Department of Health and Human Services
National Institutes of Health
National Institute of Nursing Research Minutes of the National Advisory Council for Nursing Research
January 18-19, 2011
The 73rd meeting of the National Advisory Council for Nursing Research (NACNR) was convened on Tuesday, January 18, 2011, at 1:00 p.m. in Conference Room 6C, Building 31, National Institutes of Health (NIH), Bethesda, Maryland. The first day of the meeting was an open session and adjourned that same day at approximately 4:50 p.m. The closed session of the meeting, which included consideration of grant applications, was convened on Wednesday, January 19, 2010, at 9:00 a.m. and continued until adjournment at 1:00 p.m. Dr. Patricia A. Grady, Chair, NACNR, presided over both sessions of the meeting.
I. CALL TO ORDER, OPENING REMARKS, COUNCIL PROCEDURES, AND RELATED MATTERS
Dr. Grady called the 73rd meeting of the NACNR to order, welcoming all Council members (including new Council members), visitors, and staff. She announced that this was the first electronic Council meeting for the NINR.
Conflict of Interest and Confidentiality Statement
Dr. Mary Kerr, Executive Secretary, NACNR, reminded attendees that the standard rules of conflict of interest applied throughout the Council meeting. Briefly, all closed session material is privileged, and all communications from investigators to Council members regarding any actions on applications being considered during the Council should be referred to National Institute of Nursing Research (NINR) staff. In addition, during either the open or the closed session of the meeting, Council members with a conflict of interest with respect to any topics or any application must excuse themselves from the room and sign a statement attesting to their absence during the discussion of that application. Dr. Kerr also reminded NACNR members of their status as special Federal employees while serving on the Council, and that the law prohibits the use of any funds to pay the salary or expenses of any Federal employee to lobby or otherwise influence state legislatures or Congress. Specific policies and procedures were reviewed in more detail at the beginning of the closed session and were available in electronic materials provided to the Council.
Minutes of Previous NACNR Meeting
Standing Council members received a copy of the minutes of the September 14-15, 2010, NACNR meeting by electronic mail. A motion to accept the minutes of the September 14-15, 2010, Council meeting was proposed, seconded, and approved unanimously. Any comments, corrections, and changes to the September 2010 meeting minutes identified at a later time should be forwarded to Drs. Grady or Kerr. The approved minutes of each quarterly NACNR meeting become part of the Institute’s permanent record and are posted on the NINR Web Site (www.ninr.nih.gov).
Dates of Future Council Meetings
Dates of future meetings in 2011 and 2012 have been approved and confirmed. Council members were asked to confirm their calendars for these meeting dates and contact Drs. Grady or Kerr regarding any conflicts or expected absences.
May 17-18 (Tuesday-Wednesday)
September 20-21 (Tuesday-Wednesday)
January 17-18 (Tuesday-Wednesday)
May 15-16 (Tuesday-Wednesday)
September 18-19 (Tuesday-Wednesday)
II. REPORT OF THE DIRECTOR, NINR—
Dr. Patricia Grady, Director, NINR
The Director’s report focused on updates since the last Council meeting and on current and impending activities and initiatives related to the NIH and NINR budgets, the NIH overall, and the NINR.
Budget Update—Dr. Grady provided an update on the current status of appropriations and projections for the NINR budget. The Institute is operating under a Continuing Resolution pending passage of the FY 2011 Appropriations bill. The President’s proposed budget for FY 2011 is $32.089 billion for the NIH and $150.198 million for the NINR, reflecting 3.2 percent increases above the FY 2010 levels.
Dr. Grady next reviewed NINR’s expenditures for FY 2010, which included: research program grants (RPGs) (72%), of which P01 grants comprise 1.6 percent; Centers (3%); research management and support (9%); training (6%); research and development (3%); intramural research (5%); and other research (2%). The NINR ranks as second highest among NIH Institutes and Centers (ICs) in the percent of budget for support of training, although it remains the third smallest among the ICs. The trend in budget increases for the NINR during the past 10 years is close to the trend for the overall NIH over time.
The number of NINR research awards remains steady, with a success rate between 20-25 percent. Most awards are made as 4-year awards, with approximately 75 percent of funds each year committed to awards made in previous years. The number of NINR full-time training awards in FY 2010 (217 awards) decreased slightly from the FY 2009 level (225 awards). In addition, the number of NINR predoctoral and postdoctoral awardees has declined slightly during the past 5 years. The NINR, which is one of the few ICs that funds predoctoral students, supports 2.5 predoctoral students to every postdoctoral researcher.
HHS, NIH, and NINR News—Dr. Grady reported on news items of interest within the Department of Health and Human Services (HHS), NIH, and NINR communities. The HHS has announced a new tobacco control strategy and proposed warning messages and graphics to combat the tobacco epidemic. HHS Agencies, including the NIH John E. Fogarty International Center, have partnered with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to transform African medical education.
Dr. Grady expressed congratulations to NIH grantees who recently have won prestigious awards: Dr. Ei-ichi Negishi, the 2010 Nobel Prize in Chemistry; Drs. Douglas Coleman and Jeffrey Friedman, the Albert Lasker Basic Medical Research Award; National Institute of Allergy and Infectious Diseases (NIAID) Director Dr. Anthony Fauci, co-recipient of the 2010 Dr. Paul Janssen Award for Biomedical Research; and five NIH scientists elected to the Institute of Medicine (IOM), including Drs. Jeremy Berg, Linda Birnbaum, Ira Pastan, Thomas Wellems, and Carl Wu. Dr. Berg is stepping down as the National Institute of General Medical Sciences (NIGMS) Director.In other NIH news, Dr. Grady reported that the Scientific Management Review Board (SMRB) has recommended merging the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as well as the creation of a new Center for Translational Medicine and Therapeutics. The NIH Advisory Committee to the Director met in December 2010 and discussed approaches to implementing the SMRB recommendations as well as updates on therapeutics for rare and neglected diseases, peer review enhancements, biomedical workforce issues, the Lasker Clinical Research Scholars Program to nurture the next generation of clinical researchers, and stem cell research. In addition, the NIH Council of Councils and the NIH Director’s Council of Public Representatives held meetings in November 2010, and an NIH Basic Behavioral and Social Science Opportunity Network (OppNet) public meeting was convened in October. The NIH announced that the National Institute on Minority Health and Health Disparities recently transitioned from an NIH Center to an Institute.
Dr. Grady reported that the 6th Annual NIH Director’s Pioneer Award Symposium was held September 30-October 1, 2010. The deadline for applications for the NIH Early Independence Award Program is January 21, 2011. Other workforce-related programs include the NIH Director’s American Recovery and Reinvestment Act (ARRA) funded Pathfinder Award to Promote Diversity in the Scientific Workforce and the Lasker Clinical Research Scholars, an historic intramural-extramural partnership to nurture the next generation of clinical researchers. The NINR has a solid record in supporting early-stage investigators, but the NIH overall is working to increase its support; currently, approximately one-third of investigators supported by the NIH are considered to be early stage. The NIH Regional Seminars on Program Funding and Grants Administration will occur on April 27-29, 2011, at the Arizona State University in Phoenix, Arizona, and June 22-24, 2011, at the Florida Atlantic University in Ft. Lauderdale, Florida. The NIH is launching the health study of the Gulf oil spill, led by Dr. Dale Sandler. The NIH also has introduced Images, a database of images in biomedical literature (for more information, see http://www.ncbi.nlm.nih.gov/images).
Dr. Grady reminded members that the NINR’s celebration of its 25th anniversary continues, including recognition by a U.S. Senate resolution and in an article in the American Journal of Nursing (Volume 110, issue 10, October 2010). In addition, former NINR intramural researchers presented at the NIH Grand Rounds, and Dr. Bernadette Melnyk, Dean and Distinguished Foundation Professor in Nursing, Arizona State University College of Nursing and Health Innovation, presented the NINR Director’s Lecture. Upcoming events include: the NINR-NIH Clinical Center Joint Conference on May 12, 2011; Science in the Cinema in the summer of 2011; and the 2011 Scientific Symposium on October 13, 2011, with poster abstracts due by March 15, 2011.
The U.S. Senate Special Committee on Aging held a forum on helping Alzheimer’s patients and families. The NIH End-of-Life (EOL) and Palliative Care Special Interest Group held its kick-off lecture in October 2010 and will meet again on January 20, 2011. NINR’s oversight of the trans-federal government EOL Palliative Care Science Needs Assessment is underway, with research reviews being conducted and a Web-based survey of federal and philanthropic funding occurring in the next months.
Dr. Grady congratulated Dr. Carol Rogers of Arizona State University, who received the American Society on Aging, National Institute of Senior Centers 2011 Research Award. Dr. Raymond Dionne, NINR Scientific Director, served as panel moderator for “Advances in the Science of Pain” conference. A new Intramural Research Program publication explores possible causes of chronic abdominal pain in children (Taylor T, et al. BMC Research Notes 2010;3:265). Dr. Grady announced that Dr. Cynthia Leaver received the 2011 Bravewell-NINR-NIH Clinical Center (BNC) Postdoctoral Fellowship in Integrative Medicine. The application period for the 2011 Graduate Partnerships Program has been extended to January 31, 2011. Applications for the NINR Summer Genetics Institute will be accepted February 1 to April 18, 2011. The NINR held its first Methodologies Boot Camp in July 2010. Dr. Grady noted several NIH and NINR Requests for Applications (RFA), including: (1) OppNET Short-term Mentored Career Development Awards; (2) Institutional Clinical and Translational Science Award; (3) Design and Development of Novel Technologies for Health Independent Living; and (4) Technologies for Health Independent Living.
NINR Outreach—Ms. Melissa Barrett, NINR Communications Director, reported on recent presentations by NINR leadership, including Dr. Grady’s presentations on various aspects of nursing science at the Federal Public Health Nurse Leadership Meeting, the Jonas Nurse Leaders Scholar Conference, The Johns Hopkins University, University of Maryland, Mount Sinai Medical Center, and Tokyo Medical and Dental University School of Nursing. Dr. Grady presented on “Bringing Science to Life: Making a Difference, Changing the World” at the Georgetown University School of Nursing. The NINR presence at the Council for the Advancement of Nursing Science (CANS) State of the Science Congress included an update by Dr. Grady, an NINR peer review presentation, and individual sessions with postdoctoral researchers. The NINR has released a book, NINR: Bringing Science to Life, which details the Institute’s history. Nursing Outlook includes a column on “Creating a health tomorrow through research, practice, and policy”. The Web site www.HealtheCareers.com interviewed Dr. Grady in an article on the shortage of nurse researchers. Dr. Grady also interviewed with the Times Higher Education (UK) for its story on the rise of multidisciplinary work. Council members were invited to visit the NINR Web Site (www.ninr.nih.gov) for additional information about these events and other NINR news.
III. UPDATE ON PEER REVIEW—
Dr. Anthony Scarpa, Center for Strategic Review (CSR), NIH
Dr. Scarpa provided an update about the NIH peer review process. In 2010, 88,000 applications were received into the CSR peer review system; 240 Scientific Review Officers oversaw 1,700 review meetings during which 17,000 reviewers vetted 64,000 applications.
Changes to the peer review system have been influenced by the NIH and CSR budgets, the number of applications submitted, and the workload placed on reviewers. The CSR has successfully reduced peer review costs by nearly $29 million by issuing non-refundable tickets with one possible change, reducing the number of reviewers, conducting 20 percent of reviews using electronic platforms, holding one meeting each year in the western United States, and replacing CD-ROMs containing materials for reviewers with electronic zipped files.
Dr. Scarpa informed Council members that CSR’s efforts to enhance peer review have addressed the review and funding for new investigators, the review of transformative research, the funding of promising research earlier, a shortened review cycle, and improved alignment of study sections with the science. Other changes have included: an increased focus on recruiting the best reviewers; additional review platforms, such as electronic media (e.g., video-assisted meetings and telepresence study sections); a greater focus on impact and significance; shorter applications and other strategies to make more efficient use of the reviewer’s time; and improvements in training. Dr. Scarpa noted that the CSR continues to appraise the peer review process and implement appropriate changes.
IV. UPDATE ON SYMPTOM MANAGEMENT RESEARCH—
Dr. Susan Marden, NINR
Dr. Marden reminded Council members that symptom management is an urgent public health concern, noting that adverse symptoms inhibit the ability to lead a normal life. Approximately 76.2 million people have incidence of pain, which is three times greater than the estimated incidences of diabetes (23.6 million) and coronary heart disease and stroke (23.3 million), and much more than cancer (11 million). With the annual cost associated with pain estimated at $100 billion, the relationship between acute and chronic pain poorly understood and treatment for chronic pain inadequate—there is a need for research in symptom management. Basic and clinical research is lacking regarding sleep disturbances, for example, which affect 70 million people, with driver sleepiness accounting for 20 percent of all serious car crashes. Symptoms result from a complex interaction of factors and are dynamic; conditions are characterized by symptom clusters.
NINR’s approach to symptom management research is to develop new and better ways to help those with illness manage adverse symptoms and improve their QOL. Specifically, NINR’s portfolio of symptom management research focuses on delineating the causative mechanisms underlying symptoms, improving the recognition of symptoms, and developing interventions and strategies that improve patient response to symptoms and symptom clusters. Symptoms studied include: pain, sleep, cognitive function, anxiety, depression, fatigue, nausea, constipation, thirst, and cachexia. Recent research findings showed that: sleep restriction increases plasma leptin levels, particularly among women; severity ratings to derive symptom clusters provide a more stable factor structure; and behavioral therapy improves sleep quality in breast cancer patients undergoing chemotherapy.
Dr. Marden provided a panorama of selected current symptom management research that illustrate the range of studies addressing underlying mechanisms, symptom recognition, interventions, and symptom clusters, as well as predoctoral and early career awards that promote the training of nurse scientists in the symptom management arena. Future research directions include an increase in biobehavioral symptom trials, identification of panels of biomarkers for adverse symptoms, and use of varied therapeutic approaches. Research also is needed to characterize symptom clusters and to target interventions that ameliorate clusters.
V. ADVANCES IN THE SCIENCE OF SYMPTOM MONITORING—
Dr. Donna Berry, Dana-Farber Cancer Institute
Dr. Berry described advances in cancer symptom research. The models used to understand cancer symptoms include the symptom management model, theory of unpleasant symptoms, symptom experience model, and symptoms experience in time. In addition, a model developed in 2009 was diagramed that included clusters, longitudinal patterns, and control interventions. Symptoms are experienced occur along the cancer spectrum including pre-diagnosis, acute care, ambulatory trans-therapy, survivor late effects, palliative/supportive care, and EOL. The cancer experience is characterized by common and uncommon sensations among diagnoses, and research on cancer symptoms is a priority among professional societies, the National Cancer Institute (NCI), and local institutions. Cancer symptoms predict clinical outcomes, including survival; however, only 3 of 68 publications on cancer symptom cluster research during the past 3 years were randomized intervention trials, and few focused on explanatory mechanisms.
The Electronic Self-Report Assessment Cancer (ESRA-C) project features symptom assessment, intervention, and monitoring in clinical practice. ESRA-C is based on a self-reporting (i.e., patient-reported outcomes) approach, which has been tested and used by the NCI and NIH-wide, through a basic computer program; it is the first system to significantly increase discussion of symptoms and QOL issues, particularly depression, impact on sexual activities, and other sensitive issues. The project has shown that patients, including elderly and computer-na├»ve patients, are willing to self-report symptoms for clinical use, and that attention to usability is a good investment. In addition, the time available for using self reports effectively is limited as oncologists are focused on helping patients through treatment with few adverse events, nurse practitioners are functioning as physician extenders, and clinical nurses are focused on scheduling and medication refills. Based on patient data from ESRA-C and a survey of its nurses, Dana-Farber Cancer Institute is implementing evidence-based fatigue management to align nursing science with clinical practice. Dr. Berry said that the burden of cancer symptoms remains moderate to high despite some efficacious interventions, and the ratio of descriptive-to-intervention research is too high. Clinical application of symptom research findings has been slow but progressing. Current organization of care services has not promoted excellence in symptom management.
VI. UPDATE OF STRATEGIC PLAN—
Dr. Mary E. Kerr, Deputy Director, NINR
Dr. Kerr provided an update of the NINR Strategic Plan for FY 2011-2016. She reminded Council that the Institute’s mission is “to advance nursing science by promoting and improving the health of individuals, families, communities, and populations through basic and clinical research and research training.” The strategic planning process has included the Council’s review of the NINR’s portfolio, input from professional and patient advocacy groups, and many NINR staff and Council meetings and retreats since the Fall of 2008. The goal to advance nursing science by supporting the exploration of the science of health is based on the notion that individuals should be actively involved in maintaining their own health through the prevention of disease and direct participation in the management of illness. The science of health encompasses investigation of multiple health determinants—including psychological, physiological, genomic, environmental, familial, societal, cognitive, and cultural—and their impact on health promotion and self-management behavior. The NINR will invest in research to: (1) advance health promotion and disease prevention; (2) improve QOL by managing symptoms of chronic illness; (3) improve EOL and palliative care; (4) enhance innovation in nursing research; and (4) develop the next generation of nurse scientists.
VI. REVIEW OF THE MEMORANDUM OF UNDERSTANDING AND REVIEW OF THE BIENNIAL REPORT—
Dr. Mary E. Kerr, Deputy Director, NINR
Dr. Kerr requested concurrence by the Council on the statement of understanding between NINR and NACNR. The statement was included in the Council’s meeting materials and includes a description of the types of applications presented to the Council for review as well as the expedited review of en bloc applications.
Dr. Kerr also provided highlights of the NIH Biennial Report, particularly the inclusion of women and minorities in NINR-supported clinical research. She noted that the overall enrollment of women and minorities in clinical trials has increased approximately 59 percent from FY 2009 to FY 2010. In addition, the enrollment of African American males in trials saw a three-fold increase in this time period.
Following this update, Dr. Grady thanked participants and attendees for their time and interest and adjourned the open session of the meeting.
This portion of the meeting was closed to the public in accordance with the determination that this session was concerned with matters exempt from mandatory disclosure under Sections 552b(c)(4) and 552b(c)(6), Title 5, U.S. Code, and Section 10(d) of the Federal Advisory Committee Act, as amended (5, USC Appendix 2). Members absented themselves from the meeting during discussion of and voting on applications from their own institutions or other applications in which there was a potential conflict of interest, real or apparent. Members were asked to sign a statement to this effect.
REVIEW OF APPLICATIONS
The members of the NACNR considered 136 research and training grant applications on which NINR was the primary Institute; these applications requested a total of $35,564,659 (direct costs year 01). The Council also considered 607 applications on which another Institute/Center was primary and NINR was secondary; these applications requested a total of $197,420,504 (direct costs year 01). The Council concurred with the IRG recommendations on these 743 applications.
The 73rd meeting of the NACNR was adjourned at 1:00pm on January 19, 2011.
CERTIFICATION I hereby certify that the foregoing minutes are accurate and complete.
Patricia A. Grady, Ph.D., R.N., F.A.A.N.
National Advisory Council for Nursing Research
Mary Kerr, Ph.D., R.N., F.A.A.N.
National Advisory Council for Nursing Research
Dr. Patricia A. Grady, Chair
Dr. Mary E. Kerr, Executive Secretary
Dr. Marion Broome
Dr. Glenn Dowling
Dr. Everette Freeman
Dr. Kevin Frick
Dr. Barbara Guthrie
Dr. Elaine Larson
Dr. Jean McSweeney
Dr. Susan Reinhard Capt. Maggie Richard, Ex Officio
Dr. Marla Salmon
Dr. Gail Stuart
Dr. Anna Alt-White
Dr. Janet Williams
MEMBERS OF THE PUBLIC PRESENT
Donna Berry, Dana-Farber Cancer Institute
Chandra Burnside, American Association of Colleges of Nursing
Eileen Hacker, University of Illinois
Louise Kaplan, American Nurses Association
Rachel Klimmek, The Johns Hopkins University
Hwayun Lee, The Johns Hopkins University School of Nursing
Mei Ching Lee, The Johns Hopkins University School of Nursing
Mariann Piano, University of Illinois
Angela Sharpe, Consortium of Social Science Associations
Darlene Summers, Consolidated Solutions and Innovations
Jianyun Xu, The Johns Hopkins University School of Nursing
FEDERAL EMPLOYEES PRESENT
Mr. Brian Albertini, NINR/NIH
Dr. Noreen Aziz, NINR/NIH
Dr. David Banks, NINR/NIH
Ms. Melissa Barrett, NINR/NIH
Mr. Brian Beckham, NINH/NIH
Mr. Raymond Bingham, NINR/NIH
Ms. Teresa Brockie, CC/NIH
Ms. Adrienne Burroughs, NINR/NIH
Dr. Yvonne Bryan, NINR/NIH
Dr. Paul Cotton, NINR/NIH
Ms. Ana Ferreira, NINR/NIH
Dr. Amanda Greene, NINR/NIH
Dr. Chris Hafner-Eaton, NINR/NIH
Ms. Crystal Esler, NINR/NIH
Dr. Rebecca Hawes, NINR/NIH
Dr. Jeanette Hosseini, NINR/NIH
Dr. Karen Huss, NINR/NIH
Ms. Deborah Jennings, NINR/NIH
Ms. Ellie Johnson, NINR/NIH
Mr. Robert Jones, NINR/NIH
Dr. Weiqun Li, NINR/NIH
Dr. Yujing Liu, NINR/NIH
Dr. Susan Marden, NINR/NIH
Ms. Angela Marshall, NINR/NIH
Dr. Jessica McIlvane, OD/NIH
Dr. Jeri Miller, NINR/NIH
Ms. Mary Murray, NINR/NIH
Dr. Mario Rinaudo, NINR/NIH
Mr. Chip Rose, NINR/NIH
Dr. Denise Russo, NINR/NIH
Dr. Anthony Scarpa, CSR/NIH
Dr. Xenia Tigno, NINR/NIH
Dr. Lois Tully, NINR/NIH
Dr. Joan Wasserman, NINR/NIH
Dr. Linda Weglicki, NINR/NIH