February 25, 2019

Experts from Texas Children’s Hospital are regularly invited to give lectures and presentations at national and international conferences, where they share their knowledge and experiences caring for some of the rarest and most complex pediatric medical conditions. Now a new video series from Texas Children’s Service Line Marketing provides direct access to those experts.

Medically Speaking features some of the brightest minds from several Texas Children’s specialty and subspecialty areas. The series is meant to be a helpful educational resource for parents and a convenient way for physicians and other caregivers to stay up-to-date on the latest in pediatric medicine. Viewers can watch talks on a variety of interesting topics, including advancements in surgery, breakthroughs in research, new clinical trials, and novel and back-practice treatments for specific conditions.

In this episode, you’ll hear from Texas Children’s ophthalmologist Dr. Madhuri Chilakapati speaking about strabismus, an eye muscle imbalance commonly known as crossed eyes, lazy eyes or wandering eyes. During the talk, Madhuri reviews the different types of strabismus, shares common pain points from parents and ways to offer better support, and shares possible treatment options.

Be on the lookout for more Medically Speaking episodes on Connect, or view additional episodes now.

Learn more about the services provided and conditions treated by Texas Children’s Division of Ophthalmology.

PLEASE NOTE:
This presentation is not intended to present medical advice or individual treatment recommendations, and does not supplant the practitioner’s independent clinical judgment. Practitioners are advised to consider the management of each patient in view of the clinical information. All content is shared for informational purposes only, and reflects the thoughts and opinions of the original author. No physician-patient relationship is being created by the use of this presentation. The presentation sets out recommendations based upon similar circumstances and is provided as an educational tool. The presenters are not attorneys, and to the extent this presentation provides commentary on current laws and regulations affecting health care activities, it is not intended as legal advice.

To better understand the impact of parental incarceration in Harris County, Texas Children’s Section of Public Health Pediatrics recently led a needs assessment of children of incarcerated parents.

The year-long study was funded by Texas Medical Center’s Health Policy Institute and involved Baylor College of Medicine, the University of Texas Medical Branch at Galveston, and the Harris County Sheriff’s Office.

“We wanted to better understand the needs of children with incarcerated parents in Harris County Jail as well identify opportunities to support these children,” said Nancy Correa, senior community initiatives coordinator for Texas Children’s Section of Public Health and Primary Care. “Parental incarceration as an adverse childhood experience has been largely overlooked and not well-studied, which is significant considering the United States has the highest incarceration rate in the world and The Annie E. Casey Foundation estimates 5.1 million American children have a parent in jail or prison during their childhood.”

After conducting interviews with inmates and caregivers of children that have parents in Harris County Jail, researchers found that seven percent of all Harris County children have a parent who spends time in the county jail each year, half of inmates have at least one child under the age of 18, and 61 percent of incarcerated parents provided all or most of the financial support for their children before being jailed.

“If the person who is incarcerated is the breadwinner, lots of family needs all of a sudden become really critical,” said Dr. Chris Greeley, the section chief of Public Health and Primary Care. “Sometimes people will get incarcerated for something relatively minor, and they can’t afford to pay bond. Because of that, a kid’s life is irrevocably altered.”

During a February 12 press conference, Harris County Sheriff Ed Gonzalez underscored the multiple hardships children of incarcerated individuals face.

“Children are traumatized by being separated from their parent,” Gonzalez said. “Sometimes they have to change homes and schools routinely. These children also suffer shame and feelings of isolation, and have urgent basic needs like food and emotional support.”

The Sheriff said his office’s goal is to make visitation at Harris County Jail – the largest jail in Texas and the third largest in the United States – more child-friendly by making the visitors’ lobbies more inviting, developing curricula and training deputies on interacting with children when they visit the jail.

Gonzalez said he also plans on reviewing his department’s policies and determining best practices for when deputies arrest a parent when a child is present. He also plans on updating the Harris County jail website to include information on community resources.

“Children of incarcerated parents have been overlooked,” Correa said. “They are the innocent and forgotten victims of crime in our community, but there are things we can do to help.”

February 18, 2019

During Heart Month we celebrate our patients and the miracles our experts perform every day providing heart care that’s the best in the nation. This year, we’re also celebrating a unified commitment to making our Heart Center even better.

Heart Center leadership, faculty and staff recently convened for the inaugural Heart Center Retreat. The event afforded the full, multidisciplinary team of surgeons, clinicians, intensivists, nurses, advanced practice providers, anesthesiologists, administrators and more the opportunity to collectively reflect on past successes, discuss areas of possible improvement, identify transformative goals, and actively plan for the future.

“If you believe some of the external ratings sources, our congenital heart disease program is one of the best in the country. Personally, I do not like to give external ratings much credence” said Dr. Christopher Caldarone, Texas Children’s chief of Congenital Heart Surgery. “A great program will hear such accolades and disregard them while searching for ways to get better. And that was the purpose of the Heart Center Retreat – to help us rise above the day-to-day and intensely focus our attention on ways to improve in terms of patient care, access, teaching, research, innovation, and quality of life for members of the Heart Center team.”

Following an introduction from President and CEO Mark Wallace, attendees heard several talks from Heart Center leadership on a variety of topics. These included reflections on the program’s growth in recent years, how the move into Lester and Sue Smith Legacy Tower has affected processes and outcomes, and what it means to be the No. 1 heart program in the nation. Attention then turned to ways to make the Heart Center even better, with talks outlining opportunities for advancement in innovation and research, plans for improved education and training, challenges posed by competition and strategies for staying ahead, and the need to relentlessly improve patient care, access and experience.

“To be our best we must do our jobs better than anyone, work together and always keep the patient top of mind,” said Dr. Daniel Penny, Texas Children’s chief of Pediatric Cardiology. “We believe that what will separate Texas Children’s Heart Center going forward is a unique combination of exceptional technical abilities coupled with a highly developed collaborative culture that is completely centered on our patients and their families.”

Following the talks, attendees split up into preselected breakout groups. The teams chose their groups based on the topic and were tasked with developing real-world strategies based on key Heart Center objectives. These included:

  • Establishing a comprehensive center for patients and families living with Fontan physiology across the lifespan
  • Developing a unified data platform to increase efficiency and improve quality control and research productivity
  • Creating an innovation fund with a streamlined application process to generate new ideas
  • Design a process that solicits, evaluates and prioritizes innovative projects
  • Improving satisfaction and efficiency in the management of new patients
  • Providing access to professional development for nursing and ancillary services

The breakout groups facilitated lively discussion and engagement. Each team was highly motivated and have since reported back to the Heart Center executive committee with proposals that include target objectives, and tactics and budgetary considerations for meeting those objectives.

Feedback from retreat participants has been positive and there are plans to make it an annual event. It’s yet another way the Heart Center has rallied around its ongoing mission to, as the leadership teams says, “get so far ahead no one can catch us.”

“Even though we’re a large, elite program, we must consistently take a critical and objective look at all aspects of our performance”, said Caldarone. “Our goal is be a large, comprehensive, and collaborative team that is nimble in our ability to mobilize expertise to meet the needs of every patient.”

This past fall, Department of Surgery leadership launched the Infinite Leadership Academy, a new initiative aimed at fostering personal and professional development among surgical providers, and preparing the next generation of surgical leaders.

The six-month program embraces one of Texas Children’s cultural cornerstones – leadership – and takes it to a new level, with a curriculum specially developed to help surgeons and APPs recognize their potential and hone their leadership skills. The academy – now in its fourth month – also underscores the Department of Surgery’s ongoing commitment to investing in its people.

“Leadership skills, like technical surgical skills, take practice to master,” said Surgeon-in-Chief Dr. Larry Hollier. “We’ve recognized that early in a career, it’s critical to develop skills that have more to do with how you fit into a team structure, how you involve others in critical decision-making, and how you move the care of the patient forward. To practice those skills effectively, it is helpful to have someone coach you. This is the goal of the leadership academy”

The program kicked off with a personality and behavior assessment to help the 20 inaugural participants more firmly identify their core skills and leadership styles. After initial evaluation, participants began taking part in regular monthly sessions designed to help build on leadership strengths. The curriculum includes lectures, reading assignments, coursework and group projects, developed to help each participant understand their personal vision and function as part of a team that can innovate and improve.

“In the limited time that I’ve been in the program, I already feel it has allowed me to become a better person and an improved leader,” said Dr. Mary Frances Musso, surgical sleep director at Texas Children’s Hospital. “I have a better understanding of my vision for growing the surgical sleep program at Texas Children’s. Leadership to me is about making new discoveries, creating a team, motivating advancement and leading the team to new innovations. It is powerful to stop and reflect how I can now improve my approach to different situations by looking at them from a different point of view and utilizing the new tools I have gained from this program. I feel invigorated to lift others up to become better leaders.”

Another key component of the program is the integration of Texas Children’s Breakthrough Communication, a course facilitated by providers and designed to equip surgeons, physicians and APPs with tools to enhance and better organize patient encounters.

“Communication in a children’s hospital environment is extraordinarily complex,” said Hollier. “We’ve developed a communication course that’s the first of its kind to teach our providers how to compassionately and effectively communicate with the patient – regardless of their age – and the parent or guardian. It will also eventually include strategies for communicating with other providers. This is and will continue to be an essential part of the leadership academy curriculum.”

The response thus far from participants has been tremendous.

“We’ve gotten a lot of interest, and currently there are more people who want to participate than we have slots,” said Hollier. “The intention going forward is to have these on a rolling basis, and to develop ongoing training for people who’ve already availed themselves of these early courses.”

February 15, 2019

Texas Children’s Cancer and Hematology Centers Director Dr. Susan Blaney recently appointed Dr. Donald Williams “Will” Parsons to the role of deputy director of the Cancer and Hematology Centers.

“Dr. Parsons is an accomplished and skilled researcher in cancer genomics and the use of ‘precision oncology’ approaches for the diagnosis and treatment of pediatric cancer patients,” Blaney said. “He is nationally and internationally recognized for his work in this area and is a true thought leader in the field. He is also a compassionate physician and a dedicated educator.”

Blaney said Parsons is highly collaborative and skilled at bringing together diverse multidisciplinary investigators to achieve a common goal: improving the care of childhood cancer patients through the application of genomics.

“Please join me in congratulating Will,” she said. “I am delighted that he has agreed to assume this new role within Texas Children’s Cancer and Hematology Centers.”

In addition to his new role as deputy director of the Cancer and Hematology Centers, Parsons also serves as co-director of the Brain Tumor Program, co-director of the Cancer Genetics and Genomics Program, and director of the Center for Precision Oncology within the Texas Children’s Cancer Center.

After graduating from Princeton University in 1992 with a degree in Chemistry, Parsons earned his Ph.D. in Pathology and his medical degree from The Ohio State University College of Medicine. He completed his pediatric residency at Johns Hopkins University and hematology-oncology and neuro-oncology fellowship training at Johns Hopkins and the National Cancer Institute.

In addition to conducting innovative translational research, Parsons and his team are making important contributions to the clinical care of childhood cancer patients. In 2016 he established the Precision Oncology Consultation Service at Texas Children’s Cancer Center, which provides recommendations on the use and interpretation of genomic testing for pediatric cancer patients nationwide. Parsons plays several leadership roles within the Children’s Oncology Group (COG), the world’s largest organization devoted exclusively to pediatric cancer research, including serving as the study chair for the NCI-COG Pediatric MATCH trial, the first nationwide trial of precision medicine for children with refractory and relapsed cancers.

Parsons mentors diverse trainees at Texas Children’s and Baylor College of Medicine (BCM) and was appointed in 2018 as Co-Director of the Pediatrician-Scientist Training and Development Program, a track of the BCM Pediatrics Residency Program that seeks to mentor future physician-scientists.

Parsons has published more than 60 scientific papers in peer-reviewed journals, including Science, Nature, the Journal of Clinical Oncology, the New England Journal of Medicine, JAMA Oncology, and Genome Medicine. He has been awarded numerous honors for his research, such as the Peter A. Steck Memorial Award for Brain Tumor Research (2009). Dr. Parsons is a Graham Cancer Research Scholar at Texas Children’s Cancer Center and has received funding from multiple sources to support his research program, including the Cancer Prevention and Research Institute of Texas (CPRIT), the National Human Genome Research Institute, and the National Cancer Institute. He serves on advisory boards of multiple pediatric cancer foundations, including the Alex’s Lemonade Stand Foundation.

To learn more about Texas Children’s Cancer and Hematology Centers, click here.

February 11, 2019

 

It’s Heart Month, which is always a special time at Texas Children’s as we celebrate our patients and families, the care we provide at our No. 1-ranked Heart Center and our many milestones. This year, we’re kicking off Heart Month celebrating yet another momentous first.

A team of experts at Texas Children’s Heart Center®, led by congenital heart surgeon Dr. Iki Adachi, became the first in the United States – and only the second in the world – to implant the Jarvik 2015 ventricular assist device (VAD), a groundbreaking new technology Adachi helped develop.

“Dr. Adachi is truly a pioneer and a world-renowned authority on mechanical heart support,” said Dr. Christopher Caldarone, Texas Children’s chief of Congenital Heart Surgery. “His work in the development of the Jarvik 2015 VAD has been tremendous and is a great example of the power of Texas Children’s in bringing new technologies to benefit our patients.”

Bridge to transplant

For patients with heart failure, a VAD can buy valuable time until they match an organ. In some rare cases, a VAD can be used as a permanent therapy for heart failure or can even improve heart function to such a degree that it makes a transplant unnecessary. VADs can either simulate heart function with pulsing action or allow a continuous stream of blood to flow through the heart. Continuous-flow VADs tend to be smaller and quieter but also more durable, and in recent years have yielded improved results in adult heart failure patients.

The Jarvik 2015 is the first and only implantable continuous-flow VAD designed specifically for small children. Development took more than a decade and was not without setbacks. After the previous prototype failed to gain FDA approval, the team of engineers enlisted Adachi to assist with crucial design modifications to the VAD’s pump while keeping the size of the device small – about the size of a AA battery. Following extensive testing in the Texas Medical Center, the FDA approved the Jarvik 2015 for clinical trial.

A chance at life

One of the most significant benefits of this new technology is that it allows the patient to become stronger, making them a better candidate for transplant. Such was the case with Katlyen Hickman.

You would never know by looking at Katlyen today that the smiling, energetic four-year-old needed multiple surgeries to save her life only a few months ago. She was born with complex congenital heart disease, including ventricular septal defects and small left heart structures, and despite numerous procedures and surgeries during her first years of life, her condition was rapidly deteriorating this past fall.

“It was clear she was moving in the direction of needing heart transplantation,” Adachi said. “She was admitted to the ICU and her heart was just getting worse and worse.”

Though the Jarvik 2015 had been cleared for clinical trials, it hadn’t been approved for commercialization. But because Katlyen’s case was so dire, and because she was too small to receive an adult-size VAD, Adachi and Texas Children’s were able to obtain expanded access from the FDA to implant the device. The fact that the team was already very familiar with the Jarvik 2015, following their extensive laboratory testing, helped facilitate the process with the FDA.

The results couldn’t have been better. Not only did the device keep Katlyen alive, but it also improved her blood flow, which helped her organs recover. This success paved the way for the next critical step in her journey – a heart transplant, which she received on November 23, 2018. It was the day after Thanksgiving. Only a month later she was discharged and spent Christmas at home with her family.

Adachi anticipates the Jarvik 2015 will do well in the upcoming multi-institutional clinical trial and hopes its availability may further accelerate the trend toward the use continuous-flow devices in children.

“Pediatric VAD support will continue to evolve as the pediatric mechanical circulatory support area matures,” he said. “The popularization of continuous-flow devices could be a landmark event that represents a paradigm shift in the field. And Texas Children continues to lead that shift.”

Learn more about Texas Children’s Heart Center and the Jarvik 2015 VAD clinical trial.

February 5, 2019

In response to an increased demand for short-term, non-chronic care, Texas Children’s Hospital The Woodlands has expanded its Acute Care Unit from 32 beds to 45.

The need for the 14-bed expansion was evident shortly after the hospital opened its doors two years ago, said the unit’s assistant clinical director Roxanne Vara.

“We were at capacity several times last year,” Vara said. “This expansion will allow us to admit more of our patients closer to home.”

The additional beds in the Acute Care Unit are located on the third floor of the hospital. By mid-February, the expansion will include a playroom equipped with a section dedicated to patients 12 and older. This section will house a PAC-MAN video game donated by The Woodlands facilities team among other age-appropriate games.

“We always want to be able to say yes if a child needs a bed at our campus, and this expansion is how we are able to continue to do that,” said Assistant Vice President Ketrese White. “We are continuously strategizing about how and where to expand and move forward.”