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Methodist Charlton Physician Receives Community Service Award

The Texas Osteopathic Medical Association presented Thomas Shima, DO, its 2014 Community Service Award. The award recognizes a physician for his or her service to the community “through the promotion of and dedication to osteopathic medicine in their practice.” Dr. Shima is the osteopathic program director for the Methodist Family Medicine Residency Program at Methodist Charlton Medical Center.
New Parkland Hospital features rapid response lab
Some tests have a 30 minute receipt-to-result time

targeted analytical tests for critical areas such as the Emergency Department, Operating Room, Labor & Delivery and the intensive care units. The lab is anticipated to perform 3.2 million tests annually and provide clinicians a turn-around-time of 30 minutes from receipt to result for most tests.

“Time is of the essence when you have a critically ill patient,” said Kyle Molberg, MD, Chief of Pathology at Parkland Health & Hospital System. “The rapid response lab will deliver test results quickly to providers, enabling them to initiate the proper course of treatment for patients as rapidly as possible.”

New laboratory equipment will offer both basic and advanced test results for blood chemistry levels, cardiac markers, liver and kidney profiles, complete blood counts, blood gases, routine coagulation testing and urinalysis panels. The lab will also be able to assess the entire blood clotting process in real time to enable precise transfusion and patient management on trauma patients.

The 6,500 square-foot lab design incorporated the Lean concepts of linear workflows with “first in/first out” processes to provide high quality service levels. The strategic location of the lab on the new hospital’s second floor directly over the Emergency Department and adjacent to other critical areas promotes prompt delivery of the specimens via the pneumatic tube system.

Through a comprehensive series of pneumatic tubes, much like bank tellers use with drive-through customers, the system will allow nurses to quickly send and receive blood products from the lab, thereby reducing errors and improving patient safety.

There will be a network of vertical and horizontal sealed tubes throughout the hospital. The system will pull carriers containing samples for testing from each loading station through use of computer monitored and controlled air-vacuum technology. Traveling at speeds of up to 60 miles per hour, carriers will be quickly transported to the lab to ensure samples are rapidly tested and results reported to clinicians.

In fiscal year 2013, Parkland’s pathology department performed more than 10 million tests, making it one of the busiest hospital pathology departments in the Metroplex.

For more information on new Parkland hospital, please visit www.parklandhospital.com
Health care professionals often talk about the art and science of medicine as the difference between intuition and scientific evidence. Although each has its role in modern medicine, innovation in the new Parkland hospital will allow physicians to quickly make evidence-based decisions that will enhance and expedite patient care.

A rapid response laboratory in the new hospital, scheduled to open in 2015, will provide 
Protein variant may boost cardiovascular risk by hindering blood vessel repair,
UT Southwestern researchers find

The team of researchers found that apoE3 binds to a receptor, ApoER2, and that together they act on endothelial cells, which are the guardian cells of blood vessels, to produce a molecule called nitric oxide (NO). Nitric oxide blunts inflammation, a process that contributes to a variety of vascular disorders.

Up to 15 percent of individuals possess the gene coding for apoE4, and why these individuals are at increased risk of atherosclerosis and coronary heart disease had previously been enigmatic. Using both cell culture and mouse models, researchers showed that in contrast to apoE3, apoE4 cannot activate endothelial cells to produce NO. The reparative and anti-inflammatory processes, therefore, do not occur. In fact, apoE4 prevents the actions of apoE3, explaining why even individuals with one copy of the apoE4 gene are at increased risk of vascular disease.

Using mutant proteins, the investigators further determined the structural feature of apoE4 that prevents the protein from having the favorable actions of apoE3 and instead causes it to antagonize cell responses to apoE3.

The findings, recently published online in the Proceedings of the National Academy of Sciences, also suggest a potential preventive treatment for cardiovascular disease in the high-risk individuals who have the apoE4 variant. 

“An important mechanism that is lost when people possess apoE4 is the ability to produce NO, which leads to a loss of both the reparative and anti-inflammatory capacities of the endothelium,” said Dr. Shaul, who holds the Associates First Capital Corporation Distinguished Chair in Pediatrics. “Now, knowing this information, we believe such individuals may benefit from treatment with an NO donor. There is a form of aspirin, for instance, that is an NO donor,” he added.

Whereas there is considerable understanding of the biology of the apoE-ApoER2 tandem in the central nervous system and in Alzheimer’s disease, the basis for the cardiovascular impact of the receptor and apoE variants had been perplexing. The new findings on apoE and ApoER2 complement the team’s prior work on ApoER2, which revealed an important role for the receptor in the blood-clotting disease known as the antiphospholipid syndrome.

Other UT Southwestern researchers on the team include Dr. Joachim Herz, Professor of Molecular Genetics, Neurology and Neurotherapeutics, and Neuroscience, and also holds the Thomas O. and Cinda Hicks Family Distinguished Chair in Alzheimer's Disease Research; Dr. Robert Gerard, Associate Professor of Molecular Biology; Dr. Eunjeong Jung, postdoctoral fellow; Ivan S. Yuhanna, senior research associate; Mohamed Ahmed, research assistant; and Dr. Chieko Mineo, Associate Professor of Pediatrics.

The study was supported by the American Heart Association and the National Institutes of Health. Additional support was provided by the Crystal Charity Ball Center for Research in Pediatric Critical Care and the Associates First Capital Corporation Distinguished Chair in Pediatrics, as well as the Lupe Murchison Foundation, the BrightFocus Foundation, and the Ted Nash Long Life Foundation.

About UT Southwestern Medical Center: UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. Numbering more than 2,700, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to nearly 91,000 hospitalized patients and oversee more than 2 million outpatient visits a year.
Researchers at UT Southwestern Medical Center have found that the most common variant of the circulating protein apolipoprotein E, called apoE3, helps repair the lining of blood vessels. Individuals with another variant, called apoE4, do not get the benefit of this repair, putting them at higher risk for cardiovascular disease.

“We believe that we have identified one mechanism by which apoE3 promotes a healthy cardiovascular system and why a genetic variant, apoE4, is detrimental,” said Dr. Philip Shaul, Professor of Pediatrics and Vice Chair for Research in the Department of Pediatrics at UT Southwestern. 
Holyoke Medical Center ER Improves Productivity and Reimbursement with T-System
T-System’s electronic physician documentation system offers financially-strained healthcare provider improved reimbursement and seamless EHR integration.

After assessing several best-of-breed solutions, Holyoke chose T-System’s solution because not only of its success with optimizing physician productivity and reimbursement, but also its ability to integrate with their enterprise system, which will still be used to capture emergency department (ED) nurse documentation.

“We needed an electronic documentation system that could keep up with the fast-paced nature of an ED. With T-System we’re very confident we have just that,” said Carl Cameron, Holyoke Medical Center’s chief information officer. “I’m impressed with how easy it’s been to integrate EV™ into our current EHR platform.”

“We are excited about the recent go-live. Achieving more accurate documentation and increasing patient throughput will have a positive impact on our community,” said Cameron.

Holyoke implemented the T-System charting solution along with integrated diagnosis decision support and clinical decision support from PEPID.

About Holyoke Medical Center: Holyoke Medical Center, located in Holyoke, Mass., first opened its doors in 1893 as a 40-bed facility. Today, the hospital has grown into a 198-bed facility, serving eight surrounding communities. Each year, Holyoke admits more than 7,500 patients, while the emergency department admits more than 45,000 patients, alone. For more information, visit www.holyokehealth.com.

About T-System: T-System Inc. advances the practice of emergency medicine with solutions proven to solve clinical, financial, operational and regulatory challenges for hospitals and urgent care clinics. About 40 percent of the nation’s EDs use T-System solutions to provide an unmatched patient experience. Through gold-standard documentation, coding and performance-enhancing solutions, T-System optimizes care delivery from the front door through discharge and beyond. Today, more than 1,900 facilities across all 50 states rely on T-System solutions. For more information, visit www.tsystem.com. Follow @TSystem on Twitter and LinkedIn, or become a T-System fan on Facebook.
T-System Inc. today announced Holyoke Medical Center has implemented T-System’s electronic physician documentation system — EV™ for physicians —improving productivity and reimbursement.
                         Texas Health Arlington Memorial earns Magnet® Recognition                 

the United States, less than 400 have currently achieved Magnet recognition. More specifically, less than 35 are located in the state of Texas. 

           The four-year designation recognizes health care organizations for quality patient care, nursing excellence and innovations in the nursing practice. The rigorous and extensive evaluation process included: written documentation detailing patient care outcomes; a three-day site visit; and interviews with nurses, physicians and various hospital staff.

“The health care needs of the community continue to be top of mind, and now our Magnet recognition will serve as a beacon to the world that Texas Health Arlington Memorial is committed to providing the very best care to patients we are humbled to serve,” said Lori Donovan, hospital chief nursing officer. “It also exemplifies our ‘magnetic’ hospital team – every nurse, physician and hospital employee – working cohesively to create an environment where patient safety and satisfaction are common practice.”

The Magnet Recognition Program is designed to highlight the role of nursing by identifying the quality of nursing leadership as well as the processes for measuring and enhancing the delivery of care. “Without the tireless work and talent exhibited daily by our nurses, this momentous achievement would not have been possible,” said Kirk King, Texas Health Arlington Memorial president. “It’s an honor to be the first facility in Arlington to receive this prominent designation, but it especially shines the well-deserved spotlight on our dedicated nurses – the individuals at the forefront of care delivery.” 

Texas Health Arlington Memorial received official notification of its designation on Sept. 17.  Few hospitals submitting applications and documentation for Magnet recognition ever achieve success. Within the U.S., just seven percent have earned Magnet Recognition status.       

About Texas Health Arlington Memorial Hospital: Texas Health Arlington Memorial Hospital is a 369-bed acute-care, full-service medical center serving Arlington and the surrounding communities since 1958. The hospital’s services include comprehensive cardiac care, women’s services, orthopedics, an advanced imaging center and emergency services. Texas Health Arlington Memorial is an affiliate of the faith-based, nonprofit Texas Health Resources system. For more information, call 1-877-THR-WELL, or visit TexasHealth.org/Arlington.

About the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program® The Magnet Recognition Program® administered by the American Nurses Credentialing Center (ANCC), the largest and most prominent nurses credentialing organization in the world, recognizes healthcare organizations that provide the very best in nursing care and professionalism in nursing practice. The Magnet Recognition Program® serves as the gold standard for nursing excellence and provides consumers with the ultimate benchmark for measuring quality of care. For more information about the Magnet Recognition Program® and current statistics, visit www.nursecredentialing.org/magnet.
Texas Health Arlington Memorial Hospital has successfully achieved Magnet® designation by the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program®, becoming the first facility in Arlington, Texas to earn the prestigious recognition. Of nearly 6,000 hospitals in
Men should discuss prostate cancer risks with healthcare providers
Parkland physician stresses importance of early detection

information necessary to make the best decisions possible for them, according to physicians at Parkland Health & Hospital System. And with September being National Prostate Cancer Awareness Month, it’s a great time to begin those discussions.

“Men who are at average risk should start talking to their physician at age 50. Men at higher risk, including African-Americans, should do so at age 45 and men with a first degree relative with a diagnosis of prostate cancer should discuss testing at age 40,” said Yair Lotan, MD, Medical Director of the Parkland Urology Clinic and Chief of Urologic Oncology at The University of Texas Southwestern Medical Center.

According to the American Cancer Society, more than 2 million men in the United States who have been diagnosed with prostate cancer are still alive today. When detected at an early stage the five-year survival rate is close to 100 percent.

Age is the strongest factor for developing prostate cancer, with about two-thirds of the cases being diagnosed in men 65 and older. But family history, and even race, can also play a role. African-American men are disproportionally affected by the disease, having higher rates of prostate cancer diagnosis and death then men of all other racial or ethnic groups in the U.S.

“Researchers still aren’t sure why race may be a factor,” Dr. Lotan said.

Symptoms of prostate cancer vary widely and most men have no symptoms. Those who do may experience difficulty in starting urination; weak or interrupted flow of urine; frequent urination, especially at night; pain or burn during urination; blood in the urine or semen; or pain in the back, hips or pelvis that doesn’t go away.

Dr. Lotan noted that while discussing prostate cancer with your doctor is important, not all medical experts agree that the benefits of screening for prostate cancer outweigh the risks.

“The U.S. Preventive Services Task Force recommends against prostate-specific antigen (PSA)-based screening for men unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risks,” Dr. Lotan said.

According to Dr. Lotan, the potential risk of PSA testing is that it can be falsely elevated, leading to unnecessary prostate biopsy and treatment of prostate cancers in some men who were destined to die of other causes, as well as mild to serious side effects from treatment of prostate cancer. Still, it’s important for those in high risk categories to get tested and there has been some reduction in prostate cancer mortality since the introduction of prostate cancer screening.

Dr. Lotan advises all men of the importance of having an informed discussion with their physician about their risk factors and recommended screenings for prostate cancer.

For more information on prostate cancer, please visit the American Cancer Society at www.cancer.org/cancer/prostatecancer/detailedguide/. Men needing to discuss prostate cancer with a physician can contact any of Parkland’s Community Oriented Primary Care health centers, which can be located by visiting www.parklandhospital.com/phhs/locations
With more than 233,000 cases expected to be diagnosed in 2014 and more than 29,000 deaths, prostate cancer continues to be a major health concern for men.

Prostate cancer is the second leading cause of cancer death in men, and that’s why it’s so important for men to speak to their healthcare providers about the disease and get the 
Methodist Charlton Receives ACCF Platinum Performance Achievement Award for Cardiac Care

The award signifies that Methodist Charlton has reached an aggressive goal of treating patients according to the high standards outlined by the ACCF and American Heart Association.

“It is an honor for Methodist Charlton to be included among the recipients of the ACTION Registry–GWTG Platinum Performance Achievement Award for two successive years,” says Ingrid Kindipan, MSN, RN, CCRN, director of cardiology services at Methodist Charlton. “The award reflects the commitment of our team of dedicated physicians, nurses and leaders to quality patient care. In many ways, it is also an affirmation of our organization’s mission to improve and save lives through compassionate quality health care.”

To receive the Achievement Award, Methodist Charlton consistently followed the treatment guidelines for eight consecutive quarters and met a performance standard of 90 percent for specific performance measures.
Note to editor: Photo available at www.methodisthealthsystem.org/Photo-Charlton-ACCF-Award

About Methodist Health System: Guided by the founding principles of life, learning, and compassion, Methodist Health System (Methodist) provides quality, integrated care to improve and save the lives of individuals and families throughout North Texas.   Methodist Dallas Medical Center, Methodist Charlton Medical Center, Methodist Mansfield Medical Center, Methodist Richardson Medical Center, and Methodist Family Health Centers are part of the nonprofit Methodist Health System, which is affiliated by covenant with the North Texas Conference of The United Methodist Church. Additional information is available at www.methodisthealthsystem.org. Connect with them through Facebook, YouTube and Twitter at www.methodisthealthsystem.org/socialmedia.
Methodist Charlton Medical Center has received the American College of Cardiology Foundation (ACCF) NCDR ACTION Registry®–GWTGTM Platinum Performance Achievement Award for 2014, one of only 256 hospitals nationwide to receive the honor.
Current Parkland Hospital turns 60 years old
Original facility was seven stories; built without air conditioning

Today, nearly 60 years later, construction is all but complete on the 17-story new acute care hospital that dwarfs the current facility which first opened to patients on Sept. 25, 1954. Having served the residents for six decades, the current facility was not without controversy. Before the Parkland groundbreaking on April 26, 1952, politicians wrestled over a moral decision, which was reconstructed in a document entitled The Sound and the Fury in the Construction of Parkland Memorial Hospital.

An excerpt from those documents said: “They decided not to install air conditioning throughout the hospital. ‘This came mostly through Mr. R.L. Thornton’s insistence that facilities in the hospital should not be better on a free basis to patients than facilities in Baylor, St. Paul’s and Methodist hospitals, where the patient was paying for hospitalization’.”

“That meant that Parkland was built on an angle on Harry Hines Boulevard so that there was a cross breeze that would cool the building,” said Walter Jones, Parkland’s Senior Vice President of Facilities and Development. “Even with windows that would open, one could only imagine the temperatures in Dallas during the summer months.”

It was during a July heat wave in 1963 that Ed Maher, longtime chairman of the hospital board, announced plans for air conditioning Parkland in 1964. Architects were commissioned to draw plans for the second through seventh floors. At the time, the basement, ground floor, first floor and the clinic were air conditioned, but with the exception of a few window units, the remainder of the hospital was not. In December 1964, a $7.5 million bond issue was approved to expand the hospital and the upper three floors were added.

The bond issuance also provided funds for additional parking facilities, improvements at Woodlawn Hospital, expansion of the south wing to provide additional space for X-ray, labs, an emergency room, operating rooms, delivery rooms, labor rooms and a fourth floor for the outpatient clinic.

In November 1979, the Parkland Board of Managers asked County Commissioners to call an $80 million bond election to modernize the hospital’s aging facility. Dallas County voters overwhelmingly approved the bond and in 1981, construction began on the 10-floor north tower, a seven-floor outpatient clinic, five-story support building, completion of shelled-in space on seven floors of the south/south wing, a new special care nursery and renovation of 15 patient-care units.

“A lot has changed since the current Parkland opened its doors. The building looks nothing like it did in 1954. The only signs of the original structure are the ‘pinkish’ colored bricks visible on certain areas of the building,” Jones said. “There have also been major advances in both medicine and technology. And while we look at the current hospital and know we are providing high quality, safe patient care, we are still limited by a 60-year-old building.”

Limited, Jones said, in that the facility is land-locked with no room for expansion up or out. And limited in the height of the floor to ceiling crawl space needed to run wires to create a truly wireless environment.

But with just months to go before the last inpatient is admitted to the current facility and the first admitted to the state-of-the-art new Parkland hospital, one can’t help but think of the aging facility and the history contained within.

“If the walls could talk, how fascinating it would be hear of all the medical ‘firsts’ and the numerous times Parkland held a place in history,” Jones said. “And we can only imagine that generations from now people will be celebrating a whole new set of ‘firsts’ in the new Parkland.”

To learn more about Parkland’s history, please visit www.parklandhospital.com/history
When the “new” Parkland opened in 1954, the seeming expansiveness of the seven-story T-shaped building almost overwhelmed employees. In its first year, the new Parkland admitted 14,719 patients, delivered more than 4,000 babies and saw 57,256 emergency patients.
UT Southwestern recognized among top 10 for leadership development by the National Center for Healthcare Leadership

UT Southwestern was the only Texas institution in the top 10, and it was selected from among 120 health systems that participated in NCHL’s 2014 National Health Leadership Survey. The NCHL is a Chicago-based, not-for-profit organization that works to ensure the availability of accountable and transformational healthcare leadership for the 21st century. Its vision is to improve the health of the public through leadership and organizational excellence.

“We are dedicated to training the next generation of physicians, but in addition we are committed to training the next generation of healthcare leaders. It takes a special blend of skills, both personal and professional, to navigate the uncertain waters that hospitals and healthcare institutions face. These individuals will do a great service to hospitals in Texas and around the country,” said Dr. J. Gregory Fitz, Executive Vice President for Academic Affairs, and Provost and Dean of the UT Southwestern Medical School. Dr. Fitz also holds the Nadine and Tom Craddick Distinguished Chair in Medical Science and the Atticus James Gill, M.D. Chair in Medical Science.

Some of the professional development efforts at UT Southwestern include:

·         Early-Career Women Faculty Professional Development Seminars for women at the level of Assistant Professor, which covers leadership topics and provides skills related to academic medicine career building and strategic thinking about career development.

·         Mid-Career Women Faculty Professional Development Seminars for women primarily at the level of Associate Professor to enhance knowledge and skills needed to support progress along the path to leadership in academic medicine, such as team building, communication skills, institutional finance, and management issues.

·         Minority Faculty Career Development Seminars to support the career development of junior faculty (senior fellows, instructors, and assistant professors) who are members of under-represented racial and ethnic minority groups and who aspire to leadership positions in academic medicine.

·         Executive Development Seminars for Associate Deans and Department Chairs that provide emerging leaders with specific training in personnel management, legal issues in higher education, communications (both interpersonal and inter-organizational) in the clinical environment, and financial management.

·         Executive Development for Interim and Aspiring Leaders, focused on emerging leaders in academic medicine and those who hold interim leadership positions to provide leadership and management tools to prepare for key leadership roles at every institutional level within a division, department, center, or institute.

·         Leadership Emerging in Academic Departments (LEAD) Program for Junior Faculty Physicians, and Scientists, which is designed for junior faculty who aspire to develop their leadership skills

Other efforts to train the next generation of leaders include programs for future medical scientists, including a dual-degree M.D./Ph.D., program, exchanges in global health projects and initiatives, enrichment programs, and programs for undergraduate and high school students interested in medical and biological careers. The Students Emerging Academy of Leaders (SEALs) workshop is designed to provide a platform for students to develop skills necessary to be effective leaders in biomedical fields. UT Southwestern’s Endowed Scholars Program in Medical Science provides generous financial support over four years to newly appointed tenure-track assistant professors. Funded by private endowment, the Endowed Scholars Program has launched the research careers of more than 75 investigators. UT Southwestern’s Global Health Interest Group encourages, educates, and equips medical students for experiences around the world, and promotes dialogue about current issues in global health.

NCHL will recognize UT Southwestern and other recipients at the its inaugural BOLD luncheon, held in conjunction with NCHL’s 2014 Human Capital Investment Conference Nov. 20 and 21 in Chicago. The conference will explore innovative ways to succeed during times of disruption, and showcase leadership development best practices.

In announcing the awards, NCHL Chief Executive Officer Andrew N. Garman said, "BOLD honors health systems for their leadership development work, which – importantly – will be available to organizations throughout the country. This will provide others the tools to assess the effectiveness of their approach to preparing current and future leaders, which is a critical factor in achieving organizational excellence.”

The other nine highest-ranking BOLD organizations included: Banner Health (Phoenix); Cleveland Clinic (Cleveland); Cone Health (Greensboro, NC); Duke Regional Hospital, (Durham, NC); Henry Ford Health System (Detroit); Mountain States Health Alliance (Johnson City, TN); North Shore-LIJ Health System (Great Neck, NY); Presbyterian Healthcare Services (Albuquerque); and Sutter Healthcare (Sacramento).

About UT Southwestern Medical Center: UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. Numbering more than 2,700, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to nearly 91,000 hospitalized patients and oversee more than 2 million outpatient visits a year.
UT Southwestern Medical Center has been named among the top 10 “Best Organizations for Leadership Development” by the National Center for Healthcare Leadership (NCHL).  UT Southwestern was recognized for its efforts to prepare current and future leaders, who are transforming healthcare.

The BOLD recognition identified healthcare organizations for their evidence-based leadership development practices, aimed at achieving excellence and improving the quality of healthcare in their communities. The practices will be shared with organizations throughout the country to help them prepare future leaders and achieve organizational excellence.
Massive weight loss increases risk of complications in body-shaping surgery, study by UT Southwestern plastic surgeon finds

           “This is one of the first large-scale studies comparing outcomes in patients losing significant amounts of weight via surgical and nonsurgical means,” said Dr. Jeffrey Kenkel, Professor and Acting Chairman of Plastic Surgery at UT Southwestern, and senior author of the study. “Major weight loss was a significant risk factor for wound complications in body contouring surgery.”

Of the 450 study participants, 124 lost 50 pounds or more before their surgery. Patients included men and women in all age groups who completed body contouring procedures including body lifts, tummy tucks, thighplasty, arm lifts, breast lifts, breast reduction, and liposuction.

Dr. Kenkel and his peers conducted statistical analyses to identify risk factors and to determine the probability of patients experiencing healing issues or complications after their surgery.

               Patients with weight loss of more than 100 pounds were found to be at higher risk for complications, regardless of weight loss method. Furthermore, post-bariatric patients had the highest rate of complications. Gastric bypass patients were at greater risk than patients who lost weight through diet and exercise. Patients who underwent restrictive bariatric procedures, such as gastric sleeve or the Lap-Band, had the lowest risk of complications among surgical weight loss patients.

           With these considerations in mind, Dr. Kenkel investigated physiological factors that make massive weight loss patients susceptible to complications, such as infection, delayed healing, ruptures, and reddening of the skin.

“In addition to identifying massive weight loss patients as a vulnerable population, these types of studies are important to help surgeons improve patient care. The data that we have collected is valuable in managing known risks and designing pre- and post-surgical treatment,” said Dr. Kenkel, who holds the Rod J. Rohrich, M.D. Distinguished Professorship in Wound Healing and Plastic Surgery.

           One reason why post-bariatric patients have more complications is nutrition. Following bariatric procedures, many patients consume less than 1,000 calories daily, which leads to lower protein levels and nutritional deficiencies. Their bodies adapt to their new nutritional state, which then changes when the body becomes stressed by surgery.

“It is imperative that patients account for their dietary deficiencies and prepare their bodies for surgery,” said Dr. Kenkel, Director of the Clinical Center for Cosmetic Laser Treatment and Chief of Plastic Surgery at UT Southwestern University Hospitals. “Nutrition plays an important role in skin healing, collagen production, and the generation of new blood vessels, all of which are important during recovery.”

           To improve patient health, UT Southwestern plastic surgeons currently conduct nutritional assessments and administer protein and vitamin supplements.

“Surgeons should monitor these patients carefully and make sure their vitamin and protein supplements are complete. Daily protein supplements are vital for achieving complication rates that are in line with non-bariatric candidates,” Dr. Kenkel said. “We can also enhance recovery by tailoring pre-operative care to the patient’s weight loss amount and method. As our understanding of these risks advances, we are able to provide the growing number of body contouring patients the best possible circumstances for a safe recovery.”

About UT Southwestern Medical Center: UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. Numbering more than 2,700, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to nearly 91,000 hospitalized patients and oversee more than 2 million outpatient visits a year.
Patients who lost more than 100 pounds and those who shed weight through bariatric surgery had the highest risk of complications from later surgical procedures to reshape their leaner bodies, a new study from UT Southwestern Medical Center shows.

The study, published in the Aesthetic Surgery Journal, compared surgical complication outcomes for 450 patients who underwent body contouring, a type of surgery to remove excess sagging fat and skin to improve body shape.
Texas Health HEB to Offer Screening Mammograms Through Mobile Health Program

Patients' insurance will be billed directly. Those without insurance may qualify for fully funded screenings.

Those interested can register by calling 1-855-318-7696 Monday through Friday, 8 a.m. to 5:30 p.m. Patients should bring a form of identification  and insurance cards (if insured).

The breast health screening will last approximately 15 to 20 minutes, including a four-view screening mammogram and breast health education. Mammograms are read by a board-certified radiologist, and the results are sent to the patient and her physician.

Women who are eligible for the mammograms must:

  *   Be age 40 and over
  *   Have no personal history of breast cancer
  *   Not have breast implants
  *   Have no known breast lumps or breast problems
  *   Not be pregnant or nursing or nursed in the past six months
  *   Not have had a mammogram in the past 12 months

"For women who fit the criteria, getting a yearly mammogram is a must," said Ajay Dubey, M.D., a radiation oncologist on the medical staff at Texas Health HEB and chair of the hospital's cancer committee. "Mammograms help physicians catch breast cancer in the earliest, and most treatable, stages."

Wellness for Life is a prevention and early detection program available to the community through the mobile health unit. The goals of Wellness for Life are to increase awareness of cancer prevention, promote the benefits of cancer screening and offer the community easy accessibility to health screening and early detection services. It's staffed by family nurse practitioners, registered nurses and other health professionals. Medical oversight is provided by a board-certified physician member of the medical staff at Texas Health Harris Methodist Hospital Fort Worth.
Texas Health Resources' Wellness for Life mobile health unit will offer screening mammograms at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford<http://www.texashealth.org/HEB> on Thursday, Oct. 2, from 9 a.m. to 3 p.m. The hospital is located at 1600 Hospital Parkway in Bedford.
Parkland stands ready to handle injuries from natural, man-made disasters
New hospital built with flexibility, surge capacity

“The hospital was planned for the unknown and designed with flexibility in mind,” said Kathy Harper, RN, Vice President of Clinical Coordination. “Although we have private patient rooms in the new hospital, in the event of a disaster in the community, our surge capacity will enable us to easily place two patients in one room.”

If a disaster is chemical or biological in nature, the new Parkland is designed so that airborne pathogens are contained and not spread through the ventilation system. Staff also has the ability to restrict access to certain parts of the hospital in order to isolate patients who may have been exposed to a pathogen.

“Having the ability to restrict access is incredibly important in a disaster situation, but it will also be important during outbreaks of influenza or other communicable diseases,” said Jorie Klein, RN, Parkland’s Director of Trauma and Disaster Preparedness.

Taking care of disaster victims is nothing new for Parkland. In 2005, staff treated more than 21,000 people displaced from the Gulf Coast who made their way north to flee the rising water. Parkland and other local facilities set up a mobile hospital in what was once Reunion Arena and then the Dallas Convention Center, seeing more than 500 patients per day in the makeshift medical facility.

“As part of our disaster preparedness, Parkland staff participates in two drills each year,” Klein said. “Those drills enable us to identify our strengths and where there is room to enhance or improve our plan based on the after-action review of our disaster response. We practice various disaster scenarios over and over to ensure that when a real event occurs we are ready for an influx of patients who may have minor cuts to life-threatening injuries.”

Although there is a well-established plan in place for the current hospital, Klein and her team are working on the emergency response plan for the new hospital.

“There are things we will do the same, but many things will be different due to technology advances and structural improvements,” Klein said. “Most important is training our staff so they know what to do and where to go in the event an emergency response code is called. We need to be prepared to handle any event whether it is natural or man-made. Another key element of the training is to teach staff to prepare their homes and families for disasters and how to respond.”

Included in the new hospital’s disaster response is a decontamination unit which has already been redesigned to allow for more capacity.

“Things may look good on paper, but you never know how well they will work until you actually test and retest,” Klein said. “We want to make sure that we are prepared for anything that may come our way.”
With hurricane season in full force, residents of Dallas County should be braced for any storm that may make its way up from the gulf. In the event a disaster does strike, Parkland Health & Hospital System staff stands ready to handle whatever Mother Nature’s fury unleashes. And with the opening of the new hospital in 2015, Parkland will be even better prepared to serve the community in any disaster.
Many patients excluded from lung cancer clinical trials due to prior cancer, UT Southwestern study finds

“Our research demonstrates that a substantial proportion of potential subjects are reflexively excluded from lung cancer clinical trials due to prior cancer,” said lead author Dr. David Gerber, Associate Professor of Internal Medicine in the division of Hematology and Oncology. In many cases, prior cancer seems to be the only reason for study ineligibility, even though the prior cancer seems unlikely to interfere with the treatment or outcomes of the current lung cancer, Dr. Gerber explained.

“The resulting impact on study accrual is sobering,” said Dr. Gerber, a co-leader of the Experimental Therapeutics Program and co-director of the Lung Disease Oriented Team at the Harold C. Simmons Cancer Center at UT Southwestern. “The proportion of potential patients excluded due to prior cancer per trial ranged up to 18 percent, with the estimated absolute number of excluded patients per trial ranging up to 207.”  Dr. Gerber projected that these effects will only increase with time; there are currently more than 13 million cancer survivors in the U.S., which is a four-fold increase over the past 30 years.

           Researchers examined lung cancer trials conducted by the Eastern Cooperative Oncology Group (ECOG), a National Cancer Institute (NCI)-funded organization that designs and conducts cancer clinical trials. Even within this organization, prior cancer eligibility criteria varied widely. Forty-three percent of trials excluded patients with prior cancer diagnosed within 5 years of study enrollment, 16 percent of trials excluded those with active cancer, 14 percent excluded those with any history of cancer, and 7 percent of trials excluded patients who had cancer within the past two to three years.

Nationwide, fewer than 2 percent of adults participate in clinical trials, with stringent eligibility criteria a key barrier to patient enrollment. Other reasons for low participation include limited access to clinical trials and lack of patient interest.

           Additional studies are needed to determine whether or not prior cancer exclusion criteria are justified, Dr. Gerber said.

“If future studies demonstrate that prior cancer does not limit lung cancer treatment options or adversely impact clinical outcomes, modifying or eliminating this longstanding and arbitrary exclusion policy in lung cancer clinical trials may result in more generalizable results, faster accrual, higher completion rates, and the delivery of better treatments to more patients sooner,” Dr. Gerber said. “Because clinical trial design is relatively centralized, we believe that implementation of such changes could occur rapidly.” 

Such changes would be particularly welcome for lung cancer, which causes more deaths than any other cancer in both men and women. According to the American Cancer Society, an estimated 224,210 new cases of lung cancer are expected in 2014, accounting for about 13 percent of all cancer diagno­ses.

“Randomized clinical trials in cancer tend to focus on a narrow, homogenous group of individuals. This study shows the impact on the overall population of such an approach. As treatment both for cancer and other life-threatening diseases improves, there are more and more long-term cancer survivors in the U.S. These people can sometimes get a second cancer later in life. It is really important from a clinical and policy perspective to be able to include such individuals in cancer trials so we have more representative information about how well cancer treatments work in this growing subgroup of patients/cancer survivors,” said co-author Dr. Ethan Halm, Chief of the William and Gay Solomon Division of General Internal Medicine, and Chief of the Division of Outcomes and Health Services Research in the Department of Clinical Sciences at UT Southwestern.

           Support for the study included a National Cancer Institute Clinical Investigator Team Leadership Award, and grants by the American Cancer Society, Harold C. Simmons Cancer Center, the Cancer Prevention Research Institute of Texas (CPRIT), and the UT Southwestern Center for Patient-Centered Outcomes Research.

UT Southwestern earlier this year established a Center for Patient-Centered Outcomes Research that supports and conducts high-quality research comparing the outcomes and effectiveness of different strategies to prevent, diagnose, treat, and monitor health conditions to improve patient care. The center, part of a national network of seven institutions, is funded through a $5 million, five-year grant from the federal Agency for Healthcare Research and Quality (AHRQ), and led by co-author Dr. Halm, who holds the Walter Family Distinguished Chair in Internal Medicine in Honor of Albert D. Roberts, M.D.

UT Southwestern’s Harold C. Simmons Cancer Center is the only National Cancer Institute-designated cancer center in North Texas and one of just 66 NCI-designated cancer centers in the nation. The Harold C. Simmons Cancer Center includes 13 major cancer care programs with a focus on treating the whole patient with innovative treatments, while fostering groundbreaking basic research that has the potential to improve patient care and prevention of cancer worldwide. In addition, the Center’s education and training programs support and develop the next generation of cancer researchers and clinicians.

Other UT Southwestern researchers involved include Dr. Sandi Pruitt, Assistant Professor of Clinical Science; Dr. Andrew Laccetti, Department of Internal Medicine; and Lei Xuan, biostatistical consultant in Clinical Sciences.
Lung cancer clinical trials exclude a substantial proportion of patients due to a history of prior cancer, as shown in an analysis by cancer researchers at UT Southwestern Medical Center.

Among more than 50 lung cancer clinical trials examined, more than 80 percent excluded patients with prior cancer from participating, according to the study published in the Journal of the National Cancer Institute. The exclusion criterion was even applied in more than two-thirds of trials in which survival was not the primary endpoint.
New ways to treat anemia could evolve from UT Southwestern research showing that acetate supplements speed up red blood cell production

           “Using rational interventions based on the mechanistic insights gleaned from our current studies, we may be able to treat acutely or chronically anemic patients with acetate supplements and thereby reduce the need for blood transfusions or erythropoietin therapy,” said Dr. Joseph Garcia, Associate Professor of Internal Medicine at UT Southwestern, staff physician-scientist at the VA North Texas Health Care System, and senior author of the study, published in Nature Medicine.

Anemia is the most common blood disorder, affecting some 3.5 million people, including children and women of child-bearing age, as well as many elderly persons. It can have a significant impact on quality of life, leading to fatigue, weakness, and decreased immune function. People who are anemic produce insufficient red blood cells, which deliver oxygen to tissues throughout the body.

UT Southwestern researchers began their studies by identifying a critical pathway that controls the production of red blood cells in conditions of stress, such as low oxygen. Using genetically modified mice, researchers observed that low oxygen, a state known as hypoxia, stimulates the production of acetate.

Acetate, in turn, activates a molecular pathway that ultimately results in the production of red blood cells, or erythropoiesis, by triggering the production of the protein that stimulates this process, called erythropoietin.

           “Our study shows that acetate functions as a biochemical ‘flare,’ linking changes in cell metabolism that occur during hypoxia with the activation of a selective stress signaling pathway,” Dr. Garcia said.

Other researchers involved in the work include Dr. Chou-Long Huang, Professor of Internal Medicine and holder of the Jacob Lemann, M.D. Professorship in Calcium Transport; Dr. Robert Hammer, Professor of Biochemistry and the Cecil H. and Ida Green Comprehensive Center for Molecular, Computational, and Systems Biology, and holder of the Graydon Heartsill Professorship in Medical Science; Dr. Jay Horton, Professor of Internal Medicine and Molecular Genetics, holder of The Dr. Robert C. and Veronica Atkins Chair in Obesity & Diabetes Research; Dr. Robert Gerard, Associate Professor of Molecular Biology; Dr. Sarah Comerford, Assistant Professor of Molecular Genetics, and the Cecil H. and Ida Green Comprehensive Center for Molecular, Computational, and Systems Biology; Dr. Young-Ah Moon, Assistant Professor of Molecular Genetics; Dr. Jian Xie, Assistant Professor of Internal Medicine; Min Xu, Research Scientist; Jason Nagati, Research Assistant; researchers Jiwen Li and  Holly Walters; and Dr. Rui Chen, former Assistant Professor of Internal Medicine.

The research was supported by funds provided by the Department of Veterans Affairs and the National Institutes of Health.

About UT Southwestern Medical Center: UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. Numbering more than 2,700, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to nearly 91,000 hospitalized patients and oversee more than 2 million outpatient visits a year.
UT Southwestern Medical Center researchers seeking novel treatments for anemia found that giving acetate, the major component of household vinegar, to anemic mice stimulated the formation of new red blood cells.

Currently, the hormone erythropoietin is administered to treat anemia, but this treatment carries with it side effects such as hypertension and thrombosis (blood clotting). The new research, which was performed in mice, suggests that acetate supplements could eventually be a suitable supplement or possibly even an alternative to administration of erythropoietin.
Methodist Charlton Names Oncology Medical Director

Methodist Charlton’s efforts and continued progress towards achieving cancer center accreditation through the American College of Surgeons. 

Dr. Gandhi moderates the Methodist Charlton general tumor and breast cancer conferences, chairs the cancer committee and sub-committee, and is a member of the oncology process improvement team with the Methodist Accountable Care Organization (ACO). 

Frank Vittimberga, MD, chief medical officer at Methodist Charlton, says, "Dr. Gandhi's drive to improve quality and efficient delivery of care are reflected in many of the positive changes we have seen at Methodist Charlton. His commitment to excellence will continue to allow us to bring world-class cancer care to our local community."

About Methodist Health System: Guided by the founding principles of life, learning, and compassion, Methodist Health System (Methodist) provides quality, integrated care to improve and save the lives of individuals and families throughout North Texas.   Methodist Dallas Medical Center, Methodist Charlton Medical Center, Methodist Mansfield Medical Center, Methodist Richardson Medical Center, and Methodist Family Health Centers are part of the nonprofit Methodist Health System, which is affiliated by covenant with the North Texas Conference of The United Methodist Church. Additional information is available at www.methodisthealthsystem.org. Connect with them through Facebook, YouTube and Twitter at www.methodisthealthsystem.org/socialmedia.
Darshan Gandhi, MD, was recently named medical director of oncology services at Methodist Charlton Medical Center. Dr. Gandhi specializes in hematology and medical oncology, and is board certified in internal medicine, hematology and medical oncology. He has been instrumental in leading
Parkland experts emphasize benefits of exercise for the elderly
It’s never too late to start working out

This finding has significant implications for a nation whose population continues to age and live longer, according to Parkland Health & Hospital System experts. With September designated as National Healthy Aging Month, Parkland geriatric providers want to emphasize the importance of regular exercise for older people.

“The truth is that it’s never too late to exercise or even to begin to exercise,” said Chiffon Okuda, RN, BAAS, Geriatric Case Manager, Parkland’s Senior Outreach Services. “Many people do not start regularly exercising until they are 50, 60 or 70 years old. And, many have exercised into their 90s and beyond!”

Okuda said exercise is beneficial for older people in many ways. It can strengthen bones, improve balance, increase energy and metabolism and help lower blood pressure, control diabetes, promote heart health and improve blood circulation.

“It boosts mental health, as well,” Okuda said. “Exercise can lift a person’s mood, even in patients with depression. Group exercise can also help a senior stay connected with his or her community.”

And, exercise can help a person avoid mobility issues. Stronger bones and muscles can reduce the risk of falls, a major health risk for aging individuals.

One of those who say exercise has been good for her is 78-year-old Roberta Brown of Dallas, who has been exercising for the past five years. Brown, who suffers from arthritis in her knee, said she learned about the benefits of exercise when she attended arthritis education classes at Bluitt-Flowers Health Center, one of Parkland’s Community Oriented Primary Care clinics, and at Parkland’s Geriatrics Department. The classes were presented by Parkland’s Senior Outreach Services.

“I didn’t know how important it was or that I could still start exercising at my age,” Brown said. “But the physical therapists showed us all the things we could do, and even got us on the floor to do some exercising.”

At home she rides a stationary bike for 20 to 30 minutes a day, three times a week, does chair exercises and when temperatures are cooler, walks for several blocks.

“The more I do, the better I feel,” she said. “When I stop exercising for a while, I notice my knee hurts more.”

Researchers in the JAMA study found that a structured, regular and moderate exercise program followed for about two and a half years reduced the risk of major mobility disability by 18 percent. The people in the study were between 70 to 89 years of age, and they had an assortment of chronic illnesses typical for their age group.

Okuda urged people to check with their doctors before starting any exercise program. And she recommended that people find a physical activity they enjoy, such as walking, swimming or a stationary bicycle.

For most people, walking may be the easiest form of exercise, starting with 10 to 15 minutes and gradually increasing to 30 or 45 minutes daily. Swimming is great for those with joint problems. Lifting light weights can help strengthen bones and increase muscle. You don’t even need to have weights – canned food or water bottles work well.

And always remember to stay hydrated, drink plenty of water and do not walk outside during the hottest parts of the day; walk early or late to avoid heat exhaustion.

“Check out local gyms and YMCAs for older adult classes,” Okuda said. “Always ask for a senior discount, and always have fun.”

For more information about Parkland’s Senior Outreach Services, call 214.590.0646.
Most people know exercise can help you feel younger and healthier, but recent research shows that even older people can benefit from physical activity regardless of age and health condition. According to a study published this year in the Journal of the American Medical Association (JAMA), structured, moderate physical activity significantly reduced the risk of losing mobility. Inability to walk without assistance is a leading cause of the elderly losing their independence.
Change in federal law to impact patients using hydrocodone
Parkland providers say changes will alter how prescriptions are dispensed

“We want our patients to be aware of this change that will be implemented across the country by all pharmacies and health care providers on Oct. 6,” said Vivian Johnson, PharmD, MBA,Vice President of Pharmacy Services at Parkland. “Patients will need to have a prescription for these medications written on a special prescription form each time the medicine is filled.”

In addition, the new law states that most nurse practitioners, physician assistants and medical residents will not be able to write an outpatient prescription for a medicine containing hydrocodone. The new prescription must be written by a physician authorized by the Department of Public Safety to write Schedule II prescriptions on special prescription forms.

Beginning Oct. 6, patients will:
Always have to get a written prescription for hydrocodone-containing medicine from their doctor
No longer be able to receive these medicines from a mail order pharmacy
Still be required to provide identification to pick up their medication
No longer be able to rely on their pharmacy to send a refill request to their doctor on their behalf
Need to check with their pharmacy to see if refills written prior to Oct. 6 will be honored by the pharmacy 
“The new law is an attempt by the government to raise the awareness and safely monitor the use of some of the most addictive and potentially dangerous opioid medications,” said Enas Kandil, MD, an anesthesiologist and pain management specialist at Parkland and Assistant Professor of Anesthesiology and Pain Management at The University of Texas Southwestern Medical Center.

Drug overdose death rates have been rising steadily since 1992 with a 118 percent increase from 1999 to 2011 alone according to the Centers for Disease Control and Prevention. Drug overdose was the leading cause of injury death in 2011. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle accidents.

For more information about this change, please contact your physician or pharmacy. Patients filling prescriptions at Parkland who have questions can call the number on their prescription bottle.
Due to a change in federal law, beginning Oct. 6, 2014, all prescriptions for any medicine containing hydrocodone, including medications such as Norco, Lortab, Vicodin and some others, will be reclassified to a Schedule II (2) Controlled Substance. According to experts at Parkland Health & Hospital System, this nationwide change will impact patients seeking new prescriptions and will also restrict the type of providers who can write a prescription for a medicine containing hydrocodone.