One of the biggest challenges for any research institution is helping junior faculty - or researchers who are switching direction - establish themselves and their work in the eyes of potential sources of funds.
"You can't come to funding institutions cold," says Associate Dean for Research Geraldine Padilla. "You need a pilot to demonstrate the feasibility of your study - willing subjects, effective procedures and a small sample to see if subjects are responding to a particular intervention."
In response, most institutions establish "seed," or intramural, funding programs. The UCSF School of Nursing's intramural funding program has a long history of supporting pilot projects that serve as successful springboards to major grants and improvements in nursing care.
Advances in symptom management for cancer patients, reducing sleep disturbances in pregnant and postpartum women, and culturally sensitive patient education for asthma self-care are among the improvements that have emerged from intramural-funded pilots.
Keys to Success
The program's success seems attributable to a number of factors.
For one, in contrast to academia's reputation for cutthroat politics, the School of Nursing fosters a genuine sense of support and camaraderie, especially for new faculty. "In my three years here, many colleagues have stepped to the plate to critique my grants and articles in a very supportive way," says Holly Kennedy, whose seed funding led to a three-year, $500,000 award from the
Department of Defense in March 2004.
"At the behest of investigators, we will always put together a review team to improve the rigor and quality of applications," adds Padilla.
In addition, the school is willing to make a substantial investment in those who need support for their pilot studies. "I suspect there aren't many other schools that have our budget ($50,000 for 2004-2005) or that offer as much in awards (up to $15,000)," says Padilla. "But we believe that amount is necessary to provide sufficient help on many initial projects."
Despite its success, faculty members consistently examine the program to ensure it remains effective. "We've tweaked it along the way," says Padilla. "For example, we've better defined our evaluation criteria and changed the timing to give people proper time to apply. And this year we are asking people to submit their applications using the NIH format, because we believe it's good training for when they apply for larger grants."
In the future, the school also hopes to stabilize its funding source. Since its inception, money for intramural funding has always come from the Dean's Fund, but Dean Kathleen Dracup hopes there will eventually be a dedicated fund or endowment that is not subject to economic cycles and the spending priorities of the state.
Padilla believes the argument for such a fund is quite simple. "The intramural program is a very important resource that helps faculty - particularly junior faculty - ready themselves for large grant applications," says Padilla. "Those grants have a lot to do with the reputation our school enjoys as the number one or number two nursing school in the nation."
Defining Exemplary Prenatal Care
When Holly Kennedy arrived at the UCSF School of Nursing in 2001, it wasn't long before she understood how supportive a place it could be. "Within a month, senior colleagues approached me and encouraged me to take the lead on a particular grant - and offered their help. I didn't get that grant, but it was a tremendous learning process and let me know the opportunities were here," says Kennedy, who is the specialty coordinator of the school's midwifery program.
Within a year she had won a $13,000 intramural funding grant from the school, the purpose of which was to clarify and expand her prior efforts to define "exemplary midwife practice." She paired her school seed funding study with one funded by Sigma Theta Tau to conduct an interpretive metasynthesis on other studies of midwifery.
Kennedy believes that outstanding midwife practices often result in optimal outcomes for newborns and their families. Hence, her third pilot grant of 2002 - $32,500 from the UCSF Academic Senate - begins to link midwife practices to perinatal outcomes.
Kennedy used these three pilot studies and her 31 years of military service (she retired in 2002 as a colonel in the U.S. Army Nurse Corps Reserves) to apply
for a three-year, $500,000 grant from the TriService Nursing Research Program.
In March 2004, she got the grant.
Working with military families, the study tests a group model of prenatal care called Centering Pregnancy™. "It's especially nice to be doing something that demonstrates the military's concern for its families, as well as to work with military families again," notes Kennedy.
She will be the principal investigator on the project, while mentoring two junior U.S. Navy and U.S. Air Force officers in the role of nurse scientist and assistant investigator. The study advances Kennedy's research program, because it allows her for the first time to conduct a large clinical trial that ties a model of care that midwives often use to perinatal outcomes.
"The experience and knowledge that I gain from this study will help when I apply
for NIH funding in the future," says Kennedy. "And the intramural funding was a major financial and psychological boost that gave me the confidence to pursue the TriService grant. It gave me a jump start and made it clear to me that if you want to succeed here - and are willing to work hard - you will be successful."
Zeroing in on Liver Disease
Geneticist Brad Aouizerat's arrival at the School of Nursing in July 2002 was, in part, a sign of the times. With genomics dominating the news, it was clear that at the very least, nursing research and nursing care would have to integrate the rapidly growing understanding of genetic influences on health.
Among Aouizerat's functions, therefore, is to serve as the school's primary resource for genetic science and to help incorporate a basic science component into other nursing-related research proposals.
His hiring also gave Aouizerat a chance to pursue his own research interests. Yet to do so, he needed to establish a track record he could present to large funding agencies. "I was a new faculty member, with no previous extramural support of my research," Aouizerat explains.
In June 2003, Aouizerat received a $15,000 grant from the school's intramural funding program to study the genomic determinants of non-alcoholic steatohepatitis (NASH). The disease, characterized by excess fat in the liver, can lead to cirrhosis and end-stage liver disease. It may affect as much as 2 percent to 3 percent of the US population, and seems especially prevalent in obese children.
"The pilot project I conducted with the support of the intramural funding program was the first peer-reviewed evaluation of my research. It allowed me to gather data to write for more ambitious awards," he says.
Aouizerat combined his nursing school grant with $35,000 from the Academic Senate Research Committee and the UCSF Liver Center to test a theory he had formed with colleagues that a subset of genes contributing to combined hyperlipidemia could also lead to NASH. Working with researchers at the Liver Center, he provided evidence consistent with his hypothesis.
"The affiliation with the Liver Center was an enormous benefit," he says. "It gave me access to facilities and a locus of interaction with other investigators…. Our group has identified variations in five genes that appear to be enriched in patients with NASH." He hopes that identifying the genetic determinants will lead to less invasive methods of diagnosis and even a means of treating the disease before it progresses to cirrhosis and the need for liver transplantation.
The findings from his two pilot studies served as the basis for the American Association for the Study of Liver Diseases to award him their American Liver Foundation Liver Scholar Award. Chosen from a nationwide pool of applicants, Aouizerat was one of only two selected to receive $150,000
to further his research on NASH.
"The seed funding really gave me a leg up early on," says Aouizerat. "Now I serve on the School of Nursing Research Committee (which oversees the intramural funding program), and I can see how the program really supports the spirit of the intramural award - how it allows investigators to collect new data, test emergent hypotheses, and move in new directions."
Power of Palliative Care
Pediatric palliative care - helping young patients and their families cope with terminal illness - has slowly crept into the consciousness of health care researchers. But there has been a glaring gap in research on fathers' roles and experience of the process.
Betty Davies has long been aware of that oversight. First, through her world-renowned work in Vancouver, Canada, on pediatric hospice care, and later through discussions in 1998 with a work group under the auspices of the National Hospice and Palliative Care Organization (NHPCO), Davies was among those who recognized that we know little about how fathers cope in this process - and that understanding them better could have important care implications.
The NHPCO work group eventually decided that one of its priorities would be to conduct research around fathers' experiences when their children are dying. "I was the researcher in the group, but I had just arrived at UCSF in 2000 [having spent her entire career in Canada] and didn't think I could get a major US grant," says Davies. Besides, it wasn't as if money was flowing into palliative care research at the time.
But Davies had another option: the intramural funding program at UCSF. "I applied on behalf of our group and received $15,000 to do our pilot." That money
has had far-reaching effects.
The pilot became the focus of a 2004 article in Death Studies. It also enabled Davies to hire Maria Gudmundsdottir, a UCSF postgraduate researcher, to coordinate the project and gain research and publication experience. "I love the fact that this gave us the opportunity to develop one of our own students," says Davies.
In addition, says Davies, "Our work has begun to make the UCSF School of Nursing an integral player in the field of pediatric palliative care - a field that is growing by leaps and bounds in the US."
In fact, in 2003 the National Institute of Nursing Research (NINR) declared a three-year focus on palliative care. This opened the door to Davies' submitting an RO1 application to the NINR, which received a very high score on its first submission. Davies is resubmitting this year, and is optimistic that she will be funded the second time around.
Perhaps most important, the study is already finding its way into clinical application. About the same time Davies began the study, she also helped initiate a collaborative project in pediatric palliative care at UCSF Children's Hospital that is partially funded by the UCSF Stanford Center for Research & Innovation in Patient Care. Davies has presented the results of her study to clinicians in the program - including the finding that some fathers experienced real frustration in their dealings with health care professionals.
"Education is very much a part of palliative care," says Davies. "And the study is helping clinicians here better understand what fathers of dying children go through."
Source: Andrew Schwartz
UCSF School of Nursing