UTMB NEWSLETTER • JANUARY 2018
Best Care in Action: UTMB Hospital Galveston initiative improves patient length of stay Spotlight on Christine Wade, director of patient care services and assistant chief nursing officer Tips for weathering flu season
Acting fast to save lives, lessen the effects of stroke
Dr. Nisha Jain Garg, professor in the departments of Microbiology and Immunology and of Pathology, was awarded $2.3 million from the National Institutes of Health to examine the previously unknown role of a DNA repair protein called PARP1 in increasing the risk of heart damage that often accompanies Chagas disease. The chronic disease is caused by a parasite called Trypanosoma cruzi, which is spread by the so-called kissing bug, triatomine. Chagas disease affects an estimated seven million people worldwide, mostly in the Americas. Each year, Chagas disease is responsible for about 17,000 deaths and costs around $8 billion in health care costs and lost productivity. The goal of this grant is to gain new insight into how how the parasite damages the body and offer a new therapy for minimizing bodily damage in people with Chagas disease. Dr. Christine Baker, professor, Department of Physical Therapy, School of Health Professions; Dr. José Barral, professor and vice chair for operations, Department of Neuroscience, Cell Biology and Anatomy, and associate dean for academic affairs in the Graduate School of Biomedical Sciences; and Dr. Yolanda Davila, professor, School of Nursing; have been accepted as members of the University of Texas System Kenneth I. Shine, MD, Academy of Health Science Education for 2018. The academy is a formal organization of distinguished scholars recognized for their teaching excellence, and serves UT System through the support and promotion of excellence in all aspects of health science education, educational Baker Barral Davila scholarship and leadership. UTMB’s Galveston and League City campuses donated more than 1,500 pounds of nonperishable food items as a community partner in the 37th annual ABC13 Share Your Holidays Food Drive in December. Lori Blackwell, UTMB’s coordinator for the food drive and administrative manager with University Events and Conferences, was joined by Larry Krcma, associate vice president of University Events, and Julian Ramirez, catering attendant, to drop off UTMB’s contributions on Dec. 8 at Ball High School in Galveston. All contributions collected in Galveston County are administered by the Galveston County Food Bank for distribution throughout the local area.
Dr. Michael Leger, director of Quality and Healthcare Safety, was recognized at a recent Health System Leadership Team meeting for his act of kindness toward a stranger at a Galveston grocery store. Donna Sollenberger, executive vice president and CEO of the UTMB Health System, shared a letter submitted by someone who observed Leger buying groceries for a woman in the Arlan’s Market checkout line. The woman didn’t have enough money to pay for her items, which included ingredients for making her daughter’s birthday cake. The letter said, “…when he realized what was happening, he handed his credit card to the cashier and told her to charge that lady’s groceries to him… All he said was, ‘Sometimes you have to pay it forward.’ … Although I’m sure many people at UTMB do nice things every day, I just thought you should know what he did to make someone’s day better and probably make a little girl’s birthday so special.”
Thirty-two students from UTMB’s School of Medicine, School of Nursing and School of Health Professions traveled to Peru during their holiday break in December to provide care to the underserved community. Drs. Ben and Sharon Raimer (SOM) and Dr. Adrianna Laprea (SHP) supervised the students during this ninth trip to Lima with Hands and Feet Medical Missions. The group saw 525 people over the course of four days, working in small interdisciplinary teams to assess and treat their patients. UTMB was recently recognized in several categories in the 2017 Best of the Island Awards sponsored by Galveston. com. Recognition included Best Place to Work, Best Large Business, Best Physician and Best Nurse. For a complete listing of the awards, visit www. galveston.com/bestofgalveston/.
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impact
From the President Happy New Year, and welcome to the latest issue of Impact! The beginning of a new year gives us an opportunity to pause and reflect on the accomplishments of the previous months and plan ahead for the many opportunities to come in 2018.
JANUARY 2018
To kick the year off, we have several events planned to discuss where we’ve been and where we are going. In addition to Town Hall on January 24, we will continue the Mondays in March series, which provides an opportunity for you to hear from UTMB executive leaders about plans and progress in the Academic Enterprise, the Health System, and Business and Finance. We are currently planning this year’s series and would like to hear from you regarding what topics you’d like to learn more about from the Executive Vice Presidents and me in the future. Please submit your ideas at http://intranet.utmb.edu/weeklyrelay/mondays-in-march.
Best Care: UTMB Hospital Galveston improves patient length of stay
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This edition of Impact also includes tips to help you stay healthy this flu season by Dr. Megan Berman, an associate professor in the Department of Internal Medicine. Flu season hit early and hard this year; we are seeing a greater number of patients filling our hospitals and clinics with flu symptoms. However, it’s not too late to get your flu vaccination, which is still the most effective way to prevent flu. Please take a look at Dr. Berman’s tips to protect yourself and your family, and refer to the Centers for Disease Control and Prevention for further information at www.cdc.gov/flu/index.htm. Among the many other stories you’ll find in this issue:
Day in the Life of a stroke coordinator
• A day in the life of Brenda Yanez, stroke coordinator • A profile of Christine Wade, director of patient care services and assistant chief nursing officer • Two Best Care in Action segments: A spotlight on UTMB Hospital Galveston’s efforts to improve average length of stay and patient throughput; and a feature highlighting Dr. Jason Ross, a senior radiology resident who provided exceptional and compassionate care to a patient diagnosed with cancer • A research study that has found a link between children who experience corporal punishment and those who later perpetrate acts of dating violence • The reopening of our Texas City and Dickinson RMCHP clinics reopened to patients following several months of repairs due to Hurricane Harvey • Nursing and medical students working together in UTMB’s Interprofessional Nursing Simulation Center in preparation for work in the real world • A “UTMB Trivia” question to test your knowledge and enter your name for a chance to win a UTMB swag bag • Numerous accomplishments and kudos in the Working Wonders column and throughout the newsletter I look forward to working with you all in the coming year to improve health and improve lives in our local communities and beyond. Thank you!
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Spotlight on Christine Wade, director of patient care services and assistant chief nursing officer
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Tips for weathering flu season
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Dr. David L. Callender UTMB President
Impact is for and about the people who fulfill UTMB’s mission to improve health in Texas and around the world. We hope you enjoy reading this issue. Let us know what you think! ON THE COVER: As UTMB’s stroke coordinator for all three campuses, Brenda Yanez is leading the charge to improve stroke services and spread awareness about the risk factors and signs of stroke to medical staff, emergency medical services personnel, patients and families. At any one time, she tracks about 10 to 15 stroke patients across the Health System, working with each individual’s care team to ensure the best outcomes. P R INT E D B Y U T MB G R A P H IC D ES IG N & P RIN TIN G S ERVICES
Vice President Marketing & Communications Steve Campbell Associate Vice President Marketing & Communications Mary Havard Editors KirstiAnn Clifford Stephen Hadley Shannon Porter Art Director Mark Navarro Contributors Shelley Smith Erin Swearingen
CONTACT US Email: impact.newsletter@utmb.edu Phone: (409) 772-2618 Campus mail route: 0144 U.S. Postal address: UTMB Marketing & Communications 301 University Boulevard Galveston, TX 77555-0144
BEST CARE IN ACTION
BY KIRSTIANN CLIFFORD
ON ANY GIVEN DAY, all 110 acute care beds in UTMB Hospital Galveston are full. While some patients are preparing for discharge, new patients are brought in by bus, ambulance and vans from prison units all over the state. As the state’s aging prison population requires increased medical care, the maximum security hospital on UTMB’s Galveston Campus often faces a challenge: there aren’t enough beds to go around.
“By opening the lines of communication and raising the level of collaboration, we are seeing patients get what they need when they need it—they aren’t waiting around,” he said. “I always tell our medical staff to advocate for their patient, don’t settle for mediocrity. If a patient needs a procedure or needs to be transported somewhere, don’t settle for tomorrow. As you can imagine, if one thing doesn’t go right, it pushes everything backward. We always want to provide a coordinated, seamless transition of care because when you do it right, the chances of the patient coming back as a readmission is much lower.”
“It’s like playing musical chairs with hospital beds,” said Dr. Olugbenga Ojo, chief medical officer of Hospital In addition to daily POCR rounds, Ojo leads Galveston (HG). “Trying to find infirma- HG Length of Stay team members (L-R): Claudia Thomas, Paulicia Grimes, a length-of-stay meeting twice a week to ry beds at units across the state for Kenia Latin, Oyebamiji Adebayo, Marjorie Kovacevich, Dr. Olubgenga Ojo, discuss patients who have been in the Veronica Kwarteng-Amaning, Nancy Ritzmann and Angel Male. offenders being discharged from HG hospital for five days or more. In addition, who still need some sort of nursing an email escalation system has been put home-type care is tough—there are into place to ensure discharge paperwork is processed efficiently. only 483 infirmary beds for a prison population of about 120,000. Oftentimes, patients end up staying at HG while we try to find infirmary capacity for them, Hospital Galveston also has acquired a multi-purpose vehicle to help transport and that increases their length of stay and affects the ability for other patients patients to and from units. to be brought to our hospital.” “We have a ‘no patient left behind’ motto,” said Kovacevich. “In the past, patients Improving the average length of stay (ALOS) and patient throughput—the process may have had to wait days for transportation to pick them up and take them to of moving patients through the treatment system—became a major focus for units in remote places several hours away. Now, that doesn’t happen. We have a driver and security available to take the patient where they need to go.” HG over a year ago, when the ALOS peaked at 9.66 days. “We knew we had to do something,” said Marjorie Kovacevich, associate vice president of Hospital Galveston. “Only patients who are sick and need to be in the hospital should be here—otherwise, it’s not the best place to be for a patient. So we came up with several interventions and goals to ensure patients are in the hospital for the appropriate length of time.” One intervention included incorporating Progression of Care Rounds (POCR), which are daily multi-interdisciplinary meetings where the care team discusses each patient in the unit.
Ojo adds that the state legislature recently agreed to create more than 160 sheltered housing beds at three units to provide a supportive environment for offenders who do not require infirmary care but have medical needs that cannot be met in a general population environment. UTMB Correctional Managed Care helped identify patients who could be transitioned from infirmary beds to the sheltered housing beds, essentially freeing up additional infirmary capacity for patients who are dependent on that level of care for their activities of daily living. Since these various initiatives have been put in place, HG has seen a steady decline in the ALOS, going from nearly 10 days in September 2016 to 6.96 in November 2017. At the same time, patient throughput has increased, allowing more patients to be treated and improving public safety by reducing the number of offenders in free-world facilities.
“We needed to replicate the standard of care provided with regards to discharge planning in Jennie Sealy Hospital. The whole premise is to have a proactive approach, talking about the patient’s needs early on and ensuring care provided is patient-centered as well as promptly identifying barriers to the discharge process,” said Kovacevich, adding that discharging patients from a correctional managed Ojo says HG staff have handled the change in culture well and continue to strive care setting has unique nuances. “For example, part of our discussions include to provide Best Care for the population they care for on a daily basis. taking into consideration an offender’s custody level and coordinating sufficient “It’s been a collaborative effort—we are all in this together,” he said. “It’s tough security for transport to and from HG in a timely manner.” getting to the top but staying at the top is even tougher, so we can’t rest now. Our Ojo says the POCR rounds have now been integrated into all HG units and have goals are to take quantum leaps and be transformative with regards to quality of helped increase communications among all team members, including case care. We will provide Best Care for every patient, every time by providing care that management, bed placement, TDCJ security, nurses and physicians. is evidence-based and patient-centered.” n
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BEST CARE IN ACTION
Everyday Best Care UTMB radiologist steps out of his comfort zone to provide exceptional, compassionate care for cancer patient BY ERIN SWEARINGEN
WHEN IRENE SLOVAK, who was an otherwise healthy 74-yearold woman, began experiencing stomach pain and fatigue, she knew something wasn’t right.
have a follow-up clinic, and the person who told her about the ultrasound needed to be the same person who told her about the CT results.”
Although she didn’t have a primary care physician, she lived near the UTMB Multispecialty Care Clinic in League City, so she called and made the first available appointment with a nurse practitioner. Suspecting the patient was suffering from acid reflux or an ulcer, the NP ordered some tests and noticed Slovak’s liver enzymes were unusually high.
Ross worked with the internal medicine physician to schedule the CT scan, talked to the patient’s insurance provider and then returned to explain to her what they suspected was the cause of her symptoms.
The NP immediately called the radiology department in Galveston to set up an appointment for Slovak to receive an ultrasound the following day. During the ultrasound, the technician noticed something she didn’t recognize. She called the manager in to review the ultrasound, who recognized the severity of the situation and called Dr. Jason Ross, a senior radiology resident, to review the case. Ross suspected cancer. “I saw what was going on and it concerned me,” he said. “As a radiologist, I generally want bad news to come from someone who the patient knows—I don’t want to scare the patient. It’s better to have the primary care physician, the one who the patient has a relationship with, deliver news. They can do it better than I can.” While reviewing the patient’s records, Ross noticed that Slovak did not have a primary care physician, and the NP from her original appointment was out of town, so he reached out to the clinic’s internal medicine physician for help. After assessing the situation over the phone, the physician asked Ross if he would be willing to talk to Slovak. “It’s not something in my wheelhouse—not something I do every day—but she was a patient under my care. I was going to try to help, even if I was a little uncomfortable,” explained Ross. “For her peace of mind and continuity of care, I needed a CT scan to be performed that same day. As a radiologist, I don’t
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Slovak reflected on her experience that day. “I just had a feeling that there was something going on. I didn’t rule out cancer or think about cancer necessarily, but I was very grateful that I was going to get an answer that day.” After the CT scan results were in, Ross met with Slovak and her husband and confirmed the mass was pancreatic cancer. By Monday, Slovak delivered the news to her children and was admitted to the hospital. She could finally receive something to ease the pain. When asked if she would have preferred to hear her diagnosis from a primary care doctor, Slovak said, “Oh no. Dr. Ross saw the results first-hand. No other doctor knew as much about me as he knew, at the time. He did it very well. If it wasn’t for him, everything else would have been delayed and I would still be miserable.” Ross shared the lessons he learned from this experience and what he hopes will help other specialists who may someday find themselves in a situation: “I sometimes feel like I didn’t do enough and I wish that I could do more. But what I hope other radiologists or specialists who don’t typically have direct relationships with patients will learn from this is, if a patient doesn’t have someone else, even if we’re uncomfortable, we can make a difference.” For Irene Slovak and her husband, it was their radiologist and his dedication to compassionate and exceptional care who changed everything. n This story was originally featured in the Winter 2018 Academic Enterprise magazine. To see the entire issue, visit https://utmb.us/2fw.
Dr. Jason Ross, a senior radiology resident, stands in front of a CT machine.
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RESEARCH
BY CHRISTOPHER SMITH GONZALEZ
A parent who spanks a child may be teaching them the wrong lesson. A new study by UTMB researchers found a link between children who experience corporal punishment and those who later perpetrate acts of dating violence. The study is published in The Journal of Pediatrics. “We wanted to determine if there is a link between childhood experiences with corporal punishment such as spanking, and later perpetration of dating violence,” said Dr. Jeff Temple, director of Behavioral Health and Research in UTMB’s Department of Obstetrics and Gynecology and senior author of the study. “While parents may think this form of physical punishment is a good lesson, substantial research indicates that it does way more harm than good. The current study adds to this knowledge by showing that being physically punished as a child is linked to perpetrating dating violence
RES EARC H B R I E F S
For this study, UTMB researchers questioned young adults in their late teens and early 20s who have been part of ongoing longitudinal study since they were in high school. The participants were asked about childhood experiences with corporal punishment and physical abuse, as well as current experiences with dating violence. There were more than 700 participants in the study from southeast Texas and about 19 percent reported having perpetrated some sort of dating violence. About 69 percent of the participants experienced corporal punishment as children. Analysis of the study results showed a significant
Compiled from press releases written by Donna Ramirez. Find out more at www.utmb.edu/newsroom.
Scientists at UTMB have discovered a promising developing drug that has been shown to selectively shrink excess fat by increasing fat cell metabolism. The drug significantly reduces body weight and blood cholesterol levels without lowering food intake in obese mice. “As fat cells grow larger, they begin to overexpress a protein that acts as a metabolic brake that slows down fat cell metabolism, making it harder for these cells to burn accumulating fat,” said senior author Dr. Stanley Watowich, associate professor in the Department of Biochemistry and Molecular Biology. “In addition, as the fat tissue expands, it secretes higher levels of hormones and pro-inflammatory signals that are responsible for several chronic diseases, including type 2 diabetes and cardiovascular disease.” The researchers discovered a molecule that blocks this metabolic brake from operating in obese white fat cells in order to increase its metabolism. In the study, mice were fed a high-fat diet until they became obese and then received either the drug or a placebo. Following 10 days of drug treatment, researchers found that the 6
as a teen and young adult. While we can’t say that spanking causes later violence, it follows that if a kid learns that physical punishment is a way to solve conflict, he or she may carry that over into conflicts with later intimate partners.”
obese mice receiving the actual drug lost more than 7 percent of their total body weight, and their white fat tissue mass and cell size decreased by 30 percent compared with the placebo group. In addition, blood cholesterol in drug-treated mice was lowered to levels similar to that of non-obese mice. Placebo-treated mice continued to accumulate white fat and gain weight throughout the study. Interestingly, mice in both the drug-treated and placebo groups consumed the same amount of food during the course of the study period, showing that the fat loss was not due to appetite suppression. The findings have been published in Biochemical Pharmacology.
The most effective way of preventing the flu is to be vaccinated each autumn. Unfortunately, there are many different flu viruses circulating around the world and which ones circulate changes over time. Each year, pharmaceutical companies produce vaccines against the flu viruses predicted to be dominant during the upcoming flu season. How well the vaccine works varies from year to year because of how much the circulating flu viruses evolve between the time the vaccine is produced and the beginning of flu season. For this reason, in most years, the flu vaccine is 50 to 70 percent effective. During the Australian 2017 flu season, the flu vaccine was only 10 percent effective because of the emergence of variant H3N2 flu that was “vaccine resistant.” Scientists from UTMB and Biomed Protection published this prediction almost two years in advance, demonstrating that the prediction of flu vaccine efficacy may be
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RESEARCH
positive association between corporal punishment and physical dating violence perpetration, even after controlling for several demographic variables and childhood physical abuse, according to the study authors. “Although mounting evidence shows the many detrimental effects of corporal punishment, many parents, much of the general public, and even some schools continue thinking this is an acceptable means to punish misbehavior,” Temple said. Global estimates suggest that about 80 percent of children worldwide are physically punished. Research, though, has found links between corporal punishment and childhood aggression and mental health problems, among other issues. While many factors can contribute to dating violence, including mental health, attitudes toward women, beliefs about violence, problem solving skills, availability of weapons, and substance use, Temple and the other study authors argue that corporal punishment should be considered as a potential risk factor of violence within romantic relationships.
“While we can’t say that spanking causes later violence, it follows that if a kid learns that physical punishment is a way to solve conflict, he or she may carry that over into conflicts with later intimate partners.”
– Dr. Jeff Temple
possible. In a new paper published in F1000 Research, scientists used the same bioinformatics platform to determine how well the current seasonal flu vaccine might protect against H3N2 flu viruses isolated in the U.S and Australia between July and September 2017. The results suggest that the current flu vaccine will work better during the 2018 U.S. flu season than the 2017 Australian flu season. In Australia, there were two groups of H3N2 viruses circulating, and the vaccine was projected to protect against the minority of viruses but not the majority viruses. In the U.S., the vaccine is projected to be effective against the majority of H3N2 flu viruses so far. “Nevertheless, this situation could change if any of the viruses from the minority group, which is not covered by the vaccine, were to become dominant,” said Dr. Slobodan Paessler, UTMB professor in the Department of Pathology. “For this reason, it’s very important that we closely monitor the evolution of the H3N2 flu viruses throughout the 2018 U.S. flu season.” Recently, lack of effectiveness in the flu vaccine has been linked to a specific mutation generated during the vaccine production process. The scientists analyzed the effect of the mutation and found that it is shifting the vaccine virus from the majority group to the minority group, potentially decreasing the vaccine’s effectiveness.
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“Common sense and scientific research both tell us that children learn from their parents,” Temple said. “Parents are a child’s first look at relationships and how conflicts are handled. Corporal punishment is communicating to children that violence is an acceptable means of changing behavior. Not only is this an ineffective strategy for changing behavior or resolving conflict, our study and other research show that physical punishment negatively impacts the short and long-term health and behavior of children.” Other authors of the study include Dr. Hye Jeong Choi, Department of Health Sciences, University of Missouri; Dr. Tyson Reuter, Psychology Houston, PC, The Center for Cognitive Behavioral Treatment; Dr. David Wolfe, Faculty of Education, Western University; Dr. Sheri Madigan, University of Calgary and Alberta Children’s Hospital Research Institute; and UTMB’s Lauren Scott, Behavioral Health and Research, Department of Obstetrics and Gynecology. n
DID YOU KNOW? Throughout UTMB’s history, UTMB’s researchers have pioneered life-saving discoveries that continue to improve the health of people around the world. Now more than ever, our researchers’ work is being recognized, from engineering the world’s first Zika virus infectious clone to growing the first human lungs in the laboratory. The funding UTMB is garnering for its research initiatives is reflective of this success. Total research funding in FY2017 was $131,998,593, an increase of $7.4 million from FY2016. Sources of research funding include $92 million from the National Institutes of Health (NIH), as well as $8.2 million from the Department of Defense. UTMB also receives research awards from NASA, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration and other federal agencies, as well as local and private organizations.
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BY KIRSTIANN CLIFFORD
UTMB Stroke Coordinator Brenda Yanez lives and breathes the mantra “Time is brain.” “Every minute counts after a person has a stroke,” she says. “About two million brain cells die each minute during a stroke, so knowing the symptoms and getting help quickly is key to reducing or even reversing the effects.” Stroke—which occurs when a vessel in the brain ruptures or is blocked by a blood clot—is a leading cause of death and long-term disability in the U.S. For the past three years, Yanez has been on a mission to change that. As stroke coordinator for all UTMB campuses, she is leading the charge to continuously improve stroke services and spread awareness about the risk factors and signs of stroke to medical staff, emergency medical services personnel, patients and families.
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I meet up with Yanez on a Thursday morning,
as she heads to daily interdisciplinary rounds on the neurology and neuro critical care units in Jennie Sealy Hospital on the Galveston Campus. At any one time, Yanez tracks about 10 to 15 stroke patients across the hospital. The rounds serve as an opportunity for collaboration among all care providers, including nursing staff, care managers, dieticians, pharmacists, residents, physical therapists and others. “We discuss each stroke patient and their plans for treatment, discharge and rehabilitation,” says Yanez, who previously worked as a nurse in the Galveston Campus Emergency Department. “UTMB has been certified as a Primary Stroke Program by The Joint Commission since 2013. We are currently working toward Comprehensive certification because we can handle the most complex stroke cases—including going into the brain and mechanically extracting blood clots. It’s exciting because most places can’t do that.” Yanez listens as the care team discusses stroke patients of all ages—including one man in his 30s who has a hole in his heart, which likely was a contributing factor. “There’s a misconception that only the elderly can have strokes, but it can happen to anyone,” she says. “A clot from somewhere in this patient’s body may have traveled through the hole in his heart and blocked an artery in the brain. We will be consulting with cardiology to see if there are treatment options to close the hole and help prevent future strokes.”
“tPA needs to be administered within four-and-a-half hours of the onset of stroke symptoms,” she says. “When I saw her yesterday, she couldn’t move one whole side of her body, but today, you can As the meeting ends, Dr. Adham Kamel, stroke medical direc- see huge improvement. It’s amazing—she can move both sides tor and assistant professor in the Department of Neurology, of her body and is already getting back to normal. tPA can be arrives with a team of residents. Yanez accompanies Kamel as life-changing and live-saving when patients get to the ER quickly.” he makes his rounds, checking in with each patient and their Yanez does some coordination exercises with the woman, asking family to make sure each they understand the plan of care. her to touch her pointer fingers together and then touch her nose. The patient has a hard time at first, but repeats the exercise until Yanez is happy to see how well one woman is doing the day she can do it almost perfectly. after having a stroke. Luckily, the woman was brought in to the hospital quickly after symptoms of slurred speech and dizziness began. The stroke team was able to give the patient tPA, an intravenous drug that dissolves clots.
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“Don’t get frustrated with yourself, you are doing very well,” Yanez says encouragingly. “Now it’s time to get up and start moving. Physical therapy is going to come by today and get you out of the bed and into the chair. If you don’t use it, you’ll lose it!”
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She reassures the patient and her husband
that she will be back later to check on them. In the meantime, Yanez and Kamel visit another patient who had a transient ischemic attack, or TIA. Known as a “mini-stroke,” it is a temporary blockage of blood flow to the brain and can indicate the likelihood of a coming stroke. Yanez takes the opportunity to educate the patient about stroke symptoms such as face drooping, arm weakness and speech difficulty. She also stresses the importance of calling 911 immediately, as the patient waited several hours before calling his daughter for help.
having a stroke when they come through the door, they may be hypertensive and diabetic—that combination dramatically increases their risk for stroke.” In addition to teaching during nursing orientation, Yanez is proud to offer eight-hour-long advanced stroke life support classes to nurses across UTMB. So far, she has helped train about 200 nurses and is recruiting “stroke champions” to continue spreading awareness in their units. By the afternoon, Yanez gets ready to head back to her office to analyze stroke readmission data and make follow-up calls to patients who were recently discharged. But before she gets there, her cell phone beeps, signaling a “stroke activation,” which is called when a patient is identified as having stroke symptoms that began within the last six hours.
“The most important thing is making sure you come straight to the ER next time because the longer you wait, the more irreversible damage is done,” she tells the patient. “And once you have one stroke, you are at a higher risk of having another one. If you were having chest pain, you would call 911 right away, right?” The patient nods. “I know you worry about your heart, but your brain is important, too—it makes your heart function.” Patients seem to appreciate Yanez’s kind but straightforward demeanor. She speaks from the heart, as her own mother suffered a stroke less than a year ago. Fortunately, her mother was able to get tPA at UTMB and has made a full recovery, but Yanez knows not everyone has a positive outcome.
“A lot of times, people get symptoms in the evening and try to sleep it off or they’ll wait and try to set up an appointment with their primary care provider. But, by the morning, it’s too late.”
“The biggest challenge is public awareness,” she says. “How do we get people to recognize when they are having a stroke and call 911? Or how can they prevent a stroke in the first place by making lifestyle changes such as quitting smoking or lowering blood pressure? A lot of times, people get symptoms in the evening and try to sleep it off or they’ll wait and try to set up an appointment with their primary care provider. But, by the morning, it’s too late.”
Yanez’s passion for educating patients and health care staff shows in everything she does. In fact, if she hadn’t become a nurse, she wanted to be a teacher. Now she gets the best of both worlds. After finishing up rounds with Kamel, she heads to the Rebecca Sealy building to teach new nursing hires about UTMB’s stroke program. She spends about 20 minutes during their orientation going over stroke risk factors, stopping to answer questions and offering herself as a resource in the future.
A patient has just arrived to the ED with facial paralysis and blurred vision, so Yanez immediately heads over to try and help the ED nurses, physicians and residents. When she gets there, the patient has already been wheeled to radiology for a head CT scan. If the scan comes back clear of any bleeding, the patient may be eligible to move forward with tPA or intra-arterial treatment, which removes blood clots by advancing a catheter through an artery in the groin, up to the site of the clot.
“It is a symphony of people—from EMS to the ED nurses and doctors, neurologists, CT and lab personnel—working together as a team to diagnose and start treating stroke patients quickly,” says Yanez, adding that UTMB provides care for more than 400 stroke patients a year. “Our record time for giving tPA is 18 minutes from the patient arriving in the ED to the needle puncture, and that’s amazing. Our goal is to always administer tPA in less than 60 minutes, and we continue to improve our numbers—our average is 40 minutes.”
I say goodbye to Yanez as she huddles with the ED staff to talk about next steps for the patient. After working in the ED for several years before becoming stroke coordinator, she feels right at home. The fast pace and time pressure are just par for the course.
“I love what I do—both the interaction with patients and caregivers,” she says. “We’re always working against the clock, but being part of a team that touches so many lives and provides “I encourage you to educate your patients on risk factors and positive outcomes keeps me energized.” n stroke prevention,” she tells the class. “Even if your patient isn’t
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LEADER SPOTLIGHT
Christine Wade director of patient care services and assistant chief nursing officer Christine Wade joined UTMB in 2012 and has spent the majority of her career managing high-volume trauma centers. In addition to support services, she oversees two emergency departments (Galveston and League City campuses), including a level 1 trauma center, level 1 burn center, two medical-surgical units, nursing house supervisors and the designated emerging infectious disease biocontainment unit and program—which she spearheaded. She also recently served as interim vice president of hospital operations while the Health System completed a national search.
Christine Wade with her husband, David, and children, Jack and Sydney, on vacation in New York City. We recently celebrated UTMB’s tremendous success with Best Care. What are your thoughts on how UTMB can maintain its five-star performance?
rooms—I like the frenetic pace and always working through different challenging situations. I finally gave up saying I have “seen it all” years ago—because honestly, I see something new every week and still get surprised.
We need to continue supporting our staff and give them the tools they need to continue providing top-notch care to our patients. Our staff is the heart and soul of UTMB and they are our most valuable asset.
How do you stay calm and level-headed in the Emergency Department work environment?
You oversee UTMB’s Trauma Center in Galveston, which sees more than 45,000 patients annually. What do you find to be the most difficult and rewarding parts of your job? Running a level 1 trauma center, we see patients and visitors during some of the worst events of their lives—the majority of them totally unexpected. While the staff is trained to handle these types of situations, you never get used to it. However, caring for patients and their families is certainly rewarding. I also get great satisfaction as I see my staff grow, return to school and progress in their own careers. One of the most important job responsibilities I have is to mentor my staff—at times providing little nudges and encouragement to help them reach their full potential.
What is the largest misconception you think patients have about coming to the ER? That you are going to have to wait. That you are going to be there all day. At the UTMB Galveston ED, we pride ourselves on an empty lobby—that’s because no one returns to the lobby once you check into the ED. We have an average of six minutes from when the patient arrives to when they are in the treatment area. This is one of the lowest times in the country. Not too long ago, we ranked No. 3 for ED throughput when compared to other academic medical centers. We will keep working until we reach No. 1.
What inspired you to go into trauma medicine? I am a third-generation nurse. My mother and both of my grandmothers were nurses. Most of my aunts are nurses, as well. I was raised to believe that nurses are amazing. As a family, we never really all sat at a holiday dinner at one time because people were always coming and going from various shifts at the hospital. I have always been drawn to the controlled but chaotic nature of emergency 12
Wade holds a master’s degree in nursing from Columbia University in New York and is considered an expert in the field of emergency nursing. She is actively involved in extensive domestic and international health care volunteerism and emergency relief. Most recently, she became involved with the American Heart Association, serving as co-chair for the Bay Area and Galveston region annual fundraising events.
A true emergency room nurse becomes calmer as things get more hectic. We Cedillo with his wife,and Ninfa, National Park in Tennessee. are José trained to handle a crisis notattoGreat panic.Smoky We liveMountains for the messy, crazy, loud, chaotic day.
You’ve gone on multiple medical missions. How have these trips impacted you as an employee and as a person? I have traveled all over the world from China to Haiti doing volunteer medical missions and emergency relief. If I ever win the lottery, that is what I would do full-time. It has made me grateful to live in the United States, where we not only have the most basic of resources such as clean water, food and sanitation, but also access to the best medical care in the world. When I’m on a mission trip, patients and their families are so grateful you are there to help them.
What’s the best advice anyone’s ever given you? Career-wise, the best advice a past mentor ever gave me was, “Make it easy for the staff to do the right thing.”
Where are you most likely to be found outside of work? Outside of work, I am with my family, who are my top priority always. I love to golf, read, watch the Philadelphia Eagles (go Birds!), and recently, as a family, we began volunteering at our local animal shelter. I also live to travel. Traveling and seeing the world outside our own community is a true educational experience. My husband and I have dragged our two kids from Thailand to Italy to the jungle of Panama. One of my greatest travel accomplishments was traveling to Tanzania, Africa and summiting Mount Kilimanjaro with my husband. At over 19,300 feet and one of the seven summits (the highest mountains of the world’s seven continents), it was one of the most difficult things I have ever done. The feeling after reaching the summit was so rewarding, I began to think “What else can I accomplish?” n
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impact
CLINIC NEWS
We are open! Texas City and RMCHP Dickinson clinics reopen to patients following Hurricane Harvey
Texas City Primary and Specialty Care Clinic The Texas City Primary and Specialty Care Clinic and the Dickinson Regional Maternal and Child Health Program (RMCHP) clinics are happy to be back doing what they do best—serving patients and the community. As two of UTMB’s most impacted clinics in the wake of Hurricane Harvey, they have officially reopened to patients following several months of repairs. Walking through the renovated Texas City clinic, it’s hard to believe it had taken on nine inches of water during Harvey, damaging all of the Sheetrock, technological infrastructure, flooring, furniture and equipment. The Dickinson RMCHP clinic took
Employees of the Dickinson RMCHP pose in a patient room after reopening on Jan. 16. impact
JANUARY 2018
on two feet of water during the August hurricane and was inaccessible for four days following the storm. All millwork, plumbing, electrical, flooring, furniture and equipment were damaged and four feet of Sheetrock was removed from all of the walls. Thanks to a great deal of hard work on behalf of Business Operations and Facilities, Information Services, providers, staff and contractors, as of Dec. 4, all clinics within the 31,000 Texas City Primary and Specialty Care Clinic square-foot Texas City location before (top photo) and after repairs (bottom) had resumed normal operations except Urgent Care, which reopened on Jan. 2, and Audiology and Speech Pathology, which is planned to reopen in February. The Dickinson RMCHP officially reopened to patients on Jan. 16. “It feels great to be back home,” said LaQueisha Hamilton, who has worked as a nurse practitioner at the RMCHP in Dickinson for the past two years. “The clinic looks better than ever—we have all new paint, new equipment and we have reconfigured some of the rooms, so the change is a positive thing. I know our patients will be happy to return to the clinic, as well.” n
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VALUES
UTMB honors three with annual MLK service awards BY SHANNON PORTER
Three UTMB employees were honored as Dr. Martin Luther King Jr. Community Service Award recipients at the annual luncheon in January on the Galveston Campus.
recipients are fixtures in both the university and in their communities.
This year’s recipients, who were selected by the UTMB Diversity Council, included Lorraine Hunter-Simpson, an office manager with Pediatrics Administration; Dr. Jeff Temple, director of Behavioral Health and Research and professor in UTMB’s Department of Obstetrics and Gynecology; and Dr. Oluwarotimi Folorunso, a postdoctoral fellow in the Department of Pharmacology and Toxicology. The award honors and recognizes the contributions of UTMB faculty, students and staff who promote diversity, inclusion, community partnership, philanthropy and civic engagement. It is presented annually to individuals who carry out King’s dream and have made a profound difference through dedication and service to UTMB and the greater community. Douglas Matthews, assistant vice president of government relations at UTMB, delivered the keynote address. The first African-American city manager in Texas when he was promoted to that post in Galveston in 1985, Matthews recalled growing up in the island city during the 1950s and ’60s. As a teenager, he helped lead the integration of the city’s two high schools—Ball High and Central High School. “Teachers at Central High taught us to always strive for academic excellence because you may not be able to control the prejudice of others; however, you can control your response. And a good education was one of the few things that could set a person free,” he said. UTMB President David Callender congratulated the award winners and encouraged attendees to continue King’s unfinished work. “We at UTMB find strength in our diversity,” Callender said. “It nurtures our sense of compassion and enables us to fulfill our mission to improve health for the people of Texas and beyond.” Imelda Wicks, consultant with UTMB’s Office of Diversity and Inclusion, read excerpts from the nomination submissions, describing how the three award
UTMB President Dr. David Callender stands with the keynote speaker, Douglas Matthews, assistant vice president of government relations at UTMB.
Among her achievements, Hunter-Simpson serves Galveston County with her philanthropic work conducted through the Leah Simone Simpson Scholarship Memorial Foundation, named in honor of her late daughter. Through the foundation, Hunter Simpson provides scholarships to assist transitioning high school students with college expenses.
In addition to serving on several regional, state and national boards, Temple’s groundbreaking research has engaged community action and service. Most notably, he founded a schoolbased program that teaches adolescents healthy relationship skills based on some of the same principles Dr. King believed in, said Wicks.
Folorunso, a two-time recipient of the Dr. Martin Luther King Jr. Community Service Award, is known for excellence as a scientist and mentor. He is involved with the Graduate School of Biomedical Sciences, where he works to further the success of minorities. He was key in developing and teaching a new course for undergraduate students in the Joint Admission Medical Program, which supports minority students pursuing careers in medicine. Dr. Charles Mouton, vice dean of academic affairs in the School of Medicine, closed the annual event by challenging attendees to think like Dr. Martin Luther King Jr. “I think we should take great pride at this institution, setting forth a call, a mission, of doing what I consider to be one of the most noble professions—administering health care to those who need it the most,” Mouton said. “That’s something we should all be truly proud of.” n
UTMB President Dr. David Callender and Imelda Wicks, consultant with UTMB’s Office of Diversity and Inclusion, stand with the winners of the annual Dr. Martin Luther King Jr. Community Service Awards. Recipients rom left to right: Dr. Oluwarotimi Dolorunso, Dr. Jeff Temple and Lorraine Hunter-Simpson.
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JANUARY 2018
impact
EDUCATION
Learn together, work as a team Nursing and medical students collaborate during interprofessional Clinical Skills Experience BY SHELLEY SMITH
Preparing students for clinical rotations provided an ideal opportunity for interprofessional practice at the Clinical Skills Experience held recently in UTMB’s Interprofessional Nursing Simulation Center. Nursing students served as instructors and coaches for medical students gaining skills for basic procedures and learning to manage high-acuity situations.
Nursing students in their final semester at UTMB who are enrolled in the Clinical Capstone course volunteered to help the medical students with their clinical skills. According to course director Dr. Rebeka Watson Campbell, the nursing students were well-versed in the procedures and able to put their skills into action as they collaborated in small groups. They demonstrated the procedure and provided coaching while medical students practiced on simulated patients.
“It is a natural fit to bring these two professions together to learn with each other,” said Dr. Rachel Kilgore, director of the Interprofessional Nursing Simulation “The saying is true: ‘Learn one, do one, teach one,’” she said. “The students Center and coordinator of the event. “We provided a low-risk environment so learn the most when they teach others.” that these professions could practice together in preparation to work in teams According to Watson Campbell, the key to interprofessional activities is to make in the real world.” the event interactive, meaningful and realistic. Faculty members from the School The course is required for medical students preparing for clinical rotations in of Nursing provided instruction and oversight for skills clinicals and simulations. their third and fourth years. Students in both schools gained mutual respect as their knowledge of each other’s roles and understanding of professional contributions to health care “Students learn basic procedures such as peripheral intravenous catheter inserincreased. The clinical lab experience is an example of activities that will be tion, venous blood draw, nasogastric tube insertion, urethral catheterization, hand incorporated in UTMB’s new Quality Enhancement Plan, IPE2Practice, designed hygiene and point-of-care testing,” said Dr. Bill Boudreaux, medical educator to enrich the interprofessional culture at UTMB. n for the School of Medicine.
impact
JANUARY 2018
15
Top tips for weathering flu season By Dr. Megan Berman, associate professor, Department of Internal Medicine The 2018 flu season is shaping up to be a nasty one, as a severe strain of the flu—H3N2—has spread to most U.S. states, including Texas. According to the Centers for Disease Control and Prevention, by the end of the first week in January, the entire continental U.S. reported widespread flu activity. Although this year’s flu season is off to a fast start with many people showing the tell-tale signs of having the flu; such as fever and/or chills, cough, sore throat, congestion, body aches, headaches and fatigue; there’s still time to take action. The following tips can help you and your family stay healthy: • Get vaccinated. It’s not too late! Flu season can last into the spring months and vaccination is the most effective way to prevent flu. You may have heard that the flu vaccine is not very effective this year; however, when you get vaccinated, your body produces antibodies that protect against three or four different strains of flu viruses. So, even if the vaccine is less effective against one strain, you are still getting protection from the other variations. In addition, if you do come down with the flu, the illness is usually less severe if you’ve had your flu vaccine. • Wash, rinse, repeat. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub. • Keep your hands away from your face. Avoid touching your eyes, nose and mouth. Germs spread this way. If you blow your nose, wash your hands afterward.
• Steer clear when you can. If you have a sick family member at home, don’t share food or drinks, cups, utensils, towels, pillows or bedding. Clean and disinfect surfaces and objects that may be contaminated. • Pamper your immune system. Keep eating a healthy diet, stay hydrated and make sure you get plenty of rest. Daily exercise also helps. • Mind your flu manners. Don’t try to stick it out at work if you aren’t feeling well. Stay home when you are sick and prevent spreading your illness to others. The rule of thumb is to stay home for at least 24 hours after you are fever free. • Take antivirals if your doctor prescribes them. If you get the flu, antiviral drugs may help make the illness milder and shorten the time you are sick. They may also prevent serious flu complications. Studies show that antiviral drugs for the flu work best when they are started within two days of getting sick, but starting them later may still be helpful. Follow your doctor’s advice for your situation. If you are a UTMB employee or dependent and need to see a primary care provider about your symptoms, call the Access 2-Care line at 409-7722273 to set up a same-day or next-day appointment. For more information on flu prevention, symptoms and treatment, visit the CDC website at www.cdc.gov/flu/index.htm.
UTMB TRIVIA This individual became the first AfricanAmerican student to graduate from medical school at UTMB—and in the state of Texas—in 1953. He continued his residency at UTMB in general surgery before leading a distinguished career as a surgeon and anesthesiologist in the Houston area. In 1968 he became the first black member of the Texas State Board of Medical Examiners and was named the first black president of the Houston Independent School District Board of Education in 1973. Prior to attending UTMB, this individual was a fighter pilot in World War II and a member of the Tuskegee Airmen. He died in a plane crash in 1973 at the age of 47. Can you name this individual? Send your answer to impact.newsletter@ utmb.edu and be entered into a drawing to win a UTMB swag bag. We’ll post the correct answer and the name of one lucky winner in the next issue of Impact. Good luck!