Performance Improvement 1996. National Institutes of Health



Cancer at a Crossroads: A Report to Congress for the Nation

Career Development Applications and Awards: Medical Department Sources and Patterns of NIH Funding

Development of Medications for the Treatment of Opiate and Cocaine Addictions: Issues for the Government and Private Sector

Directions in Nursing Research Training

Evaluation Design Study for the National Research Service Awards (NRSA)

Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment

Measuring Social Inequalities in Health

Report on Outreach Activities of the National Library of Medicine: A Five-Year Review

The Status of Biomedical Research Facilities

Study of the Minority Access to Research Careers Honors Undergraduate Research Training Program

Support for Bioengineering Research

TITLE: Cancer at a Crossroads: A Report to Congress for the Nation


ABSTRACT: This evaluation of the National Cancer Program (NCP) was undertaken at the request of Congress to assess the achievements of NCP, identify barriers to reducing the burden of cancer, and make recommendations for future research and program directions. NCP comprises not just the cancer research community, but government at all levels, business and industry, the total health care system, and every United States citizen. The report concludes that the strongest strategy for a renewed war on cancer should include three essential elements: (1) applying currently available knowledge about cancer prevention and care to all segments of the population; (2) increasing support for translational research that develops basic cancer knowledge into preventive strategies, new technologies, and effective treatments; and (3) increasing support for basic cancer research to ensure continued new discoveries that lead to better cancer prevention and care. The report notes that six major issues must be addressed to mount an effective war on cancer: (1) need for health care reform with universal cancer care coverage written in statute; (2) absence of coordination in NCP; (3) inadequate cancer care: (4) current laws, policies, and regulations that hinder the development of effective cancer treatments; (5) lack of support for translational research; and (6) need to increase basic science research. (Final report 34 pages, plus appendixes.)

AGENCY SPONSOR: National Cancer Institute


PHONE NUMBER: 301/496-5515

PIC ID: 6008

PERFORMER ORGANIZATION: National Cancer Institute, Bethesda, MD

TITLE: Career Development Applications and Awards: Medical Department Sources and Patterns of NIH Funding


ABSTRACT: This study was undertaken to find out, first, if the graduate medical school and residency enrollment in departments that have been sources of National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other NIH Career Development (K) awards and applications has continued to increase over time, or is leveling off or decreasing; and second, to examine whether that potential supply of applicants is in fact reflected in applications received and applications funded by NIDDK and by other institutes. The supply of potential applicants for K awards may be leveling off or decreasing, based on 1994 data of the American Medical Association, but an encouraging aspect of these data is that enrollment in postdoctoral programs in departments from which NIDDK applicants have come is not decreasing, for the most part. Applications to NIH for individual support by K awards have increased in the last 8 years, but this increase is primarily from clinical sciences departments. Applications from basic sciences have declined slightly. The relative standing of NIDDK among NIH ICDs, with respect to applications received, applications funded, and both received and funded in proportion to agency budget, has remained constant. NIDDK is third or fourth among ICDs by these criteria, and its support of Career K trainees is consistently above the NIH average.

AGENCY SPONSOR: National Institute of Diabetes and Digestive and Kidney Diseases


PIC ID: 6019

PHONE NUMBER: 301/496-6623

PERFORMER ORGANIZATION: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD

TITLE: Development of Medications for the Treatment of Opiate and Cocaine Addictions: Issues for the Government and Private Sector


ABSTRACT: The Medications Development Division (MDD) at the National Institute on Drug Abuse (NIDA) was established to coordinate and encourage academic, private, and Federal regulatory involvement in developing and bringing to market new medications to treat drug abuse. This report examines MDD's progress and explores the factors that hinder the development of antiaddiction medications. The report finds that pharmacotherapy for the treatment of drug addiction has received little attention. In fact, despite the success of methadone for the treatment of opiate addiction, only two additional drugs have been approved, both of which were developed in the late 1960's and early 1970's. Furthermore, there is still no approved medication for the treatment of cocaine addiction. The report also finds that the major disincentives to pharmaceutical research and development for antiaddiction medications include (1) an inadequate scientific base on the mechanisms of addiction and on the prevention of relapse, particularly for cocaine addiction; (2) lack of financing for treatment and trained treatment specialists; (3) narrow Federal and State regulations; (4) relatively small market for such drugs; (5) pricing issues and social stigma against drug abusers; (6) liability issues and difficulties in conducting clinical research; and (7) lack of sustained Federal leadership. The report provides recommendations to help remove these barriers. (Final report 199 pages, plus appendixes.)

AGENCY SPONSOR: National Institute on Drug Abuse

FEDERAL CONTACT: Laura Rosenthal

PHONE NUMBER: 301/443-6487

PIC ID: 5831

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine, Washington, DC

TITLE: Directions in Nursing Research Training


ABSTRACT: The National Institute of Nursing Research (NINR) supports mechanisms to permit nurse scientists to follow research career paths. This report summarizes information on NINR's funding of these efforts, its recommendations for nursing research training in a National Research Council report, and the views and recommendations of the scientific community. This report also discusses research training issues in the broad context of Federal and academic perspectives. The report finds that (1) during its formative years, NINR placed a high priority on training at the predoctoral level in order to ensure a beginning cadre of nurse scientists; (2) the numbers of Nursing Research Service Awards (NRSA) applications and part-time enrollment are decreasing for most nursing doctoral students; (3) the number of NRSA full-time training positions must increase in the next 5 years; (4) NINR and the nursing research community must design and implement creative research training programs to ensure that scientists in nursing research have access to high-quality training in research-intensive environments. The report recommends that NINR (1) disseminate this report widely; (2) analyze the research career paths of NINR trainees and fellows to determine the criteria for successful training experiences; (3) emphasize the need to increase the number of nurses with doctoral degrees; and (4) support research consortia and partners. (Final report 19 pages.)

AGENCY SPONSOR: National Institute on Nursing Research

FEDERAL CONTACT: Suzanne L. Feetham

PHONE NUMBER: 301/402-1446

PIC ID: 6051

PERFORMER ORGANIZATION: National Institute of Nursing Research, Bethesda, MD

TITLE: Evaluation Design Study for the National Research Service Awards (NRSA) (Volume I)

Description of National Research Service Awards Program (Volume II)


ABSTRACT: The NRSA program is designed to meet the need for scientists and institutions to carry out the Nation's biomedical research agenda. This evaluation design study provides a detailed plan for the evaluation of career outcomes of predoctoral and postdoctoral trainees and fellows and the NRSA programs in which they have participated. The design study is divided into three parts: the first part describes the program and its history; the second part details previous evaluation efforts; and the third part discusses the proposed evaluation design. The report finds that (1) in 1994, NRSA provided $373 million, distributed among 2,356 individual fellowships and 12,032 traineeships awarded by institutions; (2) approximately 15 percent of the graduate students in the biomedical and behavioral science area are supported by NRSA funds; and (3) NRSA is the largest research training program in the United States. The evaluation design study proposes three approaches for the evaluation: (1) an analysis of existing databases to provide initial data, to help define sampling strategies, and to be the basis for comparisons between NRSA participants and nonparticipants; (2) a survey of prior NRSA recipients and of institutions; and (3) site visits to institutions. See also PIC ID 6012.1. (Final report 75 pages.)

AGENCY SPONSOR: Office of the Director


PHONE NUMBER: 301/496-9285

PIC ID: 6012

PERFORMER ORGANIZATION: National Institutes of Health, Division of Strategic Evaluation, Bethesda, MD

TITLE: Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment


ABSTRACT: When fetal alcohol syndrome (FAS) was first described in published medical literature, hopes were high for its prevention. However, preventing this condition has been very complicated. This report responds to the mandate of Congress in the ADAMHA Reorganization Act that a study of FAS and related birth defects be carried out. The committee convened to write the report has members whose expertise includes pediatrics, developmental psychology and neurology, obstetrics, nosology, teratology, epidemiology, substance abuse prevention and treatment, and psychiatry. The committee was charged with improving the understanding of available research knowledge and experience on diagnosis, prevalence, surveillance, and prevention and treatment of FAS and related birth defects. The committee-revised diagnostic criteria aim to increase clarity, rigor, and consistency by expanding the traditional designations of FAS and other alcohol-related effects. Recommendations include: (1) cross-sectional and longitudinal research to assess the characteristics and clinical expression of these syndromes across the patient's life span; (2) research to identify potential structural or functional brain abnormalities that may be associated with FAS and related birth defects; (3) further clinical research on the adverse developmental effects of prenatal alcohol exposure; and (4) the development of more specific biologic diagnostic markers. (Prepublication report 40 pages, plus appendixes.)

AGENCY SPONSOR: National Institute on Alcohol Abuse and Alcoholism


PHONE NUMBER: 301/443-2369

PIC ID: 6006

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine, Washington, DC

TITLE: Measuring Social Inequalities in Health


ABSTRACT: This report presents the findings of a conference held in Annapolis, Maryland, in September 1994. The conference provided the conceptual background for measures of socioeconomic gradients in federally supported health data sets and recommended improvements. It also recommended methods for implementation in the context of data gathering under health care reform. The socioeconomic gradients under consideration were those used in federally supported surveys, vital statistical and disease registries, and hospital discharge data. These gradients are subsequently used to evaluate programs or as variables to help assess factors affecting health outcomes. The conference made very specific recommendations for improving existing measures or adding new ones in ongoing general purpose surveys. It evaluated current measures and recommended modifications to the vital statistical and disease registries and to hospital discharge data critical to future health care reform discussions. The conference also provided investigators wanting to apply for NIH funds with improved tools for implementing the newly revised guidelines for the inclusion of women and minorities in clinical research. The most important recommendation made was that the availability of existing social class data be advertised and that researchers be encouraged to analyze them. (Final report 5 pages.)

AGENCY SPONSOR: National Institute of Child Health and Human Development


PHONE NUMBER: 301/496-3136

PIC ID: 6020

PERFORMER ORGANIZATION: National Institute of Child Health and Human Development, Bethesda, MD

TITLE: Report on Outreach Activities of the National Library of Medicine: A Five-Year Review


ABSTRACT: In October 1987, Congress encouraged the National Library of Medicine (NLM) to develop an outreach program to transfer the latest scientific findings to all health professionals. Congressional concern was underscored in 1988 when the Senate Subcommittee on Appropriations expressed particular interest in the development of an outreach program for rural and remote health care professionals. This report evaluates NLM's outreach efforts between 1990 and 1994. The report finds that (1) the number of outreach projects increased from 16 in 1989 to almost 300 at the end of 1994; (2) in 1989, approximately 30,000 user codes had been issued, and by 1994, user codes numbered close to 100,000; (3) in 1989, there were 4 million searches of the NLM databases, and in 1994, there were 7 million searches; (4) similar changes have occurred in the use of Grateful Med; and (5) although these increases in use are impressive, and although measurement of the precise number of users of NLM's information systems from all sources is not yet available, it is reasonable to postulate that the number of users is far short of the total population of United States health care professionals who could benefit from such use. The study was carried out jointly by NLM, the University of Texas Health Science Center/San Antonio, Texas, Meharry Medical College, and Oak Ridge Associated Universities in Tennessee. (Final report 100 pages.)

AGENCY SPONSOR: National Library of Medicine

FEDERAL CONTACT: Karen Wallingford

PHONE NUMBER: 301/496-2311

PIC ID: 6010

PERFORMER ORGANIZATION: National Library of Medicine, Bethesda, MD

TITLE: The Status of Biomedical Research Facilities


ABSTRACT: The National Science Foundation (NSF) has been authorized and directed by the House of Representatives in H.R. 1210 to "design, establish, and maintain a permanent data collection and analysis capability for the purpose of assessing and identifying the research facilities needs of universities." This survey is conducted every 2 years, and the results are reported to Congress by September 1. In order to meet NIH needs, additional samples of medical schools, hospitals, and independent research organizations were added to NSF's sample of research universities. This arrangement is efficient and cost-effective for NIH because of the overlap between NSF's needs and those of NIH. NIH has input on all aspects of the biomedical facilities survey and complete control of the biomedical facilities report. "The Status of Biomedical Research Facilities" was prepared for NIH, assessing trends in aspects of extramural research facilities. The results were used by the Director of NIH, other HHS agencies, and the Office of the Secretary to plan research programs and review current policies regarding construction programs.

AGENCY SPONSOR: Office of the Director


PHONE NUMBER: 301/496-5011

PIC ID: 3562.1

PERFORMER ORGANIZATION: National Science Foundation, Washington, DC

TITLE: Study of the Minority Access to Research Careers Honors Undergraduate Research Training Program


ABSTRACT: The National Institute of General Medical Sciences (NIGMS) sponsors the Minority Access to Research Centers (MARC) Honors Undergraduate Research Training Program. Under the program, highly qualified minority institutions receive support to provide science courses and research training for honors students in their third and fourth years of college. Each year, there are 60 to 70 undergraduate training programs supporting approximately 560 trainees. This report presents the results of a survey on the outcomes of the MARC program and the training pathways of MARC students. The survey included all 3,062 former MARC students: those who had received support prior to, but were no longer receiving it in, fiscal year 1994. The report finds that: (1) a substantial number of former students (over 700) have already obtained research or clinical doctorates; (2) since the program began in 1977, about 1,400 blacks, Hispanics, and Native Americans obtained a bachelor's degree and had received a Ph.D. in the biological sciences by the end of the 1993 school year; (3) 92.2 percent of former MARC students had received bachelor's degrees and almost one-half of these entered graduate programs and one-third entered medical school; and (4) MARC students have pursued and obtained Ph.D.s, M.D.s, and other doctoral degrees at greater rates than minority biology and chemistry students who did not participate in the MARC program. See also PIC ID Nos. 4462.1 and 4462.2. (Final report 50 pages plus appendix.)

AGENCY SPONSOR: National Institute of General Medical Sciences


PHONE NUMBER: 301/594-2764

PIC ID: 4462

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: Support for Bioengineering Research


ABSTRACT: The NIH Revitalization Act of 1993 mandated that the HHS Secretary, acting through the NIH Director, conduct a study of support for bioengineering research. The legislation directed evaluations of the Federal commitment to innovation, the Federal role for enhancing innovation, and the coordination among Federal agencies and between the public and private sectors. NIH is the largest source of support for bioengineering research within the Federal Government. It conducted a detailed inventory of sources and amounts of public and private funding for basic bioengineering research for fiscal 1993. To assist in understanding how innovation in bioengineering proceeds, a case study was conducted in a representative field of bioengineering: implantable prostheses. Data were collected on the science base, patents, and new health care products. One of the most important findings of the effort was that relevant data are inadequate to assess the innovation process with confidence. The report recommends that NIH (1) establish an interagency Bioengineering Coordinating Committee; (2) include basic bioengineering research within appropriate intramural programs; and (3) provide, through the Federal Register, a "comment period" notice to solicit research topics suggested for inclusion in the annual Small Business Innovation Research Omnibus solicitation. See also PIC ID 5581.1. (Final report 11 pages.)

AGENCY SPONSOR: National Heart, Lung, and Blood Institute


PHONE NUMBER: 301/496-1586

PIC ID: 5581

PERFORMER ORGANIZATION: National Heart, Lung, and Blood Institute, Rockville, MD