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Volume 11 | Issue 6
Inside This Issue
June Edition 2021
Informed Consent: Substance and Signature By Robert Morton, CPHRM, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management The Doctors Company
F Former Smokers Most Likely to Be Hospitalized, Die From COVID-19 See pg. 11
INDEX Oncology Research......... pg.5 Healthy Heart....................... pg.8 The Framework.................. pg.10 Hospital News..................... pg.13
Researchers at Rice University Found That Bodily Inflammation After the Death of a Spouse Can Predict Future Depression See pg. 12
or decades, consent documents have helped protect physicians against the claims of dissatisfied patients. Times have changed, however, and modern medicine requires a more complex and complete acknowledgment of both the patient’s and the physician’s rights and responsibilities to each other. True informed consent is a process of managing a patient’s expectations; it is not just a signature on a document. Achieving an accurate diagnosis requires the patient to provide accurate information to the physician. The physician must then provide sufficient information to the patient so that he or she can make a reasonable and informed decision regarding a comprehensive plan for medical or surgical treatment. This physician responsibility cannot be delegated. A successful exchange of information between the doctor and the patient accomplishes two things. First, when the physician explains diagnoses, treatment alternatives, expected outcomes, and potential risks to the patient, it demonstrates that the physician recognizes the patient’s rights and will remain responsive to them. Second, it shifts the decision-making responsibility from the physician alone to a mutual responsibility of both
physician and patient. At its best, informed consent should protect and inform the patient and the doctor.
the recovery process and the expected short- and long-term effects on the patient. Identify any uncertainty and risk involved with a specific treatment plan, including the probability factors, if possible. Discuss reasonable assumptions the patient may make about the treatment plan. Whenever possible, supply reading materials and the consent document for the patient to take home and discuss with his or her family. Encourage questions. Questions provide a better understanding of the patient’s comprehension of the information and facilitate the dialogue between the patient and the physician. If time permits, consider scheduling a second visit with the patient to review the consent form, clarify expectations, and ensure patient comprehension of the proposed treatment—especially with elective procedures. Documentation Documentation is another key component of the informed consent process that cannot be entirely delegated to a nurse or another member of the healthcare team. If the doctor-patient discussion proceeds
Times have changed... modern medicine requires a more complex and complete acknowledgment of both the patient’s and the physician’s rights and responsibilities to each other. Litigation often results from a discrepancy between the patient’s expectations and the outcome of treatment. Informed consent cannot eliminate malpractice claims, but an established rapport between the patient and the physician based on robust exchanges of information can prevent patient disappointment from ripening into a claim. Physician-Patient Dialogue Avoid medical jargon when discussing diagnoses, treatment plans, risks, and expected outcomes with the patient. Define and explain medical words and concepts using simple pictures and analogies. If there are alternative treatment options, discuss them in detail. Also, outline
see Informed Consent...page 14
PRSRT STD US POSTAGE PAID PERMIT NO 1 HOUSTON TX
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your malpractice insurance? Unlike other Texas medical liability insurers, which are investor-owned companies, The Doctors Company remains fiercely independent and dedicated to your interests. Ask yourself, “Do I want an insurer founded by and for physicians that’s guided by my peers? Or do I want a profit-focused insurer that’s directed by Wall Street?” Join us and discover why delivering the best imaginable service and unrivaled rewards is at the core of who we are.
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Neurocognitive Disease and Traumatic Brain Injury (TBI): Affected Populations, Treatments and Impact of Covid-19 By Dr. Shama Rasheed, MD, Director at NH Hospital
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eurocognitive disease and traumatic brain injury (TBI) tare described as an acquired cognitive decline in one or more cognitive domains and tends to involve problems with thinking, reasoning, memory and problem solving. As memory starts to decline, which can happen at any age for a number of reasons, behaviors change, which eventually affects one’s quality of life. These behavior changes can consist of the inability to pay attention, stay motivated or focus and can even cause people to become more irritable or respond insensitively. Neurocognitive disease is seen in a wide range of patient populations. Psychological disorders such as anxiety and depression, chronic neurological disease like Parkinson’s, Dementia and Alzheimer’s, and traumatic brain injuries. Additionally, neurocognitive
disease is seen in drug addiction, neurotoxicity and PTSD patients. Acute neurocognitive impairment is increasingly observed in adult and pediatric patients with COVID-19 and those who have recovered from the disease. Neurons have been found to be highly susceptible to infection. Studies are showing that the virus can cause extensive neuronal damage with only minimal respiratory effects. NH Hospital, a state-of-the-art medical facility located in Houston, is providing patient-centered care through an integrative, holistic approach and functional medicine in order to treat the root cause of diseases such as neurocognitive disease. NH Hospital tailors its care for each patient based on the individual’s biochemical makeup and gene-environment interfaces. This is done through brain mapping, comprehensive DNA testing and wellness and micronutrient testing. There is a myriad of ways to treat
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neurocog nitive disease and TBI. These therapies, all offered at NH Hospital, include brain mapping, Bio Electro Magnetic Energy Regulation (BEMER), light therapy, Omega 3, IV infusions, neutral lipids, stem cell exosomes, cryotherapy, metal detoxing, sleep therapy, oxygen hydration and group therapy. One of the most compelling treatment therapies is exosome therapy. Exosome therapy is a stem cell-based therapeutic approach to treat TBI. Research suggests that the exosomes may help in neurogenesis and brain remodeling. There are some specific advantages that exosomes display, which many other treatment modalities cannot compare with. Recent, and continuing, research in stem cell exosome therapy appears to be at the forefront of treatment modalities for those suffering from cognitive disease. “Exosomes can cross the blood-brain barrier, are less invasive, are less or not tumorigenic, and are less or not immunogenic. Their shelf life and half-life are longer in patients,
which is good for long term storage without any loss of function (ASC Chemical Neuroscience – Sa. Ghosh / S Garg / Su. Ghosh).” Bio Electro Magnetic Energy Regulation (BEMER) therapy is an FDA-approves treatment which uses electromagnetic waves to stimulate muscles and increase blood circulation throughout the body. BEMER uses the electromagnetic pulses to create a balance in the body which helps with anxiety and other mental disorders such as neurocognitive disease. Brain mapping allows NH Hospital to visualize a patient’s brain and identify irregular brain waves that cause neurological issues such as TBI and neurocognitive disease. Doctors see Neurocognitive...page 14
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Woodlands North Houston Heart Center Achieves Milestone of 100 TAVR Procedures By Vanessa Astros
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obert Aertker, MD, performed the 100th transcatheter aortic valve replacement (TAVR) procedure at St. Luke’s Health—The Woodlands Hospital, a significant milestone for the medical community in North Houston. Dr. Aertker is an interventional cardiologist at Woodlands North Houston Heart Center. “Completing 100 TAVR procedures is an incredible achievement for Woodlands North Houston Heart Center,” said Vincent Aquino, MD, interventional cardiologist and Chief of Cardiology at St. Luke’s The Woodlands Hospital and an assistant professor at Baylor College of Medicine. “Dr. Aertker, Dr. Bruce Lachterman, Dr. Mark Mettauer, and the team are passionate about offering new hope to patients with aortic stenosis through TAVR. We are committed to offering patients the most advanced treatment option for valve replacement in a safe, compassionate environment at The
June 2021
Woodlands Hospital.” TAVR is a minimally invasive cardiac procedure for patients with aortic valve stenosis at low, intermediate or high risk for standard valve replacement surgery. In a traditional open-heart surgery, the old valve has to be removed and replaced. During a TAVR surgery, the old valve is pushed to the side when the new valve is inserted. TAVR patients typically go home the next day and experience minimal scarring. The heart valve team treats the entire spectrum of patients from low to high-risk candidates and from different age groups, including patients older than 90 years. The team has also performed multiple “valve in valve” procedures to treat patients with failing surgical valves. “We are very pleased with the growth of the valve program. Procedural volume is important to the success of the program, however what I am most proud of is our track record of quality outcomes,” said Dr. Aertker,
who is also an assistant professor at Baylor College of Medicine. “The most recent review of our outcome data shows outstanding clinical outcomes and safety. This is a reflection of choosing the right patients for the right therapy. We have put together a great team to ensure optimal outcomes for our patients.” Woodlands North Houston Heart Center has a long-standing history of providing the most advanced care to the local community. The group boasts a number of firsts in The Woodlands and North Houston area. A sampling of what the group has brought to the community to Robert Aertker, MD, with transcatheter aortic valve enhance patient care includes being the first to: • Perform percutaneous transluminal complex heart failure patients, coronary angioplasty including patients with heart • Implant the Watchman FLX left transplants and left ventricular atrial appendage occluder assist devices (LVAD’s) • Implant the Edwards Sapien The Woodlands North Houston 3 transcatheter aortic valve Heart Center is affiliated with Baylor replacement College of Medicine. Baylor boasts • Implant the Micra AV leadless the highest National Institutes of pacemaker Health (NIH) funding in Texas. This • Perform an endovascular aortic collaboration connects patients with aneurysm repair (EVAR) the most advanced therapies and • Have a dedicated advanced heart research available. failure specialist to care for the most
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Oncology Research Three Questions to Ask Your Oncologist About Clinical Trials By Caesar K. Tin-U, M.D., Texas Oncology
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hen it comes to cancer, advancements in clinical trials and research are our greatest hopes for eliminating the disease. Discoveries like new drug therapies or combinations of drugs, innovations in radiation therapy, and better screening and diagnosing methods come from clinical trials – research studies that examine the safety and effectiveness of different cancer treatments and reveal insights into the disease and ways to deliver better care. Breakthroughs that advance prevention and treatment of cancer are made possible by the courageous patients who volunteer to participate in clinical trials. Yet less than 5% of adult cancer patients participate
in clinical trials, according to the National Center for Biotechnology Information. Clinical trials follow strict compliance with federal, state, and local regulatory requirements. Each patient is carefully evaluated to ensure the patient is a strong fit for a particular clinical trial. Here are three questions to ask your oncologist about participating in a clinical trial. What types of clinical trials are available? Patients are encouraged to play an active role in their cancer care. This includes being informed of all treatment options available. Ask your oncologist about clinical trial availability. At any given time, there are hundreds of active clinical trials at various stages of evaluation. For example, prevention trials focus on preventing cancer or the recurrence of cancer, and might focus on diet and nutrition or the use of different medications or vitamins to determine if risk of developing cancer is lowered. Similarly, treatment trials are designed to answer questions about
new treatments, vaccines, therapies, or surgical procedures. What are the benefits and risks of participating in a clinical trial? The benefits and risks of clinical trials vary by trial. And, just as every patient experiences symptoms and side effects differently, this is true for clinical trial participants as well. Some of the benefits of participating in a clinical trial include treatment that may be more effective than other available treatment options and access to treatments often not available to the public. Patients enrolled in clinical trials also receive the same standard of treatment and care as those not participating in trials. While there are inherent risks with participating in research, the benefits often outweigh them. For example, in some cases, the risks
include side effects that are not dissimilar from those experienced with traditional forms of treatment like chemotherapy and radiation therapy. Am I eligible for a clinical trial? Not all patients are eligible for clinical trials, even when it seems like you may be a good fit. Factors considered before approving a cancer patient for a clinical trial depend on such criteria as age and sex, cancer type, stage of cancer, previous treatments, and medical history. If you’re interested in a trial but not eligible for trials currently available, discuss your interest in participating with your oncologist. New clinical trials open regularly. see Oncology Research...page 14
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Mental Health Latinx Young Adults Who Worry About Heart Conditions at Higher Risk for Mental Health Disorders Heart-Focused Anxiety a Significant Predictor of Depression By Laurie Fickman
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or coffee drinkers, a common scenario might involve drinking an extra cup only to end up with a racing heart and a subtle reminder to themselves to cut down the caffeine. But for those who have a different thinking pattern, one that includes heart-focused anxiety, the racing heart might conclude with the fear of a heart attack and a trip to the emergency room. It turns out young Latinx adults who experience heart-focused anxiety could be at greater risk for mental health disorders. “We have empirical evidence that individual differences in heart-focused anxiety are related to more severe co-occurring anxiety and depressive symptomatology among a particularly at-risk segment of the Latinx population,” reports
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Michael Zvolensky, Hugh Roy and Lillie Cranz Cullen Distinguished University Professor of psychology at the University of Houston, in the Journal of Racial and Ethnic Health Disparities. The population segment to which Zvolensky refers is Latinx young adults with previous trauma who were born in the United States. Their trauma might include racism related and transgenerational stress. This is only the second study on heart-related anxiety in the Latinx community, both conducted by Zvolensky. “In our first study, we assessed middle aged adults, presumably more concerned about their health. This study is unique, however, because even among a group generally too young to experience mounting health concerns, we are seeing a similar pattern, which tells us it’s probably relevant to the whole Latinx population,” said
Zvolensky. According to previous research, the Latinx population can somaticize mental health problems, meaning they don’t view them as mental health issues, but rather turn them into physical symptoms and report them as such. As examples, anxiety might be reported as a headache or a problem with breathing. “This population also struggles with a lot of chronic physical health co-morbidities including heart disease and obesity, so this research is a good fit for a population who tends to blame mental health issues on physical ailments, which generates greater mental health risk,” said Zvolensky, who is also director of the Anxiety and Health Research Laboratory/Substance Use Treatment Clinic at UH. To make matters worse, treatment for mental health conditions among Latinx populations is often limited or nonexistent. “Latinx persons underutilize mental health services compared to non-Latinx whites and are more likely to use primary care for the delivery of mental health services which are often inadequate for successfully addressing mental health problems,” said
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Zvolensky, who created and assessed reports from 169 college aged, Latinx college students who had been exposed to trauma. “Results indicated that heart-focused anxiety was a statistically significant predictor for general depression and overall anxiety,” said Zvolensky. Clinically, the results of the study could ultimately guide the development of specialized intervention strategies. “We can screen for heart-focused anxiety and that’s much more efficient and precise than screening for a whole range of mental health problems,” said Zvolensky. “If you reduce heart-focused anxiety, you do that person a great service because you’re likely decreasing their risk for a whole range of mental health problems. And that’s called precision medicine.”
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Healthy Heart New Designation in EMS Continuing Education Accreditation Achieved American Heart Association Digital Resuscitation Portfolio’s Adaptive Learning to Aid CPR Training Amid Pandemic By The American Heart Association
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he American Heart Association — the world’s leading voluntary organization dedicated to a world of longer, healthier lives — has announced Resuscitation Quality Improvement® (RQI®) and HeartCode® 2025 courses in the Association’s digital resuscitation portfolio have achieved a newly approved accreditation status for emergency medical services (EMS) continuing education. The Commission on Accreditation for Prehospital Continuing Education (CAPCE), a nonprofit body charged with reviewing and accrediting EMS continuing education, instituted an F4 designation in mid-2020, which describes the requirements for classifying a course as adaptive learning and broadens the definition of classroom instruction. With more than 700 F4 course completions to date, the
June 2021
Association becomes the first, and only, CAPCE-accredited continuing education provider to issue course completions with the new designation. EMS professionals in the U.S. must complete continuing education for license and certification renewal every two years with hours originating from a combination of distributed learning or multimedia instructional delivery and classroom or live, online courses, as mandated by the National Registry of Emergency Medical Technicians. “Adaptive learning is a truly novel education delivery platform that allows students to interact with a simulated patient or patient care scenario,” said Jay M. Scott, executive director, Commission on Accreditation for Prehospital Continuing Education. “Through integrated testing, critical decisions and case-based actions supplant the need for a traditional post-test. The interactive nature is dynamic for students, and educators
can infuse more excitement, sensitivity and specificity into the learning process. The Commission on Accreditation for Prehospital Continuing Education enthusiastically endorses adaptive learning programs for EMS education.” The CAPCE designation signifies a course or program where students’ actions, performance and choices guide the direction of learning activities, including virtual programs using adaptive learning technology and patient simulations. CAPCE now recognizes courses rooted in adaptive learning — a core component in RQI and HeartCode programs — as equivalent to classroom instruction, which helps advance EMS continuing education and CPR training amid the COVID-19 crisis. Launched last October, the Association and Laerdal Medical, a global company providing healthcare solutions, co-developed RQI and HeartCode 2025 courses affording healthcare professionals with the True Adaptive™ learning experience. Artificial intelligence is used to deliver a customized, personalized and efficient approach that is driven by an individual’s specific knowledge level and unique needs. The courses respond
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to each learner’s competence, actions and performance. RQI and HeartCode 2025 courses verify competence and validate performance in Basic Life Support, Advanced Life Support/ Advance Cardiac Life Support and Pediatric Advanced Life Support. The Association must report course completions to CAPCE monthly to maintain the F4 continuing education designation and accreditation status. For more information about the RQI program, HeartCode portfolio and True Adaptive learning, visit RQI Partners, the partnership between and service provider for the Association and Laerdal Medical, at www.rqipartners. com.
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St. Joseph Medical Center in Houston Kicks Off $92 Million Renovation Upgrades to Houston’s First Hospital will Include Addition of New Urgent Care Facility Plus Enhanced Patient Rooms and ER Services
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t. Joseph Medical Center (SJMC) – founded in 1887 as the first hospital in Houston – is ready for its makeover. The 134-year-old facility has kicked off $92 million in renovations over the next two years, including the addition of a new urgent care facility, to continue serving the local community for generations to come, as it has through the Spanish Flu, Hurricane Harvey, and COVID-19 pandemic. The first phase of the renovation —to be complete by the end of the year —will include new catheterization lab suites, updated interventional radiology rooms, a dedicated women’s imaging unit, and enhanced patient rooms, while the Emergency Department will also see a host of upgrades, including a new entrance, new separate behavioral health safe rooms, and a modified
Kim Bassett, president of St. Joseph Medical Center. “These upgrades are a reflection of our continued commitment to our neighbors as St. Joseph grows with them, invested personally and professionally in their long-term health.” As part of the Steward Health Care family, SJMC is physician-owned and -led with a mission to provide the highest-quality care at a sustainable cost through personalized, ongoing medical services that positively impact patients’ physical, emotional and mental wellbeing. “These renovations have been thoughtfully designed to empower St. Joseph physicians to provide the best possible care and enhance their patients’ experience,” said Sanjay Shetty, M.D., President of Steward
ambulance entrance to allow for better access. SJMC will also be adding an on-site- urgent care clinic staffed by primary care physicians to serve Houstonians who need care immediately, but who do not require a trip to the emergency room. Meanwhile, the Mary J. Gibbs Women’s Building will be adding a women’s emergency room on the ground floor along with expansion of the triage area to better serve expectant mothers. Future phases of the project, slated for completion by August 2023, will include a new pharmacy, blood lab, VIP Labor and Delivery suites, additional med surg beds and a new kitchen and dining area. “St. Joseph Medical Center has built a treasured legacy in the Houston community, with our 1,500 frontline healthcare heroes serving more than 200,000 patients a year,” said
North America. “As a physician-owned and -led network, Steward Health Care doctors are at the forefront of each hospital upgrade to ensure the enhancements are completed with both the provider and patient in mind. The plans for SJMC reflect a tremendous commitment by this hospital’s leadership to the local community, and we at Steward Health Care in turn promise the full strength of our global network to support making that vision a reality.” The renovation project aims to streamline the structure of SJMC by reducing square footage for ease of navigation for both staff and patients. With the installation of cutting-edge diagnostic equipment, SJMC expects to be able to perform more innovative procedures and increase the overall capacity of its service lines, allowing it to support the expanding downtown community for generations to come.
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Former Smokers Most Likely to Be Hospitalized, Die From COVID-19, New UTMB Study Finds
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esearchers at the University of Texas Medical Branch at Galveston looked at over 10,000 COVID-19 patients and found that significantly more former smokers ended up in the hospital and died from COVID-19 than those who still smoked or had never smoked at all. Smoking can lead to increased risks of infections and worse outcomes for a range of diseases including pneumonia, tuberculosis, and rhinovirus, among others, but what about COVID-19? As scientists and medical experts race to learn more about the new disease, experts at UTMB looked at medical records and smoking habits of thousands of patients and found a surprising link between the new disease and the hard to brake habit. “COVID-19 predominantly
found. In the past year, medical experts around the world have found that a number of different factors, including age, obesity, chronic kidney disease, diabetes, cancer, among others, can affect the severity of a COVID-19 infection and the likelihood that individual will end up in the hospital or die. Despite agreement about the association between severe COVID-19 and these comorbidities, the relationship between tobacco use and the severity of COVID-19 infection remains controversial, the researchers stated in the paper. One variable that may be affecting the outcome of these patients is age. The risks of smoking-related disease result largely from cumulative damage; hence, the consequences of smoking occur disproportionately among the elderly, authors of the
effects the respiratory system and smokers are at risk of viral infections so we were interested in understanding the impact of coronavirus among smokers,” said Dr. Gulshan Sharma, senior author and professor and director of the Division of Pulmonary, Critical Care & Sleep Medicine at UTMB. The team of doctors and researchers looked at the medical records of 10,216 patients who had tested positive for COVID-19 and provided information about their smoking habits. The majority, about 87 percent, indicated they’d never smoked while about 9 percent were former smokers and 3.9 percent said they were current smokers. Former smokers were the group most likely to end up hospitalized or die because of COVID-19, their analysis
study said. In the study, the UTMB researchers estimated that the odds of hospitalization from COVID-19 increased by 6 percent for every year of age in the population studied. “The risk of severe COVID-19 among former smokers is significantly driven by the effect of age and comorbidities,” said Dr Puebla Neira, first author of the study. In the cohort the researchers studied, the mean age of former smokers was 10 years older than that of current smokers, and 12 years older than that of never smokers. “Everyone should get vaccinated for COVID-19,” Sharma said. “Vaccine hesitant groups among former smokers should especially be encouraged to get vaccinated to reduce their risk of severe disease.”
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A New Study from Researchers at Rice University Has Found That Bodily Inflammation After the Death of a Spouse Can Predict Future Depression Inf lammation and future depressive symptoms among recently bereaved spouses will appear in the June 2021 edition of the journal Psychoneuroendocrinology. Lead author Lydia Wu, a Rice psychology graduate student, and Christopher Fagundes, associate professor of psychology and principal investigator for the Biobehavioral Mechanisms Explaining Disparities (BMED) lab at Rice, led the study. The research team evaluated 99 people who lost their spouses within 2-3 months of the study on a number of factors, including physical and mental
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health, across a three-month period. “Prior research has already linked bodily inflammation to a host of health issues, including cancer, memory issues, heart problems and depression,” Wu said. “We were interested in how systemic inflammation affects the mental health of spouses after losing a loved one. In particular, can inflammation help us identify who will experience clinical levels of depression at a future point in time?” The researchers found that widowed spouses who had higher levels of bodily inflammation right after the loss of their partners
showed more severe symptoms of depression three months later than those with lower inflammation, especially if they didn’t experience significant depression initially. Fagundes said depression following the death of a spouse is normal, and research shows that undergoing psychotherapy right away can actually interfere with people’s natural ability to cope. “We know that most people are remarkably resilient,” he said. However, when depression is persistent or occurs six or more
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months after a spouse’s death, it may be a sign that clinical intervention is needed, Fagundes said. “Until this study, it was difficult to know who was at risk for these persistently high levels of depression and grief until the six-month mark,” he said. “This study identifies a potential biomarker that could help us predict who is at greatest risk for long-term repercussions of loss.”
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Hospital News Memorial Hermann Now Offering Walk-In COVID-19 Vaccine Clinics Across Greater Houston
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emorial Hermann is pleased to offer free COVID-19 vaccination to community members across Greater Houston. To provide additional, convenient access to the COVID-19 vaccine, firstand second-dose walk-ins are now being accepted at select Memorial Hermann hospitals and clinics for individuals 16 years of age and older. Please note: A parent or legal representative must
The following Memorial Hermann locations are currently host vaccine clinics:
accompany 16- and 17-year-olds to their vaccination appointments. Should individuals need assistance receiving vaccination, one caregiver may accompany them to their appointment. Also please note, Memorial Hermann locations administering the Moderna vaccine will only vaccinate individuals 18 years of age and older.
• • • • • • • • • • • •
Memorial Hermann-Texas Medical Center Memorial Hermann Greater Heights Hospital Memorial Hermann Southwest Hospital Memorial Hermann Southeast Hospital Memorial Hermann Memorial City Medical Center Memorial Hermann Katy Hospital Memorial Hermann Northeast Hospital Memorial Hermann Medical Group Spring Primary Care (located in the CCC) Memorial Hermann Medical Group Physicians at Sugar Creek Memorial Hermann Neighborhood Health Center - Greater Heights Memorial Hermann Neighborhood Health Center - Northeast Memorial Hermann Neighborhood Health Center - Southwest
Kelsey-Seybold Announces New Clinic Location to Open in Gulfgate Shopping Center The Clinic Will Expand Access to Coordinated, Evidence-Based Care To Serve Houston’s Southeast Residents
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elsey-Seybold Clinic announced plans to build a 19,137-square-foot clinic in the Gulfgate Shopping Center, at 520 Gulfgate Center Mall, Houston, TX 77087, or the northeast intersection of I-45 and the 610 South Loop. Kelsey-Seybold Clinic -- Gulfgate represents another significant investment in the City of Houston by the city’s largest physician-led organization, with enough room for up to 11 providers offering primary and specialty care. The Gulfgate clinic announcement comes on the heels of five other new clinic announcements including: Memorial Villages, Memorial City, River Oaks, North Channel, and Lake Jackson. “Even with its proximity to downtown and the Texas Medical
Center, the Gulfgate area is a densely populated area in southeast Houston and Kelsey-Seybold Clinic’s new location will offer convenient access to medical care. Expanding into this area will improve access to evidence-based primary and specialty care as well as many diagnostic services for patients living in and around the Gulfgate and Southeast Houston area,” said John Lyle, Senior Vice President of Operations, Kelsey-Seybold Clinic. “Expansion into this area, conveniently located inside loop 610 near I-45 South, helps close the gap for patients who don’t have access to a Kelsey-Seybold location nearby.” The new Gulfgate Clinic will expand access to coordinated, evidence-based care in an area
with limited primary healthcare options. Patients will have access to an on-site pharmacy, laboratory, X-ray, ultrasound, 3D digital mammography and other diagnostic testing, as well as an extensive referral network for various Kelsey-Seybold specialists with offices at neighboring clinics, including Downtown at the Shops, and Berthelsen Main Campus. “We know from past experience that when new patients come to a Kelsey-Seybold location near their home or work, the quality of care they receive and the convenience of having
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so many amenities under one roof keeps them coming back,” said Victor Simms, M.D., M.P.H., F.A.C.P., Chair, Clinic Planning Committee, and Chief of Internal Medicine, Kelsey-Seybold Clinic. “We’re excited to welcome current patients who work and live nearby this new location, and look forward to meeting and caring for the new patients who have never been to a Kelsey-Seybold Clinic before.”
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Informed Consent
Medical Disclosure Panel. Check your state for requirements. Informed Consent in Special Situations The informed consent process for same-day surgery patients may occur in the physician’s office before scheduling the procedure. That will allow the patient time to think about the information, ask questions, and make an informed decision. Hospitalized patients must be informed as far in advance of the procedure as practicable. If time permits in an emergency in which the patient is unable to provide consent, the physician must contact a legally authorized representative to obtain an informed consent. If the nature of the emergency does not permit time to contact a legally authorized representative, consent is implied. Consent may be waived under emergent conditions that threaten life, limb, eyes, and the central nervous system. If the patient is incompetent or otherwise cannot consent, the physician is legally bound to obtain informed consent from the incompetent patient’s authorized representative, except in an emergency. This type of consent should be thoroughly documented in the medical record. Additional Tips and Suggestions • Develop and use procedure-specific forms that the patient can sign when the informed consent discussion takes place. • Obtaining consent from the patient after a sedative or sleep-inducing medication is administered is not recommended. However, when a change in the patient’s condition requires a change in treatment, secure the patient’s consent. Thoroughly document in the medical record the facts and
conditions surrounding the need for the revised consent. • Additions or corrections to the consent form must be dated, timed, and signed by both parties. • Any member of the healthcare team may sign as a witness to the patient’s signature, although this serves only to verify that it was the patient who signed the form. The witness does not obtain consent or verify the patient’s competency to give consent. • A patient’s questions or obvious lack of understanding about the procedure should be referred to the attending physician as soon as possible. • Translate consent forms to the most common non-English languages that you encounter in your practice, and verify that the form is translated correctly. Patient Safety Measures Every physician should develop his or her own style and system for the informed consent process, making it easier to avoid omissions and—more importantly—ensuring consistency of application. Do not speed through the process. Give the patient and the family time to absorb and comprehend the information. Preprinted materials are extremely helpful for patient understanding and will serve as a trigger for other questions. Assess the patient’s level of understanding just before documenting the process. One way of doing this is to ask the patient to repeat back to you his or her understanding of the information you have communicated. This will increase the likelihood that you will be able to manage the patient’s expectations effectively.
the body is exposed to extremely cold Continued from page 3 temperatures for several minutes. Cryotherapy treatment can be delivered are able to see which parts of the brain as whole-body or to just one area and are not working the way they should and can be administered in a number of will use that information to personalize a ways. Studies show that cryotherapy can reduce inflammation and oxidative stress treatment plan for each patient. Cryotherapy is a technique where associated with dementia, mild cognitive
impairment and other age-related forms of cognitive decline. In conclusion, there are many groups of people affected by neurocognitive disease, including those who have or have had Covid-19. Thankfully, NH Hospital is able to provide a variety of treatment options for those impacted.
Continued from page 1 successfully and the patient requests treatment, the doctor is required in some jurisdictions to write a note in the patient’s record. Additionally, the consent document must include the patient’s name, doctor’s name, diagnosis, proposed treatment plan, alternatives, potential risks, complications, and benefits. To some extent, physicians who use an informed consent document can protect themselves further by including a statement to the effect that the form only covers information that applies generally and that the physician has personally discussed specific factors with the patient. The consent document must be signed and dated by the patient (or the patient’s legal guardian or representative). Many consent forms also require a physician signature. Consent forms should include statements to be signed by the patient and the physician. The patient attests that he or she understands the information in the treatment agreement. The physician attests that he or she has answered all questions fully and believes that the patient/ legal representative fully understands the information. These statements help defend against any claim that the patient did not understand the information. Some states have specific requirements for informed consent forms, procedure-specific disclosures, and legal standards for disclosure of risks. For example, Texas maintains lists of procedures and attendant risks and hazards through the Texas
Neurocognitive
Oncology Research Continued from page 5
These three questions are the beginning of open and ongoing discussions about your cancer care with your physician. The American Cancer Society recommends evaluating all treatment options
June 2021
before deciding to participate in a clinical trial, and taking into consideration travel, time, medical coverage, and any potential costs, among others. Texas Oncology has helped
develop more than 100 FDA-approved cancer therapies through research and clinical trials. I’m proud to work with our patients and oncology care teams who, together, are helping others by supporting medical research.
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Hands-Only CPR CPR CAN DOUBLE OR EVEN TRIPLE A PERSON’S CHANCE OF SURVIVAL
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