Houston Medical Times by Rick Delarosa

Serving Harris, Brazoria, Fort Bend, Montgomery and Galveston Counties

Celebrating National Nurses Week May 6-12 2022

HOUSTON

Volume 12 | Issue 5

Inside This Issue

May Edition 2022

Using Virtual Reality to Bridge Gaps in Nursing By Lindsey Hendrix

UTMB Unveils School of Public and Population Health See pg. 11

INDEX Legal Matters........................ pg.3 Oncology Research......... pg.6 Healthy Heart....................... pg.7 Hospital News....................... pg.8

Inspired Students Make Intubation More Intuitive See pg. 12

efore nursing students at Texas A&M University ever enter a clinic, even before they engage in face-to-face clinical scenarios with people acting as patients, they already have hours of experience interacting with patients. They’re accomplishing this through new, innovative virtual reality (VR) simulations developed by their professors. Since early 2020 (in the pre-pandemic days), a team at the Texas A&M College of Nursing has been working on integrating VR simulations into their curriculum to help bridge the gap between classroom and clinic. They have launched two simulations so far that provide immersive experiences for students to hone their skills before working with real patients. “VR simulation is in that area that we call a ‘safe container,’” said Elizabeth Wells-Beede, PhD, RN, C-EFM, CHSE-A, CNE , clinical assistant professor at the College of Nursing. “We’re all human and mistakes are going to be made. This is a place that we hope to create that psychologically safe environment for mistakes to be made, where we as the experts can help walk the students through the processes, and then they take that experience into practice and not make the mistake with a real-life patient.” Clinical simulation is not new.

It has been used in nursing education for many years and allows students to apply the theory they’ve learned from books and skills they’ve learned in labs

Through Cutting-Edge Technology, Texas A&M Nursing Students Gain Clin ical Ex per ience Before Working Directly with Patients (such as checking vital signs, inserting IVs and conducting evaluations) to patient scenarios that they could encounter in a clinical setting. In a traditional simulation, a student is presented with a standardized patient (or trained actor), a mannequin or a computer-based program, to name a few. The student must work through the case presented to them by reading the patient’s chart, interviewing the patient and conducting an examination to decide what action to take. Virtual reality is a new, emerging form of clinical simulation that provides more accessible and immersive experiences that don’t

require learners to travel to clinical settings, helping with the increasing burden on clinical practice partners to place learners. The technology used at Texas A&M is being developed in close collaboration with Jinsil Hwaryoung Seo, PhD, associate professor and director of the Institute for Applied Creativity at the Texas A&M College of Architecture. Nursing faculty write the clinical scenarios and then work with Seo and her students to turn those scenarios into immersive, virtual reality experiences. To access the simulated world, nursing students put on VR headsets that transport them into a virtual setting that can be a clinic, home or school. There, they meet with a virtual patient and work through their case to make a decision while their instructor observes and provides feedback. “I am convinced VR is the future of simulation,” said Cindy Weston, DNP, APRN, FNP-BC, CHSE, associate dean for clinical and outreach affairs at the College of Nursing. “This is an immersive platform that’s deeper than what we’ve been able to do in the past with simulation in the other variety of forms it takes. Student learners feel see VR...page 14

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Legal Matters ACGME Is Instituting New Mandatory Medical, Parental and Caregiver Leave Requirements for Residency and Fellowship Programs: Are You Ready?

By Lori Oliver, JD & Laura Little, JD Polsinelli, PC

rganizations overseeing physician training (like ABMS and ACGME) have recently demonstrated a renewed commitment to supporting physicians’ holistic development by adopting new mandatory leave requirements for physicians-in-training (Residents and Fellows). These changes come at a time when the U.S. is reacting to a post COVID-19 pandemic vision of work: long gone are the days when personal identities and commitments are expected to drop at the workplace door. Rather, employers are being asked to see their personnel

as whole people, with conflicting personal and professional priorities. In Medicine, residency and fellowship training programs are finding a similar need to accommodate their trainees’ personal lives—particularly in family planning and wellness. Residency and Fellowship years collide with prime family development years. Recognizing this, the ABMS and ACGME have adopted new minimum leave requirements to standardize medical, parental, and caregiver leave rights across training programs nationwide. Specifically, last year, the ABMS adopted new leave policies expressly calling for its programs to offer medical, parental and caregiver leave to all Residents/Fellows. Now, beginning on July 1, 2022, the ACGME will require all ACGME-accredited Programs to offer six (6) weeks of paid leave to all Residents/Fellows for medical, parental and caregiver leave, with the right to take such leave kicking-in on the individual’s very first day in the

Program. The new requirements apply to Sponsoring Institutions (the institutions that administer ACGME-accredited Programs) and call for them to take key steps prior to July 1, 2022 to be in compliance with the new core institutional requirements. The ACGME recently clarified that the ACGME Institutional Review Committee will not take enforcement actions against Sponsoring Institutions pertaining to the new requirements until after July 1, 2023. However, the requirements go into effect on July 1, 2022, making now the time for Sponsoring Institutions to develop and implement new leave policies and align their existing leave framework with the new requirements. The following checklist describes

activities Sponsoring Institutions should consider now to ensure their teaching program remains compliant with ACGME accreditation requirements: • Recruitment Materials: Ensure interview processes for Residents/ Fellows include information regarding institutional policies for vacation and leaves of absence, including paid benefits during such absences. • Appointment/Employment Agreements: Amend all Appointment Agreements and Employment Agreements entered with Residents/Fellows (and associated templates for future agreements) to describe the new see Legal Matters...page 14

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Nine Tips for Telehealth Clinical Documentation By Sue Boisvert, BSN, MHSA, Patient Safety Risk Manager The Doctors Company

s the course of the pandemic continues to unfold and threats from new variants appear, many practices and patients are once again considering telehealth options—a trend that may continue even after the pandemic runs its course. Regardless of whether the care is delivered in person or through telehealth, the required levels of skill and expertise and the standard of care are the same. Clinical documentation plays a significant role in demonstrating regulatory compliance, establishing medical necessity for billing, and defending the provider in the event of a licensing board complaint or professional liability claim. Due to the unique differences between an in-person patient visit and telehealth, documentation plays an essential role in proving that the standard of care has been met. The practice of telehealth creates additional and specific documentation requirements.

May 2022

Consider the following nine tips for documenting telehealth care: 1. Modality: Specify clearly in the patient’s record the telehealth modality used. Examples include “secure interactive audio-video session using [name of] telehealth platform,” “telephone medication management consultation,” or “asynchronous diagnostic test follow-up by portal/text/ email.” 2. Geography: Note the patient’s physical location and geography. For example, including “at her home in Tennessee” is necessary for billing purposes and determining venue in the event of regulatory or professional liability action. Also document the provider’s location as “in the clinic,” “from the hospital,” or “from the home office.” 3. Informed consent: Obtain informed consent for telehealth visits. Advise patients about the risks of a telehealth visit, including the potential for technical difficulties, information security concerns, and that it may be necessary to convert the visit to an in-office visit depending on patient

needs. In the progress note, summarize the discussion, the questions asked and answered, and the patient’s decision. Include a copy of the signed consent form. Find our sample “Telehealth Informed Consent” form on our Informed Consent Sample Forms page. 4. Identity: Confirm patient identity to reduce the risk of billing fraud and medical identity theft. Ask new patients to hold a photo ID close to the camera. Document confirmation of patient identity. Patients also have the right to ask for provider identification. 5. Appropriateness: Determine quickly if the patient and environmental conditions are appropriate for a telehealth visit. Some patients may not be appropriate candidates for telehealth

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visits based on their cognitive status. If the patient cannot answer questions or provide an accurate history and no support person is available, the visit may need to be rescheduled. Documentation in this situation might include “the visit was rescheduled at the patient’s request because her husband could not be available.” Evaluate and address distractions in the environment. Document patient assessment, environmental conditions, actions taken, and recommendations made. For more information on addressing patient distractions, see our article “Telehealth’s Newest Safety Risk: see Telehealth...page 13

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HOW MUCH ASSURANCE do you have in your malpractice insurance?

With yet another major medical liability insurer selling out to Wall Street, there’s an important question to ask. Do you want an insurer with an A rating from AM Best and Fitch Ratings, over $6.2 billion in assets, and a financial award program that’s paid $120 million in awards to retiring members? Or do you want an insurer that’s focused on paying its investors? Join us and discover why our 80,000 member physicians give us a 90+% satisfaction rating when it comes to exceptional service and unmatched efforts to reward them.

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Oncology Research 5 Tips To Reduce Stress As A Cancer Patient By Jorge Darcourt, M.D., M.H.C.M., Texas Oncology– Houston Medical Center and Sugar Land

of getting involved. Take it easy. Taking it easy is not always easy, especially for people who are used to caring for others. However, it is not impossible. Keep things simple and take your schedule day by day or week by week. Avoid added stressors by sticking with your top priorities to create a routine that best resembles your new version of ‘normal.’ Enjoy the freedom of editing out unnecessary activities and commitments. The internet is not your physician. It’s no surprise the first thing patients want to do is start searching the web for more information, but take care to avoid going down internet

rabbit holes that lead to more fear and added stress. Rely on your cancer care team to answer any questions you may have. They will be straightforward and honest, and will provide you with expert advice rooted in science and medicine and balanced by experience – not algorithms that don’t take the individual into account. Breathe. Stretch. Walk. Meditate. Sometimes worrying about the big things can make patients forget the little things when it comes to health, even when their bodies are fighting an epic battle. The simplest activities – including deep breathing, see Oncology ...page 13

10 NEW TOWNHOMES 10 MINUTES AWAY FROM HOUSTON MEDICAL CENTER

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hat’s going to happen to me? How can I manage all these appointments? How can I keep up with so many medications? Your mind is racing with questions, and facing all of the unknowns that come with cancer is understandably stressful. From diagnosis to prognosis, cancer patients experience a whirlwind of emotions and face an overwhelming number of decisions regarding their treatment journey. Adding to the stress, cancer patients often worry more about the wellbeing of their loved ones than themselves. In time, mental stress can negatively impact a patient’s physical health.

While excessive stress is detrimental to everyone, it presents additional challenges for those who are immunocompromised, such as cancer patients. So how can patients make themselves a top priority and reduce stress while battling cancer? Here are five ways to help reduce stress as a cancer patient. Lean on others. You are not alone in your cancer journey. Asking for and receiving help will benefit you as well as your inner circle of friends and family who want to support you. Indeed, the entire cancer community is committed to patient support. Whether they are fellow cancer patients, survivors, or healthcare workers, a community of support is available to you in your fight to beat cancer. Seek out a support group. Research patient advocacy organizations to join. You will discover that not only do these groups provide you a safe space, but you are also likely to find a lifelong friend in the process

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Healthy Heart Heart Complications After a Stroke Increase the Risk Of Future Cardiovascular Events By The American Heart Association

eople who survive an ischemic stroke are more likely to develop major heart complications during the first month after their stroke, and, as a result, they also have an increased risk of death, heart attack or another stroke within five years, according to new research published in Stroke, the peer-reviewed, flagship journal of the American Stroke Association, a division of the American Heart Association. After a stroke, people often have cardiovascular complications, known as stroke-heart syndrome. These conditions increase the risk of disability or death in the short term, yet the long-term consequences for people with stroke-heart syndrome is unknown. “We know heart disease and stroke share similar risk factors, and there’s a two-way relationship between the risk of stroke and heart disease. For example, heart conditions such as atrial fibrillation increase the risk of stroke, and stroke also increases the risk of heart conditions,” said Benjamin

J.R. Buckley, Ph.D., lead author of the study and a postdoctoral research fellow in preventive cardiology at the Liverpool Centre for Cardiovascular Science, University of Liverpool in the United Kingdom. “We wanted to know how common newly diagnosed heart complications are after a stroke and, importantly, whether stroke-heart syndrome is associated with increased risk of long-term major adverse events.” The analysis found: • Overall, among all stroke survivors in the study, about 1 in 10 (11.1%) developed acute coronary syndrome, 8.8% were diagnosed with atrial fibrillation, 6.4% developed heart failure, 1.2% exhibited severe ventricular arrythmias and 0.1% developed ’broken heart’ syndrome within four weeks after the stroke. • Risk of death within five years after a stroke significantly increased among the participants with new heart complications: 49% more likely if they had developed acute coronary syndrome; 45% more likely if they had developed atrial fibrillation/flutter; and 83% more

likely if they developed heart failure. Severe ventricular arrhythmias doubled the risk of death. • Chance of hospitalization and heart attack within five years after a stroke was also significantly higher among those who developed heart complications within the one-month window. • Stroke survivors with Takotsubo syndrome were 89% more likely to have a major heart event within the five years after their stroke. • People with stroke and newly diagnosed cardiovascular complications were 50% more likely to have a recurrent stroke within five years after the first stroke. “I was particularly surprised by how common stroke-heart syndrome was and the high rate of recurrent

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stroke in all subgroups of adults with stroke-heart syndrome” Buckley said. “This means that this is a high-risk population where we should focus more secondary prevention efforts.” The study’s results build on the understanding of the two-way link between the brain and the heart and extend this understanding to long-term health outcomes. “We also need to develop and implement treatments to improve outcomes for people with stroke-heart syndrome,” Buckley said. “The American Stroke Association recommends a personalized secondary stroke prevention plan for every stroke survivor.” To read the full study visit heart. org/news

May 2022

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Hospital News MD Anderson Receives Over $10 Million From Break Through Cancer to Support Collaborative Research With Leading Cancer Centers Funding Is Part Of $50 Million In Grants to Teams At Five Cancer Centers Charged To Work Together

he University of Texas MD Anderson Cancer Center was awarded more than $10 million in grants to support collaborative research teams working to advance novel interception and treatment strategies that will improve outcomes for several cancer types with the greatest unmet need, including pancreatic cancer, ovarian cancer and glioblastoma (GBM). Funded by Break Through Cancer, this work is part of $50 million in grants being made to teams across five cancer research centers: MD Anderson, Dana-Farber Cancer Institute, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Memorial Sloan Kettering Cancer Center, and Koch Institute for Integrative Cancer Research at MIT. This new model for collaboration enables researchers to boldly tackle some of the biggest challenges in cancer. Break Through Cancer’s innovative approach will help overcome conventional barriers to multi-institution teamwork by using streamlined processes and systems for more effective data collaborations. Giulio Draetta, M.D., Ph.D., MD Anderson’s chief scientific officer, and David Jaffray, Ph.D., MD Anderson’s chief technology and digital officer, serve as members

of the Break Through Cancer Board of Directors. “Collaborative team science is the cornerstone of our work at MD Anderson, with the goal of advancing breakthroughs that can improve patients’ lives. We also know that, to make real progress, our research cannot stand alone,” Draetta said. “Break Through Cancer’s unique approach unites some of the greatest minds in cancer research to better understand disease mechanisms underlying currently intractable cancers. Through this work, we hope to drive real impact and innovation.” All projects funded by Break Through Cancer will use a model that allows researchers and physicians from each institution to work collaboratively in real time. Additionally, new technology and systems will make data collaborations frictionless. Reducing the day-to-day barriers to cross-institutional collaboration, such as contract negotiations, data access, intellectual property management and authorship rights, will pave the way for faster discoveries. Together with Jaffray, Caroline Chung, M.D., MD Anderson’s chief data officer, has worked closely with Break Through Cancer to coordinate our approach to data. In partnership with Break Through Cancer’s growing multi-institutional data science team, Chung has shaped the

VA Advances Equity in Benefits, Services and Health Care Action Plan Addresses Discrepancies Among Underserved Veterans

he Department of Veterans Affairs released its Equity Action Plan, April 14, to eliminate barriers to health care, benefits and services, and create opportunities to improve access and experiences for historically marginalized Veterans. VA’s Equity Action Plan is part of the Biden-Harris administration’s

May 2022

broader focus on advancing equity as outlined in Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. “The department’s mission is to ensure equity and access for all those who served their country

interface between data governance and data science to enable seamless collaborations across institutions and domains — basic science, clinical research and data science — to make transformative advances in cancer. “New models and infrastructure are essential to enable the seamless collaboration required for an effort of this significance,” Jaffray said. “Our work will allow researchers across the country to collaborate as if they are standing shoulder to shoulder, transforming the team science process so we can accelerate meaningful progress.” Projects have been funded based on their unique cohort of researchers and potentially transformational science. The projects and faculty researchers include: • Intercepting Ovarian Cancer – Barrett Lawson, M.D., Karen Lu, M.D., Larissa Meyer, M.D., and Linghua Wang, M.D., Ph.D. • Targeting Minimal Residual Disease in Ovarian Cancer – Tyler Hillman, M.D., Ph.D., Amir Jazaeri, M.D., Karen Lu, M.D., Linghua Wang, M.D., Ph.D. and Shannon Westin, M.D. • Conquering KRAS in Pancreatic Cancer (in partnership with the Lustgarten Foundation) – Ronald DePinho, M.D., Timothy Heffernan, Ph.D., Raghu Kalluri, M.D., Ph.D., Anirban Maitra, M.B.B.S., Shubham Pant, M.D.,

in uniform and the Equity Action Plan is a natural extension of that mission,” said VA Secretary Denis McDonough. “We have efforts underway to change policies, processes and procedures, as well as identify infrastructure and data enhancements to enable access to all Veterans, including underserved Veterans.” To serve all Veterans, VA must reach the most marginalized and underserved — regardless of race, gender, age or socio-economic status. The plan sets forth a myriad of goals to effectively incorporate equity across the department. To help achieve

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and Linghua Wang, M.D., Ph.D. Revolutionizing GBM Drug Development Through Serial Biopsies – Kadir Akdemir, Ph.D., Sangeeta Goswami, M.D., Ph.D., Jian Hu, Ph.D., Jason Huse, M.D., Ph.D., Wen Jiang, M.D., Ph.D., Betty Kim, M.D., Ph.D., Frederick Lang, M.D., Vinay Puduvalli, M.D., Padmanee Sharma, M.D., Ph.D., Shiao-Pei Weathers, M.D., and Ying Yuan, Ph.D. “We are honored to be part of this united effort that aligns so well with our mission to end cancer,” said Peter WT Pisters, M.D., president of MD Anderson. “This tremendous support from Break Through Cancer will stimulate compelling projects being led by many of the top minds across the country, and we look forward to seeing impactful results.” •

broad equity in every area of VA operations and engagement this includes: • Building and maintaining trust with underserved Veterans. • Developing data to measure equitable delivery of care and services. • Improving access for advancing outcomes when it comes to: • Health care, benefits and services for underserved Veterans. • Contracts awarded to minority, small disadvantaged, and women-owned businesses. 

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What You Need to Know About Hair Loss

udden hair loss, also known as telogen effluvium, is a common cause of temporary hair loss after a stressful experience. The stress can push many hair follicles into a resting phase and within two or three months, the hairs will fall out. Dr. John Wolf, chair and professor of dermatology at Baylor College of Medicine, discusses how this can happen and how to manage it. While evidence exists of a clear connection between COVID-19 and sudden hair loss, telogen effluvium isn’t directly tied to the virus. Not everyone who is diagnosed with COVID will experience hair loss either. Hair loss can be caused by a “shock to the system,” such as the pregnancy and birth of a child, major surgery, physical accidents or any infection with a high fever or stress. People who lose weight quickly, either through a diet, exercise or illness also can experience a type of telogen effluvium. Typically, telogen effluvium will

May 2022

occur about three months after the “shock,” Wolf said. “Any time you comb or shampoo, you will see hair falling out, as 10% of hair is programmed to fall out. If the hair follicle isn’t damaged, it will always grow new hair,” Wolf said. “In telogen effluvium, you’ll suddenly have as many as half of the hairs on your head in the resting phase, and they will fall out.” The stress of COVID treatment, or pandemic life, also can be a factor in hair loss. Wolf said it’s not surprising that people experience hair loss after having a high fever or being placed on a ventilator during a hospital stay since both are mentally and physically stressful situations. In most telogen effluvium cases, the body will heal itself and grow the hair back. There’s currently no treatment or cure, but Wolf recommends shampooing and brushing the hair carefully with a natural-bristle brush or a comb with wide teeth.

If the rapid hair loss continues, a dermatologist may change the diagnosis to alopecia areata, which consists of round patches of hair loss on the scalp. The most common form of hair loss in men and women, however, is a genetically predetermined disorder called androgenetic alopecia, but it occurs at a much slower pace. Traction alopecia can occur if the hair is repeatedly pulled back from the hair

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follicle too tightly. If you’re experiencing hair loss or other scalp issues (dandruff, pimples, general itchiness), it’s best to seek a dermatologist for proper diagnosis and treatment. Talk with a healthcare professional before starting an over-the-counter treatment, which can have a long-term effect on the hair follicles.

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UTMB Unveils School of Public and Population Health

ocused on training the next generation of public health workforce and improving the overall health and well-being of residents, the University of Texas Medical Branch is announcing its newly established School of Public and Population Health today. “The ongoing COVID-19 pandemic has emphasized the urgent need for more public health professionals trained in epidemiology, disease surveillance, as well as the need for expanded public health resources,” said Dr. Kristen Peek, Dean of the School of Public and Population Health. “A school dedicated to public and population health will build upon our strength in science and research, healthcare policy and delivery to prepare the next generation of public health leaders.” The newly established School of Public and Population Health transitions from the previous Department of Preventive Medicine and Population Health. Being in one of the fastest growing

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and the most diverse regions in the United States, UTMB is dedicated to meeting the strong demand for public health education. “The master of public health program alone has grown tremendously over the last few years,” said Dr. Cara Pennel, Associate Dean of Academic Affairs in the School of Public and Population Health. “We look forward to welcoming and training more public health professionals to solve major health problems and fill the gap in public health services.” The new school will continue to prioritize research in biostatistics and data science; global health and emerging diseases; population health and health disparities; bioethics; and aerospace medicine and environmental health. In addition to the current array of educational opportunities for graduate students, physicians, medical students, and health science professionals, the School of Public and Population Health is also planning to develop additional Master of Public Health tracks including

bioethics and global health, as well as a Doctor of Public Health. “To address the ongoing and future public health and population health crisis, we need more highly trained, diverse public health professionals,” said Dr. Ben Raimer, President of UTMB. “We are committed to continue providing quality public health education, foster collaborations, contribute to a healthier more equitable

public health and healthcare systems for all Americans.” The University of Texas Board of Regents approved creation of a School of Public and Population Health in May of 2021. The School of Public and Population Health at UTMB will welcome the first cohort of students this Fall. Current students will transition to the new School of Public and Population Health.

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Inspired Students Make Intubation More Intuitive Rice Engineering Team’s Wireless Video Laryngoscope Would Aid Airway Managers

ice University bioengineering students are making a critical procedure easier for airway managers and safer for patients with a simplified, high-tech intubation device. The Gateway to Airway team at Rice, working with an anesthesiologist, has developed a sleek laryngoscope that simplifies intubating patients for scheduled or emergent procedures. The handheld, 3D-printed device contains a miniature wireless camera. Clinicians can use a switch on the comfortable handle to adjust light from an LED near the camera, which feeds high-resolution video to one or multiple monitors. The team -- seniors Reed Corum, Rebecca Franklin, David Ikejiani and Victoria Kong -- will present the device at the George R. Brown School of Engineering’s annual Engineering Design Showcase on Thursday, April 21, at 4:30 p.m. The competitive event, open to the public, will be held this

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year at the Robert L. Waltrip Training Center, the inflatable facility on the west side of campus. The Oshman Engineering Design Kitchen was approached by Dr. Kenneth Hiller, an anesthesiologist in private practice, about collaborating on a laryngoscope that would allow easier access to image the throat and larynx and help place a breathing tube into the trachea. Hiller, who has a patent on the design, recognized early on that engineering it into a true product would require specialized knowledge. “Current state-of-the-art devices have limitations,” Hiller said. “Placing an endotracheal tube can be challenging in a significant number of patients’ airways. For years, I’ve mulled over what I’d like in a device that can simplify the process and improve patient safety.” “He came to us with something built out of popsicle sticks and a

Rice University bioengineering students -- from left, Reed Corum, Rebecca Franklin, Victoria Kong and David Ikejiani -- have developed a simplified, wireless video laryngoscope to help clinicians intubate patients before procedures or in an emergency. Photo by Jeff Fitlow

metal tube and said, ‘This is what I’m working towards but I don’t know how to build it myself,’” Franklin recalled. “He wanted a video laryngoscope that not only had wireless video but also had a better blade profile,” Kong said. “There are two main types of laryngoscopes: with straight blades and with curved blades, and all of the video laryngoscopes on the market are in the curved blade format. While that’s great for compressing the tongue to get it out of the way, it has a very high displacement volume. It takes up a lot of room in the mouth.

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“That makes it very difficult for the physician to insert the endotracheal tube to give the patient air,” she said. “The straight blade gives you a more direct line of sight. We wanted to combine the stabilization afforded by curved blades and a straight-blade profile, and we did that by tapering our blade.” Hiller’s request was for a device that would cost under $500. “That’s within the constraints of our project see Rice...page 13

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Telehealth

Continued from page 4 Distracted Patients.” 6. Others present: Include documentation of all participants. Others may be present at the patient’s location and may assist with or affect the quality of the visit. Document in the progress note the name and relationship of all individuals present on the patient’s side of the interaction. For example, document “visit conducted with child sitting on mother’s lap.” On the provider’s side, document the names of assistants who are present and their purpose. For example, a medical assistant may serve as a chaperone during remote sensitive visual examinations. In addition,

Oncology

Continued from page 6 stretching, walking, and meditating – are beneficial as stress relievers and improve overall physical health. Even if you’re too exhausted to do much beyond getting out of bed, simply taking one to five minutes to quietly observe the cadence and depth of your own breath, the sound of wind

Rice

Continued from page 12 and overall design, but it’s looking like we can easily get it below $200,” Corum said. The vacuum-formed, disposable sleeves that cover the blade can be made quickly for pennies, he said. “It’s unfortunate that we’re developing this so late in the COVID pandemic, because any procedure that requires intubation requires a laryngoscope as well,” Ikejiani added. “I wasn’t really aware of the impact this could have in the context of COVID-19,” Kong said. “But as we got into it, I realized this is an important tool to help airway managers minimize contact with potentially contagious aerosolized particles. And the wireless video capability of our device further creates distance for the safety of the health care provider.” Kong noted all of the video-enabled laryngoscopes on the market require wiring to an external monitor, often a small one on the handle of the device itself. “That limits the amount of space and number of people who can be working on the

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document the use of interpreters who assist from a third location by video or telephone. 7. Assisted assessment: Plan for and provide instructions to patients if they will be performing tasks during the examination. With preparation, patients may be able to measure and report their weight, vital signs, and home point-of-care testing results. Document results and specify “patient provided.” When patients assist in various aspects of physical examination, document the details as “patient assisted.” For more information on patient-assisted assessment, see our article “Strategies for Effective Patient-Assisted Telehealth Assessments.” 8. Safety concerns: Scan the

patient’s environment for possible safety concerns. As the volume of telehealth visits increased during the pandemic, clinicians were afforded a window into patients’ homes and lives that would not otherwise have been possible. This opportunity was both a blessing and a challenge. Visualizing the patient’s surroundings facilitates patient safety activities such as fall reduction, environmental allergy assessment, and brown bag medication checks. In some cases, however, providers may see conditions that require intervention that are not directly related to the visit. Examples include evidence of hoarding, unsanitary conditions, abuse, and potential human trafficking. Objectively document observations, discussions

with the patient, recommendations, and follow-up plans. 9. Quality improvement: Consider revising electronic health record templates to include some of these documentation recommendations as checkboxes, dropdowns, or text macros. Periodically evaluate telehealth visit documentation to ensure compliance with the recommendations. Following these nine tips can help you ensure that your telehealth documentation is patient-centered, comprehensive, and effective. You can also benefit from familiarizing yourself with the regulatory and payer requirements specific to your practice location(s).

through the trees, or the pattern of light through the clouds can serve as a moment to release tension and not let stress get the best of you. Realize remission. Some patients may be in disbelief when hearing they are in remission. Rather than embracing the positive, a fear of recurrence or other worst-case scenarios can cause stress and anxiety. You may be surprised to suddenly find yourself experiencing

negative emotions when the news is good. Some feel guilty, because they can’t help but think of others who don’t have a similar outcome. Others have been holding in so many emotions that come flooding out once the treatment is concluded. After the ordeal of treatment, some patients simply have difficulty accepting their new reality and feel that somehow remission is toogood-to-be-true. Fortunately, there are tools

available to patients to learn to cope with being in remission, including Acceptance and Commitment Therapy (ACT), designed to help patients reduce the severity of their fear of recurrence. Cancer patients in remission have reason to celebrate and realize their outcome for what it is – hope for the future.

same patient,” she said. “Having the screen attached makes the scope more delicate and harder to transport from room to room,” Franklin said. “Having the video accessible on a tablet means a doctor in another room can watch and give feedback about technique to the airway manager performing the actual procedure.” She noted the off-the-shelf camera’s wireless range is about 33 meters. The students said they anticipate future refinements to include stainless steel construction for durability. They also see uses for the device beyond the clinic. “EMTs use their scopes in the field, and we can see expanding to people, for example, in the military who require remote oversight where users may not have expertise gained from years of experience,” Kong said. “This has been a distinct privilege for me to collaborate with such a prestigious institution and such talented, motivated students,” said Hiller. “I would welcome opportunities to work with Rice on future ventures.”

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May 2022

Houston Medical Times

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HOUSTON

Continued from page 1 like they’re in the environment, and it’s a safe space for them to hone and develop skills with faculty guidance and feedback.” Better care for vulnerable patients Currently, the College of Nursing has applied VR simulation in two areas: Screening, Brief Intervention and Referral to Treatment (SBIRT), and forensic nursing. SBIRT is an approach that health care providers use to quickly recognize when a patient uses drugs and/or alcohol in risky ways so that they can provide brief intervention and refer them to specialty care if more extensive treatment is needed. Forensic nurses are professionally trained to treat victims of violence through patient-centered, trauma-informed care. Both SBIRT and forensic nursing involve patients in vulnerable situations that require highly competent, compassionate and experienced care providers. “We know that when confidence is high, nurses’ performance, retention, and their ability to perform the skill is high,” Weston said. “VR simulation builds their confidence and then we’re able to assess their competence before they head into the clinical setting.” The SBIRT VR simulation has been in use for about a year. It is currently instructor-guided, meaning that when students are interacting with the patient inside the virtual world, an instructor monitoring the simulation from the outside answers on behalf of the patient. The team is working on taking this to the next level and is currently developing an artificial intelligence capability for the platform.

Published by Texas Healthcare Media Group Inc. Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo Web Development Lorenzo Morales Texas A&M nursing students take part in a virtual SBIRT simulation in Round Rock, Texas, while Elizabeth Wells-Beede facilitates the simulation from a computer.

The first forensic nursing VR simulation, which launched last month, is self-contained. In it, nurses complete a number of tasks to learn how to conduct a sexual assault examination. The goal is to help them become comfortable performing the exam before working with a live standardized patient. “We have had an overwhelming excitement with all of it,” said Stacey Mitchell, DNP, MBA, MEd, RN, SANE- FAAN, clinical professor and director of the Texas A&M Health Center of Excellence in Forensic Nursing. “Most of the students, every time they put on the VR headset, they say, ‘Oh my gosh, this is so amazing!’ They are thrilled and excited that we’re bringing this to them.” Bridging gaps in rural areas The VR simulations are not only designed to bridge gaps inside nursing school. As part of three Health Resources and Services

Administration (HRSA) grants, they are helping to bridge gaps in rural and medically underserved areas as well. Specific areas of focus include mental health, chronic disease management, medication management, postpartum care, and forensic nursing. “We’re trying to meet the need for those areas, and that’s really not where the big VR companies are. They’re looking at the acute care setting, not the ambulatory care setting where we are,” Wells-Beede said. “Although this whole VR world is building up around us, we are doing something in between that’s going to meet the need for rurally underserved areas. This is where I feel our niche is; we are a land-grant institution and we’re giving back to our community by doing these simulations that can actually be brought into the community setting.”

is also important to ensure these rights align with and are properly integrated with other leave policies, such as federally-required family and medical leave rights under FMLA.) GMEC Oversight: Ensure the Sponsoring Institution’s Graduate Medical Education Committee (“GMEC”) is charged with oversight of leave policies and actually reviews implementation of all institutional policies governing vacation and leaves of absence (including this new leave requirement) no less than annually. Your institution may need to revise policies and/or processes to assure this requirement is met. Resident/Fellow Program

Progression: Ensure that each ACGME-accredited program provides Residents/Fellows with information about the impact of taking extended leaves on their completion of the program and their eligibility to participate in certifying board exams. Support Well-Being: Ensure each ACGME-accredited program dedicates institutional resources to, and adopts processes to, make resources available to Residents/ Fellows to support their overall well-being and education and to minimize how leave of absences impact clinical assignments.

Legal Matters Continued from page 3

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medical, parental and caregiver leave policies. Institutional Policies: Adopt institutional policies and procedures describing the new leave rights and how to apply for the leave. (This may be a new policy or modification of an existing policy, but it must be clear on when the leave entitlement arises, address the additional one week paid leave right during applicable years, and clearly provide for continuation of certain insurance policies during the leave period. It

May 2022

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Houston Medical Times

Women Have a Higher Risk of Stroke Stroke is the No. 4 cause of death in women and kills more women than men. In fact, one in five women will have a stroke. Women experience unique life events that can impact their risk, including pregnancy and menopause. Pregnancy

Preeclampsia

The risk of stroke in pregnant women is 21 per 100,000, with the highest stroke risk during the third trimester and post-partum. Those with high blood pressure should be treated with medications and monitored closely.

This is high blood pressure that develops during pregnancy. Preeclampsia doubles the risk of stroke later in life. If you have any history of hypertension, talk to your healthcare provider about taking low-dose aspirin starting in the second trimester.

Birth control pills have become much safer over time, but women who are already at risk of stroke should take extra precautions. Get screened for high blood pressure before the pill is prescribed. And never smoke while taking oral contraceptives.

Migraines with aura

Atrial fibrillation

Migraine with aura is associated with ischemic stroke in younger women, particularly if they smoke or use oral contraceptives. Smokers with migraines accompanied by aura should quit immediately.

This increases stroke risk among women over age 75 by 20 percent.

Hormone replacement therapy This type of therapy should never be used to prevent stroke in postmenopausal women.

Birth control pills

Go Red for Women Luncheon May 13 The Post Oak Hotel 2022 Chair Houston Go Red for Women Liz Youngblood, RN, MBA, FACHE President Baylor St. Luke's Medical Center and SVP/COO St. Luke's Health

The Go Red for Women movement unites the community with passion and purpose to fight the #1 and #4 health threats to women. Because losing even one woman is too many. Rock your red and join us!

TM Go Red trademark of the AHA, Red Dress trademark of the DHHS.

May 2022

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Healthy Heart