Luft F C
Franz Volhard Clinic, Virchow Klinikum, Humboldt University of Berlin, Germany.
J Mol Med (Berl). 1997 Aug;75(8):545-50.
Patient- and proband-oriented research (POR) into the mechanisms of disease has been most successful in the United States over the past 50 years. To foster POR in universities across the country the National Institutes of Health (NIH) instituted 5-year renewable competitive grants for the establishment of General Clinical Research Centers (GCRCs). The number of GCRCs grew from 5 in 1960 to a maximum of 93 in 1969. Currently 74 GCRCs are in operation at 47 of more than 120 medical schools in the United States. They range in size from 4 to 30 beds, with an average of about 10. Each GCRC supports a Program Director, diet kitchens, core laboratory, biostatistical and computing support, nursing staff, and an administrative assistant. The GCRC is available to enable and facilitate POR of faculty investigators based at the parent university. Investigators make applications to the GCRC for support of a given project, the project is evaluated by the GCRC institutional advisory committee and ethics committee, and if found acceptable the resources of the GCRC including bed space, nursing support, laboratory, and statistical capabilities are made available. The GCRC grant supplies the university with overhead support, but more importantly GCRC-supported investigators regularly bring in grant support from NIH far and above that provided by the GCRC grant itself. NIH also provide for research fellowships through the GCRC, including salary support to encourage young physicians to participate in basic POR. These grants are competitive and last for a 3-year funding cycle. The costs of the GCRCs in terms of beds per day are less than those of the Clinical Center at NIH and the overall scientific productivity has been greater. Further, the prestige of having a GCRC and the resources a GCRC provides, have been a major impetus for university support. Despite general problems in terms of recruiting young physicians to careers in basic POR, the GCRC has been a stellar success scientifically, fiscally, and also in facilitating the separation between patient care costs and those engendered by research.
在过去50年里，以患者和先证者为导向的疾病机制研究（POR）在美国最为成功。为了在全国各大学推动POR，美国国立卫生研究院（NIH）设立了为期5年、可续签的竞争性拨款，用于建立综合临床研究中心（GCRC）。GCRC的数量从1960年的5个增加到1969年最多的93个。目前，美国120多所医学院中的47所设有74个GCRC在运营。其规模从4张床位到30张床位不等，平均约为10张。每个GCRC都有一名项目主任、饮食厨房、核心实验室、生物统计学和计算支持、护理人员以及一名行政助理。GCRC可供母大学的教职研究人员开展和促进POR。研究人员向GCRC申请对特定项目的支持，该项目由GCRC机构咨询委员会和伦理委员会进行评估，如果被认为可以接受，GCRC的资源包括床位、护理支持、实验室和统计能力将可供使用。GCRC拨款为大学提供间接费用支持，但更重要的是，由GCRC资助的研究人员经常从NIH获得远远超过GCRC拨款本身提供的资助。NIH还通过GCRC提供研究奖学金，包括薪资支持，以鼓励年轻医生参与基础POR。这些拨款具有竞争性，为期3年的资助周期。GCRC按每天床位计算的成本低于NIH临床中心的成本，且整体科研生产力更高。此外，拥有一个GCRC的声望以及GCRC提供的资源，一直是大学提供支持的主要推动力。尽管在招募年轻医生从事基础POR职业方面存在普遍问题，但GCRC在科学、财政方面都取得了巨大成功，并且在促进患者护理成本与研究产生的成本分离方面也很成功。
