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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.
Methodist Mansfield Medical Center Names Vice President of Operations









“Dent is an accomplished leader in the health care industry. His professional talents and open, personal style are well suited for guiding Methodist Mansfield’s ancillary and support services to a superior level of operational excellence as we continue to grow and serve the health care needs of Tarrant, Johnson, Ellis and South Dallas counties,” says John Phillips, FACHE,  president, Methodist Mansfield. “The new role provides an exceptional opportunity for Dent and his team to focus on providing superior quality of services, exemplary patient satisfaction and higher employee engagement.”

Smith has a solid track record of driving innovation, enhancing patient satisfaction and achieving organizational success. During his 30 year tenure in the Catholic healthcare arena, he has led initiatives to enhance clinical integration and hospital operations while building effective teams, attaining aggressive patient satisfaction scores, and meeting financial goals.

Smith has Bachelor of Science degrees in radiologic technology, business administration from the University of Central Arkansas and a Master of Health Administration degree from Webster University.  He has received multiple awards and was the first recipient of the Blandford Award while in the Saint Vincent Health System. This award is given to the leader who best demonstrates the core values of reverence, integrity, compassion and excellence. 

He and his wife Maureen are eager to relocate to Mansfield from Kentucky and become a part of our 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.
Dent Smith has joined Methodist Mansfield Medical Center as vice president of operations. In this new role, he is charged with enhancing focus on operational excellence and patient satisfaction as well as oversight of operational synergy with Methodist Health System. He is responsible for the coordination and leadership of many of the hospital’s clinical and nonclinical support departments as well as construction-related activities.

Prior to joining Methodist Mansfield, Smith served as vice president of professional and ancillary services at Saint Joseph Hospital in Lexington, Kentucky for six years. 
T-System Offers a Complimentary Screening Tool to Prepare Unscheduled Care Providers for Ebola Patients
Screening tool can help providers with early identification and avoid potentially releasing infected patients






The Texas Health Presbyterian Hospital of Dallas stated that their facility originally released the first U.S. Ebola patient due to lack of communication between clinicians, according to a Modern Healthcare article published on Saturday. The announcement reminded unscheduled care providers of not only the importance of team communication, but also the importance of utilizing tools designed for this specialized type of care.

“News regarding the Ebola diagnosis hit very close to home, as T-System is headquartered in Dallas,” said Robert Hitchcock, M.D., FACEP and chief medical informatics officer at T-System. “We felt it was critical to design a tool that enhances the screening process, team communication and patient care. We hope in doing so, we can help ensure the infection doesn't spread throughout the United States.”

The tool is designed to provide screening criteria specific to the identified Ebola Virus Disease in accordance with guidance from the U.S. Centers for Disease Control and Prevention. Urgent care, ED and EMS care providers can use this consistent method to quickly assess a patient and determine next steps.

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, revenue cycle management 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.
To help healthcare providers quickly and accurately identify patients infected with Ebola Virus Disease (EVD), T-System Inc. today announced the release of a complimentary screening tool. Providers can download the free tool on T-System’s website to help their staff rapidly identify patients potentially infected with the Ebola virus.
Parkland recognizes extraordinary nurses
National DAISY awards implemented for inpatient, outpatient nurses






The not-for-profit DAISY Foundation is an international program based in Glen Ellen, CA, and was established by family members in memory of J. Patrick Barnes. In 1999, Barnes, 33, died from complications of Idiopathic Thrombocytopenic Purpura (ITP), a little known but not uncommon auto-immune disease. The care Barnes and his family received from nurses inspired this unique means of thanking nurses for making a profound difference in the lives of their patients and patient families.

Last week Michelle Burkhardt, RN-BC, received Parkland’s first inpatient DAISY award. Burkhardt, who works in a surgery unit, was nominated by her peers for the compassion shown to every patient in her area. In fact, many of her patients return to Parkland just to visit Burkhardt and update her on their progress. Vanessa Grifaldo, RN, a nurse at Parkland’s Vickery Health Center, received the award for the outpatient/community medicine setting. Grifaldo was described as “a devoted, authentic employee who not only works hard but works smart. She exhibits high standards and excellent performance” at all times.

“We are proud to be among the hospitals participating in the DAISY Award program. Nurses are heroes every day,” said Ron Laxton, DNP, RN, Parkland’s Chief Operating Officer and interim Chief Nursing Officer. “Given the current national nursing shortage, The DAISY Award could not be launched at a better time.”

For their efforts Burkhardt and Grifaldo received a certificate commending them for being an “extraordinary nurse.” The certificate reads: “In deep appreciation of all you do, who you are, and the incredibly meaningful difference you make in the lives of so many people.” The honorees also received a DAISY recognition pin and a sculpture called A Healer’s Touch, hand-carved by artists of the Shona Tribe in Africa. DAISY honorees are also recognized on the national DAISY Foundation website.

“When Patrick was critically ill, our family experienced first-hand the remarkable skill and care nurses provide patients every day and night,” said Bonnie Barnes, President and Co-Founder of The DAISY Foundation. “Yet these unsung heroes are seldom recognized for the super-human work they do. The kind of work the nurses at Parkland are called on to do every day epitomizes the purpose of The DAISY Award.”

For more information on The DAISY Awards, visit their website at www.DAISYfoundation.org      
Each month two nurses at Parkland Health & Hospital System will be honored with The DAISY Award for Extraordinary Nurses. The award is part of the DAISY Foundation’s program to recognize nurses who demonstrate outstanding clinical skills and compassionate care. 
A New Investigational Cardiac Pacemaker as Small as a Vitamin
First in Texas: Baylor Heart and Vascular Hospital Team Implants Device as Part of Clinical Study



size of a multivitamin. The first implantable pacemakers, developed in the late-1950s, were nearer the size of a transistor radio.

Cardiologists on the BHVH medical staff implanted the world’s smallest pacemaker, the Medtronic Micra™ Transcatheter Pacing System (TPS) as part of a study by Medtronic. “This is an investigational device that could be a game-changer because of its size and the technology housed inside of it,” says Dr. Robert C. Kowal, MD, PhD, principal investigator for this trial at BHVH. Fifty institutions around the globe are participating in the trial.

One-tenth the size of a conventional pacemaker, the Micra TPS is delivered directly into the heart through a catheter inserted in the femoral vein (groin). Once positioned, the pacemaker is securely attached to the heart wall and can be repositioned or retrieved if needed.

“This miniaturized technology is designed to provide patients with the advanced pacing technology of traditional pacemakers via a minimally invasive approach. In the past, we made a surgical incision in the chest and created a ’pocket‘ under the skin where we placed the pacemaker,” explained Dr. Kowal. “This one is placed inside the heart via catheter.” This eliminates a potential source of complications, and any visible sign of the device, he said.

Pacemakers are the most common way to treat slow or irregular heart rhythms. A pacemaker helps restore the heart's normal rhythm and relieve symptoms by sending electrical impulses to the heart to increase the heart rate. The miniature device does not require the use of wires, known as “leads,” to connect to the heart. It is attached to the heart via small tines; and then the pacemaker delivers electrical impulses that pace the heart via an electrode.

“We are proud that Baylor Heart and Vascular Hospital in Dallas was selected among an elite group of institutions to take part in this clinical trial. If positive, the results of the trial could potentially benefit the more than 1 million people globally who receive pacemakers each year,” said Nancy Vish, PhD, RN, FACHE, president and chief nursing officer of BHVH.

About Baylor Heart and Vascular Hospital: Baylor Jack and Jane Hamilton Heart and Vascular Hospital is the first North Texas hospital dedicated solely to the care and treatment of patients with cardiovascular diseases and related conditions. As part of the Baylor Health Care System, Baylor Hamilton Heart and Vascular Hospital strives to provide quality and safety in the delivery of patient care.

About Baylor Scott & White Health: Baylor Scott & White Health, the organization formed from the 2013 merger between Baylor Health Care System and Scott & White Healthcare, is today the largest not-for-profit health care system in the state of Texas. With total assets of $8.6 billion* and serving a geographic area larger than the state of Maine, Baylor Scott & White Health has the vision and resources to provide its patients continued quality care while creating a model system for a dramatically changing health care environment. The organization now includes 46 hospitals, more than 500 patient care sites, more than 6,000 active physicians, 36,000 employees and the Scott & White Health Plan. For More Information visit:

www.BaylorScottandWhite.com

* based on unaudited fiscal year 2014 financial statements
Cardiologists on the medical staff at Baylor Jack and Jane Hamilton Heart and Vascular Hospital (BHVH) today implanted an investigational cardiac pacemaker the
Breast Cancer Awareness: Early Detection Saves Lives
By Angel Biasatti / Director Community Relations and Marketing









Routine Screening Means Seeing Your Doctor

A mammogram, combined with a clinical breast exam, is the most effective way to find and treat breast cancer early. Women from 20 years of age into their 30s should have a doctor perform a clinical breast exam at least once every three years. The American Cancer Society recommends annual clinical exams and mammograms for women beginning at age 40. 

Women who have a family history of breast cancer or other high-risk factors may need more frequent mammograms at a younger age. A doctor can assess and make a personalized recommendation when screenings should begin, how often they should occur, and which techniques should be used.

A mammogram — an X-ray of the breast — is currently the best available screening method for early detection. The latest technology, digital mammography, uses less radiation than film mammography, and studies show it improves cancer detection in women under 50 and patients with dense breasts.

In some cases, magnetic resonance imaging, or MRIs, can be another effective tool. Breast MRI is only recommended for screening if you have a very high risk for breast cancer. This includes women with a significant family history of breast or ovarian cancer (especially in first-degree relatives who were diagnosed before menopause), women with personal or close family history of breast cancer genes, or women with a history of radiation to the chest area. Currently, breast MRI is more commonly used as a diagnostic (versus screening) tool in certain women with an abnormal physical exam, mammogram, ultrasound, or biopsy.

As a survivor, Lisa feels she is uniquely qualified to communicate and discuss all the issues surrounding cancer with both compassion and wisdom. 

Lisa suggests that women become educated and empowered and learn the facts. “Sometimes women are hesitant to have a mammogram because they fear the results,” she says. “But a mammogram could be a matter of life and death. Finding cancer early means a better chance of successful treatment. Be informed, know your risk for breast cancer, and understand the risks and benefits of any test you undergo. This knowledge can help you feel empowered, because significant treatment options offer tremendous hope for anyone diagnosed with breast cancer.”

She also recommends asking your doctor the following questions:

1.       Are you a specialist in my type of cancer? How many cases like mine have you treated in the last year? Some oncologists specialize in specific carcinomas such as breast, sarcomas, and blood cancers such as lymphoma and leukemia. Doctors generally have better success treating a condition if they have a lot of experience with it. You’ll need to know if the physician is a specialist in your specific type of cancer.

2.       Are you board certified, and how many years have you been in practice? Board certification and experience ensure the physician is a specialist in his or her field of expertise.

3.       How can you be reached after hours? Is there always someone on call? Having a physician who is available after hours is vital to the patient’s well-being and safety, especially after a surgery and during chemotherapy sessions. An oncological emergency needs to be treated immediately and is sometimes a matter of life and death. The after-hours physician can assess the acuity of the patient’s needs and, if necessary, direct the patient to the emergency department and call in medical orders for intervention, which can save valuable time and lives. 

Take an active role in your own health and develop a close relationship with your doctor. The earlier breast cancer is detected, the better chance for a cure.

Methodist Health System has joined the Mayo Clinic Care Network, a clinical collaboration between Methodist and Mayo Clinic that provides physicians at Methodist easy access to Mayo Clinic’s specialists, knowledge, and expertise. For more information, visit Methodisthealthsystem.org/Mayo. 

For more information on breast health or schedule a spa mammogram, visit MethodistHealthSystem.org/Mammogram.
Being diagnosed with breast cancer can be a scary and unfamiliar path. Fortunately, patients at Methodist Mansfield Medical Center have Lisa Smith, a breast cancer survivor and director of radiology, to help guide them through the challenges. Lisa says it is part of giving back to others as she shares her experiences with the patient, providing advice and emotional support. One in eight women will have invasive breast cancer in her lifetime. The stage at which breast cancer is detected influences a woman’s survival rate. If detected early, the five-year survival rate is now 98 percent. Women can reduce their risk of breast cancer by scheduling a mammogram.
Parkland personal protective equipment video available
Video created for initial screening of Ebola patients






preparing to deal with infectious disease cases. Providers and health care entities do not need further permission from Parkland to use it in their training materials.

The video is available on YouTube at https://www.youtube.com/watch?v=1GNKJL1_ejg or on Parkland’s website at www.parklandhospital.com/ebola

To date, this educational video has been viewed 26,000 times.

“As a public safety net hospital, we believe it is our responsibility to care for anyone who presents at our doors. Part of that mission is to share with others in the health care industry our knowledge of best practices,” said Alex Eastman, MD, MPH, Parkland’s Disaster Medical Director. “We have people at Parkland who are experts in proper use of PPE and we created this video to train our own staff.”

Founded in 1894, Parkland is one of the largest public hospital systems in the country. It is licensed for 861 adult beds and 107 neonatal beds. Services include a Level I Trauma Center, the second largest civilian burn center in the U.S. and a Level III Neonatal Intensive Care Unit. The hospital averages about 47,000 admissions and 1 million outpatient visits annually. The system also includes 12 primary care clinics, 12 school-based clinics and numerous outreach and education programs.

For more information and Ebola Virus Disease educational materials, visit www.parklandhospital.com/ebola
Parkland Health & Hospital System is making available to hospitals, health systems and cities across the country a video on the proper methods to don and doff personal protective equipment (PPE) when screening for Ebola patients. Parkland has received numerous requests from all over the country for permission to use this video. The health system wants to make it clear that the video is available to any organization that would find it useful in
John Moore named Parkland CFO
New leader has significant healthcare finance experience






where he has served as Vice President/Chief Financial Officer since 2008. In that role, Moore was responsible for financial operations, patient accounting, Health Information Management, patient access, information systems, communications and wound care. He was financially responsible for $700 million net revenue including three acute hospitals, three rehabilitation hospitals, two skilled nursing facilities, 12 physician practices, one physician joint-venture, one ambulatory surgery center, and one free-standing emergency department. During his tenure, he improved operating cash flow margin from 11.8 percent to 18.6 percent over a four-year period.

Prior to his work at Carolinas HealthCare System, Moore was Chief Financial Officer at Northwest Medical Center Oro Valley in Tucson where he was responsible for opening and staffing all financial-related areas of a de novo hospital.

In addition, Moore served as senior financial analyst for Triad Hospitals, Inc., in Plano, Chief Financial Officer of Samaritan Surgicenters of Arizona in Phoenix, and accounting manager for HCA-The Healthcare Company in Dallas.

“Like all health systems, Parkland is navigating a shifting landscape with regard to healthcare finance,” said Fred Cerise, MD, MPH, Parkland’s President and CEO. “John’s extensive experience will help guide Parkland through the many challenges our industry is facing at the moment. His efforts will play a big role in ensuring we have the resources to deliver the best possible care to our patients. Now, more than ever, Parkland must ensure that every dollar spent on our services is used as efficiently as possible. I know John is the right person for this extremely important position.”

Moore earned a Bachelor of Business Administration degree from Baylor University in Waco. He is a Certified Public Accountant, and a member of the Healthcare Financial Management Association.
John Moore has been named Executive Vice President and Chief Financial Officer of Parkland Health & Hospital System. He replaces interim CFO Mark Erath, whose contract expired. He will begin on Jan. 5, 2015.

Moore comes to Parkland from Carolinas HealthCare System in Charlotte, North Carolina
North Texas Poison Center at Parkland celebrates 30 years of service
Countless individuals aided by poison specialists






The center averages now more than 340 calls daily, a significant increase from its humble beginnings of about 30 calls a day. Nearly two-thirds are incoming calls to the Poison Center and the remaining third are follow-up calls from poison specialists to ensure the immediate concern has passed at the home or office of the caller. And while the number of calls has increased, the underlying cause has remained constant with about half related to things your mother told you not to do.
         
“When we started the Poison Center the majority of calls were from parents who were frantic because their child had gotten into medicine or household products they shouldn’t have,” said Lena Williams, RN, who was the Poison Center’s first director. “There have always been ‘look-alike’ medicines and candy which become an easy target for kids.”
         
But, Williams said, it goes back to what kids put in their mouths – and they can do it in a split second.
         
“Even though it’s been years, I still remember a mom who called about a Black Widow spider. We asked where her child had been bitten and to describe the area around the bite,” Williams recalled. “She told us the spider hadn’t bitten her child; her child had eaten the Black Widow. Again, you never know what a child is going to ingest.”
         
And the outcome?
         
“Everyone was fine,” Williams said, “well, except for the Black Widow.”
         
What has changed over the years is the type of calls the center receives. In decades past, a call could come from a farmer who dipped his cows in the wrong liquid. The solution, center staff offered, was to “wash his herd.” Or the call asking how much gopher bait could kill a cow? “On those we’d phone our Texas A&M University contacts and then relay the information back to the farmer,” Williams said.
         
“Today, the majority of calls we receive are related to prescription drugs and potential overdoses,” said Rachel Harvey, RN, CSPI, Manager, North Texas Poison Center.
         
Every day in the U.S., 114 people die as a result of drug overdose and another 6,748 are treated in emergency departments for the misuse or abuse of drugs, according to the Centers for Disease Control and Prevention. Nearly nine out of 10 poisoning deaths are caused by drugs.
         
“We continue to receive calls about children who have gotten into their parents or grandparents prescription drugs,” Harvey said.
         
What hasn’t changed is the education provided by specialists in the center.
         
Today, as in years past, Poison Center staff is on the front lines dispelling myths and squelching rumors, whether it’s about chemical insecticides used in spraying for West Nile Virus, the effects of synthetic marijuana, or the Tylenol scare in the early 1980s when capsules in the Chicago-area were found to be laced with cyanide.
                     
“Public education is one of the most important services the Poison Center provides,” Williams added. “If you can reach out to children at a young age and stress the importance of poison prevention, it’s something they’ll remember for a lifetime and they’ll pass it on to their children.”
         
And for others, specialists with the North Texas Poison Center are available 24/7 to answer questions from frantic moms, farmers or anyone else with a poison question by calling 1.800.222.1222. Visit the North Texas Poison Center on Facebook at www.facebook.com/NTXPC. You can also follow on Twitter @NTXPoisonCenter.
Countless individuals have been able to breathe a sigh of relief over the past three decades thanks to the assistance they received from specialists at the North Texas Poison Center housed at Parkland Memorial Hospital. To celebrate its 30 years of service to the region, staff will host an anniversary party from 1 to 3 p.m., Thursday, Nov. 20 in the Poison Center, 5201 Harry Hines Blvd., Dallas, 75235.
UT Southwestern scientists uncover novel looping mechanism that controls the fitness of cells, impacting aging and disease








“Our results suggest a potential novel mechanism for how the length of telomeres may silence genes early in life and then contribute to their activation later in life when telomeres are progressively shortened. This is a new way of gene regulation that is controlled by telomere length,” said Dr. Jerry W. Shay, Professor and Vice Chairman of Cell Biology at UT Southwestern, who led the team with his colleague, Dr. Woodring E. Wright, Professor of Cell Biology and Internal Medicine.

Telomeres cap the ends of the cell’s chromosomes to protect them from damage. But the telomeres become shorter every time the cell divides. Once they shorten to a critical length, the cell can no longer divide and enters into a senescent or growth-arrest phase in which the cell produces different products compared to a young quiescent cell. Most research in this area has focused on the role that the process plays in cancer, but telomere shortening also has been shown to influence which genes are active or silent.

Dr. Shay and Dr. Wright found that even before the telomeres shorten to the critical length that damages the DNA, the slow erosion in length has an effect on the cell’s regulation of genes that potentially contributes to aging and the onset of disease.

The findings, published in the journal Genes and Development, required the researchers to develop new methods for mapping interactions that occur near the endcaps and to use an extensive array of methodologies to verify the impact.

Specifically, the team showed that when a telomere is long, the endcap can form a loop with the chromosome that brings the telomere close to genes previously considered too far away to be regulated by telomere length. Once the telomere and the distant genes on the same chromosome are close to each other, the telomere can generally switch those genes off.

Conversely, when telomeres are short, the chromosome does not form a loop and the telomere can no longer influence whether target genes are switched on or off.

The researchers were able to identify three genes whose expression patterns are altered by telomere length but believe this number is the just the tip of the iceberg.

“We have developed the concept that telomere shortening could be used as a timing mechanism to respond to physiological changes in very long-lived organisms, such as humans, to optimize fitness in an age-appropriate fashion,” said Dr. Wright.

The work was supported by the National Institute of Aging, Lung Cancer Specialized Programs of Research Excellence (SPORE), the National Institutes of Health (NIH) Post-doctoral Training Fellowship, the Austrian Science Fund, and the American Federation for Aging Research, in laboratories constructed with support from the NIH.

Other UT Southwestern researchers involved in the work include Postdoctoral Researchers Jerome Robin and Andrew Ludlow, Biostatistical Consultant Kimberly Batten, and Research Scientist Guido Stadler. Dr. Shay and Dr. Wright hold the Southland Financial Corporation Distinguished Chair in Geriatric Research and are members of the Harold C. Simmons Cancer Center.

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. 

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 approximately 2,800, 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 about 92,000 hospitalized patients and oversee approximately 2.1 million outpatient visits a year.
A novel looping mechanism that involves the end caps of DNA may help explain the aging of cells and how they initiate and transmit disease, according to new research from UT Southwestern Medical Center cell biologists.

The UT Southwestern team found that the length of the endcaps of DNA, called telomeres, form loops that determine whether certain genes are turned off when young and become activated later in life, thereby contributing to aging and disease.
UT Southwestern cancer researchers identify gene mutations and process for how kidney tumors develop








one another in the genome,” said Dr. James Brugarolas, Associate Professor of Internal Medicine and Developmental Biology, who leads UT Southwestern’s Kidney Cancer Program at the Harold C. Simmons Cancer Center.
The scientists’ findings are outlined in separate reports in the Proceedings of the National Academy of Sciences and Nature Genetics.

More than 250,000 individuals worldwide are diagnosed with kidney cancer every year, with lifetime risk of kidney cancer in the US estimated at 1.6 percent. Most kidney tumors are renal cell carcinomas, which when metastatic remain largely incurable.

Researchers with UT Southwestern’s Kidney Cancer Program had previously identified a critical gene called BAP1 that is intimately tied to kidney cancer formation. Their latest research shows how BAP1 interacts with a second gene, VHL, to transform a normal kidney cell into a cancer cell, which in part appears to be based on the two gene’s close proximity in humans, said Dr. Brugarolas, a Virginia Murchison Linthicum Endowed Scholar in Medical Research.

The newest findings suggest that the transformation begins with a mutation in one of the two copies of VHL, which is the most frequently mutated gene in the most common form of kidney cancer, clear cell type, which accounts for about 75 percent of kidney cancers. The VHL mutation is followed by a loss of the corresponding chromosome arm containing the second copy of VHL, as well as several other genes including PBRM1 and BAP1. This step eliminates the remaining copy of VHL and along with it, one of the two copies of PBRM1 and BAP1, two important genes that protect the kidney from cancer development. The subsequent mutation of the remaining copy of BAP1 leads to aggressive tumors, whereas mutation of the remaining copy of PBRM1 induces less aggressive tumors, said Dr. Payal Kapur, a key investigator of both studies who is an Associate Professor of Pathology and Urology, and the Pathology co-Leader of the Kidney Cancer Program.

This model also explains why humans born with a mutation in VHL have a high likelihood of developing kidney cancer during their life time. In these individuals, all kidney cells are already deficient for one VHL copy and a single deletion eliminates the second copy, along with a copy of BAP1 and PBRM1. In contrast, in other animals, these three genes are located on different chromosomes and thus more mutational events are required for their inactivation than in humans. Consistent with this notion, when UT Southwestern researchers mutated VHL and BAP1 together, kidney cancer resulted in animals.

In a second collaborative study with Genentech Inc., published in Nature Genetics, investigators implicated several genes for the first time in non-clear cell kidney cancer, a less common type that accounts for about 25 percent of kidney cancers. Researchers identified a gene signature that can help differentiate subtypes of non-clear cell tumors to better define their behavior. Specifically, the researchers characterized alterations from 167 human primary non-clear cell renal cell carcinomas, identifying 16  significantly mutated genes in non-clear cell kidney cancer that may pave the way for the development of novel therapies. The research team also identified a five-gene set that enabled molecular classifications of tumor subtypes, along with a potential therapeutic role for BIRC7 inhibitors for future study.        

               Other UT Southwestern researchers involved included Dr. Renee McKay, Assistant Professor of Developmental Biology and Director of Research Administration of the Kidney Cancer Program; Dr. Ivan Pedrosa, Associate Professor of Radiology and the Advanced Imaging Research Center, and Radiology co-Leader of the Kidney Cancer Program, who holds the Jack Reynolds, M.D., Chair in Radiology; Dr. Robert E. Hammer, Professor of Biochemistry and the Green Center for Systems Biology, who holds the Graydon Heartsill Professorship in Medical Science; Dr. Xian-Jin Xie, Associate Professor of Clinical Science and the Harold C. Simmons Cancer Center; Dr. Dinesh Rakheja, Associate Professor of Pathology and Pediatrics, who holds the John Lawrence and Patsy Louise Goforth Distinguished Professorship in Pathology; Dr. Thomas Carroll, Associate Professor of Internal Medicine and Molecular Biology; Dr. Vitaly Margulis, Associate Professor of Urology; Dr. Yair Lotan, Professor of Urology, who holds the Helen J. and Robert S. Strauss Professorship in Urology; Dr. Arthur Sagalowsky, Professor of Urology and Surgery, and Urology co-Leader of the Kidney Cancer Program, who holds The Dr. Paul Peters Chair in Urology in Memory of Rumsey and Louis Strickland; Dr. Nick Grishin, Professor of Biophysics and Biochemistry, and a Virginia Murchison Linthicum Scholar in Biomedical Research; and researchers Andrea Pavía-Jiménez, Shan-Shan Wang, Yi-Feng Gu, Nicholas Wolff, Karoliina Stefanius, Alana Christie, Sadia Saleem, Samuel Peña-Llopis, Eboni Holloman, Haley M. Hill, and Lisa N. Kinch.

The latest findings were made in conjunction with Genentech Inc., a leading biotechnology company that discovers, develops, manufactures and commercializes medicines to treat patients with serious or life-threatening medical conditions. The company, a member of the Roche Group, has headquarters in South San Francisco, California.

UT Southwestern’s Kidney Cancer Program includes more than 20 physicians, many of whom are renowned international leaders in their fields of urology, adult and pediatric oncology, radiation oncology, radiology, and pathology. In addition, more than 50 research laboratories are affiliated with the Kidney Cancer Program. The Kidney Cancer Program launched in 2013 to build upon landmark discoveries made by scientists at UT Southwestern over the last three decades. Dr. Steven McKnight, Chairman of Biochemistry, and Dr. David Russell, Vice Provost and Dean of Basic Research, discovered HIF-2α, a protein that mediates kidney cancer development. Subsequent studies by Dr. Richard Bruick, Professor of Biochemistry and holder of the Michael L. Rosenberg Scholar in Biomedical Research, and Dr. Kevin Gardner, Adjunct Professor of Biophysics, paved the way for the development of a drug that blocks HIF-2 activity by Peloton Therapeutics, Inc., a UT Southwestern start-up company founded by Dr. McKnight and now operating in UT Southwestern’s BioCenter. In addition, researchers at UTSW discovered that the TSC1/TSC2 complex regulates TOR, which is the target of two kidney cancer drugs. Years later, Dr. Brugarolas identified mutations in TSC1 in kidney cancer, and the presence of these mutations may identify patients most likely to respond to TOR inhibitors. Finally, recent discoveries by several investigators at the Kidney Cancer Program determined that there are different subtypes of kidney cancer with different biology and outcomes.

Dr. McKnight holds the Distinguished Chair in Basic Biomedical Research and The Sam G. Winstead and F. Andrew Bell Distinguished Chair in Biochemistry. Dr. Russell holds the Eugene McDermott Distinguished Chair in Molecular Genetics.

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 individual with innovative treatments, while fostering groundbreaking 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.

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.
Using next generation gene sequencing techniques, cancer researchers at UT Southwestern Medical Center have identified more than 3,000 new mutations involved in certain kidney cancers, findings that help explain the diversity of cancer behaviors.

           “These studies, which were performed in collaboration with Genentech Inc., identify novel therapeutic targets and suggest that predisposition to kidney cancer across species may be explained, at least in part, by the location of tumor suppressor genes with respect to
New measurement of HDL cholesterol function provides powerful information about cardiovascular risk









HDL’s key function is the removal of cholesterol from plaque in blood vessels and delivery to the liver for excretion. Until recently, this functional property could not be measured. The new study, led by Dr. Anand Rohatgi, Assistant Professor of Internal Medicine at UT Southwestern, measured cholesterol efflux using this new method of measurement in more than 3,000 participants from a multi-ethnic, population-based cohort known as the Dallas Heart Study.

The study found that this functional measurement of cholesterol efflux provided significantly different information than did standard measurements of HDL cholesterol. The findings uncovered a significant protective relationship between cholesterol efflux and cardiovascular risk. The better a person’s cholesterol efflux, the less likely he or she was to suffer a heart attack, stroke, or death from heart disease. The association was much stronger for cholesterol efflux than for the traditional measurement of HDL cholesterol level.

HDL cholesterol has long been considered good cholesterol because numerous population studies have shown a consistent, strong, inverse relationship between HDL cholesterol levels and risk of heart disease. “Unfortunately, that observation has not translated into effective therapies that target HDL cholesterol,” said Dr. Rohatgi. “Niacin raises HDL cholesterol 20-25 percent and newer drugs called CETP inhibitors raise HDL cholesterol even more, but none have been shown to reduce cardiac events.”

“So now we’re looking under the hood, so to speak, and we’re realizing that the whole story of what HDL does is not being told by HDL cholesterol levels alone,” said Dr. Rohatgi. “HDL is very dynamic. It has many functions that are not fully captured by the measurement of static cholesterol levels. The hypothesis has changed from an HDL-cholesterol hypothesis to an HDL-function hypothesis to better capture cardiovascular risk and provide a better target for therapy to reduce that risk.”

Atherosclerosis, which is a hardening and narrowing of the arteries, is caused by the buildup of fatty plaques made up of cholesterol and cells on artery walls. Atherosclerosis is the leading cause of heart attacks, and understanding how HDL acts to remove cholesterol from these plaques could offer a target for reducing heart disease risk.

“We drew on the strengths of the Dallas Heart Study to thoroughly investigate the relationship between HDL function and cardiovascular disease,” said Dr. Rohatgi. “What we found was a strong, graded, protective relationship between cholesterol efflux and incidence of cardiovascular events among people who were free from heart disease at baseline testing.”

This is the first report of a measure of HDL function in a population-based study and supports future studies investigating HDL cholesterol efflux and cardiovascular disease.

Other UT Southwestern researchers who contributed to the study include Dr. Amit Khera, Associate Professor of Internal Medicine and holder of  the Dallas Heart Ball Chair in Hypertension and Heart Disease; Dr. Jarett Berry, Associate Professor of Clinical Science and Internal Medicine; Edward Givens, research technician; Colby Ayers, faculty associate in Clinical Science; Dr. Ian Neeland, cardiology fellow; Dr. Ivan Yuhanna, research associate; Dr. James de Lemos, Professor of Internal Medicine and holder of the Sweetheart Ball-Kern Wildenthal, M.D., Ph.D. Distinguished Chair in Cardiology; and senior author Dr. Philip Shaul, Professor of Pediatrics and holder of the Associates First Capital Corporation Distinguished Chair in Pediatrics.

The research was supported by grants from the National Institutes of Health, the American Heart Association, and the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp. The Dallas Heart Study was supported by the Donald W. Reynolds Foundation and by the National Center for Advancing Translational Sciences of the NIH.

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 about 92,000 hospitalized patients and oversee approximately 2.1 million outpatient visits a year.
Groundbreaking research from UT Southwestern Medical Center shows that cholesterol efflux capacity (cholesterol efflux), which measures HDL cholesterol function, appears to be a superior indicator of cardiovascular risk and a better target for therapeutic treatments than standard measurements of HDL. Current measurement methods reflect only the circulating levels of HDL and not the functional properties of this lipoprotein.

The latest findings appear online today in The New England Journal of Medicine.
Parkland named one of safest hospitals by Security magazine
Police department named to annual list for fifth consecutive year






This is the fifth time the Dallas County Hospital District Police Department has received national recognition from the publication for its efforts in creating a safe and secure environment for patients, staff and visitors. In 2015, they will celebrate 30 years as an authorized police department recognized by the state of Texas.

Members of the Dallas County Hospital District Police Department continually conduct training programs such as workplace violence prevention, infant protection, active shooter training and security awareness for employees. In addition, officers are responsible for patrolling more than 15,244,961 million square feet of property owned or managed by Parkland. This includes patrolling the new Parkland hospital scheduled to open in mid-2015.
         
“Ensuring that all individuals including patients, physicians, staff and visitors who are at Parkland or one of its locations feel safe and secure is the number one priority for our police officers,” said Kenneth Cheatle, Chief of the Dallas County Hospital District Police Department. “We take our responsibility to protect and serve everyone at Parkland seriously and continuously look for ways to enhance our operations to meet those goals.”
         
Unlike most hospitals in the United States, Parkland has its own fully operational police department, including investigations, patrol, parking, communications and a crime prevention unit. The department, which was the first of its kind in Texas, is comprised of 75 sworn officers and 50 non-sworn employees. Officers respond to more than 11,000 calls each year. Last year, there was a 21 percent increase in the number of reports to the police. The increase, Cheatle said, was due in part to the department’s awareness training, an increase in area of responsibility and encouraging staff and others to report incidents when they occur.
         
The “2014 Security 500” list is based on data from a security industry benchmarking survey as well as public resources and records. The list can be found at http://www.securitymagazine.com
The Dallas County Hospital District (Parkland) Police Department has been ranked 10th on Security magazine’s “2014 Security 500” list, recognizing organizations worldwide for best security practices. Parkland is among 70 hospitals and medical centers from across the country named to the list.
Complimentary Documentation Templates Help Unscheduled Care Providers Prepare for Onslaught of Influenza
Point-of-care tool allows providers to diagnose and treat flu patients quickly and accurately





tool on T-System’s website. Templates are available for four different care settings: emergency department, emergency department pediatric, primary care and urgent care.

The Centers for Disease Control and Prevention (CDC) estimates 5 to 20 percent of U.S. residents get the flu and more than 200,000 people are hospitalized for flu-related reasons each year. In recent years, the flu has caused extreme resource and space constraints for unscheduled care providers nationwide.

“Responding to influenza surges can be a daunting task for healthcare professionals if a sufficient strategy is not in place to handle increased patient volumes,” said Robin Shannon, RN, MN, MBA, T-System’s director of documentation solutions. “Epidemics like the flu result in increased numbers of people seeking quick and accurate diagnosis and treatment in unscheduled care settings. T Sheets have an intuitive design, critical clinical content and an efficient workflow to help providers document care during patient surges.”

The flu T Sheets® are point-of-care tools designed to support consistent documentation and capture of critical patient health information, while ensuring hospitals meet regulatory and reimbursement needs. The paper templates incorporate the latest CDC guidelines to reflect diagnostic and treatment protocols specific to the virus strains identified this season.

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, revenue cycle management 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, or become a T-System fan on Facebook.
As the influenza season approaches, T-System, Inc. today announced their annual complimentary flu T Sheets® to help unscheduled care providers manage the upcoming flu season and the associated overcrowding. Healthcare organizations and clinicians can download the free documentation
Parkland Smoking Cessation Clinic participates in innovative study
Monetary incentives improve outcomes







published online this month in the American Journal of Public Health, found that patients who received the incentives had a smoking abstinence rate of 49 percent after four weeks, compared to 25 percent for those who did not receive the incentives. After 12 weeks, the rates were 33 percent compared to 14 percent.

Although smoking rates have declined to 18 percent among adults in the U.S., smoking prevalence is nearly 30 percent among those living in poverty. “Smoking has become increasingly concentrated among individuals of lower income and education. Effective interventions are needed to improve smoking cessation rates in this vulnerable population,” said Darla Kendzor, PhD, Assistant Professor and lead investigator on the study at The University of Texas School of Public Health Dallas Regional Campus.

“Smoking continues to be the number one cause of disease and preventable death in this country, and the financial impact it has on our country’s health care costs is staggering,” said David Balis, MD, Medical Director of Parkland’s Smoking Cessation Clinic and one of the study researchers. “Deciding to quit smoking is the most beneficial step anyone can take to improve their health.”

Each year more than 480,000 deaths in the U.S. are attributed to smoking-related causes, and at least 80 percent of lung cancers are due to smoking. Smoking cessation is the focus each November during Lung Cancer Awareness Month, and the annual Great American SmokeOut sponsored by the American Cancer Society.

Researchers from The University of Texas Health Science Center and The University of Texas Southwestern Medical Center collaborated on the two-year study at Parkland, which focused primarily on lower-income smokers. Funding for the study came from The University of Texas School of Public Health and the American Cancer Society.

“Safety net hospitals, such as Parkland, provide care to many low-income, uninsured and vulnerable populations,” Dr. Balis said. “The reasons many in these populations find it difficult to quit smoking are many, including higher levels of stress, less access to health care and less availability of smoking cessation options.”

Dr. Kendzor said researchers “wanted to investigate how small and potentially cost-effective financial incentives might help safety net hospital patients quit smoking.”

At the Parkland Smoking Cessation Clinic, patients receive behavioral group counseling, meet with health care professionals individually and can receive medication to help them stop. Those who qualified for the study received these services, but half of the eligible group also received gift cards each week if they remained abstinent. The gift cards started at $20, and increased by $5 each week, up to a total of $150 for those who were continuously abstinent. Smoking abstinence was confirmed at each visit by measuring carbon monoxide levels in the breath.

The average amount patients received was less than $64. The researchers noted that Parkland’s Smoking Cessation Clinic sees about 200 patients a year. The cost of incentives for all new patients would amount to about $12,800 a year, compared with the average cost of $70,000 for the initial year of lung cancer treatment for a single case.

For more information about the Parkland Smoking Cessation Clinic call 214.590.5603.
Anyone who has ever tried to quit smoking knows that you can use all the help you can get. And, as it turns out, a little spending money doesn’t hurt either.

A recent study conducted with patients from the Smoking Cessation Clinic at Parkland Health & Hospital System found that offering small financial incentives to socioeconomically disadvantaged smokers significantly improved quit rates. The study, 
Smart Steps to Watching your Health this Thanksgiving
By Angel Biasatti
Director Community Relations and Marketing/Methodist Mansfield Medical Center









endocrinology, diabetes, and metabolism physician on the medical staff at Methodist Mansfield Medical Center. “There are no forbidden foods, however; if you have diabetes it is best to avoid foods with concentrated sugar.”

She recommends that you watch your caloric intake. “Stay away from high-fat munchies like potato chips that are high in calories, and indulge in fresh vegetables and fruit,” she recommends. “Before the meal, try a hot broth-based soup, which can help you feel full and keep you from overeating.”

Prepare your family’s traditional recipes, but substitute calorie-laden ingredients with those that have less fat and sugar.

Throughout the holiday season, exercise is particularly beneficial. “It is very important to get as much exercise as possible so that you are helping your body with the extra goodies that are around during the holidays,” Dr. Szuszkiewicz-Garcia says. “Go out and take a walk with your family after the Thanksgiving meal. Consider cheering actively by jumping up and down or dancing while watching the football gameThe increase in your physical activity will really help.”

Dr. Szuszkiewicz-Garcia explains that one reason diabetes has become so prevalent is that the typical American diet is high in fat and concentrated sugars. When combined with inactivity, these habits become strong risk factors that cause many adults to develop type 2 diabetes.

Current figures show that the number of adults with diabetes in the United States is on the rise, and it is estimated that one-third of those may have the disease without knowing it, according to the National Institute of Health. In addition, about one out of every four adults has what’s called prediabetes.

“People with diabetes have high levels of glucose, or sugar, in their blood because their bodies have trouble using or producing insulin,” Dr. Szuszkiewicz-Garcia explains. What may start out as being overweight can lead to diabetes, high blood pressure, and high cholesterol. All of these can increase a risk for cardiac disease and stroke.

“We encourage people to reduce their risk of developing diabetes and heart disease by adopting a healthy lifestyle, eating less and exercising more,” says Dr. Szuszkiewicz-Garcia. “If you have diabetes, controlling your blood glucose, blood pressure, cholesterol, and diet can prevent or delay complications.”

Managing your dietary habits is important during the holiday season, but it is also a lifelong commitment. If you embrace the challenge, you’ll not only feel better and have more energy, you’ll be making an important investment in your health.

To find healthy recipes this holiday season visit MethodistHealthSystem.org/HealthyRecipes and fight off holiday weight gain.
Don’t let the roasted turkey, homemade dressing, and pumpkin pie get you off balance this Thanksgiving. Instead of stuffing yourself at one huge meal packed with carbohydrates and sugar that can wreck havoc on diabetes and other health issues, plan to eat smaller portions of healthier foods throughout the day instead. When you do sit down to eat your Thanksgiving meal, take time to savor the flavors and enjoy conversations with family and friends.

“You can enjoy holiday goodies and still manage your diabetes by being sensible with food portions,” says Magdalene Szuszkiewicz-Garcia, MD, an independently practicing
New liver gives mother of three a life without pain










was treated with a round of prednisone and cyclosporine, but neither worked. Discouraged, she decided to look elsewhere for care and discovered that Dr. Marlyn Mayo, Associate Professor of Internal Medicine at UT Southwestern, specialized in immune-related liver diseases, such as PBC. UT Southwestern also has a liver-disease satellite clinic in El Paso, which would make the logistics of her care easier.

Dr. Mayo determined that Mrs. Linss had a rare variant of PBC known as rapidly ductopenic PBC, which leads to cirrhosis quickly. During one visit to her physician in Dallas, Mrs. Linss pointed out some painful bumps under her skin. These turned out to be deposits of lipoprotein X, an abnormal lipoprotein particle that was accumulating because her liver was unable to correctly process cholesterol. The xanthomas, as they are called, increased and they made everyday living difficult. Walking was painful and opening a jar impossible. Dr. Mayo referred the patient for a liver-transplant evaluation and she was placed on the transplant waiting list at UT Southwestern.

Liver-transplant lists are ordered according to the severity of the liver disease based on a “MELD” score, which factors in creatinine levels, bilirubin levels, and INR (a measurement of how quickly blood clots). The higher the MELD number, the sicker a patient is and the higher they are placed on the waiting list. Mrs. Linss’ MELD score of 17 meant it would be a significant amount of time before she received an organ, and that’s when Dr. Jorge Marrero, Medical Director of the Liver Transplantation Program at UT Southwestern, went to bat for her. The organization that oversees transplant lists, UNOS, allows physicians to bring special cases before the board, and he did just that, arguing that her rare form of PBC put her at special risk and led to a decrease in her quality of life. The UNOS board awarded Mrs. Linss the extra MELD points.

UT Southwestern’s liver-transplant program started in 2007 with nine transplants, and the program has been steadily growing. They anticipate performing 40 transplants this year, the highest number since the program began, and foresee an accelerating rate of increase in the annual volume of transplants performed for the fifth consecutive year.

UT Southwestern is engaged in liver-disease and liver-transplant research, and is home to the NIH-sponsored Acute Liver Failure Study Group, which gathers data from 15 tertiary-care liver transplant centers around the country on acute liver failure – a sudden, devastating collapse of liver function. The medical center also is engaged in federally funded clinical studies on alcoholic hepatitis, hepatitis B, and hepatocellular carcinoma, as well as clinical trials in hepatitis C, PBC, primary sclerosing cholangitis, and hepatic encephalopathy.

Availability of donor organs is a key concern for all transplant programs. Dr. Juan Arenas, Surgical Director of the Liver Transplantation Program at UT Southwestern, is working on ways to increase available donor livers. He is a member of a panel that is reviewing the geographical rules governing the distribution of donor livers, advocating for more equitable distribution. He is also poised to begin using extracorporeal membrane oxygenation (ECMO) technology to perfuse organs of individuals who have experienced irreversible cardiac arrest, which will ultimately make more donor livers available.

Michelle Linss got the call that there was a donor liver available for her on Aug. 28 of this year. The surgery went well. The itching she had been experiencing for so many years went away almost immediately. The pain from the lipoprotein X deposits in her hands, her feet and elsewhere has dramatically diminished. And being able to have her follow-up visits at the UT Southwestern liver clinic in El Paso makes life easier for the busy working mother of three.

On Oct. 4, the entire Linss family – Michelle; husband Eddie; Alexandria, 19; Kaleb, 11; and Kaden, 7 – hopped on a plane to Dallas, where they celebrated by watching a Cowboys football game and the next day going to see “the hospital where Mom got her transplant.” 

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 about 92,000 hospitalized patients and oversee approximately 2.1 million outpatient visits a year.
The itching started when Michelle Linss, now 37, was pregnant with her third child. When she told her obstetrician, they thought it was due to the hormonal changes of pregnancy and would resolve following delivery. But the young El Paso woman was still itching a year later, launching a six-year journey of testing and treatment, worry and waiting, finally leading – with the advocacy of a UT Southwestern Medical Center physician – to a liver transplant in August 2014.

Mrs. Linss’ medical problem was diagnosed as primary biliary cirrhosis (PBC), a disease in which the bile ducts are damaged, causing bile to build up in the liver. She