March 2019 by UTMB Health

UTMB NEWSLETTER â&#x20AC;˘ MARCH 2019

Supporting the job of living: Day in the Life of an occupational therapist

Correctional Managed Careâ&#x20AC;&#x2122;s contributions to Best Care Interprofessional education is focus of Warren event Dancing is a hidden talent for secondyear resident

School of Medicine students present an illustration of “Old Red” to State Rep. Mayes Middleton, R-Wallisville. UTMB students visited the Texas Legislature in early March as part of the Texas Medical Association’s First Tuesdays at the Capitol event. According to the TMA, the March 5 event gave physicians in training a chance to meet with legislators to discuss issues related to medicine and the future of practicing in the state.

Dr. Laura Rudkin, professor and chair in the Department of Preventive Medicine and Community Health, has been elected president of The University of Texas System Kenneth I. Shine Academy of Health Science Education. The academy is both a service organization and honorific body that recognizes and utilizes faculty excellence to serve UT System in all aspects of health science education, educational scholarship and leadership. Rudkin, who has been a member of the Shine Academy since 2013, will serve a one-year term. Dr. Gayle Olson, professor in the Department of Obstetrics and Gynecology, is president-elect and will serve as president following Rudkin’s term.

Congratulations to Dr. Kevin Merkley, who has been appointed chair of UTMB’s Department of Ophthalmology and Visual Sciences. Merkley assumed the role as interim chair in March 2015 and is the inaugural holder of the Theisinger Distinguished Chair in Ophthalmology. He has more than 20 years of management experience in the private sector, currently serves as medical director for the Joffe MediCenter in Houston and has also served as director for our Ophthalmology Residency

Program. He is a fellow of the American Academy of Ophthalmology and a member of the American Society of Cataract and Refractive Surgery and Association of University Professors of Ophthalmology. He assumed the permanent role immediately.

Congratulations to the UTMB School of Medicine’s Educational Affairs Department for capturing first-place honors in the Houston Livestock Show & Rodeo’s Go Texan Day contest, which recognized the department for its chili cook-off event. The Go Texan Day Contest encourages organizations to host events that promote and celebrate the rodeo and Texas culture. Ashley Shriver, second from left, and Alma Block, second from right, with UTMB School of Medicine’s Educational Affairs Department receive the Houston Livestock Show & Rodeo bowlegged “H” trophy.

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From the President Welcome to the March 2019 issue of Impact. M A RC H 2 0 19

With the arrival of spring comes a time of tremendous activity for UTMB—opening a new hospital, moving some of our clinics to improve access and continuing expansion and renovation work in League City and Galveston. Please stay tuned in this and future issues of Impact to learn more about these projects, which are so important for the longterm success of our mission.

Best Care part of Correctional Managed Care’s culture

I hope you had a chance to access the 2019 Mondays in March presentations, either in person or online. If you haven’t—or if you want to refresh what you heard—I encourage you to view the video of each session. We did something a little different this year in hosting a series of panel discussions among UTMB experts on our growth, the changing health care landscape, our academic foundation and a look ahead with senior executives. The videos are available at www.utmb.edu/mondays-in-march. Also, we want to know what you think about this year’s format and how we can make Mondays in March even better next year. Please send your feedback via the web form at www.utmb.edu/mondaysin-march/feedback.

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New insights for triggers of pre-term birth

In the meantime, this issue features:

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• A Day in the Life of Diane Ugartechea, an occupational therapist who serves inpatients and outpatients at our League City Campus; • Best Care in Action in our Correctional Managed Care program; • UTMB scientists who’ve gained new insights into what triggers pre-term birth; • How the “What’s Wrong with Warren” interactive case study promotes interprofessional education; • Latin dance as a hidden talent; • CMC trivia question; and • Numerous other accomplishments and kudos.

Day in the Life of an occupational therapist Page 6

Please keep making the effort to stay informed about UTMB’s plan and progress, and keep up the great work you’ve been doing to improve health. As always, send your story ideas to the Impact team for consideration. Thank you! Health Tips: When to choose an urgent care clinic vs. an ER

Dr. David L. Callender UTMB President

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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!

Vice President Marketing & Communications Steve Campbell

ON THE COVER:

Editors Stephen Hadley Shannon Porter Jessica Wyble

Diane Ugartechea, an inpatient and outpatient occupational therapist at UTMB’s League City Campus, says she supports the job of living for her patients.

P R I N T E D B Y U T MB G RAPHIC D ESIG N & PRIN TIN G SERVICES

Associate Vice President Marketing & Communications Mary Havard

Art Director Mark Navarro

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

B E S T C A R E I N AC T IO N

Best Care part of culture within CMC BY STEPHEN HADLEY

FOR FAVOUR ONWUKWE, HER COMMITMENT TO WORKING AS A NURSE at Hospital Galveston for more than 14 years comes down to the connection she has with her patients. “When you work in the Texas Department of Criminal Justice, you become a part of your patient’s family,” said Onwukwe, a nurse clinician IV in the Hospital Galveston Telemetry Unit. “You see them when they are healthy and you may be the last person to hold their hands on their last day. To us, our patients aren’t offenders. When you have that in the back of your mind, you are going to give them the best care that you can.” Onwukwe’s attitude toward caring for her patients is emblematic of the way UTMB’s Correctional Managed Care’s health care professionals overall approach every aspect of their roles, said Dr. Olugbenga Ojo, chief medical officer and chief physician executive for TDCJ’s hospitals and clinics at UTMB. Ojo, who highlighted CMC’s numerous contributions to delivering exemplary care as part of his Best Care Lunch & Learn presentation on March 8, said UTMB provides constitutionally mandated levels of care to more than two-thirds of the state’s incarcerated offenders.

Favour Onwukwe poses with her co-workers in UTMB Correctional Managed Care’s Hospital Galveston. From left, Jennifer Bloys, Briana Moore, Claudia Thomas, Jeffery Harper, Onwukwe, Oyebamiji Adebayo, Solomon Teshome, Cleo Glover, Penny Priestley, Bryan Hicks, Angel Male, Nichelle Franklin and Kiki Baldwin. for everything from admission through discharge,” “It has a taken a lot of teamwork, education, buy-in he said. “But it only pays a fixed cost, regardless of and engagement with everyone involved to make how much we incur in providing that care.” this happen,” he said.

“There are 145,000 patients incarcerated in the state of Texas and UTMB takes care of 120,000 of those patients,” Ojo said, adding that Texas Tech is contracted by TDCJ to handle the remaining 25,000 patients. “Everything that happens to our patients is statutorily mandated, meaning they must have access. In fact, inmates are the only Americans who are guaranteed access to health care in this country today. So, it behooves us to give them high-quality care while keeping costs down.”

Ojo said the change in reimbursement methodology Dr. Owen Murray, vice president for UTMB Offender caused UTMB-CMC to examine operations at Hos- Care Services, said inmate care in Texas is a model pital Galveston, most notably by focusing on quality that other states are working to emulate. of care related to six areas of emphasis: hospital “UTMB providing this level of care works in the state’s acquired conditions/patient safety indicators (HAC/ best interests,” Murray said. “Good care and good PSI); mortality, patient experience, length of stay outcomes lead to better costs, and we should be and 30-day readmissions. able to document a value proposition to the state, By focusing on Progression of Care Rounds (POCR) both clinically and fiscally. We’ve had a long history to address avoidable patient days, as well as adding of care here. We have 3,000 employees taking care infirmary beds, conducting length-of-stay meetings of these patients 24/7 out in our facilities, and they More than 3,300 CMC staff handle nearly 10 million twice a week and implementing Patient-Centered do a very good job under difficult circumstances.” medical, dental and mental health patient encoun- Resource Optimization Program (PROP) initiatives Onwukwe, the nurse in a Hospital Galveston facility ters at prison units scattered all across the state for patients with HIV and cirrhosis, UTMB-CMC was known as 7A, is one of those. of Texas and at Hospital Galveston on UTMB’s Gal- able to significantly trim length of stay at Hospital “Doing this job, it has to be a calling,” she said. “As veston Campus, the only maximum-security prison Galveston. nurses, we are taught to be compassionate so when hospital on the campus of a major U.S. academic “At the end of FY18, our average length of stay I’m coming to work, I’m not coming to take care of medical center. dropped to 6.94, a 17 percent decrease,” Ojo said. offenders. I’m coming to take care of my patients.” n In 2017, the state changed the way it reimburses “That’s unheard of, but it came about by focusing To watch Dr. Ojo’s or any of the other UTMB-CMC for the care it provides to patients, from on the right issues.” Best Care Lunch & Learn presentations, visit a cost-based approach to a diagnosis-related group UTMB-CMC took the same analytical approach with http://intranet.utmb.edu/best-care/bestor DRG, Ojo said. the other quality metrics, and each area showed care-lunch-learns-2019. “DRG is a payment classification system that pays improvement throughout the fiscal year, Ojo said.

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RESEARCH

BY DONNA RAMIREZ

SCIENTISTS HAVE GAINED NEW INSIGHT on a poorly understood key player in the timing of labor and delivery, bringing researchers closer to being able to prevent pre-term births.

this type of signaling does during pregnancy, we investigated the role of paracrine signals called exosomes in the timing of labor and delivery.”

According to the World Health Organization, an estimated 15 million infants are born too early each year. Complications from pre-term birth are the leading cause of death among children under five years old and are responsible for about a million deaths each year globally. In the U.S., approximately one out of every 10 infants was born prematurely in 2017.

The researchers collected blood plasma samples from pregnant mice and isolated the exosomes. Exosomes collected during either early or late pregnancy were injected into a separate group of pregnant mice during the human equivalent of the beginning of the third trimester.

Dr. Ramkumar Menon, UTMB associate professor in the Department of Obstetrics and Gynecology, said that when a woman is at the end of her pregnancy, the normal childbirth process begins when the fetus releases chemicals signaling that his or her organs have matured enough for delivery. This chemical release shifts the mother’s hormone levels, which increases inflammation in the uterus and begins labor and delivery. “There’s another component of the biological clock that contributes to the timing of birth—a type of cell-to-cell communication between the maternal and fetal cells called paracrine signaling,” said Menon. “Because little is known about what

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“We showed that injecting a high concentration of late-pregnancy exosomes caused labor-associated changes without the other hormonal and chemical triggers usually involved in this process,” Menon said. “Injections of the early-pregnancy exosomes had no effect. This shows that exosomes play a more important role in labor and delivery that has never been reported before.” UTMB’s Dr. Samantha Sheller-Miller, the primary author of the study, conducted the animal model experiments that produced the novel finding. Other authors contributing to the study were UTMB’s Dr. Jayshil Trivedi and Dr. Steven Yellon from Loma Linda University. n

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BY JESSICA WYBLE

Diane Ugartechea is a believer in occupational therapy—and not just because it’s her chosen profession. She’s actually living proof that it works. After enduring extensive brain surgery to remove a benign tumor, the UTMB occupational therapist was left partially blind and with paralysis in her face. Simple tasks like eating and flossing her teeth were challenging and doctors predicted that she would never fully regain her eyesight. But determined to return to the life she knew and the work she loved, Ugartechea focused on her recovery and diligently practiced the rehabilitation techniques she usually teaches her patients. Miraculously, 10 weeks after surgery

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she was back at work on the Galveston Campus, with 20/20 vision and her strong commitment to her patients. Fast forward seven years and Ugartechea is still doing what she loves—now at the League City Campus, where she serves as both an inpatient and outpatient occupational therapist. Seeing patients in both the hospital and rehabilitation gym setting requires coordination and careful scheduling, so at the start of each day, Ugartechea thoroughly reviews her patient list and plans her schedule—as much as she can, anyway.

From left, Lexi Godleski, Emily Simms, Diane Ugartechea, Hannah Broughton and Gregory McGowen work together regularly at UTMB’s League City Campus.

Before her work day begins, her phone is ringing. It’s the first of many calls Ugartechea will receive from a local, non-UTMB hand surgeon. “She sends us lots of patients,” says Ugartechea, who is one of 19 occupational therapists who help rehabilitate patients at UTMB’s various campuses and clinics. “It’s nice because she has options. She could choose many other options in the region, many of which are actually closer to her practice, but she trusts us with her patients’ care. It’s nice to have that relationship.” As UTMB’s only certified hand specialist, Ugartechea primarily treats patients with extensive hand injuries, although she’s not exclusively limited to them. Among her patients on a recent day at the office were two individuals recovering from deep cuts on and around their hands caused by broken glass.

For the other patient, full recovery is right around the corner. Ugartechea spends their session together focusing on finer detail movements—working with beads, resistance devices and other fine motor tools from Ugartechea’s trusty cart. The injury is on the inside of the middle finger, right around the knuckle, so the bulk of the activities focus on bending the fingers and grasping items. The patient moves through the activities as instructed, but not without sharing a few complaints first. Ugartechea is no stranger to the mumbles and grumbles that sometimes come with rehabilitation work. She’s not fazed a bit.

“I had one patient from the BP explosion a few years back who While the injuries may sound similar, Ugartechea knows that had some pretty severe burns on his hands,” she recalls. “He every case is different. So she starts her time with each patient actually came back to find me recently—maybe 12 years later— by first assessing the wound to determine how it’s healing. This and he thanked me for everything he could do now, from brushprocess helps her develop a plan of action for the appointment. ing his teeth to putting on his shoes. But he also talked about remembering how much it hurt those first few sessions when For one patient, the injury is fresh and just a week or so post-sur- I kept challenging him to put his shoes on and tie them. I told gery. During the patient’s appointment, Ugartechea removes him he has to just keep moving.” the dressing and fashions a thermoplastic cast before sharing care instructions and a home exercise program.

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Knowing that consistency and movement can make all the difference, Ugartechea maintains a tough-love approach with all of her patients, but makes a point to do so with empathy. “I always keep in mind, what if that was me, my mom or my grand- “I teach a class at the OT school, and also meet with the plastic surgery residents each year,” says Ugartechea. “At the school, mother,” she said. “I approach each session with that thought.” I meet with second-year OT students to teach hand therapy A natural in her field, it’s hard to believe Ugartechea was once techniques and discuss the certification opportunity. With the on a totally different career path, working as an administrative residents, we provide an in-service to familiarize them with our assistant in the oil and gas industry. It wasn’t until an unexpected role, the services we provide, the referral process and various layoff that Ugartechea found her way back to school to study treatment techniques.” occupational therapy, a field she had learned about through the safety committee at her previous employer.

“I volunteered to help the safety group with one of their events and in the process met the occupational therapist we had on site,” she says. “I learned all about what she did specifically in ergonomics, but she informed me there was so much more to the field. I remember being fascinated.” Nearly two decades later, Ugartechea knows she made the right decision. “I really enjoyed my time there and appreciate the experience I gained, but I’m definitely where I’m supposed to be now,” she says.

The partnership between plastic surgery and occupational therapy doesn’t stop there. UTMB faculty members even solicit Ugartechea’s feedback when selecting new members of their team.

“The plastic surgery group frequently asks us to sit in on interviews for potential new faculty members, because we work so closely with them in our daily routines,” says Ugartechea. “That gesture shows how much they respect and value our opinion, which means a lot.” From the OT students and plastic surgery residents to her everyday patients, Ugartechea says that more than anything, her job is to educate.

Ugartechea shares the enthusiasm she has for her work not only with her patients, but also her colleagues, including Lexi Godleski. “People see the ‘occupational’ part of my title and assume I’m somehow going to help them find a job, especially if their curGodleski works as an occupational therapist at the League City rent condition has put them out of work,” she says. “Instead, I Campus alongside Ugartechea, whom she credits with motivathelp them understand that ing her to become a certified I support the job of living.” hand therapist as well. When patients’ roles as “Diane is a great hand therspouses, parents, and apist,” says Godleski, who caregivers become diswill sit for the Hand Therrupted in the wake of apy Certification Examinaunexpected injuries and tion later this year. “She was ailments, Ugartechea helps my mentor when I started them return to these roles with UTMB five years ago. through the use of funcShe’s personable, empathettional activities. ic and truly cares about her

“I support the job of living.”

patients.”

While Ugartechea spends the majority of her Mond a y - t h r o u g h - F r i d a y, 8 a.m.-until-5 p.m. schedule on the League City Campus with patients, she does travel to the Galveston Campus occasionally to teach students and residents.

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“These roles are just like a standard daily job except most individuals do not consider it as such. It’s amazing to see previous patients come back and show off all they can do, all the progress they’ve made since being discharged from our services,” she says. “It makes me proud to know that I helped plant that seed. I had a role in that.” n

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Annual interactive case study at UTMB promotes interprofessional education BY CORTNEY MARTIN

Over the past four years, it’s safe to say that 16-year-old Warren Bernard is the patient UTMB students have come to know best. Between 700 and 1,000 students a year work on Warren’s case, but it’s not for his benefit—it’s for theirs. Warren is actually a fictitious patient created for an interactive case study—called “What’s Wrong with Warren?” (WWW)—that engages students from all four schools at UTMB. For one afternoon every year, students participating in the activity spend hours learning about Warren’s symptoms, working together to diagnose and treat him, exploring how his illness could impact others in his life and developing long-term plans for Warren’s care. Shelley Smith, UTMB’s director of Interprofessional Education, said WWW was conceived when a group of faculty members attended an interprofessional education conference a few years ago, and were tasked with developing a project.

participated this year as well alongside UTMB students. Smith said their attendance was beneficial since these disciplines are not represented at UTMB, yet are important to patient care. Warren’s case has remained the same since the activity was developed, but a new group of students participate each year—and the benefits gained from the experience remain extremely valuable to those involved, year after year. “Participating in What’s Wrong with Warren allowed me to gain a glimpse into what it is like to be in another program, be it the School of Nursing or the Physician Assistant program,” James Pittman, a first-year School of Medicine student, said. “The art of medicine is a team-based endeavor that should be encouraged by more programs like this.” At the end of the afternoon, after spending time working in groups to learn about the roles and responsibilities of each discipline, completing “consultations” with students from other disciplines and building a timeline for Warren’s case, the students met to debrief and discuss what they learned.

“What they came up with was a case study that would help students understand their roles and responsibilities in a patient care scenario,” Smith said. The other goal was to provide all the phases of care, including community response and rehabilitation. “WWW helped me realize that all of us health care providers bring different skills and knowledge to the team,” said Fatima Moon, a This year, the annual interprofessional education activity took place Physician Assistant Studies student. “Everyone plays a role and it the afternoon of Feb. 6 across several campus buildings, with the would not be possible to achieve our goals if we did this on our own.” bulk of the activity centering on Levin Hall. Students from the Texas Southern University College of Pharmacy and the University of Houston Clear Lake social work program

Learn more about interprofessional education at UTMB online at https://www.utmb.edu/ipep. n

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