August 20, 2018

Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital (BIPAI) and several global partners recently celebrated the graduation of the first class of the East African Pediatric Hematology and Oncology Fellowship Program at Makerere University College of Health Sciences.

The East Africa Pediatric Hematology and Oncology Fellowship Training Program is the result of cooperation and commitment between some of the most eminent institutions in Africa and on the world-stage in cancer care, medical education, health policy, and pediatric hematology and oncology. As part of the comprehensive Global HOPE (Hematology-Oncology Pediatric Excellence) initiative, which launched in February 2017, the two-year fellowship program is building a critical mass of pediatric hematology-oncology specialists to independently provide effective, evidence-based pediatric cancer and hematology care in the African setting.

In the United States, 80 percent of children with cancer survive. In sub-Saharan Africa, the overwhelming majority of pediatric patients do not. The mortality rate is estimated to be as high as 90 percent, meaning that thousands of children die from cancer across Africa each year, with the most common types of childhood cancers being blood cancers, including leukemia and lymphoma.

Most childhood cancers are treatable. However, up until this point, the main reason for the staggering death rate across Africa has been due to an inadequate health care infrastructure and a significant lack of expert physicians and other health care workers trained to treat children with cancer and blood disorders. With the ambitious efforts of Global HOPE to build medical capacity to diagnose and treat pediatric blood disorders and cancer in Africa, the impact is already evident in the higher numbers of children receiving care in Uganda, Botswana and Malawi.

“Traditionally, physicians in Africa have gone abroad to obtain higher specialist clinical training, and often do not return,” said Dr. David Poplack, director of Global HOPE and associate director of Texas Children’s Cancer and Hematology Centers. “By training physicians through the fellowship program, we are increasing the number of pediatric hematology-oncology specialists who will be practicing in East Africa. This will improve the overall survival for children with cancer and blood diseases in the region.”

At the graduation ceremony, Poplack was awarded an Honorary Doctor of Science from Makerere University for his academic contribution in the field of science. Under his leadership for the last 25 years, Texas Children’s Cancer and Hematology Centers established itself as an internationally-recognized leader in the treatment and research of pediatric cancer and blood disorders. With a desire to expand care to areas of the world with limited resources, Poplack and his team have worked over the past decade to provide care to children in sub-Saharan Africa. With the inception of Global HOPE, access to care will only continue to increase with this training of pediatric hematology-oncology physicians through the fellowship program.

“This first class of graduates of the fellowship program represents an exponential increase in the number of pediatric oncologists in east Africa – and by extension – a huge increase in the number of children diagnosed with cancer who may now receive high quality treatment and the chance of recovery,” said John Damonti, president of the Bristol-Myers Squibb Foundation. “We congratulate the graduating physicians and are proud to support the creation of a sustainable, highly qualified team of oncology and hematology healthcare providers in southern and east Africa, to help change the health outcomes for children.”

Partners involved in the Global HOPE initiative include: The Ministry of Health of the Republic of Uganda, Makerere University College of Health Sciences, East African Community, Uganda Cancer Institute, Baylor College of Medicine Children’s Foundation- Uganda, Mulago National Referral Hospital and the Bristol-Myers Squibb Foundation.

August 13, 2018

Creating viable, long-term health care solutions for children and mothers worldwide has always been a part of Texas Children’s mission. To further that charge, a new division has been created within the Department of Surgery – the Division of Global Surgery. The division will be led by Dr. Jed Nuchtern, who has been Texas Children’s chief of Pediatric Surgery since 2012.

“This is a wonderful new opportunity for Texas Children’s Hospital, the Department of Surgery and Dr. Nuchtern, said Surgeon-in-Chief Dr. Larry Hollier. “Providing surgical expertise in underserved areas has been a great passion for Dr. Nuchtern, and he has traveled extensively bringing surgical care to children around the world. I would like to thank him for his continued commitment to patient care and surgical excellence.”

Through Global Health programs, Texas Children’s collaborates with international governments and health organizations to share its expertise and best practices, with a strong focus on sustainability. This collaboration includes providing surgical training and direct care and treatment in many underserved nations, such as Argentina, Haiti, Malawi, Mexico, Pakistan, Tanzania and Uganda. Due to lack of resources, facilities, education and support, surgical interventions thought of as routine here in the United States, such as repairing a broken bone or simply suturing a wound, are difficult to perform and thus much less common in these countries. A more complicated procedure like a C-section becomes altogether life-threatening.

The creation of the new Division of Global Surgery will help Texas Children’s forge new partnerships, offer providers opportunities for exposure, and facilitate care and capacity building to improve the lives of children and women across the globe, beginning in sub-Saharan Africa.

Leveraging resources, infrastructure and successful global medical programs already in place in the region – including Baylor International Pediatric AIDS Initiative (BIPAI) Network, Texas Children’s Cancer and Hematology Centers’ Global HOPE (Hematology Oncology Pediatric Excellence), and existing efforts by the Department of OB/GYN – Nuchtern and his team will first focus on surgical care for pediatric cancer patients, 50 percent of which require some form of surgical intervention, to increase surgical capacity. Ultimately, the approach will have the combined effect of improving care of children with cancer as well as those suffering from other pediatric surgical diseases.

“While the initial focus is on cancer surgery, our approach is to help build capacity in children’s surgery overall,” Nuchtern said. “Our goal is to marshal all of the talent and energy of Texas Children’s department of surgery toward the goal of serving children throughout the world.”

Preliminary objectives include identifying individuals interested in participating, working with partners to develop the infrastructure necessary to provide quality care, and organizing a special group tasked with developing training opportunities, a central focus of this initiative. Building on successes and lessons learned, and through continued collaboration with Global HOPE, the long-term vision includes a surgical facility for women and children in Lilongwe, Malawi, expansion of care capacity in Central America, and, ultimately, recognition for Texas Children’s as a leader in global surgical outreach.

“We’re one family, and this is a team effort that requires substantial perioperative support from nursing, anesthesia, pediatrics, radiology and pathology,” Hollier said. “Dr. Nuchtern and the new Division of Global Surgery will coordinate with all hospital services to ensure that Texas Children’s is well-represented when going abroad and that these children and women receive the best possible care.”

Nuchtern will retain his duties as chief of Pediatric Surgery until a successor is found. A national search is currently underway. Pediatric Surgery at Texas Children’s has grown to include outstanding programs in surgical oncology, surgical critical care, colorectal and pelvic health, and basic science research. The GI Surgery program has consistently been recognized as one of the top five children’s hospital programs for GI & GI Surgery in U.S. News & World Report. Under Nuchtern’s leadership, the division also has received national and international acclaim for the separation of conjoined twins’ cases and many cutting-edge fetal surgeries. Additionally, the Trauma program was re-designated as a Level I trauma center and has expanded educational offerings to the state and region.

August 2, 2018

Over the course of a two-and-a-half-day meeting in late February, 18 Texas Children’s system leaders came together to strategize streamlining business operations between Texas Children’s Hospital and the Texas Children’s Health Plan. Led by Lou Fragoso, president of the health plan, and Richelle Fleischer, senior vice president of Revenue Cycle at Texas Children’s Hospital, the group worked to challenge business as usual, with an eye toward transforming how the system runs.

This “rapid improvement event,” organized and facilitated by the Texas Children’s Business Process Transformation team, was a key step in the We Are Family initiative, a multi-month undertaking by Texas Children’s system leaders committed to breaking down barriers between the hospital and the health plan in an effort to help the organization work more efficiently as a singular entity. Among the working group’s goals was to plot a roadmap of and deconstruct the revenue cycle process between the hospital and the health plan in order to identify waste and collaborate on solutions that will increase the system’s efficacy.

“We sought to take advantage of our ‘system-ness’ to create a seamless interchange of claim processing, with the potential to save over $30 million in the process,” Fleischer said.

The driving force behind this effort is a desire to leverage the shared organizational identity between Texas Children’s Hospital and Texas Children’s Health Plan in order to reach the common goal of improving patient care.

“During the rapid improvement event, we had a room full of people who wanted to do the right thing for Texas Children’s,” Fragoso said. “When we work together, we can reduce unnecessary or duplicative work, improve the member or patient experience, use data to help deliver better health outcomes, and ultimately make Texas Children’s a leading force in advancing how care is delivered.”

“The biggest accomplishment of the event was the building of relationships between the health plan and the hospital team,” echoed Dr. Heidi Schwarzwald, chief medical officer of Pediatrics at Texas Children’s Health Plan. “Opening new lines of communication, creating efficiencies, and reducing waste will allow for more resources to be available for innovation and improvements in care coordination and delivery throughout our system.”

The We Are Family initiative kicked off in December 2017 with the initial process assessment and event design planning phase taking place between January and February 2018. Further implementation planning followed February’s rapid improvement event, with project kickoffs beginning in April. Implementations and transitions are now underway, with reports of these projects’ measurable results expected in Q4.

Of the 71 ideas suggested at February’s event, the team consolidated and selected 14 high-impact solutions, with 12 projects centered around these solutions currently ongoing. One project has focused on improving antiquated communications technology between the health plan and the hospital. The health plan and the hospital previously relied on fax communications to exchange patient information, a cumbersome and time-consuming process.

Based on the collaborative solutions recommended at the rapid improvement event, the system has transitioned to an entirely digital communications process, thereby reducing administrative burden and allowing employees to focus on timely claims processing and communication with members and providers.

“Ultimately, we’re giving our most important assets, our people, time back in their days,” said Dr. Lia Rodriguez, medical director at Texas Children’s Health Plan. “We’re reallocating resources to focus on what we do best: providing our patients and their families with the best care possible.”

Projected improvements resulting from the We Are Family initiative include:

  • 25,000 hours saved
  • 85,000 fewer phone calls
  • 68 percent fewer handoffs
  • 11,000 reduced paper claims
  • 12,000 faxes eliminated
  • 1,200 reduced appeals

“Just imagine if we take the results from our collaborative effort in February and apply that same concept across the rest of our system,” said Fragoso, who revealed that Texas Children’s Hospital and Texas Children’s Health Plan are already working on a second We Are Family initiative, this time focused on improving outcomes and experience for health plan members by using the hospital’s specialty pharmacy. “As we begin to think differently about how we interact, Texas Children’s will redefine what it means to be a health system in the future. When we unite as one amazing team to improve the lives of the families we serve, Texas Children’s has the ability to completely transform the way care is delivered.”

June 27, 2018

Scientists at Texas Children’s Hospital, Rice University and Baylor College of Medicine have won a prestigious National Institutes of Health grant to study the dynamic processes and cellular players linked to discrete subaortic stenosis (DSS), a congenital heart disease.

The $2.2 million, four-year R01 grant administered by the National Heart, Lung and Blood Institute will allow a team led by Dr. Sundeep Keswani and Jane Grande-Allen to develop computer and tissue-engineered models to predict the recurrence of DSS lesions of the left ventricular outflow tract (LVOT).

Keswani is a surgeon and director of surgical research at Texas Children’s and an associate professor in the Michael E. DeBakey Department of Surgery at Baylor. Grande-Allen is Rice’s Isabel C. Cameron Professor of Bioengineering and chair of the university’s Department of Bioengineering.

In normal hearts, blood passes through the tract from the left ventricle to the aorta. In patients with DSS, a fibrous tissue membrane forms and prevents blood flow from leaving the heart. Heart surgery is the only current option to manage the disease, but up to 30 percent of patients have an aggressive form of DSS in which the membrane recurs, and these patients may have to undergo further cardiothoracic surgery. The researchers believe a better understanding of how the fibrous membranes form will help doctors manage the disease.

“We have found some striking differences between patients who have the aggressive form of the disease and those who do not,” Keswani said. “These findings will give insight into the mechanism of how this membrane forms and perhaps why some humans have a more pro-fibrotic phenotype.

“This project is the just the beginning of understanding how different kinds of biomechanical forces interact with cells in the LVOT to produce fibrosis,” he said.

Working with co-investigator Philippe Sucosky of Wright State University, the research team has developed preliminary computational fluid dynamic models that mimic the complex shear forces and the altered geometry of the tract observed in DSS. The models will help the researchers develop a physical bioreactor to investigate interactions between the major cellular players in DSS: the endocardial endothelial cells that are exposed to shear forces, the cardiac fibroblasts that facilitate fibrosis and the circulating immune cells.

“Understanding the mechanisms of how altered shear forces induce fibrosis in the LVOT is a major gap in our knowledge,” Grande-Allen said. “If we can predict recurrence of DSS lesions of this outflow tract, we can change the way the disease is managed and really improve the quality of life for these children.”

Preliminary computer model data suggested that altered internal geometries in children’s hearts generate turbulence in the flow of blood. That affects the shear forces in the LVOT that in turn trigger an inflammatory response by endothelial cells and encourage the formation of fibrous tissue.

In the future, Grande-Allen and Keswani expect their work will help prevent fibrotic lesions by identifying targets in advance. That ability could also help treat other fibrotic cardiovascular diseases associated with altered flow.

Keswani said Texas Children’s, which U.S. News & World Report ranked No. 1 in the nation this week for pediatric cardiology and heart surgery, is uniquely suited to take on the project. “This world-class facility and tremendous volume have driven this project from the bedside to the bench, and this award will hopefully allow us to return to the bedside armed with new tools to help these patients,” he said. “This collaboration is the perfect weave between bioengineering and surgery.”

“Bioengineers bring a unique way of approaching surgical challenges and surgeons bring the surgical insight and the science, resulting in a synergistic relationship,” Keswani said. “In addition, it has been absolutely essential to the success of this project to have the support of our surgical leadership, who are strong advocates for surgical research as a means to develop innovative care for patients.”

Keswani is the principal investigator for Texas Children’s Laboratory for Regenerative Tissue Repair and a pediatric and fetal surgeon. His laboratory investigates the interaction of inflammation and the extracellular matrix that drives fibrosis with the goal of developing anti-fibrotic, regenerative therapies. Grande-Allen’s Integrative Matrix Mechanics Laboratory specializes in studying the composition and behavior of biological tissues, with a particular interest in heart valves.

The project also received support from the Virginia and L.E. Simmons Family Foundation Mini-Collaborative Research Fund and a gift from Lew and Laura Moorman.

May 29, 2018

On May 23, a day after the opening of phase one of Legacy Tower, another significant milestone was reached in Texas Children’s Hospital’s storied history. At 7:15 a.m., a 9-month-old boy was taken back to a new, state-of-the-art operating room for the first surgery in Legacy Tower, Texas Children’s new home for heart, intensive care and surgery.

Watch this video highlighting the clinical features of Legacy Tower, including the facility’s new operating and transitional ICU rooms.

Dr. Larry Hollier, surgeon-in-chief, Dr. Edward Buchanan, chief of plastic surgery, Dr. Howard Weiner, chief of neurosurgery, and Dr. Robert Dauser, neurosurgeon, along with a team of anesthesiologists, nurses, physician assistants and operating room staff, performed the successful craniofacial procedure. Following the surgery, the patient was taken to the hospital’s new neurological ICU, a first-of-its-kind unit dedicated to pediatric patients who require specialized neurological care.

“As the largest and busiest department of surgery in the country, we are called upon every day to perform some of the most complex surgeries on the sickest of children,” said Hollier. “Legacy Tower is an answer to those calls, and this is the first of many positive outcomes in our new home.”

Weiner agreed and said the new tower is a game changer that will allow various teams at Texas Children’s to offer better family-centric care.

“This is a huge day at Texas Children’s Hospital,” he said. “It’s a privilege to be here and to be part of something so transformational.”

Phase one of Legacy Tower, Texas Children’s 640,000-square-foot expansion, officially opened on May 22 with six technologically-advanced operating rooms for neurosurgery, orthopedics, plastic surgery, transplant and pediatric surgery – one with intraoperative MRI – and 84 ICU beds, including dedicated surgical, neurological and transitional ICU rooms. This milestone will help Texas Children’s continue to provide the highest-quality care possible to patients and families, particularly those children who are critically-ill.

Beginning at 7 a.m. on May 22, seven specially-trained clinical teams safely transported 45 critically-ill patients to their new, spacious, state-of-the-art critical care rooms. More than 150 Texas Children’s staff members were involved in the move, and the careful transfer of the patients took seven hours.

Click here to view a video and photo gallery of the patient move to Legacy Tower.

Dauser said the Legacy Tower, specifically the operating rooms and their location to other specialties and services, are fantastic.

“Having the ability to conduct an intraoperative MRI in a room adjacent to one of the ORs has tremendous advantages,” he said. “Having an ICU dedicated to neuro patients also is a plus.”

Buchanan said such features provide the perfect environment for him and his colleagues to treat some of the sickest and most complex patients in the country.

“We all are very excited,” he said.

The second phase of Legacy Tower will open in September and house Texas Children’s Heart Center®, ranked No. 1 in the nation by U.S. News & World Report for cardiology and heart surgery.

Ten-year-old Skye Jeary couldn’t believe her eyes as she was wheeled into her new, spacious room in Texas Children’s Legacy Tower. She was in awe when she saw the size of her room and commented on how she’ll have plenty of space to accommodate her stuffed unicorn and her mom who is in a wheelchair.

On May 22, Texas Children’s reached an historic milestone when the doors of Legacy Tower opened for the first time to care for our most critically ill patients. Beginning at 7 a.m., seven specially trained clinical teams began safely transporting 45 critically ill patients from the pediatric intensive care unit and progressive care unit in West Tower to their new, spacious, state-of-the-art critical care rooms in Legacy Tower.

More than 150 Texas Children’s staff members were involved in the patient move to Legacy Tower, and the careful transfer of the patients took seven hours, which was a lot sooner than originally anticipated due to the efficiency and effectiveness of the Legacy Tower teams involved on Move Day.

“The planning for the patient move was unbelievably detailed,” said Dr. Lara Shekerdemian, service chief of Critical Care Services at Texas Children’s. “The patient move involved nursing, administration, physicians, nurse practitioners, all members of the team as well as the amazing family support team that guided the families through what could have been a potentially overwhelming event for them.”

Patient and family services teams were assigned to each family member to help accompany and escort them from their current unit to the new unit in Legacy Tower and to get them settled in their new rooms.

“Our families were so excited about the move,” said Michelle Lawson, director of Texas Children’s Clinical Support Services. “They were being cheered on along the way and they were excited to be in their brand new space. They couldn’t believe we built it just for them.”

The Legacy Tower Go Live Support Center was set up on the fourth floor of Texas Children’s Pavilion for Women and comprised of 867 individuals from across the hospital system who focused on patient move tracking from West Tower to Legacy Tower. The team included support staff from Supply Chain, Security, BioMedical Engineering, Facilities Operations, Information Services, Pharmacy, Respiratory Care, as well as ancillary support teams from Texas Children’s Hospital The Woodlands, Texas Children’s Hospital West Campus and our Health Centers.

“We had floor plans on the wall that were physically tracking the patients as they moved from West Tower to Legacy Tower,” said Matt Timmons, director of Business Operations and Support Services at West Campus. “We also documented it on a spreadsheet displayed on projectors so anybody in the Go Live Support Center knew exactly where our patients were throughout the entire move process.”

While patients were being moved safely to Legacy Tower, Mission Control ensured a smooth process for the patient move by collaborating with teams from the The Woodlands Campus and West Campus to manage the inflow of patients across the system while the move process was underway.

Seven hours after the patient move process began, staff cheered and clapped their hands as the last patient was moved to Legacy Tower.

“We call today the Super Bowl of patient moves,” said Texas Children’s Vice President of Nursing Gail Parazynski. “We observed the tireless leadership, unity, and undying compassion our team has exhibited all week during the first phase of the Legacy Tower Go-Live. The success of this go-live is a true testament to the leadership and dedicated teamwork at Texas Children’s Hospital.”

One day after this historic move, the first surgery was successfully performed in the new state-of-the-art operating room in Legacy Tower.

View the photo gallery of the patient move to Legacy Tower below. Click here to read the story of the first surgery in Legacy Tower and watch video of the state-of-the-art features of our new OR in Legacy Tower.

The second phase of Legacy Tower will open in September and house Texas Children’s Heart Center®, ranked No. 1 in the nation by U.S. News & World Report for cardiology and heart surgery.

May 22, 2018

The Department of Surgery hosted the ninth annual Edmond T. Gonzales Jr. Surgical Research Day May 18 at Texas Children’s Pavilion for Women providing a forum for researchers across the department to showcase their work.

This year 110 abstracts were submitted for review, 11 of which were chosen for oral presentations and 99 were accepted for poster presentations. This year eight students vied for the Best Presentation award and three faculty members were chosen to present their research.

The 2018 keynote speaker was Chandan Sen, who holds various roles at the Ohio State University Wexler Medical Center, including the John H. and Mildred C. Lumley Chair in Medicine, professor and vice chair of research in the Department of Surgery, associate dean of Translational Research, director of the College of Medicine, director of the Center for Regenerative Medicine and Cell-Based Therapies and executive director of the Ohio State Comprehensive Wound Center. Sen spoke about the regenerative medicine frontier and the reprogramming of tissue function in vivo.

Awards presented at the event were the Samuel Stal Research Award for outstanding research by a resident or fellow, the Research Mentor Award, and Best Oral Presentation and Best Poster Presentation.

  • The Samuel Stal Research Award was presented to Dr. Rodrigo Zea-Vera in Congenital Heart Surgery. The award is named after Dr. Samuel Stal, former chief of Plastic Surgery at Texas Children’s.
  • Pediatric Surgeon Dr. Sundeep Keswani was honored with the Research Mentor Award. The award is given on an annual basis to honor a Department of Surgery faculty member who serves as a research mentor through career development, professional guidance or cultivation of research interests.
  • Best Oral Presentation award was given to Urology Fellow Dr. Jeffrey White. He presented his work on the mining of CNV databases discovering a role for RBFOX-2 in penile development.
  • Best Poster award was given to researcher Jennifer Brown from otolaryngology for a poster on the implementation of a tracheostomy educational program for outpatient otolaryngology nurses.

Recipients of the 2018 Clayton Awards, former known as Surgical Seed Grant Awards, were announced as the grand finale of Texas Children’s Hospital Surgical Research Day. This grant program, funded by the Department of Surgery, allows surgery researchers to generate the preliminary data necessary for National Institutes of Health (NIH) grant applications and other extramural funding. 2018 Clayton Awards recipients are as follows:

Dr. Arvind Chandrakantan, Anesthesiology
Obstructive sleep apnea in vitro: A novel approach for cellular and molecular discovery

Dr. Erin Gottlieb, Anesthesiology
Antithrombin Levels in Neonates and Young Infants Undergoing Congenital Heart Surgery

Dr. Julie Hakim, Pediatric and Adolescent Gynecology
Understanding the Role of Estrogen in Vaginal Scar Tissue Formation

Dr. Brian Kelley, Neurosurgery
Molecular and Structural Mechanisms of Diffuse Axonal Injury

Scott Manson, Ph.D., Urology
Myofibroblast-Targeted Therapies for Renal Fibrosis in Obstructive Uropathy

Dr. Bindi Naik-Mathuria, Pediatric Surgery
Promoting Safe Firearm Storage in Households with Children

Dr. Irene Tung, Ophthalmology
The Effect of Oral Omega-3 Supplementation in Children with Meibomian Gland Disease and Chalazia

Xinyi Wang, Ph.D. Pediatric Surgery
The Role of Hyaluronan in Renal Tubulointerstitial Fibrosis