FOR OMICOON THESE DATA
SHOW THAT EACH THOUGH YOU'RE
BOOSTED WITH A VACCINE DIRECTED
PERIODS THE ANCESTRAL, IT GIVES
YOU INCREASE IN IMMUNITY TO THE
VARIANTS AS WELL, SO HERE WE'RE
LOOKINGA THE NEUTRALIZING
ANTIBODY TO EITHER THE WILD TYPE
OR TO OMICRON, CAN YOU SEE HERE
IN THE FAR LEFT WHICH SHOWS
TITER SEVERAL MONTHS AFTER THE
RNA, MODEL CITIZEN DENERVATA AND
BEFORE THE BOOSTER, YOU CAN SEE
THE TITERS ARE LOWER AND YOU
GIVE THE BOOST AND TITERS GO UP,
SO AGAIN BOOSTING WITH ANCESTRAL
DOES INCREASE TITERS OF ANTIBODY
TO OMICOON, SO THIS IS A VERY
IMPORTANT PIECE OF LABORATORY
DATA.
THE BOOSTING THAT YOU SEE, CAN
YOU SEE REGARDLESS OF WHAT BOOST
YOU GIVE, SO THESE ARE LOOKING
AT PATIENTS WHO ARE INITIALLY
IMMUNIZED WITH EITHER AD26, THE
JNJ, MRNA, MODEL CITIZEN
DENERVATA OR THE PFIZER RNA, AND
THEN BOOSTED FROM MODERNA, THE
JNJ AND THE PFIZER, CAN YOU SEE
IN EACH INSTANCE IT DOESN'T
MATTER WHAT YOU GOT IPT GREATER
I SHALY THAT IN FACT ANY OF
THESE SCRAK SEENS WILL GIVE YOU
A GOOD BOOST.
YOU CAN TELL EVEN THOUGH THIS IS
NOT A RANDOMIZED CONTROL TRIAL,
THESE DATA WERE DEVELOPED
LONGITUDINALLY SO THERE ARE A
LOT OF CONFOUNDERS BUT BY AND
LARGE YOU ARE GETTING HIGHER
ANTIBODY TITERS WITH A BOOST
WITH RNA THAT DOESN'T TELL YOU
ABOUT DURABILITY AND AS I
MENTION INDEED A MOMENT THAT'S
STILL 1 OF OUR UNANSWERED
QUESTIONS.
SO WHAT WE DO KNOW IS THAT IN
ADULTS THESE VACCINES LOOK
REALLY SAFE, REALLY EFFECTIVE
AND THERE'S CLEAR ADDITIONAL
PROTECTION FROM A THIRD DOSE, IN
CHILDREN, AT LEAST FOR PFIZER,
WHERE WE HAVE EMERGENCY
AUTHORIZATION, THEY APPEAR SAFE
AND EFFECTIVE IN AGES 5-17.
WE DON'T HAVE ANY GOOD
LABORATORY CORRELATES PROTECTION
THAT COULD HELP THEN INFORM HOW
OFTEN 1 MIGHT NEED A BOOST, WE
DON'T KNOW THEN, DURATION OF
PROTECTION FROM EITHER
INFECTION, SYMPTOMATIC DISEASE,
HOSPITALIZES OR DEATH AND IT'S
UNCLEAR THIS FAR WHAT IS THE
BEST REGIMEN FOR CONCERN UNDER 5
YEARS OF AGE ALTHOUGH THERE ARE
DATA BEING REVIEWED AT THE
MOMENT.
SO EARLIER THIS WEEK, THE FDA
AUTHORIZED A FOURTH DOSE FOR
ADDITIONAL INDIVIDUALS OR A
SECOND BOOSTER THIS, IS FOR
ANYONE 50 YEARS OF AGE OR OLDER
AND AT LEAST 4 MONTHS AFTER
RECEIPT OF A FIRST BOOSTER DOSE,
FORRIFIES THERAPY AND INCLUDES
PEOPLE, AGAIN, 50 YEARS OF AGE
AND OLDER AND ANYONE 12 AND
OLDER PRETTY EXTENSIVE FROM A
LOT OF THE WORK THEY'VE DONE IN
PARTICULAR, SOME OF THE WORK IN
ISRAEL, THEY HAVE SAFETY DATA
NOW IN 700,000 PERSONS.
THERE'S NOT AS MUCH SAFETY DAT
ON MODERNA ON THE FOURTH DOSE SO
THAT'S A SMALLER SOMEBODY, IT'S
VERY CLEAR WHERE PEOPLE HAVE
LOOKED AT ANTIBODY TITERS AFTER
A SECOND BOOSTER THAT ANTIBODY
TITERS GO UP AND DATA THAT HAS
GOTTEN A LOT OF PLAY COMING FROM
ISRAEL AND I THOUGHT IT WAS
IMPORTANT TO TRY TO GIVE DETAIL
ON THAT.
SO THIS--THESE DATA COME FROM A
NONRANDOMMIZED COHORT OF 500,000
INDIVIDUALS AGES 60-100 WHO WERE
FOLLOWED FOR 40 DAYS.
SO WHAT HAPPEN INDEED IN COHORT,
THEY WERE GETTING A FOURTHS
SHOT, SO WHAT THE INVESTIGATORS
DID HERE, THEY LOOKED AT THE
RATES OF DEATH IN THE
INDIVIDUALS WHO HAD ALREADY
GOTTEN THE FOURTH SHOT VERSUS
THOSE WHO HAD NOT.
SO IT'S SORT OF AN IMMEDIATE,
VERUS DEFERRED LOOK, AGAIN THERE
ARE ENORMOUS CONFOUNDERS IN THIS
TYPE OF ANALYSIS, BECAUSE OFTEN
THOSE WHO SHOW UP FIRST TO GET
THE ADDITIONAL DOSE HAVE HEALTH
SEEKING BEHAVIOR AND OTHER
REASONS WHY THEY MIGHT NOT GET
INFECTED, MIGHT NOT DIE.
IN ANY EVENT WITH THOSE CAVEATS
THERE WERE 232 DEATHS AND THOSE
THAT DID NOT RECEIVE THE FOURTH
DOSE, THOSE RIENCHLING FROM
12,000 TO 328,000.
AND THERE WERE 92 DEATHS IN
THOSE WHO DERECEIVE A FOURTH
DOSE, FROM 550,000 TO 233,000.
SO THE ADJUSTED HAZARD RATIO FOR
DEATH, SO THE DECREASE IN
MORTALITY FROM THOSE OVERALL IN
THIS STUDY, WAS .22 SO THATIA A
PRETTY REDUCTION IN DEATH BASED
ON GETTING A FOURTH DOSE.
LAST FEW WORDINGS ON POST ACUTE
SEQUELAE OF COVID-19 OR P A SC,
THIS IS BEING STUDIED LARGELY
THROUGH THE RESEARCH AND COVID
TO ENHANCE RECOVERY INITIATIVE
OR RECOVER.
THIS IS BEING PREDOMINANTLY CO
LED BY HEART LUNG AND BLOOD AND
UROLOGY AND SEEKS TO UNDERSTAND
PREVENT AND TREAT P A SC
INCLUDING LONG COVID.
THERE ARE ALSO 3 PROTOCOLS AT
THE NIH CLINICAL CENTER, GO
GOING ON RIGHT HERE IN THE
HOSPITAL.
I JUST TELL YOU A LITTLE BIT
ABOUT THE 1 STUDY HERE IN THE
HOSPITAL.
IT'S LOOKING AT 3 COHORTS THAT
NIAID.
AND MIKE SNELLER S&P THE PI,
LOOKING AT ADULTS OF INDIVIDUAL
WITH A HISTORY OF COVID AND
PERSISTENT SYMPTOMS, HISTORY OF
COVID AND NO PERSISTENT SYMPTOMS
AND AN INDIVIDUAL WITHOUT A
HISTORY OF COVID WHO HAD BEEN IN
CONTACT WITH SOMEONE WHO HAD.
DATA COLLECTION IS PRETTY
EXTENSIVE, INDIVIDUAL HISTORIES
AND PHYSICALS, ROUTINE LABS,
MARKERS OF INFLAMMATION,
COAGULATION, DIRECTED STUDIES OF
SARS-COV-2 IMMUNOLOGY AND I
HAVEROLOGY.
MENTAL HEALTH EVALUATION, EKG,
ECHO CARDIO GRAMS AND A PET AND
6 MINUTE WALKING TEST.
THESE ARE SYMPTOMS THAT ARE MORE
PREPTULENT IN THE SURVIVORS AND
CONTROL GROUP AND YIEF SEEN FROM
MANY OTHER STUDIES ARE A BIT
MORE ANECDOTA BECAUSE THEY'RE
OFTEN FROM LARGE HOSPITAL BASED
RECORDS BUT AT LEAST WE HAVE A
CONTROL GROUP TO LOOK AT,
FATIGUE, DISNIA,
CONCENTRATIONING, ANOSMIA,
TROUBLE SLEEPING, CHEST PAIN AND
DISCOMFORT ARE ALL SIGNIFICANTLY
GREATER IN THE COVID-19 COHORT.
IF YOU THEN LOOK AT ALL THE
SURVIVORS AND COMPARE THOSE WHO
HAVE SYMPTOMS FOR THOSE WHO DO
NOT.
NOTED A LOT FALLS OUT FOR US
ISSUES THE 2 THINGS THAT FALL
OUT WERE FEMALE GENDER
IDENTITIER AND HISTORY OF AN
ANXIETY DISORDER.
IF YOU LOOK AT THE ANTIBODY
TITERS IN THESE COHORTS, I THINK
IT'S REALLY QUITE INTERESTING,
YOU HEAR A LOST DISCUSSION OF
WHETHER WELL I WAS INFECTED, I'M
PROTECTED I DON'T NEED GOAT
VACCINATED.
HERE WE'RE USING AN ASSAY AS A
SURROGATE FOR NEUTRALIZATION.
LOOKINGA THE INHIBITION OF THE
SPIKE PROTEIN BIND TO ACE 2, YOU
CAN SEE FOR NONVACCINATED
INDIVIDUALS WHERE PART OF OUR
CONTROL GROUP, AGAIN THIS STUDY
STARTED IN JUNE OF 2020.
NO 1 WITH ANTIBODY LEVELS TO
SARS-COV-2.
WHEN THAT GROUP, THE VACCINATED
1 YOU SEE THE ANTIBODY TITERS GO
UP, IF YOU LOOK AT THE SURVIVORS
THAT ARE NOT VACCINATED YOU SEE
AN AMAZING ARRAY OF ANTIBODY
TITERS WITH A LARGE PERCENTAGE
OF THEM NOT HAVING WHAT WOULD BE
CONSIDERED A POSITIVE ANTIBODY
RESPONSE, SO IN OTHER WORDS AS
HAS BEEN SEEN WITH OTHER
CORONAVIRUSS, THE HOST IMMUNE
SYSTEM DOESN'T NECESSARILY KICK
INTO HIGH GEAR.
IN CONTRAST, THE INFECTED
INDIVIDUALS WERE VACCINATED
ARGUE LEEBL HAVE THE HIGHEST
ANTIBODY TITERS AND THIS IS THE
GROUP WE LOOK TO DEVELOP HYPER
IMMUNE IMMUNO GLOBUE LYNN FOR
OTHER STUDIES.
LOOKING AT DECLINE IN ANTIBODY
LEVELS OVER TIME IN THE INFECTED
INDIVIDUALS INTERESTINGLY THAT
RATE OF DECLINE DOESN'T APPEAR
TO BE QUITE AS RAPID AS WHAT WE
SEE WITH SO IN TUMRY THEN ON
THAT STUDY FROM THE INTRAMURAL
PROGRAM, PARTICIPANTS IN THE
COVID-19 GROUP REPORTED MORE
SYMPTOMS THAN THOSE OF THE
CONTROL GROUP, FACAS TIGER
DATABASE, DISNEYA, INSOMNIA,
IMPAIRMENT, CHEST DISCOMFORT AND
AGENT, HOWEVER FINDING THIS ON
THE LAB EXAM UNCOMMON TO FIND
THEM THERE, THEY WERE
NONAPOPTOTICET ASSOCIATE WIDE
THOSE INDIVIDUAL WHO IS WERE
SURVIVORS AND HAD SYMPTOMS SO
JUST IN MY LAST SLIDE TO GIVE
YOU THOSE 2 WEBSITES I THINK
WERE IMPORTANT TO KNOW, 1 NEAR
THE NIH TREATMENT GUIDELINE THE
OTHER FOR THE NCATS WEBSITE THAT
TALKS ABOUT VARIANTS AND THE
ACTIVITY OF THE DIFFERENT
COUNTERMEASURES SO I KNOW THAT
WAS FAST.
I APOLOGIZE BUT THANK YOU VERY
MUCH FOR YOUR ATTENTION EMPLOY.
>> WELL, AS ALWAYS IT'S A MASTER
CLASS AND EVERYTHING THAT'S
GOING ON AND THANK YOU FOR THE
GREAT SUMMARY.
CRAIG?
>> THANKS CLIFF, GREAT
PRESENTATION SO I HIGHLIGHTED
THAT BA2 IS THE DOMAIN NABT
OMIKRON SUBVARIANT.
MY QUESTION IS ABOUT FUTURE
POTENTIAL INTEL ABOUT FUTURE
POTENTIAL VARIANTS.
WHAT'S THE SURVEILLANCE
MECHANISM, I ASSUME IT'S AN
INTERNATIONAL SURVEILLANCE FOR
NEW VARIANTS AND IS THERE ANY
CONCERN OR INTEL ABOUT ABOUT
SOMETHING COMING ON THE HORIZON?
>> SO THERE ISN'T ANYTHING I'M
AWARE OF ON THE HORIZON.
THE BULK OF THE DATA THAT ARE
GENERATED YOU KNOW COME FROM A
VARIETY OF RESOURCES.
NCATS THROUGH THEIR PORTAL I
SHOWED HAS BEEN TRYING TO
COLLECT DATA FROM ANY SOURCE
THEY CAN.
SO THEY WILL ACTUALLY GET DATA
FROM COMPANIES WHO ARE VERY
INTERESTED IN THEIR OWN
PRODUCTS.
THEY WILL GET DATA FROM THE CDC
SURVEILLANCE, EFFORTS THAT GOES
ON, THEY WILL TRY TO GET
SURVEILLANCE FROM THE GROUP IN
GERMANY THAT'S COLLECTING
VARIANTS SO THEY'RE TRYING TO
PULL IN EVERYTHAT THEY CAN,
WITHIN THE U.S. GOVERNMENT
THERE'S A GROUP LOOKING AT THAT
SPECIFICALLY FROM ALL DIFFERENT
AREAS TO TRY TO GET AHEAD OF
THINGS.
THE 1 THING THAT GETS A LITTLE
BIT OF BUZZ IS SOMETHING THAT'S
KAWLTED DELTA CRON, A VARIANT OF
DELTA AND OMICRON, SO FOR
THERE'S NOTHING BIOLOGIC
ASSOCIATED WITH THAT, THE
DISCUSSION GOES FROM YOU KNOW WE
NEED TO KEEP AN EYE ON IT ON
SOME OF THIS IS JUST PC R
ARTIFACT AND CONTAMINATION, SO
IT'S INTERESTING BECAUSE OMICRON
IS SUCH A VARIANT FROM DEALTA
AND YOU KNOW THE SPECULATION IS
THAT THIS MIGHT HAVE BEEN
SOMETHING THAT JUST WAS BREWING
IN A PATIENT FOR A VERY, VERY
LONG PERIOD OF TIME THAT THEN
GOT INTO THE GENERAL POPULATION.
BUT THAT'S, YOU KNOW
SPECULATIVE.
I HAVE TO SAY IT'S STILL PRETTY
AMAZING TO ME THAT WE'RE NOT
SEEING A BUMP IN BA2 REFLECTED
IN THE NUMBERS OF CASES AND YOU
KNOW EVERYONE SORT OF WATCHING,
YOU KNOW AND HOLDING THEIR
BREATH TO SEE WHAT WILL HAPPEN
THERE.
>> THANK YOU.
THANK YOU.
STEPHANIE.
>> EASY QUESTION, THAT'S A JOKE.
DO YOU THINK WE'RE BETTER
PREPARED AS A NATION OR AS A
PLANET FOR THE NEXT PANDEMIC
BASED ON EVERYTHING WE'VE LEARN
FRIDAY THIS 1?
>> I THINK WE'RE BETTER AWARE OF
HOW DIFFICULT IT CAN BE TO DEAL
WITH SOMETHING LIKE THIS AND
THERE'S A LOT OF TALK ABOUT HOW
WE NEED TO BE BETTER PREPARED
AND THERE'S A LOT OF EFFORT
GOING INTO LESSONS LEARNED THAT
WE COULD TAKE INTO THE NEXT
OUTBREAK BUT THE ACTUAL ACTIVITY
THAT I THINK NEEDS TO TAKE PLACE
TO BE ABLE TO DO THAT IS STILL
IN THE FUTURE.
>> THANK YOU.
>> ELEGANTLY PUT.
ANY OTHER QUESTIONS?
CLIFF, AGAIN, THANK YOU SO MUCH.
AS LARRY SAID OR JIM SAID, KEY
KEEP THINKING IT'S THE LAST TIME
WE WILL NEED TO BE UPDATED BUT
WE ARE VERY APPRECIATIVE OF ALL
OF THE WORK.
THANK YOU.
>> ALL RIGHT, LET'S SWITCH GEARS
AGAIN AND GO OVER TO MARILYN
FRINRE WHO IS OUR SERVICE CHIEF
IN PHARMACY OPs AND MARILYN
WILL TURN DIRECTLY TO YOU.
THANK YOU.
GOOD MORNING IT YOU HEAR ME
OKAY?
>> WE CAN.
>> CAN YOU SEE MY SLIDES
HOPEFULLY?
OKAY, THANK YOU.
SO GOOD MORNING EVERYONE.
I'M MARILYN FARINRE, AND I AM
CHIEF OF OERATIONS HERE AT THE
FARNLACY AT THE CLINICAL, IT'S
MY PLEASURE TO BE WITH YOU THIS
MORNING AND MY PRESENTATION, THE
PERMANENT PHARMACY PLACEMENT
PROJECT, THAT I WILL REFER TO AS
THE P4 PROJECT WILL PROVIDE AN
OVERVIEW OF THE--THE FDA CAUSE
INSPECTION SET UP A SERIES OF
EVENTS THAT BEGAN WITH THE
SUSPENSION OF ACTIVITIES IN THE
PHARMACEUTICAL DEVELOPMENT
SECTION OF THE PHARMACY.
IN APRIL 2016, THE ADVISORY
COMMITTEE TO THE DIRECTOR AND
THE CLINICAL CENTER WORKING
GROUP QUAIM OUT WITH A RED TEAM
REPORT.
AND THAT REPORT IT WAS FOUND
THAT PHARMACY FACILITIES
PERFORMING CELL PRODUCING
OPERATIONS WERE OUT DATED AND
FULL REMEDIATION WAS
RECOMMENDED.
THIS REQUIRED ALL OF OPERATIONS
TO MOVE INTO TEMPORARY SPACES.
IN APRIL OF 2017 THE INTRAVENOUS
ADMIXTURE UNIT MOVED INTO THEIR
TEMPORARY SPACE AND IN 2019 THE
OUTPATIENT AND UNIT DOSE
PHARMACIES MOVED INTO SPACES OF
THEIR OWN.
RENOVATION OF THE OUTDATED
FACILITY BEGAN IN 2021.
SO THROUGHOUT THE P4 PROJECT,
THE PHARMACY STAFF AS A GROUP
HAVE REALLY HELD TRUE TO THEIR
MISSION.
NOW OUR MISSION IS TO SUPPORT
AND CONDUCT CLINICAL RESEARCH BY
PROVIDING SPACE, HIGH QUALITY
CARE, 1 PATIENT, 1 MEDICATION AT
A TIME.
SO THE TIMELINE FOR THE PROJECT,
IT'S DISCIPLINARY VOIDED INTO 3
MAIN PHASES.
THE OUTPATIENT PHARMACY WILL
MOVE INTO THEIR SCHEDULED
LOCATION OR INTO THEIR SCHEDULED
SPACES ON THE SECOND OF MAY.
THIS WILL BE FOLLOWED CLOSELY BY
THE UNIT DOSE PHARMAC SKPE
BAKUGAN THEY WILL START
OPERATING ON MAY 24th.
INTRAVENOUS ADMIX TOUR UNIT WILL
BEGIN OPERATIONS IN THE FALL OF
THIS YEAR.
SO THE P4 PROJECT IS COMPLICATED
WITH MANY MOVING PARTS.
AND SO THERE'S HEIGHTENED
AWARENESS OF WHAT THE 4 MAIN
GOALS OFLET OPERATIONS ARE.
AND THAT IS WHEN WE MOVE, WE
WANT TO MAKE SURE WE CONTINUE
OPERATIONS WITH UNINTERRUPTED
PHARMACEUTICAL CARE AND WE WANT
TO DO SO SAFELY.
WE ALSO WANT TO SUCCESSFULLY
IMPLEMENT AND INTEGRATE ALL
PHARMACY AUTOMATION.
IN ADDITION WE WANT TO MAKE SURE
THAT ALL OF OUR SUPPLIES,
MEDICATIONS AND SUPPLIES ARE
RELOCATED TO THE NEW SPACES AS
EFFICIENTLY AS POSSIBLE.
AND WE WANT TO MAKE SURE THAT
ALL OF OUR STAFF ARE TRAINED AND
THAT THEY REMAIN ENGAGED.
SO THE RENOVATED PHARMAC SEA
LITTLE OVER 10,000 SQUARE FEET.
THE OUTPATIENT FAMILIES ARNLACY
IS IN YELLOW HERE IN THE SCREEN,
THE UNIT DOSE SECTION IS IN THE
MIDDLE AND IT OCCUPIES THE BLUE
SECTION OF THE FLOOR PLAN.
THE IVAU IS THE LARGEST SECTION
OF THEM ALL AND THAT OCCUPIES
ALL OF THE WHITE AREA ON THE
FLOOR PLAN.
WE'RE FORTUNATE TO HAVE A BANK
GRADE VAULT FOR ALL OF OUR
CONTROLLED MEDICATION STORAGE
AND WE ALSO HAVE A PHARMACY
LOUNGE THAT IS A RELAXING SPACE
FOR STAFF TO TAKE SOME BREAKS.
SO THE RENOVATED PHARMACY IS
IMPRESSIVE BUT MORE IMPORTANTLY
IT DOES PROVIDE ALL COMPLIANCE
WITH ALL OF REGULATIONS AT THE
MOMENT FOR ALL CURRENT
REGULATIONS.
THE NEW FEATURES INVOLVE
SEGREGATED COMPOUNDING AREAS,
ENGINEERING CONTROLS TO,A LOW
FOR THE PROCESSING OF BOTH
HEALTH BENEFITS AND
ACTUARIALITANTS AS WELL AS
HEALTH BENEFITS AND
ACTUARIALITANT MEDICATION, LOSS
OF AUTOMATION TO PROVIDE SAFE
PROCESSES, STREAMLINED WORK
FLOWS, AND COMPREHENSIVE
INVENTORY MANAGEMENT.
THERE'S ALSO INCREASED CAPACITY
IN THE NEW FACILITY AS WELL AS
CAPABILITY OF ELECTRONIC
DOCUMENTATION THAT PROVIDES FOR
ACCURATE AND COMPLETE RECORD
KEEPING.
A TOTAL OF 5 CAR O CELLS WERE
ADDED TO THE OPERATION, 1 IN THE
OUTPATIENT FACILITY, 2 IN THE
UNIT DOSE FACILITIES AND 2 IN
THE IVAU MIX TERAREA.
SO THE PIXELSATURE SHOWS 1 OF
THE CAR O CELLS IN THE UNIT DOSE
AREA AND RIGHT NOW THE WINDOW IS
SHET.
BUT WHEN IT'S OPEN, YOU WOULD BE
ABLE TO SEE THE ROWS AND ROWS OF
MEDICATION BINS, THAT'S FOR ALL
OF OUR MEDICATION.
THIS PROVIDES HIGH DENSITY
STORAGE, AS WELL AS INVENTORY
SECURITY.
BAR CODE SCANNING PROVIDES FOR
ACCURATE MEDICATION SELECTION,
AND THE INVENTORY CAN BE
MONITORED PER MANAGEMENT OF--AND
THIS IS ALSO DEPICTED IN THE
PICTURE, THIS IS WHAT IT LOOKS
LIKE.
THEY WILL CHECK IN WHERE THE
ARROW IS PLACED, THEY WILL CHECK
IN FOR THEIR VISIT AND THEN THEY
WILL PROCEED TO ENTER INTO THE
PHARMACY TO BE MET BY A
PHARMACIST AT 1 OF THE 3
TRANSACTION WINDOWS.
--AS WELL AS ROBOTIC DISPENSZING
SYSTEM.
SO THE STORAGE AND RETRIEVAL
SYSTEM IS REALLY IMPORTANT TO
PROVIDE ACCURATE AND COMPLETE
RETRIEVAL OF PRESCRIPTIONS FOR
MEDICATIONS DURING PICK UP.
USERS ARE PROMPTED TO MAKE SURE
THAT THEY COLLECT ALL OF THE
PATIENTS PRESCRIPTIONS AND
THANKED OVER DURING THE
DISPENSING PROCESS, IT ALSO
PROVIDES TO ENHANCE SECURITY AND
CHAIN OF CUSTODY REQUIREMENTS
FOR BOTH CONTROLLED MEDICATIONS
AS WELL AS INVESTIGATIONAL
MEDICATION.
THE ROBOT AUTOMATES THE FILLING
PROCESS AND LIABLES VILES MAKING
IT READY FOR DISPENSING AND
MAKING TIME FOR THE PHARMACIST
TO SPEND ON MORE CLINICAL
RESPONSIBILITY HERE'S PICTURES
OF WHAT IT LOOKS LIKE NOW, SO
THE FIRST PATIENTS IN THE CLINIC
UPPER SHOWS THE INTANS INTO THE
OUTPATIENT PHARMACY, YOU CAN SEE
THE FROSTED GLASS DIVIDERS, THAT
SEPARATE THE DIFFERENT
TRANSACTION WINDOWS.
THE SECOND PICTURE IS OF A NOISE
ABSORBING WALL, THAT'S DESIGNED
TO DAMPEN SOUND AND THE THIRD
PICTURE OF THESE FROM THE INSIDE
OF THE PHARMACY AT 1 OF OUR ADA
COMPLIANT TRANSACTION WINDOWS.
THERE'S ACCESS TO A COMPUTER
MONITOR OR COMPUTER SCREEN FOR
THE PHARMACIST TO BE ABLE TO BE
ABLE TO REVIEW COUNSELING AND
TALKING WITH THE PATIENTS.
THE PICTUREOT LEFT SHOWS THE
ROBOT, THE DISPENSING ROBOT IN
THE FACILITY AND THERE'S A
MONITOR TO MONITOR THE WORK FLOW
AND PRIORITIZE PATIENTS WORKING
ON PRESCRIPTIONS.
WE HAVE ADDITIONAL STORAGE FOR
BULKY ITEMS AND A LOT OF UNITS
BOTH REFREJERATED AND FREEZERS
IN THIS SPACE.
THIS PHARMACIST SHOWS THE
VERIFICATION WORKING STATION OR
FORM CYST REVIEW ORDERS AND
VERIFY THEM FOR PROCESSING.
SO THE MAILING OF PRESCRIPTIONS
HAS BEEN A BIG PART OF THE
PHARMACY OPERATIONS FOR SOMETIME
BUT THE PANDEMIC MADE IT OFTEN
MORE SO.
SO THE FIRST PICTURE SHOWS THE
MAIL PACKAGE STATION WHERE
PRESTRIPGZS ARE PACKAGED AND
READY FOR PICK UP BY MAIL
CARRIERS.
SO THIS SECOND PICTURE SHOWS 2
CABINETS WHERE PACKAGES ARE
TEMPORARILY STORED BEFORE
THEY'RE PICKED UP AND THE THIRD
PICTURE SHOWS THESE DOORS THAT
ARE LEAD INTO THOSE CABINETS BUT
FROM THE OUTSIDE.
THIS IS WHERE MAIL CARRIERS WILL
COMMUNICATE WITH STAFF IN THE
PHARMACY VIA VIDEO INTERCOM AND
ARE GRANTED ACCESS TO 1 OF THE 2
CABINETS TO PICK UP THOSE PACK
PACKAGES.
BUT THE UNIT DOSE PHARMACY
TOTALS ABOUT 2346 SQUARE FEET.
THERE'S A BULL PEN AREA FOR
TECHNICIAN AND PHARMACIST WORK
STATIONS.
THERE'S A PREPARATION AREA FOR
PACKAGING OF ORAL SOLUTIONS AND
SUSPENSIONS.
AND THEN THERE'S A STAGING AREA
FOR MEDICATIONS THAT ARE
AWAITING DELIVERY TO THE NURSING
UNITS FOR ADMINISTRATION.
AND OF COURSE, THERE'S ALSO LOTS
OF ROOM FOR ALL OF THE
AUTOMATION.
THERE'S 1 OF THE CAR O CELLS
HERE AND THEN THE SECOND
CAROUSEL IS IN THE CORNER.
SOIE ROBOT AND MEDICATION
PACKAGER WAS ADDED TO THE UNIT
DOSE SECTION.
THE AUTOMATED CENTRAL PHARMACY
SYSTEM OR THE XR2 ROBOT
AUTOMATES THE MEDICATION FILLING
PROCESS, IT FILLS AND LABELS
MEDICATION IF A FORM READY FOR
DELIVERY.
THE MEDICATION PACKAGER
BASICALLY DOES WHAT YOU WOULD
THINK A PACKAGER DOES.
IT TAKES MEDICATION FROM BOTH
PACKAGES, AND PUTS THEM INTO
SINGLE UNITS OF USE FOR
DISPENSING TO PATIENTS.
BOTH PIECES OF AUTOMATION MAKE
THE DISPENSING PROCESS SAFER AND
A LOT MORE EFFICIENT FOR OUR
STAFF.
SO HERE ARE PICTURES OF THE
ACTUAL AUTOMATION.
SO THE FIRST PICTURE ON THE LEFT
SHOWS THE ROBOT.
THE MIDDLE OF THE PICTURE SHOWED
THE WALKWAY AND THE ROBOT IS
ACTUALLY WAY IN THE BACKGROUND
AND THIS, THE BODY OF THE ROBOT
SLIDES UP AND DOWN THIS WALKWAY
TO RETRIEVE MEDICATIONS FROM
THESE TRAYS TO THE LEFT.
IT HAS A ROBOTIC ARM THAT WILL
RETRIEVE OR RETURN MEDICATIONS
TO 1 OF THOSE TRAYS.
AND THEN THE THIRD PICTURE IS
THAT OF THE MEDICATION PACKAGER.
SO HERE ARE MORE PICTURES OF THE
ACTUAL PHARMACY SPACE.
THE FIRST PICTURES OF THE ORDER
VERIFICATION STATION, THAT'S THE
BULL PEN WITH THE WORK STATIONS
FOR BOTH PHARMACISTSAs WELL AS
TECHNICIANS.
THIS IS WHAT THE ORAL DOSE FAC
PAGS STATION LOOKS LIKE AND THIS
IS WHERE LIQUID MEDICATIONS ARE
DRAWN UP INTO DOSE SPECIFIC
SYRINGES OR CUPS.
AND THE THIRD PICTURE OF THE
INVENTORY PROCESSING STATION,
ARE MEDICATIONS ARE RECEIVED
FROM THE BHOAL SALER AND SORTED
OR DISTRIBUTIONS BEFORE SORTED
TO THE CAR O CELL, ROBOTS OR
PACKAGER.
SO THE IV, OR THE INTRAVENOUS
ADMIXTURE UNIT HAS THE LARGEST
LARGEST
LAY OUT OF THE THE FACILITY IT
IS 12,570 SQUARE FEET AND IT
OCCUPIES THE WHITE AREA.
SO IT'S IMPORTANT TO HAPPENED
THAT THERE'S UNIDIRECTIONAL FLOW
OF BOTH PEOPLE AND MATERIALS
THROUGH THE CLEAN ROOM OR THE
IVAU.
THE INTRAVENOUS ADMIXTURE UNIT
AND I WILL START WITH BY GOING
OVER THESE FLOW OF PEOPLE AND
THEN I WILL GO OVER THE FLOW OF
MATERIALS.
SO STAFF WILL ENTER INTO THE
PERMANENT IVAU FACILITY INTO A
COMPOUNDING VESTIBLE THAT IS
SHOWN HERE.
HERE THEY WILL RETRIEVE SCRUBS
FROM A VENDING MACHINE.
HAY WILL THEN PROCEED INTO A
LOCKER ROOM WHERE THEY WILL
CHANGE INTO THE SCRUBS AND STATE
OF EMERGENCY AWAY THEIR STREET
CLOTHES IN LOCKERS.
THEY PERFORM HAND HYGIENE IN THE
SINK ROOM AND DON ADDITIONAL
PERSONAL PROTECTIVE EQUIPMENT
SUCH AS HAIR NETS, BOOTIES AND
SUITS BEFORE THEY WALK INTO THE
CLEAN ROOM.
THE IVAU IS DIVIDED INTO 2
SECTIONS.
SO THE TOP SECTION WITH THE 5
STARS, IS THE NONHAZARDOUS
SECTION OF THE FACILITY, AND IT
HAS A TOTAL OF 6 COMPOUNDING
ROOMS, SO STAFF WILL WALK INTO
THIS ENTRANCE HERE AND PROCEED
INTO THE NONHAZARDOUS CORRIDOR
HERE AND THEY CAN EITHER ACCESS
1 OF THE ROOMS THROUGH THIS
CORRIDOR.
AGAIN THERE ARE A TOTAL OF 6
ROOMS.
IT'S IMPORTANT TO NOTE THAT WHEN
THEY'RE EXITING THE FACILITY,
THEY DON'T GO BACKWARDS BUT THEY
GO DOWN THE CORRIDOR AND THROUGH
THIS EXIT HERE FOLLOWING THE
PLURIBU ARROW.
THE OTHER SIDE OF THE FACILITY
WHICH IS THE BOTTOM HALF OF THE
FACILITY IS FOR THE HAZARDOUS
COMPOUNDING.
THERE ARE A TOTAL OF 6 ROOMS ON
THE FACILITY AS WELL AND STAFF
IN THIS CASE WILL ENTER THROUGH
THIS ENTRANCE SHOWN BY THE RED
ARROW HERE.
THEY WILL COME INTO THIS
ENTRANCE AND EITHER ACCESS THIS
CORRIDOR TO THE ACCESS THESE 4
ROOMS OR ACCESS THIS CORRIDOR TO
ACCESS THESE 2 ROOMS.
WHEN LEAVING THE FACILITY THEY
WILL LEAVE THROUGH THIS
CORRIDOR, OUT THROUGH THE
ENTRANCE, AND BACK INTO THE MAIN
CORRIDOR.
FOR THESE 2 ROOMS ON THIS SIDE,
THEY WILL EXIT THE FACILITY
THROUGH THIS CORRIDOR AND INTO
THE MAIN CORRIDOR.
IN TERMS OF PRODUCT AND
MATERIALS AND CLEAN ROOM, THEY
FOLLOW A DIFFERENT ROUTE.
EACH PRODUCT OR SUPPLY IS
THOROUGHLY WIPED DOWN WITH
DISINFACT ANT BEFORE BEING
PASSED INTO THE CLEAN ROOM.
WE HAVE 2 CLEAN ROOMS, WE HAVE 2
CLEAN UP SET UP ROOMS, 1 IS 1
FOR THE HAZARDOUS SECTION AND
THE OTHER IS FOR THE
NONHAZARDOUS SECTION.
SO HAZARDOUS MEDICATIONS ARE
PASSED THROUGH IN THE HAZARDOUS
SET UP AND NONHAZARDOUS
MEDICATIONS ARE PASSED INTO THE
NONHAZARDOUS SET UP ROOM.
SO WHAT HAPPENS IN A PRODUCT HAS
TO BE MADE?
SO THE Xs ON THE SCREEN DENOTE
THE PASS THROUGH THROUGHOUT THE
FACILITY.
EACH COMPOUNDING ROOM HAS A
TOTAL OF 2 PASS THROUGHS.
THEY PASS THROUGH AND AN OUT
PASS THROUGH.
SO IF A MEDICATION HAS TO BE
MADE, DEPENDING ON IF IT'S A
HAZARDOUS MEDICATION OR A
NONHAZARDOUS MEDICATION THAT
WILL ORIGINATE FROM 1 OF THESE 2
ROOMS WHICH IS THE SET UP ROOM,
THOSE MEDICATIONS WILL THEN BE
TAKEN TO--ONCE THE MEDICATION
HAS BEEN COMPOUNDED AND THE
FINAL PRODUCT IS READY FOR
PHARMACIST VERIFICATION, THE
TECHNICIAN WILL PLACE THE ITEM
INTO AN OUT PASS THROUGH AND
WILL BE PICKED UP AND TAKEN TO
THIS PASS THROUGH OVER HERE AND
THEN IT WILL BE DELIVERED
THROUGH NURSING UNITS OR THE
PATIENT CARE UNITS.
SO THE IVAU AND THE FACILITY HAS
SIGNIFICANT DIFFERENCES AND ALL
OF THOSE ARE TO MAKE THE
FACILITY SAFER AND MORE
EFFICIENT.
THERE ARE 12 COMPOUNDING ROOMS
IN CONTRAST TO THE 3 COMPOUNDING
ROOMS THAT WE HAVE IN THE OLD
FACILITY.
WE HAVE 10 BIOLOGICAL SAFETY
CABINETS, 2 ISOLATORS, WE HAVE A
SIGNIFICANT NUMBER OF HIGH
NUMBER OF PASS THROUGH CHAMBERS,
38 AS COMPARED TO 6, AND ALL OF
THE PASS THROUGH CHAMBERS IN THE
NEW FACILITY HAVE HEPA FILTERS
TO FILTER THE AIR.
ALL OF THE WORK FLOW WILL BE
AUTOMATED A HUNDRED% AND IT
PROVIDES FOR PREMOTE PRODUCT
VERIFICATION BY ALL OF OUR
PHARMACISTS.
THAT MEANS A PHARMACIST COULD
POTENTIALLY VERIFY PRESCRIPTION
OR MEDICATION HAS BEEN PREPARED
FROM ANYWHERE IN THE FACILITY.
SO THE AUTOMATION THAT WILL
SUPPORT THE PERMANENT IVAU OR
INTRAVENOUS ADMIXTURE UNIT IS
THE OMINICELL IVX, THIS IS USED
DURING THE COMPOUNDING PROCESS
TO GUIDE THE PREPARATION OF EACH
PRODUCT.
PICTURES ARE TAKEN AT EACH STEP
OF THE PROCESS AND BAR CODE
SCANNING IS USED WITH VOLUMETRIC
MEDICATION SOPHISTICATED INSURE
MEDICATIONS ARE PREPARED
ACCURATELY AND PROPERLY.
HERE ARE SOME PICTURES OF THE
IVAU.
THIS FIRST PICTURE SHOWS THE
MAIN CORRIDOR THAT SEPARATES THE
HAZARDOUS SIDE FROM THE
NONHAZARDOUS SIDE.
THE SECOND PICTURE OF THE LOCKER
ROOM WITH A VIEW INTO THE SINK
ROOM.
THAL THIRD PICTURE IS THE
NONHAZARDOUS CORRIDOR OF WHICH
EACH DOOR LEADS INTO A
NONHAZARDOUS COMPOUNDING ROOM.
THESE 2 PICTURES ARE OF
BIOLOGICAL SAFETY CABINETS, 1 IS
IN THE NONHAZARDOUS COMPOUNDING
ROOM AND THIS 1 IS IN THE
HAZARDOUS BUFFER ROOM.
SO IT DOES TAKE A VILLAGE.
THERE'S BEEN A LOT OF PLANNING,
ACCORD NATION AND HARD WORK TO
MAKE THE PEOPLE AND PROJECT
SUCCESSFUL AND THIS TEAM WORK
HAS BEEN INCREDIBLE.
IT REALLY TAKES A VILLAGE.
AND THE PARM PHARMACY DOESN'T
WANTS TO GIVE OUT A SPECIAL
THANKS TO THE CONSTRUCTION TEAM
FOR THE BEAUTIFUL FACILITY.
THANK YOU SO MUCH.
AND WE HAVE COME A LONG WAY.
SO THIS IS THE WAY IT WAS.
SO THESE ARE PICTURES FROM THE
ARCHIVES.
THE 2 ON THE FAR LEFT ARE FROM A
1954 ARTICLE IN THE JOURNAL OF
THE AMERICAN PHARMACEUTICAL
ASSOCIATION.
AND THIS PICTURE ON THE TOP
RIGHT HAND CORNER IS FROM THE
1968 ARTICLE HIGHLIGHTING THE
IVAU AT THE TIME.
THE OTHER 2 PICTURES ARE UNDATED
BUT OBVIOUSLY IN THE PAST.
WE'VE DEFINITELY COME A LONG
WAY.
AND WITH THAT, THANKS FOR YOUR
ATTENTION AND I WILL TAKE ANY
QUESTIONS.
>> MARILYN, THANK YOU SO MUCH,
IT'S A GORGEOUS FACILITY, I MEAN
IT JUST PUT IN THE CHAT.
YOU MUST BE THRILLED.
CAN WE PULL THE SLIDES DOWN.
>> SURE, THANK YOU.
YOU AND YOUR TEAM MUST BE
THRILLED TO BE IN THAT NEW SPACE
WHERE NOT ONLY DO YOU HAVE
EFFICIENT SPACE BUT YOU HAVE A
LOT OF SAFETY IN THERE IN TERMS
OF SYSTEMS.
NOW MUCH PLANNING DID THE ACTUAL
TEAM ON THE GROUND, HOW MUCH
WERE YOUR TEAM MEMBERS ABLE TO
CONTRIBUTE TO THE DESIGN?
>> SO THE--SO I'VE BEEN IN MY
POSITION SINCE 2019 SO I CAME IN
DURING THE TRANSITION, SO
WE--MOST OF THE PHARMACY STAFF
AND LEADERSHIP AS WELL AS STAFF
INHERITED THE DESIGNS, WELL,
WE'VE DONE A LOT OF WORK IN
TERMS OF TRYING TO UNDERSTAND
THE INTENT OF THE DESIGN AND TO
MAKE SURE THAT WE HAVE
ACCOMMODATED A LOT OF THE MEANS
OF OUR STAFF AS WELL AS THE
FACILITY.
SO WE WEREN'T INVOLVED IN THE
ORIGINAL DESIGN BUT WE'VE
DEFINITELY TAKEN THE DESIGN AND
MADE IT OUR OWN SO TO SPEAK.
>> GOOD.
JIM?
>> I THINK MARILYN SAID IT RIGHT
AND SO, THOSE OF YOU THAT HAVE
BEEN ON THE BOARD FOR A WHILE,
THE FDA CAME IN 2015 AND 2016
AND IT WAS IN 2019 THAT MARILYN
AND THEY CAME AND SAID,
DR. GILMAN, THIS--THE DESIGN,
THAT THE OLD GROUP PUT TOGETHER
IS, YOU KNOW SOLVES A LOT OF
PROBLEMS BUT IT'S NOT THE WAY WE
THINK IT SHOULD BE DESIGNED.
WELL, THAT LEADER SHN TEAM WAS
GONE AND SO IT WAS A DIFFICULT
DECISION TO SAY, OKAY, WE'RE
GOING TO POSTPONE--WE'RE GOING
TO STOP.
THERE HAS TO BE MORE MONEY
THAT'S ADDED TO THE PROJECT AND
IN ORDER TO GO AND TO DO IT THE
WAY THE CURRENT PHARMACY
LEADERSHIP TEAM SAYS THAT IT
WOULD FUNCTION THE BEST, AND NOT
TO THROW ANYBODY THAT USED TO BE
HERE UNDER THE BUS BUT THEY
SAID, THIS IS THE WAY WE THINK
IT SHOULD BE DESIGNED AND DAN
WHEELAND AND YOU SAW RICK'S NAME
AT THE TOP OF THE SLIDE, RICK
WAS THE PROJECT OFFICER, PROGRAM
MANAGER FOR THIS AND SO, WE HAD
TO TAKE A PAUSE.
WE HAD TO GO BACK AND REDO THE
DESIGN AND MORE MONEY HAD TO BE
ADDED BUT YOU CAN SEE THE WAY
IT'S TURNED OUT AND I THINK THAT
ALL OF THOSE MEASURES WERE AT
LEAST IMPORTANT IF NOT
NECESSARY, THANKS.
>> GREAT.
>> WELL, WELCOME.
>> ALL RIGHT, SO I'M GOING TO
TAKE THE CHAIR'S PREROGATIVE NOW
AND WE'RE GOING TO GO INTO A
BREAK.
LET'S COME BACK AT ACTUALLY DAN,
YOU'RE STILL ON HERE, DAN
WHEELAND, CAN WE SKINNY YOURS
DOWN JUST A LITTLE BIT.
LET'S COME BACK AT 5 OF 12 AND
WE WILL THEN STILL AIM FOR OUR
KD--SALLY BY 1:00 O'CLOCK, DAN
ARE YOU OKAY WITH THAT?
>> YES MA'AM.
>> ALL RIGHT.
THANKS SO MUCH AND WE WILL SEE
EVERYBODY AT 5 OF THE HOUR.
WELCOME BACK EVERYBODY,
AND WE WILL GO AHEAD AND GET
STARTED.
DAN, THANKS SO MUCH FOR BEING SO
FLEXIBLE AND WE GOING TO GO TO
YOU TO HEAR IN MORE UPDATES ON
FACILITIES AND THEN WE'RE GOING
OVER TO MARSTON, SO WE'RE
LOOKING FORWARD TO IT AND I AM
COMMITTED TO EVERYONE THAT WE
WILL FINISH BY 1:00 O'CLOCK SO I
VERY MUCH APPRECIATE EVERYBODY
HANGING IN THERE WITH US TO GET
SOME GOOD TOPICS LEFT.
DAN?
>> THANK YOU MA'AM.
NEXT SLIDE, PLEASE, CARLY.
SO WE'RE GOING TO TALK ABOUT
PROJECTS RECENTLY AWARDED, THOSE
THAT HAVE BEEN SUBSTANTIALLY
COMPLETED RECENTLY AND THOSE
UNDERCONSTRUCTION IN JUST A
BRIEF ANNOUNCEMENT REGARDING
POSITIVE RESULTS FROM THE
QUARTERLY MEETINGS CONDUCTED
WITH THE APPROPRIATIONS
COMMITTEE STAFF, 2 GOOD
DEVELOPMENTS, 1 IS THAT THE
FISCAL YEAR 22 BUILDINGS AND
FACILITIES APPROPRIATION WAS
INCREASED FROM THE PREVIOUS
AMOUNT OF $200 MILLION TO
$250 MILLION REPRESENTING A 25%
INCREASE WHICH WAS THE LARGEST
PERCENT CANCER CENTER INCREASE
OF ALL, ALL APPROPRIATIONS AND
NOW REPRESENTS THE BASE FOR
FUTURE YEAR APPROPRIATIONS.
SECONDLY, THE INCREASE IN
SPECIAL AUTHORITY WHICH ENABLES
US TO TAKE IC APPROPRIATIONS AND
USE THEM FOR REPAIRS AND
IMPROVEMENTS THAT THRESHOLD WAS
MOVED FROM 3.5 TO $5 MILLION PER
PROJECT AND IN AGGREGATE FROM
$40 MILLION TO $100 MILLION AND
I THINK AS EVERYONE MAY RECALL
THESE ENGAGEMENTS RESULTED IN
THE AFTERMATH OF THE NATIONAL
ACADEMIES CONSENSUS STUDY
REGARDING OUR BACK LOG OF
MAINTENANCE AND REPAIR SO WE'RE
STARTING TO SEE SOME VERY
POSITIVE DEVELOPMENTS FROM THIS
AND THE OTHER THING I WOULD JUST
ADD IS THE PRESIDENT'S BUDGET AS
DR. TABAK AS JUST RELAYED
EARLIER WAS JUST ANOWBSED FOR
FISCAL YEAR 23 AND IN THE
PRESIDENT'S BUDGET, THE
BUILDINGS AND FACILITIES
APPROPRIATION WOULD INCREASE
FURTHER FROM 250 TO $3 BILLION,
SO POSITIVE AN ACTMENTS DUE TO
RESOURCES.
NEXT SLIDE.
SO AS DR. TABAK SHARED WITH YOU,
WE RECENTLY AWARDED LAST TUESDAY
SPECIFICALLY THIS VERY IMPORTANT
PROJECT FOR SURGERY, RADIOLOGY,
LABORATORY MEDICINE, AND
INCLUDING CATHETERIZATION
LABORATORY AND INTERVENTIONAL
RADIOLOGY.
NEXT SLIDE.
--AND THEN THE IN THE LOWER
VIEW, YOU CAN SEE A VIEW FROM
THE STREET PERSPECTIVE FROM WEST
LOOKING TO THE EAST.
NEXT SLIDE.
THIS IS THE DESIGN BUILD TEAM
THAT WAS AWARDED THE PROJECT LED
BY HENSEL, PHELPS, WHO WAS THE
CONSTRUCTOR, ZGF WAS THE
ARCHITECT OF THE RECORD AND THE
CRC AND FAMILIAR WITH THE
EXISTING BUILDING AND THEN THE
PLUMING AND ELECTRICAL DESIGN
HAS ELABORATE EXPERIENCE WORKING
ON NIH'S SITES, SO WE BELIEVE
WE'VE GOT A WORLD CLASS TEAM
HERE, THE AMOUNT OF THE AWARD
WAS APPROXIMATELY $638 MILLION.
SO, WE ARE INVESTING HEAVILY IN
THESE KEY AREAS AND WE WANT TO
THANK THE BOARD FOR THEIR
SUPPORT, I RECALL THAT YOU WROTE
AN IMPORTANT LETTER THAT WAS
INSTRUMENTAL IN ENABLINGITOUS
GET TO THIS CRUCIAL MILESTONE.
NEXT SLIDE.
--STAFF ALIKE NEXT SLIDE.
ANOTHER PROJECT WHICH MAY NOT BE
HIGHLY VISIBLE, BUT IS
ABSOLUTELY CRUCIAL TO PATIENT
SAFETY, WE REPLACED ALMOST A
QUARTER OF A MILE OF PIPING IN
THE BASEMENT OF THE CLINICAL
RESEARCH CENTER MUCH THE
EXISTING PIPING WAS OVERICIZED
AND THAT MIGHT SEEM LIKE AN
ADVANTAGE BUT ACTUALLY IT SLOWED
DOWN THE VELOCITY OF WATER
ENABLING THE CREATION OF
SEDIMENT AND BIOFILM AND
SECONDLY WAS CONSTRUCTED OUT OF
GALVANIZED PIPE WHICH HAD
EXPERIENCED SOME COROCEAN AND SO
WE RE--CORROSION AND WE REPLACED
IT WITH A SMALLER DIAMETER
COPPER PIPE AND THAT INVOLVED A
20 HOUR WATER OUTAGE THROUGHOUT
THE ENTIRE HOSPITAL AND I WANT
TO THANK THE CLINICAL CENTER FOR
THEIR EXCEPTIONAL COLLABORATION
IN SCHEDULING AND PULLING OFF
THAT IMPORTANT OUTAGE TO IMPROVE
THE QUALITY OF THE WATER FOR OUR
PATIENTS.
NEXT SLIDE.
WE ALSO COMPLETED A STERILITY
LAB FOR THE LABORATORY OF
MEDICINE THAT WILL PROVIDE
DRAMATICALLY ENHANCED
CAPABILITIES TO LOOK AT THE
STATUS OF VARIOUS PRODUCTS
WITHIN THE CLINICAL CENTER AND
INSURE THERE THEY'RE OF THE
PROPER STERILITY, NEXT SLIDE.
WE ALSO COMPLETED A SIGNIFICANT
PROJECT FOR THE CENTER FOR
CELLULAR ENGINEERING, CELL
PROCESSING FACILITY, THE
COMMISSIONING QUALIFICATION AND
VALIDATION WERE COMPLETED OR ARE
SCHEDULED FOR COMPLETION THIS
MONTH AND THERE WILL BE
ENVIRONMENTAL MONITORING,
PERFORMANCE QUALIFICATION IN
JUNE, ENABLING THE OPERATION OF
THIS CRITICAL FACILITY.
NEXT SLIDE.
SO WE'VE GOT SOME PROJECTS THAT
ARE IN VARIOUS PHASES OF
CONSTRUCTION.
NEXT SLIDE, PLEASE, CARLY.
WE'RE CONDUCTING IMPROVEMENTS
RELATIVE TO STERILE PROCESSING
IN BOTH THE B1 LEVEL AND ON
LEVEL 2 TO PROVIDE THE IMPROVED
SAFETY PRODUCTION WORK FLOW AND
REGULATORY COMPLIANCE RELATIVE
TO THE STERILEAISATION PROCESS.
IN ADDITION I SHOULD ADD THERE'S
A ROBUST STERILIZATION
CAPABILITY IN THE BASEMENT OF
THE NEW ADDITION THAT I REFERRED
TO EARLIER, SO THESE ARE GOING
TO BE IMPORTANT NEAR TERM
IMPROVEMENTS THAT WILL BE EVEN
BUILT UPON WHEN WE CONSTRUCT THE
NEW ADDITION.
NEXT SLIDE.
WE CONTINUE WITH THE RENOVATION
OF THE EWING WHICH IS SHOWN WITH
THE MRI WOOD COVERED WINDOWS,
STILL IN CONSTRUCTION AND WILL
PROVIDE A DRAMATICALLY IMPROVED
CAPABILITY FOR THE DEPARTMENT OF
TRANSFUSION MEDICINE WHICH IN
2011 WAS IDENTIFIED AT THE
DEPARTMENT THAT WAS NOT
RELOCATED INTO THE CRC THAT
NEEDED THE MOST ATTENTION AND
HENCE THEY CAME FIRST IN LINE
AND THIS WILL PROVIDE CELL
PROCESSING AS WELL AS THE BLOOD
BANK AND OTHER KEY--AND THIS
JUST SHOWS YOU A CROSS SECTION
OF THE BUILDING AND THE CLINICAL
CENTER RELATED OCCUPANCIES ARE
HIGHLIGHTED IN GREEN.
NEXT SLIDE.
THIS PROJECT AGAIN IS SORT OF
BEHIND THE CURTAIN BUT IT WILL
ENABLE US TO OPERATE MORE
AUTONOMOUSLY RELATIVE TO THE
POWER FOR OUR CENTRAL UTILITY
PLAN WHICH WILL INDEED ENABLE US
TO GENERATE STEAM AND CHILLED
WATER ENOUGH TO TREAT THE MOST
CRITICAL FUNCTIONS ON CAMPUS
INCLUSIVE OF PATIENT OPERATIONS
AND GIVEN CLIMATE CHANGE AND
EXTREME WEATHER, SOME OF WHICH
WE JUST TALKED ABOUT, WE ARE
KEENLY AWARE OF THE CRITICALITY
TO DEVELOP RESILIENT
INFRASTRUCTURE.
THIS IS FULLY FUNDED AND
SCHEDULES FOR COMPLETION A
LITTLE OVER A YEAR FROM NOW.
NEXT SLIDE.
ON THE SAME TOPIC OF RESILIENT
INFRASTRUCTURE, WE'RE INVEST FLG
A NEW UTILITY VAULT FOR ALL OF
THE ELECTRICAL EQUIPMENT SERVING
THE EXISTING BUILDING 10 COMPLEX
AS WELL AS THE ADDITION AND
WE'RE ALSO INVESTING IN A
PATIENT PARKING GARAGE WHICH
WILL EVENTUALLY ENABLE US TO
REMOVE OR DECOMITION THE
UNDERGROUND PARKING WHICH IS
SUFFERING FROM DETERIORATED
CONCRETE AND ALSO CONSTITUTES TO
SOME EXTENT SECURITY RISK AND
REQUIRES A HUNDRED PERCENT OF
INSPECTION OF ALL THOSE
VEHICLES.
NEXT SLIDE.
THIS IS A PICTURE OF THE PARKING
GARAGE.
NEXT SLIDE.
THIS PICTURE IS THE UTILITY
VAULT WHICH WILL HOWES ALL OF
THE ELECTRICAL EQUIPMENT SERVING
THE ENTIRE BUILDING 10 COMPLEX,
NEXT SLIDE.
ANOTHER PROJECT INITIATED BY
DR. GILMAN IS THE ADDITIONAL
PROTECTIVE ISOLATION PATIENT
CARE IN THE PEDIATRICS WARD AND
WE ARE APPROXIMATELY 50% OF THE
WAY THROUGH THAT HAVING WORKED
ON THE SOUTHERN PORTION AND
COMPLETED THAT AND NOW WE'RE
WORKING ON THE NORTHERN PORTION
OF THAT WARD.
NEXT SLIDE.
THIS DESCRIBES A LITTLE BIT OF
THE STATISTICS IN TERMS OF THE
NUMBER OF ROOMS THAT ARE
INVOLVED IN THE CONVERSION OF
THOSE INTO THE PROTECTIVE
ENVIRONMENT AND AIR BORN
INFECTION ISOLATION ROOMS.
NEXT SLIDE.
THIS JUST GIVES YOU A FLOOR PLAN
OF THE SAME.
NEXT SLIDE.
SO IN SUMMARY, THE INCREASE IN
THE BUILDINGS AND FACILITIES
APPROPRIATION AND THE SPECIAL
AUTHORITY WILL PROVIDE MORE
RESOURCES FOR FACILITIES, LIKELY
RESULT OF THE NATIONAL ACADEMIES
OF CONSENSUS REPORT AND THE
RESULT IN QUARTERLY MEETINGS
WITH THE APPROPRIATIONS STAFF.
THE MOST NOTE WORTHY DEVELOPMENT
THIS PRESENTATION OF COURSE IS
THE AWARD OF THE SURGERY
RADIOLOGY AND LABORATORY
MEDICINE PROJECT, WHICH YOU
HELPED ADVOCATE FOR AND YOUR
SUPPORT IS SIGNIFICANTLY
APPRECIATED AND SO THIS
CONCLUDES MY PRESENTATION AND
SUBJECT TO YOUR QUESTIONS.
THANK YOU.
>> TERRIFIC, THANK YOU.
YEAH, SOMEONE WAS JUST PRIVATELY
CHATTING ME THAT IT WAS SEVERAL
YEARS AGO THAT THE BOARD HAD A
CHANCE TO DO A TOUR OF THE
CLINICAL CENTER, OBVIOUSLY
SELECT PARTS OF IT WAS HUGE BUT
IT WAS REALLY GREAT TO SEE.
I HOPE THAT WILL BE SOMETHING
THAT THE BOARD CAN RETURN TO IN
THE FUTURE.
NOTHING LIKE SEEING SOMETHING.
LOTS OF GREAT THINGS ON THE
HORIZON.
ANY QUESTIONS FOR DAN?
OR THE REST OF THE TEAM?
OKAY, LET'S KEEP MOVING.
ALL RIGHT.
SO, SIEM SORRY, RICK, GO AHEAD.
>> SO LAURA, I THINK THIS IS
REALLY EXTRAORDINARY PROGRESS
AND PARTICULARLY THE NEW
SURGICAL MEDICAL LAB MEDICINE
BUILDING AND THE RENOVATIONS TO
THE PEDIATRIC SPACE, VERY MUCH
CONSISTENT WITH THE RESEARCH
DIRECTIONS AROUND BOTH CELL
BASED THERAPIES AND GENETICS
THAT I THINK WILL LIKELY BECOME
AN INCREASING PART OF THE
CLINICAL RESEARCH PORTFOLIO OF
THE HOSPITAL, SO, THESE ARE I
THINK ARE REALLY, REALLY
IMPORTANT AND IT'S REALLY GREAT
TO SEE THEM COME TO FRUITION
OVER THE LAST, YOU KNOW 6 YEARS.
>> GREAT STUFF AND NOTHING LIKE
NEW, RIGHT?
MOVING ON.
THANK YOU.
WE WILL HEAR FROM DR. MARSTON
LINEHAN WHO IS CHIEF THE
UROLOGIC SURGERY AND UROLOGIC
ONCOLOGY SECTION.
THIS IS A REAL TREAT, I HAVE TO
SAY FOR US, TO GET TO HEAR SOME
OF THE SCIENCE THAT CONNECTS ALL
OF US.
SO MARSTON, OVER TO YOU.
THANK YOU VERY MUCH FOR BEING
HERE.
>> THANK YOU VERY MUCH FOR
INVITING PLEA, IT'S A REAL
HONOR.
--INVITING ME, - IT IS A REAL
HONOR.
OKAY.
CAN YOU ALL SEE MY SCREEN OKAY.
>> YES.
>> OKAY.
WELL, THANK YOU VERY MUCH.
IT'S A REAL HONOR AND I CAN'T
TELL YOU HOW MUCH THE INTRAMURAL
SCIENTISTS APPRECIATE ALL THE
EFFORT AND WORK THAT YOU DO TO
SUPPORT THE WORK THAT WE DO AT
THIS MARVELOUS CLINICAL CENTER
RESEARCH HOSPITAL.
THIS AFTERNOON, I WILL SPEAK
ABOUT THE IDENTIFICATION OF THE
VHL KIDNEY CANCER GENE.
HOW IT LED TO MOLECULAR
DIAGNOSIS, UNDERSTANDING OXYGEN
SENSING AND PRECISION THERAPY.
NIWHEN WE START OUR WORK ON
KIDNEY CANCER HERE AT THE
CLINICAL CENTER, RESEARCH
HOSPITAL IN THE EARLY 1980S,
KIDNEY CANCER WAS THOUGHT TO BE
A SINGLE DISEASE, WE DID THE
SAME SURGERY ON EACH PATIENT, WE
TREATED PATES WITH METASTATIC
DISEASE ALL WITH THE SAME DRUGS,
NONE OF WHICH WERE EFFECTIVE,
NOW WE KNOW THAT KIDNEY CANCER
IS NOT A SINGLE DISEASE, IT'S
MADE UP OF A NUMBER OF DIFFERENT
TYPES OF CANCER, EACH WITH
DIFFERENT HISTOLOGYYS SHOWN
HERE, DIFFERENT CLINICAL
COURSES, RESPONDING DIFFERENTLY
TO THERAPY AND AS I WILL SHOW
YOU CAUSED BY DIFFERENT GENES.
WE NOW KNOW OF 18 DIFFERENT
GENES THAT CAUSE KIDNEY CANCER.
AND AS OF 2 DAYS AGO, WE KNOW OF
14 DIFFERENT GENETICALLY DEFINED
TYPES OF HEREDITARY KIDNEY
CANCER.
NOW MOST OF WHAT WE KNOW REALLY
ABOUT THE GENETIC BASIS OF
KIDNEY CANCER, WE'VE LEARNED
FROM STUDYING FAMILIES.
WITH THIS MARVELOUS RESEARCH
CLINICAL CENTER, WE FOLLOW OVER
3000 PATIENTS FROM NEARLY 1500
FAMILIES, THE LARGEST EXPERIENCE
FOR SURE IN THE WORLD WITH CLEAR
CELL APPLIED ILLEGALSARY CHROMO,
AND ONCOCYTIC RENAL CELL CANCER.
NOW, HERE OVER THE PAST 38 YEARS
WE'VE DESCRIBED 8 NOVEL DISEASES
AT THE CLINICAL CENTER AND WE
HAVE IDENTIFIED 9 DISEASE GENES
HERE FOR A NUMBER OF DIFFERENT
KINDS OF CANCER AND DIFFERENT
DISEASES.
WE STARTED, OUR WORK BEGAN WITH
A PAPER WHICH WE PUBLISHED IN
NATURE AND IN THE MIDDLE 80S IN
WHICH WE SHOWED CONSISTENT LOSS
OF A SEGMENT OF CHROMOSOME 3,
THE THIRD CHROMOSOME IN TUMORS
FROM PATIENTS WITH CLEAR CELL
KIDNEY CANCER THAN WE WERE
SEEING HERE.
AND I WILL SAY, I WILL TELL YOU
THIS, THERE'S NO WAY WE COULD
HAVE DONE THIS WORK ANYWHERE
ELSE OTHER THAN HERE AT THE
CLINICAL CENTER, I MEAN IT JUST
WOULD NOT HAVE BEEN POSSIBLE.
AND THIS WORK SUGGESTED THAT
THERE WAS A KIDNEY CANCER GENE
IN THIS LOCATION.
NOW THIS WORK BEGAN 17 YEARS
BEFORE THE HUMAN GENOME WAS
SEQUENCED THERE WAS NO MAP OF
THE REGION TO SEARCH, THERE'S NO
WAY WE COULD DO THIS BY MAPPING.
SO WE TURNED TO THE STUDY OF
HEREDITARY KIDNEY CANCERS TO USE
THE POWER OF GENETICS TO
LOCALIZE AND IDENTIFY KIDNEY
CANCER GENES.
OUR HOPE WAS THAT THAT WILL
ENABLE US TO A-DEVELOP PRECISION
DIAGNOSIS, PRECISION SURGERY,
PRECISION THERAPY AND TO PROVIDE
THE FOUNDATION FOR THE
DEVELOPMENT OF TARGETED THERAPY
FOR THESE PATIENTS AND I WILL
SHOW YOU 1 STORY ON THAT, SO, WE
STARTED WITH THE STUDY OF A
VON HIPPEL-LINDAU, A HEREDITARY
CANCER IN WHICH PATIENTS
ARE--MULTIFOCUS CLEAR CELL
KIDNEY CANCER.
WE ESTIMATE THESE PATIENTS ARE
ACTUALLY AT RISK FOR THE
DEVELOPMENT OF UP TO 800 TUMORS
FOR KIDNEY.
THESE WERE CANCER, THESE ARE
ADDRESSIVE CANCERS, THEY CAN
SPREAD AND KILL THESE PATIENTS,
SADLY.
WE'VE HAD 63 PATIENTS OVER THE
LASTER 38 YEARS WHO'VE DEVELOPED
METASTATIC DISEASE, NOW TO
PREVENT THAT WE PERFORMED OVER
800 PROCEDURES ON VHL PATIENTS
WITH KIDNEY CANCER HERE ADDED
THE CLINICAL CENTER.
AND WE'VE DEVELOPED A PRECISION
CLINICAL MANAGEMENT APPROACH FOR
EACH TYPE OF GENETICALLY DEFINED
KIDNEY CANCER.
FOR VL FOR EXAMPLE, INSTEAD OF
REMOVING THE ENTIRE KIDNEY WHICH
THEN WOULD HAVE BEEN DONE PRIOR
TO THAT TIME WE DEVELOPED AN
APPROACH OF ACTIVE SURVEILLANCE,
WHICH AT THE TIME WAS CONSIDERED
HEARASSY BY MY FIELD, WE
RECOMMEND PARTIAL NEFF RECTIFIED
ME.
NOW AS I MENTIONED WE HAD A
NUMBER OF PEOPLE DEVELOP, A
NUMBER OF POWER PATIENTS DEVELOP
METASTATIC DISEASE OVER THE PAST
34 YEARS WHEN WE INSTITUTED TO
APPROACH, WE HAVE NOT YET HAD A
SINGLE PATIENT, NOT 1 YET
DEVELOP METASTATIC DISEASE WHEN
MANAGED IN THIS FASHION.
I WANTED TO SHOW YOU THIS.
THIS IS A VIDEO
OF ROBOTIC PARTIAL
NEPHRECTIFIED ME, AND IN WHICH
WE ENUCLE8 THIS TUMOR WE COME
RIGHT OROUND AND NUCLE8 IT AND
TAKE THESE TUMORS OUT AND BECOME
CLOSE TO THE TUMOR FOR ANY OTHER
GENETICALLY DEFINED TYPES OF
CANCER, WEEZ DO A COMPLETELY
DIFFERENT OPERATION, FOR
PATIENTS FOR EXAMPLE WITH FH
DEFICIENCY CANCER, HLRCC, WE
DON'T DO ROBOTIC SURGERY, WE DO
OPEN SURGERY, WE DON'T DO AN
ENUCLEATION LIKE WE DO HERE, WE
DO A WIDE MARGIN SO DEPENDS ON
THE GENE, IT'S PRECISION
SURGICAL THERAPY.
NOW OUR PATIENTS ARE ALSO AT
RISK FOR PANCREAT CIANCIARULO
AND EBD O KRIN NIEWMORS PENT
WHICH ARE MALIGNANT AND CAN
SPHRED.
OUR PATIENTS ARE ALSO AT RISK
FOR BRAIN, AND SPINAL HEMAGIAL
BLASTOMAS FOR WHICH OUR PATIENTS
HAVE UNDERGONE OVER 1200
PROCEDURES AT THE CLINICAL
CENTER.
THESE ARE VHL ASSOCIATED
CEREBELLAR AND SPINAL
HEMANGIOBLASTOMAS.
AND FINALLY 92% OF OUR PATIENTS
TWEP RETINAL ANGIOMAs AND I'M
SAT TO SAY WE HAVE A NUMBER OF
PATIENT WHO IS COMPLETELY LOST
THEIR SIGHT. THIS IS THE FIRST
MANIFESTATION OF VHL, WE CAN SEE
THESE IN 1 YEAR-OLD.
SOPHISTICATEDY WE RECOMMEND
GERMLINE MUTATION TESTING IN
CHILDREN, IN BABIES TO DETERMINE
WHO'S AFFECTED AND WHO'S NOT
BECAUSE LASER PHOTO THERAPY CAN
HELP PRESERVE VISUAL FIELDS.
NOW WE HAVE NO WAY OF KNOWING
WHO WAS AFFECTED WHO WASN'T IN
THESE FAMILIES SO TO FIND THE
VHL GENE WE BROUGHT THESE
FAMILIES TO THE MERCHANDISELOUS
CLINICAL CENTER RESEARCH
HOSPITAL AND THIS IS A TRUE NIH
PROJECT.
ONE OF MY ASSISTANTS TOLD ME
LAST YEAR, SHE SAID, YOU KNOW,
OVER THE YEARS YOU'VE WORKED
WITH 138 INDIVIDUALS AT NIH FROM
29 LABS AND BRANCHES.
FROM 8 DIFFERENT INSTITUTES AT
NIH, SO THIS IS TRULY, I'M
GIVING THIS TALK BUT THIS IS
TRULY AN NIH PROJECT AND HAS
BEEN SINCE THE VERY BEGINNING.
SO TO FIND THE VHL GENE, WE
STUDIED THE FANLLYS HERE AT THE
CLINICAL CENTER ASK TRACED THE
GENE TO THE SHORT ARM OF
CHROMOSOME 3 WHERE WE HAD SEEN
THE ABNORMALITY IN SPORADIC
CLEAR CELL KIDNEY CANCER, SO WE
WERE VERY ENCOURAGED TO SEE
THAT.
NOW WEINARY ONED THE REGION UP
HERE AT THE TOP, WITH GENETIC
LINKAGE ANALYSIS, AND THEN DOWN
HERE BELOW, WE DID WHAT WAS
CALLED PHYSICAL MAPPING,
IDENTIFIED THESE ARE CDNAs
THEY'RE CALLED AND THE SEVENTH
CDNA HERE WE CALL G7 WAS THE
SEVENTH CDNA PIECE OF DNA THAT
WHEN WE LOOKED AT, AND THIS
TURNED OUT TO BE THE VHL GENE IN
THE SPRING OF 1993, NEARLY 10
YEARS AFTER WE STARTED THIS
PROJECT--MUTATIONS OF THE GENE
WHICH SEGREGATED WITH THE DEC IN
THE FAMILIES WHICH IS EXACTLY
WHAT WE FOUND.
WE THEN WENT ON TO DEVELOP A
BLOOD TEST WHICH IS USED WORLD
WIDE FOR ALL OF OUR GENES WE
DEVELOPED AND WAS POSITIVE IN
100% OF OUR FAMILIES.
NEXT WE WANTED TO SEE IF THERE
THIS WAS THE GENE THAT WE LOOKED
FOR FOR SO LONG?
WAS THIS THE GENE FOR TUMORS?
WE TESTED TUMORS FROM PATIENTS
WITH SPORADIC NONFAMILIAL KIDNEY
CANCER AND SURE ENOUGH WE FOUND
MUTATION OR METHYLATION CHRKS IS
THE SILENCING THE GENE IN 91% OF
THE TUMORS.
NOW WE DID NOT FIND THE VHL GENE
MUTATION IN OTHER HISTOLOGIC
TYPES OF KIDNEY CANCER THAT I
SHOWED YOU A MINUTE AGO,
PROVIDING THE FOUNDATION FOR THE
DEVELOPMENT OF PRECISION
CLINICAL MANAGEMENT, PRECISION
THERAPY, AND PRECISION SURGERY
BASED ON THE GENO TYPE OF THE
CANCER.
NOW THIS WAS A COMPLETELY
[INDISCERNIBLE] GENE WE HAD NO
IDEA WHEN WE FOUND IT HOW IT
WORKED.
AND WE WANTED TO KNOW HOW THE
VHL GENE WORKED SO TO DO THIS,
WE FIRST IDENTIFIED 2 PROTEINS,
A LONG C AND ELONGIN B HERE
WHICH FORMED A COMPLEX WITH VHL
AND I WILL PUBLISH THIS IN
SCIENCE AND JOINT WEB CONNECTED
WITH A YOUNG SCIENTIST BILL
KAELIN WHO WILL HEAR MORE ABOUT
IN A MINUTE, HOWEVER WE STILL
DIDN'T REALLY KNOW OR HAVE A
CLUE ON HIGHWAY HOW THIS WORKED.
NOW, THE NEXT YEAR, WE AND AGAIN
WITH BACK-TO-BACK WITH BILL
KAELIN'S GROUP, SHOWED THE VHL
GENES THAT ARE OXYGEN SENSITIVE.
WELL, HOW'S THAT HAPPEN.
WELL, THE FOLLOWING YEAR WITH
RICK CLASSENER, WE SHOWED THAT
THE VHL COMPLEX INCLUDES A
PROTEIN CALLED COL2, A RECENTLY
DISCOVERED GENE THE YEAR BEFORE.
WE LOOKEDDA THE HOMOLOGOUS YEAST
PROTEINS OVER HERE ON THE RIGHT
AND YOU CAN SEE THEIR COMPLEX,
HOW THEY WORK AND THE REASON VHL
HAD TO BE BE BE A DEGRADATION
COMPLEX THAT TARGETS
TRANSCRIPTION FACTORS THAT
REGULATE THE STABILITY OF
HYPOXIA INDUCIBLE RNAs, IN
OTHER WORDS THAT ARE OXYGEN
SENSITIVE, AND WE REASON IT HAD
TO BE HYPOXIA INDUCIBLE AND
SHORTLY THEREAFTER OUR COLLEAGUE
PETER RADCLIFF PROVED THAT,
SHOWED THAT, THAT VHL DOES
INDEED TARGET HYPOXIA INDUCIBLE
FACTOR FOR DEGRADATION, THAT VHL
TARGETS HIF FOR DEGRADATION AND
THIS IS OXYGEN SENSITIVE.
BUT NO 1 KNEW HOW THAT WORKED
UNTIL SHORTLY THEREAFTER IN
2001.
PETER RADCLIFF AND BILL KAELIN
SHOWED THE MECHANISM FOR VHL HIV
OXYGEN SENSING.
IN RETROSPECT VERY SIMPLE.
IT'S PROLEGAL HYDROX ACE, WHICH
PUTS HYDROXYL GROUPS WHEN
THERE'S OXYGEN IN THE CELL AND
NORM OXIA AND THERE ARE
COMPLEXES, VHL CAN TARGET AND
DEGRADE, HOWEVER IF YOU ARE LOW
IN OXYGEN, YOU'RE IN HYPOXIA,
YOU CAN'T THROW THOSE ON HERE,
THE COMPLEX CAN'T TARGET HIT THE
GRADE AND CAN'T ACCUMULATE.
AND THAT'S HOW IT WORKS.
AND IN 2019, THE NOBEL ASSEMBLY
AWARDED BILL KAELYN AND PETER
RATCLIFFE, AND GREG SEMENZA THE
NOBEL PRIZE OF HOW CELLS SENSE
AND ADAPT TO OXYGEN
AVAILABILITY, AND THEY WERE VERY
GRACIOUS TO CITE OUR WORK AS
BEING CRITICAL TO THIS DORPHY.
NOW OF COURSE OUR GOAL, OUR
EFFORT, OUR TARGET HAD BEEN TO
DEVELOP THERAPIES.
SO UNDERSTANDING THE VHL PATHWAY
HAS PROVIDED THE FOUNDATION FOR
THE DEVELOPMENT AND FDA APRAWFAL
NONPRECISION THERAPEUTIC AGENTS.
TARGETING THE DOWN STREAM GENES
REGULATED BY THE VHL HIFF WAGHT
WAY.
NOW, YOU KNOW HAVE HIGH
RESPONSE, WE WERE TARGETING THE
DOWN STREAM GENES WUWE WANTED TO
DO BETTER.
WE WANTED TO TARGET HIF ITSELF,
INSTEAD OF JUST THE QUOTE DOWN
STREAM GENES.
TUMORIGENESIS, AND THIS WORK LED
TO THE DEVELOPMENT BY RICK BROOK
AND HIS COLLEAGUES OF AN AGENT
BELZUTIFAN THAT TARGETS HIF TO
ITSELF.
SO THEY CONTACTED US AND ASKED
IF WE WOULD DO A TRIAL, WE SAID
OF COURSE.
WE THEN CONDUCTED A MULTICENTER
TRIAL LED BY RON KD--SALLY HA IN
OUR GROUP EVALUATING THIS AGENT
BELZUTIFAN IN VHL PATIENTS.
IN THIS TRIAL, WE HAVE SEEN A
98% PARTIAL RESPONSE OR STABLE
DISEASE IN RENAL TUMORS IN WHICH
92% OF OUR TARGET LESIONS GET
SMALLER.
AND CNS AND ANGIO BLASTOMAS WE
SEE A 60% RESPONSE WITHA 86%
PARTIAL RESPONSE FROM THESE
BRAVE PATIENTS WE HAVE WORKED
WITH AND BEEN OUR PARTNERS ALL
THESE YEARS.
AND AGGRESSIVE PANCREATIC INDO
KRIN CANCERS WE HAVE A 91%
OBJECTIVE--91% OBJECTIVE
RESPONSE RATE WITH A 14%
COMPLETE RESPONSE RATE IN
ENDOCRINE TUMORS.
IN 12 VHL PATIENTS WITH 16
RETINAL HEME ANG I DON'T MEANAS,
TREATED WITH THIS AGENT, WHICH
HAS REALLY VERY MODEST SIDE
EFFECTS WE'VE SEEN IMPROVEMENT
IN A HUNDRED% OF OUR LESIONS.
AND MY COLLEAGUE, IN
OPHTHALMOLOGY EMILY CHU HAS BEEN
BY OUR SIDE FOR NEARLY 3 DECADES
WITH THESE PATIENTS.
SHE HAS DONE 6 CLINICAL TRIALS
WITH AGENTS TARGETING THIS
PATHWAY AND NOT SEEN A WHOLE LOT
UNTIL THIS.
NOW OR GOAL HAS BEEN OBVIOUSLY
TO DEVELOP A THERAPY SO THESE
BRAVE PATIENTS WON'T HAVE TO
HAVE SURGERY, AFTER SURGERY
AFTER SURGERY FOR THEIR TUMORS
WHICH WE'VE LIVE WIDE FOR
NEITHER 40 YEARS, THE PATIENTS
ON THIS TRIAL, CAN YOU LOOK AT
THIS SLIDE HERE, THE PATIENTS ON
THIS TRIAL, IF YOU LOOK AT THE 2
AND HALF YEARS BEFORE THEY
STARTED THERAPY AT 53 SURGICAL
PROCEDURES IN THE 2 AND HALF
YEARS AFTER WE STARTED DRUG,
ONLY 3 SURGICAL PROCEDURES IN
THIS PATIENT POP VIEWLINGS.
SO WHAT I'VE SHOWN YOU IS THAT
KIDNEY CANCER IS NOT KIDNEY
CANCER IT'S A NUMBER OF
DIFFERENT CANCERS, DIFFERENT
MEDICAL COURSES, RESPONDING
DIFFERENTLY TO THERAPY, CAUSED
BY DIFFERENT GENES WITH
DIFFERENT PATHWAYS AND IT'S OUR
HOPE THAT OUR CONTINUED STUDY OF
KIDNEY CANCER FAMILIAL AND
SPORADIC AT THE CLINICAL CENTER,
INSTEAD OF STUDYING THESE
PATHWAY AND GENES WILL DEVELOP
EFFECTIVE FORMS OF THERAPY FOR
EVERY PATIENT AFFECTED WITH THIS
DISEASE AND I WANT TO
ACKNOWLEDGE OUR COLLEAGUES AS I
MENTIONED, THIS IS A REAL NIH
TRIAL.
I'M INDEBTED TO THE COLLEAGUES
IN OUR GROUP OUR THERAPEUTICS
AND CLINICAL TIME LED BY RON,
AND MATT, AND NIH IT WOULD TAKE
MY 5 SLIDES TO SHOW EVERYBODY
FROM NIH ACROSS THE WHOLE FIELD.
OUR COLLEAGUES IN RADIOLOGY
ASKING SURGICAL AND NEUROLOGY,
AND BEFORE THAT FERS IT ED, I
STARTED WORKING WITH ED IN 84 ON
THIS.
THE MARVIN MUSCAN EVERYBODIOUS
EMILY CHU, ENDOCRINE ONCOLOGY,
IT GOES BACK TO JEFF NORTON,
DOUG, STEVE, I CAN'T TELL YOU
HOW MANY SURGICAL COLLEAGUES
WE'VE WORKED WITH, THE WONDERFUL
MA RIAMOLECULAR MEDICINE, TRACE
WHO HELPED US DEVELOP NOVEL
APPROACHES TARGETING THE VHL HIF
PATHWAY, ENDOCRINOLOGY, WERE
ALSO INCREDIBLY APPRECIATIVE OF
THE CLINICAL CENTER AND NIH FOR
SUPPORTING 2 U01 PROJECTS BASED
ON CHL WITH THE INSTITUTE AND
OUR WORK WITH BILL KAELIN AND
DAVID Mc DORMOT FOR THE VHL
CANCERS SO THANK YOU VERY MUCH
IT'S BEEN A HONOR TO HAVE AN
OPPORTUNITY TO COMMUNICATE WITH
YOU, THE WONDERFUL WORK OF THE
SMALL PIECE THAT IS ONGOING AT
THIS WONDERFUL CLINICAL CENTER.
THANK YOU VERY MUCH.
>> I SEE A COUPLE HANDS THERE,
OKAY.
ELEN LET ME GO TO YOU FIRST AND
THEN GO TO RICK AND JOHN.
>> OKAY.
CONGRATULATIONS ON THIS
WONDERFUL RESEARCH.
THAT'S WHY WE LOVE NIH.
BUT I ALSO WANT TO THANK YOU FOR
MAKING IT SIMPLE ENOUGH FOR
PEOPLE LIKE ME TO UNDERSTAND.
SO THANK YOU.
>> THANK YOU.
>> ELLEN, YOU ARE PRETTY
SOPHISTICATED BUT I WILL ALSO
GIVE DR. LINEHAN CREDIT FOR
MAKING VERY UNDERSTANDABLE AND
QUITE AN ACTION PACKED STORY IN
TERMS OF DEVELOPMENT.
RICK AND THEN JOHN.
>> DR. LINEHAN THANK YOU VERY
MUCH IT WAS JUST TERRIFIC AND I
THINK THAT EARLIER IN THE COURSE
OF OUR CONVERSATION THIS MORNING
AND TALKING ABOUT EFFORTS AT THE
CLINICAL CENTER TO THINK ABOUT
ADDRESSING AND I KNOW THAT
HISTORICALLY RENAL CELL CANCER,
I UNDERSTAND HOW ARE NOT 1
DISEASE BUT IN GENERAL ARE
THOUGHT TO HAVE A HIGHER
INCIDENCE AMONG AFRICAN-AMERICAN
MEN SO I WONDER WHETHER AS PART
OF THE CENTER'S EFFORTS TO
REALLY FOCUS ON EQUITY WE CAN
BEGIN TO REALLY TEASE OUT FOR
EXAMPLE, RESPONSE RATES BY RACE,
GIVEN AGAIN WITH A DISEASE THAT
IS HISTORIC LOAMACYY AND I'M
SURE YOU KNOW MORE THAN THIS
ABOUT THIS THAN ME BUT
HISTORICALLY HAD A HIGH INITANCE
AMONG AFRICAN AMERICANS, JUST
ANOTHER CONTRIBUTION THE CENTER
COULD MAKE TO A NATIONAL
CONVERSATION AROUND EQUITY WHERE
CLINICAL DISPARITIES ARE
ADDRESSED WITH THIS KIND OF
SCIENCE.
>> ABSOLUTELY.
THANK YOU FOR BRINGING THAT UP
AND ABSOLUTELY OF COURSE.
FOR MANY, MANY REASONS, 1 IS
IT'S THE RIGHT THING TO DO BUT
ANOTHER OF COURSE, BUT ANOTHER
THING IS SCIENTIFICALLY, IT'S
VERY IMPORTANT.
WHAT IS GOING ON HERE, WHAT
IS--HOW DOES THAT WORK, I AGREE,
IT'S HIGHER INCIDENCE IN BOTH
MALES AND FEMALES, SO PEOPLE WHO
ARE OF AFRICAN AMERICAN DESCENT,
ANOTHER THING IS THAT ACTUALLY
THEY GET A LITTLE DIFFERENT TYPE
OF KIDNEY CANCER.
THEY GET MORE APPLIEDULARAR SKPE
BAKUGAN LESS CLEAR CELL AND
THAT'S A VERY--IT'S A VERY
IMPORTANT POINT AND WE'RE
WORKING VERY HARD TO EXPAND OUR
EFFORTS IN THOSE AREAS AND OF
COURSE, I'M A NEUROLOGIC SURGEON
AND OF COURSE, WE MANAGE
PATIENTS WITH PROSTATE CANCER,
KIDNEY CANCER, PROSTATE CANCER,
BLADDER CANCER AND IN PROSTATE
CANCER WE HAVE SIMILAR ISSUES
THERE, EARLIER ONSET, WORST
DISEASE AND WE'RE MAKING A BIG
EFFORT TO EXPAPPED OUR YORK IN
THAT AREA AND REACHING OUT TO
OUR COLLEAGUES WITH DR. GALLAN'S
HELP AT HOWARD'S, MATTER OF FACT
1 OF OUR FORMER FELLOWS IS
FORMING ATTENDINGS ARE DOWN
THERE AT NEUROLOGIC SURGERY
WE'RE WORKING WITH THAT GROUP
AND ALSO WORKING WITH OTHER
GROUPS THAT HAVE NETWORKS ACROSS
THE COUNTRY, IN THIS CASE,
AFRICAN AMERICAN PHYSICIAN WHO
IS HAVE HIGH PERCENTAGE OF
PATIENTS WITH AFRICAN AMERICAN
DESCENT AND I AGREE THESE ARE
INCREDIBLY IMPORTANT AND
IMPORTANT FOR MANY REASONS TO DO
IT BUT ALSO SCIENTIFICALLY IT'S
SOMETHING THAT'S VERY IMPORTANT
TO UNDERSTAND.
>> THANK YOU.
JOHN AND THEN ANTOINETTE?
SO I JUST WANT TO EMPHASIZE A
FEW THINGS AND THANK MARSTON WHO
I THINK KNOWS I'M 1 OF HIS BIG
FANS, HE'S A DOCTOR, I MEANEE
TAKES CARE OF PEOPLE, THAT'S
WHAT HE DOES 12 HOURS, 14 HOURS,
24 HOURS A DAY AND THIS ALL
HAPPENED IN THIS SETTING AND
WHAT I REALLY WANT TO EMPHASIZE
IS WHAT MARSTON ALLUDED TO AND
THAT IS THE PARTNERSHIPS HE
CREATED BETWEEN THE BASIC
SCIENTISTS COMMUNITY AND THE
CLINICIAN SCIENTIST COMMUNITY
BOTH ACROSS THE NIH AND ACROSS
THE COUNTRY.
I MEAN THAT'S WHY THE MAGIC
HAPPENS AND THIS IS MAGIC.
I MEAN THIS A MONUMENTAL
ACCOMPLISHMENT THAT YOU HEARD
TODAY, INCLUDING A NOBEL PRIZE.
I MEAN, IT DOESN'T GET BETTER
THAN THAT.
SO, WHEN YOU ASK, WHY DO WE NEED
THE NIH?
WHAT DOES IT HAVE?
IT'S THAT ENVIRONMENT THAT
ENABLES THREEZ SORTS OF
THINGS--THESE SORTS OF THINGS TO
HAPPEN TO ME THAT IS SO SPECIAL.
SO MARSTON, THANK YOU FOR
PRESENTING THIS AND PRESENTING
IT IN A WAY THAT I THINK
EVERYBODY CAN CAPTURE THAT
MAGIC.
>> THANK YOU VERY MUCH.
I MEAN I COULDN'T HAVE PUT IT
BETTER.
I MEAN WE SAY, DR. GALLAN, WE
STUDY THE HUMAN MODEL TO ANSWER
ARE AND YOU KNOW WE COULDN'T DO
IT, I MEAN I COULDN'T HAVE DONE
THIS, ANYWHERE ELSE AND AS YOU
SAID, ALL THESE OTHER
COLLEAGUES--BE SURPRISED THE
PROGRESS PEOPLE CAN MAKE WORKING
TOGETHER IF YOU'RE NOT SO QUITE
CONCERNED WITH WHO GETS CREDIT
FOR THE WORK AND YOU CAN LOOK AT
THAT AND LOOK AT THE AUTHORSHIP
IN THOSE PAPERS, THAT'S THE WAY
WE BELIEVE.
AND YOU KNOW IT'S THESE
MARVELOUS AND OF COURSE WE ALL
KNOW IT BUT THESE MARVELOUS
BRAVE PATIENTS THAT ARE OUR
PARTNERS IN ALL THIS WORK AND
WITHOUT THEM, I TELL THEM EVERY
WEEK, WITHOUT THEM, WE WOULDN'T
HAVE BEEN ABLE TO MAKE ANY
PROGRESS BUT HAVING THE
OPPORTUNITY TO BRING THOSE
PEOPLE HERE, TO WORK IN THIS
WOBDERFUL HOSPITAL, WONDERFUL
CLINICAL CENTER, I CAN'T IMAGINE
ANYTHING BETTER AND FOR SOMEONE
LIKE ME, IT'S BEEN THE DREAM OF
A LIFETIME AND WE'RE VERY
ENCOURAGED BY THE PROGRESS
THAT'S BEEN MADE BUT WE HAVE A
LONG WAY TO GO BUT WE WILL GET
THERE.
>> ANTOINETTE.
>> THANKS, DR. LINEHAN FOR WHAT
YOU'VE BEEN DOING ON THE STUDY
OF KIDNEY CANCER AND ISSUES.
ALTHOUGH I KNOW I'VE BEEN
DIAGNOSED WITH KIDNEY CANCER, I
DID HAVE AN ISSUE WITH MY
KIDNEYS A LITTLE BIT OVER 10
YEARS AGO AND I KEPT GOING TO
THE DOCTOR AND DOCTOR AND
DOCTOR, THEY HAD NOT A CLUE WHAT
WAS HAPPENING TO ME BECAUSE MY
BLOOD WORK WAS SAYING EVERYTHING
IS OKAY BUT DUE TO MY SIZE, IT
REALLY WASN'T SO MY DR. AT
GEORGE TOWN BY THE WAY HER LAST
NAME IS MELLIBLE, NEVERROLOGYIST
THERE, SHE GOT ME BACK ON TRACK,
SHE DID A SPECIAL TEST BECAUSE
SINCE I'M [INDISCERNIBLE], I HAD
[INDISCERNIBLE] AND THAT'S WHY
THE BLOOD WORK WAS REALLY OFF
AND TELLING ALL THE DOCTORS
EVERYTHING'S OKAY, I KEPT GOING,
I DIDN'T KNOW WHAT WAS GOING ON
WITH ME TO THE POINT THAT BY THE
TIME I WAS ABLE TO GET IN TO SEE
DR. NEELABLE, MY KIDNEY
FUNCTIONS WERE AT 34% AND THEY
DIAGNOSED ME WITH STAGE 3
CHRONIC KIDNEY DISEASE.
WELL SHE GOT ME, IT 1 OF THE
MEDICATIONS I WAS ON, WAS REALLY
DAMAGING MY KIDNEYS SO I WAS
TAKEN OFF THE MEDICATION AND
SHE'S BEEN MONITORING ME EVERY
YEAR SINCE THEN AND EVERY TIME I
SEE HER, I SAY THANK GOD FOR
DR. NEELABLE, BECAUSE SHE SAVED
ME FROM BEING ON KIDNEY DIALYSIS
AND SHE SAVED MY KIDNEYS, RIGHT
NOW I MOVE FROM WASHINGTON D. C.
AND I'M NOW LIVING IN
ALLEGEHENYAND WHEN I WAS IN DID
D. C. NIGH KIDNEY FUNCTION WAS
TO LET STAGE 3 AND THEY WERE
BASICALLY LEVELED OFF DUE TO THE
TREATMENT THAT DR. NEELABLE HAD
GIIVE ME.
RIGHT NOW, SINCE I'M LIVING IN
THE APPALACHIA MY WATER SUPPLY
IS WELL WATER AND MY KIDNEY
FUNCTIONS HAVE IMPROVED TO I'M
STAGE 2 CHRONIC KIDNEY DISEASE
AND EVERYTHING'S REALLY LEVELING
OFF AND I DEFINITELY FEEL A
WHOLE LOT BETTER AND I'M NOT
SURE IF THE DOCTOR IS ON YOUR
TEAM IS THE HUSBAND OF THE
DOCTOR AT GEORGE TOWN, BUT
THAT'S A POWER COUPLE THERE.
THANK YOU.
>> IT'S FUNNY,IME SO GLAD YOU'RE
DOING BETTER AND EVERYTHING, YOU
KNOW IT'S 1 OF THE WONDERFUL
THINGS ABOUT THE NIH AND THE
CLINICAL CENTER IS WE HAVE THE
OPPORTUNITY TO SEE SO MANY
PATIENTS WITH DIFFERENT DISEASES
AND TO HELP THEM AND THE NICE
THING WE DON'T HAVE TO CHARGE
THEM FOR INSURANCE OR ANY OF
THAT SORT OF STUFF, IT MAKES
SUCH A DIFFERENCE THAT WE MIGHT,
IF WE DO SURGERY WE MIGHT
INFLICT PAIN BUT WE DON'T
INFLICT FINANCIAL PAIN SO IN
OTHER WORDS WE CAN TREAT ALL
PATIENTS AND THAT'S A WONDERFUL
THING ABOUT WORKING HERE.
YOU JUST NEVER HAVE TO WORRY
ABOUT THAT.
IT'S NEVER AN ISSUE WITH WHO YOU
WILL BRING SOMEBODY IN OR NOT.
SO WE'RE THRILLED ABOUT THAT AND
ALSO, SO GLAD TO HEAR YOU'RE
DOING BETTER.
THAT IS GREAT.
>> YES, ALSO WHAT RICK WAS
SAYING REGARDING THE KIDNEYS
ISSUES WITH AFRICAN AMERICANS
VERSUS OTHER RACES, I ALSO
NOTICED WHEN I WAS IN D. C.,
IT'S LIKE THEY'RE PUTTING THE
DIALYSIS CENTERS IN STRIP MALLS,
THEY'RE EVERYWHERE NOT IN
HOSPITALS LIKE THEY WERE YEARS
AGO, NOW THEY'RE JUST LIKE
EVERYWHERE.
AND I ALSO NOTICED THAT THE
KIDS, THE FOLKS ARE GETTING MUCH
YOUNGER WHO ARE BEING SUBJECT TO
DIALYSIS BECAUSE I USED TO RIDE
METROACCESS IN D. C. AND I WOULD
LEAVE OUT EARLY IN THE MORNING
AND WE WERE DROPPING PEOPLE OFF
AT KIDNEY DIALYSIS CENTERS AND
STRIP MALLS AND SORE SOME OF
THESE BUILDINGS, LIKE--IT WAS
LIKE AT LEAST IN THE 70S BY THE
TIME THEY NEED THAD TYPE OF
INTERVENTION, IF THEY EVER
NEEDED IT SO IS THERE SOMETHING
GOING ON IN THE INNER CITY OR
WITHIN THE BLACK COMMUNITY THAT
YOU THINK THAT MAY BE INCREASING
THIS DAMAGE TO OUR KIDNEYS?
>> WELL I'M A UROLOGIC SURGEON,
THE PEOPLE WHO STUDY THAT ARE
OTHER KIDNEY DOCTORS AND
NEFFROLOGYIST HOWEVER I KNOW
THIS IS AN IMPORTANT AREA THAT
PEOPLE ARE LOOKING AT.
YES THIS, THIS IS AN YSH, NO
QUESTION ABOUT IT AND A LOT OF
PEOPLE ARE WORKING ON THAT, BIG
EFFORT ON THAT.
BIG EFFORT TO GOING ON TO HELP
PEOPLE WITH THEIR KIDNEY
FUNCTION, ABSOLUTELY, VERY
IMPORTANT QUESTION.
>> OKAY, GREAT.
ALL RIGHT.
JUST TERRIFIC, WHAT A GREAT WAY
FOR US TO CONCLUDE THIS MEETING
MARSTON, THANK YOU SO MUCH, THIS
REALLY DOES BRING THIS TO LIFE,
I WANT TO SAY A SPECIAL THANK
YOU TO ELLEN, FOR ALL THE GREAT
PARTICIPATION.
YOU HEARD WITH ELLEN AND OUR
DEPARTED BEE, BY THE WAY THAT WE
WERE TALKING ABOUT BEFORE, AND
NOW, WITH--YOU SEE HOW IMPORTANT
IT IS TO HAVE THE WORDS OF
PATIENT, FANTASTIC ELLEN, GLAD
YOU ARE NOT LEAVING THE PATIENT
GROUP.
THAT WILL BE IMPORTANT.
THANKS TO OUR NEW MEMBERS
ANTOINETTE, DAVID AND CRAIG, I
THINK QUIEWR IN FOR A REAL
TREAT.
JIM, DID WE CONFIRM FRIDAY
JULY 15 AS OUR MEETING?
>> I BELIEVE WE HAVE AND I
BELIEVE THE MOST RECENT
DESCRIPTION I HEARD OF THAT
MEETING IS, IT WILL BE A HYBRID
MEETING WHICH MEANS WE WILL HAVE
PEOPLE PRESENT WE ALSO HAVE THE
OPTION OF ATTENDING VIRTUALLY
AND STILL PARTICIPATING IN THE
MEETING.
HYBRID MEETINGS WE'RE DOING SOME
EXPERIMENTING WITH--IT'S A
LITTLE DIFFERENT BUT--I HOPE
THAT SOME OF THE NEW MEMBERS CAN
COME TO THE CLINICAL CENTER, WE
WOULD LOVE TO BE ABLE TO SHOW
YOU THE FACILITIES, THERE'S SOME
OPPORTUNITIES WE HAVE WHEN
YOU'RE HERE THAT WE DON'T HAVE
WHEN WE'RE ALL ON THE COMPUTER,
SO, I'M HOPEFUL THAT WE CAN SEE
SOME OF YOU IN PERSON.
>> TERRIFIC.
GOOD.
WELL, ONCE AGAIN, THANKS ALL,
THIS IS A GREAT MEETING.
WITH THE SPIRIT OF OPTIMISM
ABOUT EVERYTHING THAT'S MOVING
FORWARD SO, THANKS TO THE TEAM,
THANKS TO OUR ONGOING BOARD
MEMBERS VA GREAT REST OF THE
DAY, EVERYONE.