Access to research is doubly important for underserved populations like those in and around Jacksonville, which is poised to become a majority minority city: 55 percent of its youngest residents are members of a minority group.
Minorities also tend to be underrepresented in health research. Although 40 percent of Americans belong to a racial or ethnic minority, individual research studies often don’t recruit groups of participants that reflect the diversity of the groups of patients who ultimately will take the medication or use the therapies that result from that research. The same medication might work differently in people with different genetic makeups, compounding the problem when research studies tend to recruit more white participants.
When clinicians working at hospitals like UF Health Jacksonville conduct research, it’s easier for more patients who are members of minority groups to participate because the research is being done where they already go for health care.
CTSI programs also seek to promote diversity among the researchers themselves, overcoming another barrier to research-participant recruitment.
The statewide OneFlorida Pragmatic Clinical Trials and Implementation Science Minority Education Program, or MEP, partners with historically black colleges and universities. Junior faculty members receive hands-on research experience by partnering with faculty members affiliated with the OneFlorida Clinical Research Consortium, led by the UF CTSI in collaboration with its CTSA partner Florida State University and the University of Miami Clinical and Translational Science Institute. This program is made possible by the James and Esther King Biomedical Research Program.
Funding also helps clinicians like Guirgis overcome a chief obstacle to conducting research: The demands on their time. Participants essentially buy back the time they would normally devote to clinical practice and put that time toward research.
“That meant research could be more than a hobby,” Guirgis said. “Once you have protected time for research, it overcomes a barrier.”
Even the initial step of devoting personal time to research is not something many clinicians can do.
“Faheem is execeptional in that he gave of his own time to work his way out of the clinic,” Leeuwenburgh said. “It doesn’t happen too often. It’s a wonderful story.”
Guirgis has helped propel initiatives in Jacksonville, Leeuwenburgh said. And his research is already showing results. Guirgis said his team has demonstrated for the first time that sepsis patients often have high levels of “dysfunctional HDL,” or high-density lipoproteins, in their blood.
They want to find out whether dysfunctional HDL , a kind of cholesterol, can predict chronic critical illness, an intensive care unit stay of greater than 14 days with organ dysfunction, or long-term adverse outcomes after sepsis. Chronic critical illness has become a common problem in sepsis patients, and results in decreased quality of life and eventual death. Research into chronic critical illness is being spearheaded by Moore and Moldawer at the Sepsis Center.
Guirgis’ study has enrolled patients in Jacksonville and Gainesville. His team will compare a cohort of emergency department patients (who have “community-acquired” sepsis) with a cohort of patients who developed sepsis after having surgery (“hospital-acquired” sepsis), looking at the differences between these two kinds of sepsis and the role of dysfunctional HDL. His ultimate goal is to develop lipid-based therapies for sepsis.
Guirgis said his interest in research has not taken away from his work with patients. Doing this research “has absolutely informed my clinical practice,” he said.
An example: The national definitions for sepsis recently changed to include a Sequential Organ Failure Assessment, or SOFA, score to predict outcomes in sepsis patients. Guirgis had already been using the SOFA score as part of his research for over three years.
Guirgis sees that his research is inextricably woven into his passion for clinical care.
“I like taking care of really sick people and turning them around,’’ he said. “Why do some people get better, and some don’t? It’s the central question of personalized medicine.”