Impact October 2017 by UTMB Health

UTMB NEWSLETTER • OCTOBER 2017

Taking the fear out of mammograms

Adding value to Best Care Out of this world research aims to grow lungs in space Spotlight on José Cedillo, director of Pastoral Care

Stella Turrubiate, a nurse at the Breast Health and Imaging Center at the League City Campus, received the Emma Josephine Loffelholz McMorris RN Spirituality Award for embodying compassion, communication and commitment to her field during the 24th Annual Nursing Conference sponsored by the Institute for Spirituality and Health at the Texas Medical Center. Turrubiate was nominated by Gail Kwarciany, an oncology clinical nurse specialist, who said Turrubiate “not only encourages others to be compassionate and respectful of others’ spiritual needs including each other, but she role models this behavior on a daily basis. Her quiet manner and gentle approach sets everyone at ease and allows effective interaction between herself and patients.” Mike Mastrangelo, program director for institutional preparedness, and the UTMB Hydrogen Fluoride (HF) Incident Preparedness Program was recognized by the Federal Emergency Management Agency (FEMA) during its annual Individual and Community Preparedness Awards. UTMB received an honorable mention for the John D. Solomon Whole Community Preparedness Award, which recognizes contributions toward strengthening communities to prepare for, respond to and recover from a disaster. HF is considered to be the No. 1 priority chemical risk in UTMB’s preparedness program; UTMB convenes an “HF Symposium” each year, which brings together national experts in various aspects of preparedness and response. David Marshall, chief nursing and patient care services officer, has been appointed to the American Nurses Credentialing Center (ANCC) Commission on Magnet Recognition. His term on the commission will run through Dec. 31, 2021. Members of the commission, which is a voluntary governing body that oversees the Magnet Recognition Program, are appointed by ANCC’s Board of Directors. They represent various sectors of the nursing community, which include nursing executive leaders, nurse managers, staff nurses, long-term-care nurses and advanced practice registered nurses. One commission member represents public consumers. The Commission on Magnet Recognition makes the final determination of award designation.

Dr. Sharron Forest, assistant professor in the School of Nursing, was selected as the 2017-2018 recipient of the American Association of Colleges of Nursing’s Novice Faculty Teaching Award, which recognizes excellence and innovation in the teaching of nursing by early-career faculty at AACN member schools. Two honorees are chosen annually for this national award, one each in two categories: didactic teaching and clinical teaching. Dr. Forest won the Novice Faculty Excellence in Didactic Teaching Award.

Photo: Jorge De La Garza

Dr. Mayukh Sarkar, a medical laboratory scientist in UTMB’s Department of Pathology, was recognized as a 2017 “Choosing Wisely Champion” by the American Society for Clinical Pathology during its annual meeting Sept. 6-8 in Chicago. This honor recognizes clinicians as well as teams of clinicians for their commitment to the American Board of Internal Medicine Foundation’s Choosing Wisely Campaign. The campaign’s ideals are intended to reduce test overuse and to encourage clinicians and patients to question which tests are really necessary to improve the nation’s health care system.

Nine UTMB employees recently graduated from the Coaching for Rising Leaders pilot program, which pairs high-potential and high-performing individuals with an associate vice president or vice president for one-on-one coaching over a period of six months. Kevin Haslam (coached by Celia Bailey-Ocha), Jill Bryant-Bova (coached by Ian Barrett), Yvette Dean (Scott Boeh), Shashan Shetty (Jeremy Brynes), Amy Blount (Kimberly Hagara), Caren Brownfield (Craig Kovacevich), Isaac Hebert (David Marshall), Karen Wong (Tom Riley), and Andrew Herndon (Bo Stults), received certificates of completion at a graduation ceremony on Oct. 4 on the Galveston Campus. Dr. Joan Richardson, chair and professor in the Department of Pediatrics and director of the Division of Neonatology, received the Charles W. Daeschner, Jr., MD Lifetime Achievement Award at the Texas Pediatric Society (TPS) annual meeting in Plano, Texas. This is the highest honor given by the TPS and was created in 2001 to recognize pediatricians’ contributions to the health and well-being of children and the education of pediatric medical students. Richardson has been a member of the UTMB faculty since 1974.

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From the President On Oct. 16, I had the pleasure of joining our UTMB family in celebrating the prestigious national honor our university received for superior quality and care provided to our patients—the 2017 Vizient Bernard Birnbaum, MD, Quality Leadership Award.

O C TO B E R 2 0 1 7

Not only did we achieve our Best Care goal to be counted among the Top 20 U.S. academic health centers, we far exceeded it. Based on the final results of our Vizient survey, UTMB now ranks ninth among 107 participating organizations and has achieved 5-star performance. What an amazing accomplishment to move from a previous ranking of 76 to No. 9 in just one year.

Adding value to Best Care

In addition, UTMB has again achieved Magnet recognition for meeting the highest standards of nursing care and innovation. We owe these tremendous achievements to the hard work of each and every member of our UTMB community.

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You can learn more about UTMB receiving the distinguished Magnet status in this latest issue of Impact, as well as how our Best Care efforts will continue in the coming months, focusing on ensuring value in patient care. Other stories in this issue include:

Research project sends lungs to space

• A day in the life of Heather Fields, a breast imaging technologist at UTMB’s Angleton Danbury Campus • A profile of Rev. José Cedillo, our director of Pastoral Care • A closer look at a UTMB Oliver Center program that provides recording devices to cancer patients so they can listen and recall their doctor visits • A research project led by UTMB and Houston Methodist Research Institute, which sent lung cells to the International Space Station and could lead to new lung therapeutics for astronauts, as well as people back home on Earth • An innovative course for School of Medicine students that teaches a new approach to diagnosing heart disease • An introduction to UTMB’s Quality Enhancement Plan (QEP) and how it will enhance student learning • An overview of this year’s President Cabinet Award recipients and their innovative projects that promote outreach, education and improved patient care in the community • Tips for preventing sports injuries by Dr. Jeremy Somerson, assistant professor of orthopedic surgery • Numerous accomplishments and kudos in the Working Wonders column and throughout the newsletter

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Day in the Life of a mammographer

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Spotlight on José Cedillo, Pastoral Care

I hope you enjoy this issue. If you have story suggestions for future editions, please let the Impact team know. Thank you!

Page 12 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: Heather Fields, a breast imaging technologist at UTMB’s Angleton Danbury Campus, has worked in radiology at the hospital for nearly a decade. She performs mammograms using a 3-D mammography machine and works hard to create a soothing atmosphere for patients to calm any pre-exam anxiety.

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

Campus mail route: 0144 U.S. Postal address: UTMB Marketing & Communications 301 University Boulevard Galveston, TX 77555-0144

Editors KirstiAnn Clifford Stephen Hadley Shannon Porter Art Director Mark Navarro

BES T C AR E

BY KIRSTIANN CLIFFORD

ADDING VALUE TO PATIENT CARE is on the mind of nearly every health care organization across the country. As we shift from a volume-based to a value-based health care world, improving outcomes and reducing costs has become critically important. UTMB is on the right track. We have proven we deliver Best Care by moving into the top 12 among academic health centers participating in the 2017 Vizient Quality and Accountability Study. Now, Dr. Gulshan Sharma, UTMB’s chief medical and clinical innovation officer, said it’s time to “hardwire” the gains, to build upon that foundation and become a “high-value practicing organization.” In the coming months, several projects will aim to improve the quality of medical practice and reduce the cost of health care by eliminating unnecessary tests, procedures and treatments; better managing valuable resources such as blood products; and continuing to manage patient medications and the protocols under which providers prescribe. “Value is not just about cost, it is also about outcomes that matter to the patient,” said Sharma. “We need to continue on this Best Care journey and maintain our gains while asking ourselves, ‘What are the health outcomes achieved per dollar spent?’ We need to make sure we are using resources appropriately to manage our patients, eliminate variation in care, be efficient and safe in the care we provide, and be courteous to our patients.” Sharma recently introduced five pillars of stewardship to help UTMB become a high-value practicing organization: (1) antibiotics stewardship, (2) blood management, (3) laboratory testing, (4) imaging utilization and (5) opioid stewardship. “These five pillars cut across every specialty and are of national importance,” he said. “It doesn’t matter where you practice, you are probably doing three or four of these activities such as ordering labs or imaging, or giving patient medications, or blood products or antibiotics. In all these areas, we need to demonstrate that we deliver great value.” For example, one area Sharma wants to take a look at is how often CT scans are used for patients presenting to our Health System with abdominal pain and determine what provides the highest value for patients. “We see a fair amount of radiation-based imaging used for evaluating patients,” said Sharma. “There is large variation among providers in the use of CT scans for patients with abdominal pain. So we are trying to encourage evidence-based approaches to avoid unnecessary expense and radiation exposure for our patients. It all boils down to being good stewards of our resources.” To encourage evidence-based practices, the Epic team recently added several questions to the electronic medical record for providers to answer before ordering a certain test. UTMB also will continue the Patient Resource Optimization Program, or PROP, which seeks to reduce variation in care to ensure we are getting the best quality supplies at the best cost. While cost was not considered in the FY17 Vizient study due to changes in methodology, it will be part of the FY18 study and will account for 5 percent of each institution’s overall score. Sharma said its inclusion underscores the importance of appropriate use of resources in health care. “Our focus now is to take responsibility of what is under our control and work on that, as well as train our future physicians on understanding the concept of value-based care,” he said. n

Dr. Sharma speaks at the Galveston Campus celebration on Oct. 16. For more photos from all three campus celebrations, visit UTMB’s Flickr gallery at www.flickr.com/photos/utmb.

Welcome to your 5-star academic health center UTMB was among 12 U.S. academic health centers to receive the 2017 Vizient Bernard A. Birnbaum, MD, Quality Leadership Award on Sept. 14. Based on the final results of our Vizient survey, UTMB now ranks ninth among 107 participating organizations and has achieved 5-star performance. When UTMB started the Best Care initiative in 2016—which is focused on delivering the best care to every patient, every time—the institution ranked 76th out of 102 participating organizations. Over the past year-and-a-half, UTMB has made remarkable improvements in quantitative measures of quality and safety. The new No. 9 ranking is a testament to the contributions of each and every member of our UTMB family—faculty, nurses and staff. The complete list of academic health centers who received the prestigious award for superior quality and safety performance are: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Mayo Clinic – Rochester NYU Langone Health Froedtert & the Medical College of Wisconsin – Froedtert Hospital Rush University Medical Center Penn State Health Milton S. Hershey Medical Center University of Utah Health UC Health University of Colorado Hospital Lehigh Valley Health Network University of Texas Medical Branch at Galveston The University of Kansas Hospital Nebraska Medicine Oregon Health & Science University Hospital

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G OOD N E W S

UTMB again achieves Magnet recognition Recognition reinforces a commitment to nursing excellence BY KURT KOOPMANN

UTMB has again been recognized for meeting the highest standards of nursing.

UTMB is one of 468 U.S. health care organizations out of more than 6,300 to achieve Magnet recognition.

The American Nurses Credentialing Center recently notified UTMB that it had met the criteria of the Magnet Recognition Program, which distinguishes health care organizations that meet rigorous standards for nursing excellence. This credential is the highest honor for professional nursing practice.

Hospitals applying for recognition must provide an environment that empowers nurses, values their contributions and supports nursing leadership.

This is the second consecutive time UTMB has received the distinguished status from the ANCC since 2012. “I am so proud of the health care team at UTMB. Our dedicated nurses, physicians, caregivers and hospital staff collaborate every day to provide the highest level of quality and experience to those we serve,” said Dr. David Marshall, UTMB’s chief nursing and patient care services officer. Magnet recognition signifies that UTMB nursing staff meet high standards of patient care, nursing excellence and innovation in professional nursing practice. The coveted status is based on quality indicators and standards of nursing practice.

Donna Sollenberger, executive vice president and chief executive officer of the UTMB Health System explained what Magnet recognition means for UTMB. “Upholding the highest standards of nursing has always been a proud tradition at UTMB,” she said. “Every day we hear from our patients about how our nurses make a difference in their lives, and it is this consistent delivery of high-quality care that lets our patients know that no matter where they are within our health system, they are being cared for by the very best.” According to the ANCC, Magnet health care facilities consistently deliver better patient outcomes than non-Magnet facilities and report higher nurse retention, recruitment and job satisfaction rates. n

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R ES EAR C H

UTMB and Houston Methodist research project sends lungs to space, could lead to new therapeutics

BY SHANNON PORTER

GROWING UP DURING AN ERA WITH AN ACTIVE SPACE PROGRAM, The bioreactor pouch design helped shed the necessary weight. Other adaptations Dr. Joan Nichols and Dr. Joaquin Cortiella were fascinated by space. Nichols, professor of Internal Medicine and Microbiology and Immunology and associate director of research and operations for the Galveston National Laboratory at UTMB, vividly remembers learning about each of the Apollo missions and astronauts like John Glenn.

included attaching Velcro to each of the pouch’s caps so they could be tethered and not get lost in the zero gravity environment. Nichols and Cortiella also developed precise, simply worded instructions so the astronauts could manage and run the different experiments on the samples.

Now, she and Cortiella, a professor and physician in the Department of Anesthesiology at UTMB, are having the chance to live a childhood dream.

“I spent weeks writing out the procedures,” Nichols said. “We have written—I don’t know how many—two-sentence blurbs, five-sentence blurbs for astronauts to understand.”

“Who on Earth would have thought that two kids from New York would someday send something into space?” Cortiella said. “For us, this was a dream come true.”

Once the materials were ready, it was time to turn their attention to the actual trip to the space station. “Our hearts were pounding. It’s like you’re in awe and don’t believe it until it actually happens,” Nichols said. “We were wondering, ‘Is it going to take off? Is it going to make it to orbit? Once it gets into orbit, is it going to dock?”

In August, Nichols, Cortiella and members from their lab traveled to Cape Canaveral, Florida, for the launch of an unmanned SpaceX resupply mission to the International Space Station. On board the SpaceX rocket were some of the UTMB lab’s lung cell samples that astronauts would grow, hopefully allowing researchers to see the implications of spaceflight on the lungs of astronauts, as well as those of us still on Earth. The research could possibly lead to future therapeutics for various lung diseases. But getting the samples into space wasn’t that simple. The mathematics and science behind making that possible is truly phenomenal, Nichols said. It took years of planning and working with NASA and others to make sure the experiment would work safely in space.

Once they received confirmation the rocket had successfully launched, everyone was in tears and jumping around, Nichols said. “People in the stands realized who we were because we all had on our ‘Lungs in Space’ shirts on,” she said. “People saw we were there and began applauding us and asking us about the project.” Dr. Joan Nichols and Dr. Joaquin Cortiella look at an example of a bioreactor pouch that contains lung progenitor and stem cells and pieces of lung scaffolding, similar to those sent to space in August. The samples were sent on board the SpaceX rocket with the hope they would grow, allowing researchers to see the implications of spaceflight on the lungs of astronauts.

What went up were lightweight bioreactor pouches containing lung progenitor cells and stem cells, as well as pieces of lung scaffolding. Progenitor cells are a type of stem cell that are usually limited to maturing into one, or very few, cell types. Other stem cells can develop into any kind of cell. The scaffolding is a collagen and elastin frame on which the lung cells grow. Each of the bioreactor pouches were adapted so that the experiments could be done in microgravity. Scientists from UTMB and Houston Methodist Research Institute worked closely with NASA to come up with an understanding of how to take their model and adapt it to a low-gravity environment. “We didn’t know how to approach space flight at all,” Nichols said. “We are used to growing our samples in small culture dishes or bioreactors, which are like bottles but big and heavy. Going into space, things have to be very light because the heavier it is, the more expensive it is to send.”

Researchers have already learned a lot about how long-term space flight can affect a person’s eyes, bones, muscles and heart. But now with NASA’s sights set on traveling to Mars, UTMB scientists think it’s important to think about other tissues, such as the lungs, and what their responses might be–or how the lungs might be altered by space flight.

Now that the lungs have returned to Earth, researchers will evaluate how the cells have changed in space, including structure of the tissues, response of immune cells and whether the cells developed fibrous tissue in response to damage, or fibrosis. Previously, lung injuries have been found to accelerate in space, and close study of these cells may help in developing therapeutics. “We know that there are some problems with lungs in space flight, but that hasn’t really been closely looked into,” Nichols said. “We hope to find out how lung cells react to the change in gravity and the extreme space environment, and then that can help us protect astronauts in space, as well as the lungs of regular people here on Earth.” n

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Taking the message and the medicine home

Oliver Center project provides audio recorders to thousands of patients so they can listen, recall doctor visits BY SHANNON PORTER

Three of the scariest words in the English language are, “You have cancer.” “Much of what we say gets lost at the time of the visit. A recording helps patients “You don’t hear anything after that,” said Dr. Avi Markowitz, chief of hematology to better understand things like side effects and toxicities,” Markowitz said. “That way they’ll better understand why things are happening.” and oncology at UTMB. But thanks to a UTMB program called Taking the Message and the Medicine Home, the university is improving communication between patients, families and care providers. Developed by UTMB’s Oliver Center for Patient Safety and Quality Healthcare in 2009, the program provides patients with an audio recording of what the nurse, physician or other care team members say during their visit.

Having that better understanding not only helps the patient, but it also helps the doctor as well. “If we know they’re having problems, we can do something to help,” Markowitz said. “If I don’t know there’s something wrong, I can’t fix it.” Kathy and Charles now bring their recorder along to every appointment with Markowitz. After each visit, Kathy will download the recording to her computer so she and her husband can refer back to it.

By bringing a recorder provided by the Oliver Center to appointments—or by using a mobile phone audio record feature—patients can capture what their provider has to say each visit. They can replay the conversation at any time to help them remember instructions and hopefully have a better understanding of what’s going on with their health during their treatment. Today, thousands of recorders have been given to UTMB patients, said Dr. Meredith Masel, director of the Oliver Center. What began in the Division of Hematology and Oncology is open to all patients, and the Oliver Center wants to expand the program. “We’ve been working to get doctors to help identify patients who could really benefit from something like this,” Masel said.

“We’ve referred back to it a few times when questions have come up,” Kathy said.

Charles and Kathy Morgan explain how they use their recorder, given to them by UTMB’s Oliver Center for Patient Safety and Quality Healthcare, during Charles’ appointments.

One example was information about a follow-up appointment: “I couldn’t remember if we were supposed to come back in a month and if everything looks good, then two months?” Kathy said. “But all I had to do was refer back to the recording and my answer was right there.”

Being able to refer back to a recording cuts back on calls to the doctor, Kathy said. Charles said he would feel comfortable taking the recorder to his appointment if for some reason his wife couldn’t make it.

Charles and Kathy Morgan have seen the benefits of using one of the pro“It’s a great tool,” Charles said. “The only thing I wish is that I would have had gram-issued recorders. it sooner.” Just over a month ago, Charles was diagnosed with colon cancer. And while Now, Charles and Kathy are becoming advocates of the program to their friends Kathy is familiar with what goes into cancer treatment after having experienced and family. it with another family member, it’s still been a shock nonetheless, she said. “I’ve always encouraged friends and family to bring something with them to take Charles, Kathy and his daughter were at his first appointment. notes at their appointments,” Kathy said. “But this makes it that much easier—and “We thought the more ears we had the better,” Kathy said. “But even three sets our doctor handed it to us!” of ears sometimes still isn’t enough.” Markowitz has been thrilled with the response his patients are giving him about That’s because your emotions are high and you stop focusing, plus it’s hard to the program and looks forward to giving other patients access to this resource. digest all of that information, she said. “It’s just one more way we can empower patients to understand that they play That’s where the recorder comes in. a specific role in their care,” Markowitz said. “And that’s truly invaluable.” n

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A day in the life of a

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BY KIRSTIANN CLIFFORD

All it takes is 20 minutes for Heather Fields to help a woman take control of her breast health. “A mammogram is the best way to detect breast cancer early—when it is most treatable,” said Fields, a breast imaging technologist at UTMB’s Angleton Danbury Campus. “It only takes a few minutes and it saves lives.” I meet up with Fields on a Tuesday morning, as she prepares for back-to-back 20-minute mammography appointments in the ADC Hospital’s diagnostic imaging area. Although the clinic is busy, she never seems rushed and works hard to create a soothing atmosphere for patients to calm any pre-exam anxiety. The mammography room is softly lit, with light music playing in the background and tranquil artwork hanging on the walls—it feels more like a spa than a clinical room in a hospital. “I do everything I can to help each woman relax and take any worries off their mind,” says Fields, who has worked in radiology at the hospital for nearly 10 years. “A lot of women have had a mammogram several times before and it’s not a big deal, but for others who may be having a mammogram for the first time or have family history of breast cancer, it can be a nervous and scary time.”

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Fields excitedly points out the impressive piece of technology in one corner of the room—it’s a new 3-D mammography machine that she’s been using since April. “This takes multiple pictures (X-rays) of breast tissue and allows Fields puts her hand on the patient’s back in a comforting radiologists to create a detailed 3-D image and see the entire manner as she positions the breast on the equipment and breast more accurately,” says Fields. “Using 3-D mammography compresses it to take X-rays from the front and sides. It’s an helps doctors more easily detect breast cancer and has helped intimate job—to get a good picture, Fields has to get in the reduce the number of false positives and unnecessary callbacks— patient’s personal space. it’s been really great.” “The positioning part of mammography can be the most chalShe adds that technology has advanced quickly since she first lenging,” says Fields. “Patients come in all different sizes, ages started doing mammograms, about seven years ago. and body habitus (physique), so it’s important to be competent “In 2010, we were still using screen-film mammography which in various positioning techniques. My goal is to get the best captured the image on actual film that had to be developed. Then image possible on every patient.” it changed quickly to 2-D digital which sent the image directly to a computer, and then it progressed to 3-D in just a few years. It makes me wonder, what is it going to be next? I can’t imagine anything better than this, but I like learning new things.”

The first patient leaves the clinic with a smile on her face and is reassured that she will hear results from her doctor as soon as the radiologist reviews the images.

In between mammograms, Fields checks the electronic medical Before inviting the first patient back, Fields goes through a series record system to see if any help is needed in the Emergency of quality control tests to make sure the machine is calibrated Department or inpatient units. As a certified radiology techniand working correctly. Once everything is ready, she introduces cian, Fields is trained and holds certifications in other imaging herself to the patient in the waiting room and brings her back “modalities” as well, including X-ray, CT (computed tomography) to the mammography room, where they go through the patient and bone density scans. I tag along as she heads to the ED with a questionnaire and discuss any questions or concerns. As the portable X-ray machine to take a chest X-ray on an elderly man patient changes into a gown, Fields stands outside the door and who took a hard fall at his home. After the X-ray, she transports describes how the screening exam usually proceeds. the patient to the diagnostic imaging area for a CT scan of his “I just talk them through it and try to be as gentle as I can while head and neck, as well. still getting the best exam possible,” she says. “An exam may be “I do find myself running around a lot when I’m not doing mama little uncomfortable, but it shouldn’t be painful. Some people mograms—I have to change hats all day long. After this CT scan, have heard horror stories about getting a mammogram and I’m going to perform a bone density scan on a patient and then getting tortured basically, but that’s not true. Most of the time, do a mammogram after that. Sometimes I have to stop and think, after their exam, patients say ‘That wasn’t so bad!’” ‘OK, what am I doing right now?’” she laughs.

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It’s impressive to see Fields expertly handle each piece of equipment. It looks like there’s a million different buttons to press and things to position perfectly before taking each picture. But she does it in a focused, meticulous way that makes it almost look easy.

With breast cancer being the second leading cause of cancer death in women (only lung cancer kills more women each year), Fields likes educating others on how important a simple mammogram can be. She points to American College of Radiology guidelines, which recommend annual screening mammograms beginning at the age of 40—earlier if there is a family history of breast cancer.

On our way back to the mammography room, we run into Michael Wedgeworth, the senior manager of diagnostic imaging at ADC. He only has good things to say about Fields, who has “I’m very passionate about women’s health and doing what I can been dedicated to growing ADC’s breast health imaging program. to be a support for them,” says Fields, adding that she looks “Heather is committed to ensuring that each mammogram goes forward to seeing familiar faces each year. “Even if it’s just lissmoothly, the patients have a good experience and that they are tening. A lot of women come in and don’t have anyone to talk empowered with all the information they need,” says Wedge- to, so I can be that person who they talk to about whatever they worth. “There’s the perception that when you get a mammogram, want as they get their exam done. More often than not, I find it’s going to hurt and be painful, but it doesn’t have to be. She’s it does help put the patient at ease and take their mind off the really good with patients and she’s very skilled in obtaining mammogram.” accurate images. Additionally, our department has a dedicated breast navigator who works with patients who have an abnormal screening mammogram, or other breast health concerns, to ensure that these patients are followed up as soon as possible.”

By the time I leave at 1 p.m., Fields has completed three more mammograms, in addition to performing two more chest X-rays, a bone density test and assisting a new staff member with using the CT machine. She’s on the move constantly—I even lose her in the hallway a few times as she jumps from one task to the next. Although her time with each patient is relatively short, she feels rewarded knowing each 20-minute appointment may help save a life.

While the majority of mammograms performed by Fields are routine screening exams, she also works with patients who have specific concerns such as a lump in their breast or a prior abnormal screening mammogram. These patients receive a diagnostic work up, which may include additional mammogram “I get a lot of satisfaction out of what I do and it makes me feel images, breast ultrasound, or even a breast biopsy if indicated. good when patients say I provided the best mammogram they’ve Fields works closely with the radiologist to review diagnostic ever had,” she says. “Detecting even the smallest of cancers procedures quickly so that patients can receive the appropriate before any symptoms appear can make a huge difference in a follow up as soon as possible. woman’s life—that’s what makes it all worthwhile.” n

“I’m very passionate about women’s health and doing what I can to be a support for them…A lot of women come in and don’t have anyone to talk to, so I can be that person who they talk to about whatever they want as they get their exam done.”

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L E A D ER S POTLIGHT

Spotlight on José Cedillo, director of Pastoral Care Rev. José Cedillo joined UTMB in May 2016 as director of Pastoral Care. An ordained bishop with the Church of God, Cedillo provides support for the spiritual, religious, emotional and value concerns of patients, families and staff. His department provides visitation, prayers, sacraments, inspirational reading material and scheduled worship services, as well as crisis intervention, and grief and bereavement support. Prior to UTMB, Cedillo worked for more than 17 years at MD Anderson Cancer Center. He served as staff chaplain for pediatrics and palliative care, as well as manager of clinical chaplaincy programs in MD Anderson’s Department of Spiritual Care and Education. A native of Nuevo Laredo, Mexico, Cedillo earned his bachelor’s degree in religious education from Lee University and his Master of Divinity degree from the Church of God Theological Seminary.

What does Best Care mean to you and how do you contribute? Best Care means I strive to provide the appropriate pastoral care to every patient, every time I have an opportunity to do so. I contribute to Best Care initiatives by striving for excellence and compassion with every pastoral care referral, and by being available to our staff as well. As an ordained clergy and chaplain, my workplace is my congregation.

As a chaplain in a hospital environment, what are the most difficult parts of your job? The most rewarding? I don’t necessarily see my duties in opposite poles, but in a continuum; there is always a lesson to learn about patients, staff and self. There are difficult situations which may include complex family dynamics, and those tend to be stressful. There are also rewarding moments when I can witness human suffering being relieved by spiritual practices and pastoral interventions.

How do chaplains support people who come from different religious backgrounds? An effective chaplain is grounded in their own spirituality which is inclusive and comprehensive. God can’t be put in a box. We see people with diverse meaning systems as part of humanity and dealing with similar issues related to human suffering and seeking meaning. This is the basis of a chaplain’s compassion and empathy—not religious dogma or exclusive domains.

What inspired you to go into this line of work? God, through people. Suffering is a human condition that I have also experienced and will continue to experience—hence, humans can journey with each other. This is the heart of chaplaincy. This is what keeps my inspiration.

José Cedillo with his wife, Ninfa, at Great Smoky Mountains National Park in Tennessee.

Do you have any mantras you live your life by? We are fellow sufferers with a common journey and a shared desired destiny.

What do you like to do outside of work? I like to play musical instruments including the guitar, keyboard and drums, work on cars and other hands-on hobbies. I also like fishing and I love snorkeling.

What’s something people would be surprised to know about you? I try to be genuine and myself as much as I can, so I don’t care to have a secret life. I once recorded a musical video for a Spanish television program. When I show that video, some people have been surprised by my singing talent.

What’s something you always wanted to do but have not done yet? Maybe like many other people, I would like to travel to exotic places in Africa, Indonesia, Europe or even Alaska. I have never been east of the Atlantic Ocean. n

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E DUCAT I O N

New School of Medicine course replaces centuries-old device with mobile technology to diagnose heart disease BY KIRSTIANN CLIFFORD

FOR THE PAST TWO CENTURIES, the stethoscope has been the iconic symbol of medicine. But if you ask Dr. Masood Ahmad, that could soon change. As a professor of internal medicine and director of UTMB’s Echocardiography Lab, Ahmad has implemented a new course for second-year medical students in Point of Care Echocardiography. Instead of using a stethoscope to “auscultate,” or listen for heart sounds, students are trained to use a small portable ultrasound device that can get real-time images of the heart right at the bedside. “Traditionally, every doctor carries a stethoscope and it is a very effective tool if you are well-trained, but the reality is we don’t have as many well-trained doctors who can use the stethoscope as we did in the old days,” said Ahmad. “As technology advances, we need to get students and physicians trained in using this handheld device, which weighs less than a pound and can obtain images with accuracy comparable to a large 400-pound scanner.” Over a two-week period, students are introduced to sonography, receiving several hours of lectures followed by hands-on experience in the lab. As one of eight students in the first point of care echocardiography class, Paul Brindley said it was a great opportunity to learn about the new technology and how it can be more accurate than using a stethoscope alone. “There have been studies showing that medical students who had just a handful of hours learning how to do this correctly were able to

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diagnose cardiac abnormalities more frequently than board-certified cardiologists using stethoscopes, which is incredible,” he said. “It’s simple to use, but there is a technique to it—it has to be in a very specific spot and manipulated just right to get quality images, so that’s what we are practicing now.” UTMB joins a large number of medical schools across the country that are implementing point of care echocardiography training in the undergraduate curriculum. After receiving positive feedback from the first class of medical students, Ahmad said he plans on offering the two-week course every semester. Handheld ultrasound devices are being used in UTMB hospitals, but not widely—yet. Ahmad hopes there will be a time when all physicians and general practitioners have their own ultrasound devices—it will enable them to see how a heart functions instead of just guessing. “There is always resistance in the beginning when a new technology is introduced,” said Ahmad. “The answer is training our physicians at an early stage while they are still in medical school so they are comfortable with this new technology and can use it in accurate assessment of cardiac patients. In this case, seeing is better than hearing.” n Dr. Masood Ahmad shows medical students how to use a portable ultrasound device to get images of the heart while at the patient’s bedside.

IPE2Practice focuses on actively implementing interprofessional education BY STEPHEN HADLEY

The focus on interprofessional education has been a foundational part of UTMB’s Academic Enterprise since it was introduced at the institution in 2008. Interprofessional education—or IPE as it’s commonly called—was introduced as part of Synergy, UTMB’s quality enhancement plan that led to a successful 10-year re-accreditation by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) in 2008.

The latest QEP is one element of the required re-accreditation package that is being readied for SACSCOC, the regional accrediting body that ensures colleges in the Southern states—including Texas—are meeting necessary educational standards. McKee said that as part of the standard re-accreditation process UTMB was also required to submit a compliance certificate in September. SACSCOC representatives will visit UTMB Feb. 6-8 to discuss the institution’s compliance and the QEP and to meet with university executives.

The next iteration of UTMB’s QEP—which was due this month in advance of the SACSCOC planned visit in February— also focuses on a team-based approach to education. IPE2Practice, as the new QEP is called, is all about taking UTMB interprofessional education to the next level, said Shelley Smith, director of Interprofessional Education and the QEP.

“We’re bringing together students from different disciplines so each understands what the other does.”

“The exponent 2 in IPE Practice is important because it stands for us taking this to the second level and building on the foundation that was successfully set with Synergy, which formally brought IPE to UTMB,” Smith said. “Our focus with this iteration is to be more practice-based, where we take interprofessional education from the classroom to practice.” 2

Smith said that when students from two or more professions actively learn about, with and from each other, they are practicing interprofessional education.

The accreditation is significant because without it, UTMB is not allowed to confer degrees to students. The accreditation period will begin in 2018 and run through 2027 with a fifth-year interim report regarding UTMB’s initiatives to implement IPE2Practice due in 2023. While UTMB could have focused on other initiatives for its QEP, Smith said continuing the emphasis on interprofessional education seemed

the logical choice. “It made sense to remain focused on IPE because it’s already here,” Smith said. “Of course, we’ve identified some gaps—particularly with implementing it into practice—so that’s what we’re addressing this time around.

“In addition, the new Health Education Center under construction is all about interprofessional education. That new building is about teams and Dr. John C. McKee, associate vice president for Institutional Effectiveness, teamwork, communication, working together and learning together. It’s an said that IPE2Practice supports UTMB’s mission and vision as institution. outward sign of an inward motion we’re making at UTMB.” “This focus prepares practitioners for the future of health care in a team- What can employees do to prepare for the February SACSCOC visit? based approached,” he said. “With IPE, we’re bringing together students “Everyone at UTMB needs to know that interprofessional education is workfrom different disciplines so each understands what the other does. With ing and that we’re going to take it to the next level now,” Smith said. “Our IPE2Practice, we’re taking that a step further by ensuring that such under- students continue to say that they want to learn how to work in teams standing is being implemented in their education.” and we are going to provide them that opportunity.” n

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2017 President’s Cabinet Awards Twenty-six UTMB faculty, staff and students recently received UTMB President’s Cabinet awards for projects that promote outreach, education and improved patient care in the community and beyond. The 11 funded projects total more than $243,000. The President’s Cabinet provides financial resources that advance UTMB’s mission to improve health. The contributions of the cabinet’s 380-plus members, which include university friends, community and business leaders from the Houston-Galveston area, and UTMB faculty members, staff and alumni, have provided more than $5 million in seed grants to more than 130 developing programs. For information on the President’s Cabinet, visit https://development.utmb.edu/cabinet-intro.

Heart Failure Kit: Impacting Readmissions through Home Monitoring Dennis Santa Ana Adult Patient Care Services This project provides heart failure patients with education on the signs and symptoms of heart exacerbation in addition to post-discharge home visits. Weighing scales and blood pressure machines will be provided to newly diagnosed Galveston County heart failure patients who have been identified as high-risk for re-admission or are under the care of the UTMB Cardiology Heart Failure Team.

Safe Kangaroo Care with our Innovative Gown Souby George and Tracey Santiago Women Infant and Children Kangaroo Care is a form of developmental care that benefits all newborns, especially those in the neonatal intensive care unit. However, current patient hospital gowns do not facilitate skin-to-skin contact or allow for privacy or proper securing of the infant. This project seeks to create a new gown so that all new mothers at UTMB can provide safe and modest skin-to-skin contact with their child within the first few hours of giving birth.

Forensic Nursing Team Nellie Loewen and Christine Wade Emergency Department This project seeks funding to purchase a new state-of-theart Secure Digital Forensic Imaging Camera system, an Arrowhead Forensics Portable Light Source and training for staff on the use and care of the equipment. Together, these tools will allow for the magnification of accurate and detailed body images that can be used by physicians to determine the most appropriate treatment for victims of assault or as evidence in a court of law.

Beds for Babies: Improving Newborn Health and Safety for UTMB Patients Matthew Johnson and Dr. Joan Richardson Health System Administration Beds for Babies is designed to ensure that new mothers receive fundamental education and their newborns have a safe and comfortable place to sleep. Baby boxes, outfitted with firm mattresses and fitted sheets, are designed to provide maximum security while guarding against the risks of newborns sleeping with adults. Video-based educational materials will be provided to new parents at UTMB and baby boxes will be filled with newborn supplies and supplemental information on proper sleeping practices.

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Healthy Living on a Budget Keegan Collins, Kelly Drago and Barbara A. Slusher Physician Assistant Studies First developed in 2015, this interprofessional community outreach program provides underserved community members access to preventive health screening and counseling on healthy lifestyle choices while also affording UTMB students the opportunity to interact and counsel patients. Health screenings performed at food distribution sites throughout Galveston include blood pressure, body mass index, point-of-care cholesterol and blood glucose screenings.

PocketPath: Providing an Innovative Tool for Each Clinician Drs. Adam Booth, Barbara Bryant, Judy Trieu and Chris Zahner Pathology In efforts to reduce the number of inappropriate blood product orders by clinicians, the PocketPath mobile application was created by three UTMB residents to provide guidelines and suggestions regarding the utilization of blood products and services at the bedside. Year one of the project will focus on launching, promoting and assessing the platform, and year two will focus on expanding the application.

UTMB Tough and Tiny Program Dr. Kanika Bowen-Jallow Surgery An after-school program with a parental involvement component will be established to target children ages 2-11 with a body mass index greater than the 95th percentile. Two one-hour sessions per month will allow parents to meet with physicians and UTMB students, eat a healthy dinner and learn about nutrition, diet and exercise while their children participate in fitness activities and group play facilitated by a certified instructor.

St. Vincent’s CHCP: Coordinated Hepatitis C Program Dr. Robert Beach, Paul Bui, Sarah Butler, Transon Vu Nguyen and Kendrick White Internal Medicine The St. Vincent’s Student Run Clinic will address chronic hepatitis C in vulnerable populations by establishing a support group and hepatitis clinic in Galveston. Project funds will be used for laboratory testing, addressing barriers and providing social support and behavioral counseling to promote sustained cure and quality of life.

Early Prevention of Addictive Behaviors for Galveston Teens Stefani Garcia, Dr. Norma Perez and Jonathan Teran School of Medicine In order to gain an understanding of what high school students already know about the negative health outcomes related to cigarette smoking and alcohol abuse, a survey will be created and administered at Ball, La Marque and Texas City high schools. Survey results will be presented to the community and health fairs focused on preventing addictive behaviors will be held at each school.

Expanding the Reach of the UTMB Health MakerHealth Space Dr. David Marshall Hospital Administration The UTMB MakerNurse Program and MakerHealth Space have provided faculty, staff and students the creative ability to make their ideas for new health devices a reality. Additionally, a similar lab was created at Ball High School in Galveston to introduce these tools to high school students. To celebrate and showcase the outstanding innovations spawned from these labs, a Galveston Maker Week event will be created and will include Mini-Maker Fairs at UTMB and the Galveston Children’s Museum.

Language Services Alignment and ServiceHub Implementation Manuel Higginbotham and Martha Livanec Patient Services To better provide and integrate language access services at all UTMB locations, a Language Access Plan will be created. It aims to provide new and accurate data to leadership, improve response times of interpreters, reduce readmissions by allowing patients to fully understand their plan of care, and improve UTMB’s compliance with regulatory entities. Technology components of the plan will include dispatching and translation software, and assistive and video remote interpreting devices as mandated by the Americans with Disabilities Act. 15

Top 6 sports injury prevention tips By Dr. Jeremy S. Somerson, Department of Orthopaedic Surgery and Rehabilitation Whether you’re playing sports for fun or as a competitive athlete, don’t let sports-related injuries keep you on the sidelines this fall. The most common types of injuries are sprains, strains and stress fractures due to overuse. The following tips can help prevent injuries no matter what sport you play: 1. Avoid overuse. Repetitive motions such as throwing a ball over and over again can lead to injury. If possible, mix up your routine with cross-training, which exercises different parts of the body to give the most-used areas some much-needed rest. Make sure to take “recovery days” to give muscles an opportunity to repair between training sessions. 2. Develop a consistent stretching and warmup routine. An adequate stretching and warmup routine that mirrors the sport being played should be performed before every practice long enough to increase your heart rate slightly.

3. Condition your muscles to increase stability. A strengthening program using light weights and highintensity interval training can improve coordination and power. Try gentle resistance training with 30 minutes of aerobic activity. 4. Focus on technique. For example, baseball players should be taught about throwing mechanics and follow the guidelines on how many throws to make in a day. By focusing on correct technique, you will not only avoid injury, but perform more efficiently and get greater gains from your sessions. 5. Wear the right gear. Depending on what sport you are playing, always wear properly fitting footwear and protective equipment such as pads, helmets, mouthpieces, face guards, protective cups and eyewear. Parents of young athletes should talk with coaches to make sure they have the proper equipment before practices begin. 6. Pay attention to warning signs. Listen to your body—it is important to keep track of symptoms such as unusual fatigue or pain that develops after practice or competition. These could be signs of existing or impending injury. Seek the advice of a medical provider if needed and remember that “no pain, no gain” does not apply here.

PARTING SHOT Graduates of UTMB’s School of Health Professions sing “The Eyes of Texas” at the end of this year’s commencement on August 11 at Moody Gardens in Galveston. Three hundred eighty-one graduates received their degrees. Since opening its doors in 1968, the SHP has granted degrees and certificates to more than 11,000 graduates.