April 8, 2016


The United States Agency for International Development (USAID) has awarded a $69.8 million grant to the Baylor College of Medicine Children’s Foundation–Malawi (Baylor–Malawi), an affiliate of the Baylor College of Medicine International Pediatrics AIDS Initiative at Texas Children’s Hospital, to support and expand HIV/AIDS programs in Southern Africa. The grant, through the USAID Regional HIV-AIDS Program, will fund a dynamic and innovative project called Technical Support to PEPFAR Programs in the Southern Africa Region, or TSP. Designed by the Baylor-Malawi team, TSP is a collaborative program that includes ICAP at Columbia University and Baylor College of Medicine Children’s Foundations in Botswana, Swaziland, Lesotho and Angola.

“While Southern Africa remains the epicenter of the HIV/AIDS epidemic, recent progress toward global elimination goals provides an impetus for coordinated, regional efforts,” said Dr. Saeed Ahmed, assistant professor of pediatrics with BIPAI who will lead TSP. “The program will address challenges related to HIV care and treatment, including pediatric and adolescent care, HIV prevention from mother to child and the unique gender aspects of the epidemic, providing a common regional platform for dissemination and rapid adoption of best practices.”

In support of the primary goal to reduce the impact of HIV/AIDS in Southern Africa, TSP objectives are to:
Improve clinical and other technical outcomes of partner programs in the region by providing mission programs with technical support and short- and medium-term program assistance and capacity building toward sustainability;

Improve and rapidly expand pediatric and adolescent treatment services in the region by providing technical assistance in the short and medium term and longterm program support;

Implement PEPFAR programs directly, in close cooperation with USAID.

The TSP will provide a wealth of technical expertise, Ahmed said, including human resource capacity, physical infrastructure, existing networking and program implementation experience, bringing together formally the unique and complementary strengths of the Baylor network and ICAP at Columbia University. The Baylor foundations are the leading providers of pediatric and adolescent HIV care and treatment in their respective countries with Centers of Excellence anchoring broad networks of satellite clinics. ICAP, the second-largest PEPFAR implementing program, offers incredible geographic scope and technical, programmatic and monitoring and evaluation expertise. Combined, the Baylor network and ICAP have managed more than $1 billion in funding over the past 5 years, and are implementing more than 50 U.S. Government supported initiatives.

To provide assistance to regional HIV/AIDS programs, Baylor-Malawi and its partners have organized a ‘Dream Team’ of experts who will provide the technical advising backbone of the program. Through its implementing partners, the Dream Team will have access to an extensive network of more than 1,500 people, including doctors, nurses, social workers, counselors, community health workers and volunteers, and pharmacists to provideHIV/AIDS program assistance and implementation.

“The high-quality assistance and program implementation provided by this project will strengthen the efforts in the region to achieve the UNAIDS 90-90-90 benchmarks, which call for 90 percent of HIV-infected individuals to know their status; 90 percent of patients who know their status to be started on and adherent to anti-retroviral therapy; and 90 percent of patients on ART to be viral suppressed by 2020” said Dr. Mark Kline, physician-in-chief, Texas Children’s Hospital and chairman of the department of pediatrics, Baylor College of Medicine.

Women and children are a special focus on the TSP program. It aims to achieve elimination of mother-to-child transmission, doubling of the number of children on anti-retroviral therapy and, through the DREAMS Initiative, assisting partners in developing interventions to address gender-based violence and reduce new HIV infections in adolescent girls and young women. DREAMS, or Determined, Resilient, AIDS-free, Mentored and Safe Women, is a PEPFAR program to reduce HIV infections among girls and young women in sub-Saharan Africa.

“This award is a true testament to the BIPAI Network’s ability and capacity as a global leader in pediatric HIV/AIDS and tuberculosis. Baylor–Malawi continues to excel in innovative program development,” said Michael Mizwa, chairman, Baylor–Malawi Board of Directors, chief operating office/senior vice president of BIPAI and director of global health at Texas Children’s Hospital.

“With the resources from this award, I am pleased that Baylor Malawi will lead a consortium that leverages the extensive expertise that is in the BIPAI network with its partners ICAP and regional ministries of health to accelerate the region’s advances to the 90-90-90 targets,” said Dr. Peter Kazembe, executive director of Baylor College of Medicine Children’s Foundation–Malawi.

April 5, 2016

Before learning about pediatric otolaryngologist Dr. Deepak Mehta on Facebook, Christina Harper was about to give up hope that her 2-year-old daughter, Harlow, would ever live a life without a tracheostomy tube.

Shortly after being born in California, surgeons discovered Harlow had bilateral vocal cord paralysis, which caused her vocal cords to stay closed, preventing her from breathing. The only solution at the time was to put a tracheostomy tube into Harlow’s tiny neck.

Although necessary, living with a tracheostomy tube wasn’t easy. It made it hard for Harlow to eat, to talk and it posed a risk of infection. All of the above is why Harper wanted to see if there was something doctors could do to mitigate Harlow’s condition and remove the tracheostomy tube.

To her dismay, no one she saw in California had any answers. So, she turned to Facebook, where parents in similar situations were trading information, advice and most of all – hope. Several of the people Harper met on the social media site pointed her to Texas Children’s Hospital, more specifically, Mehta, an expert in complex airway surgery.

Mehta joined Texas Children’s Otolaryngology Department last year and works with a multidisciplinary team that aims to treat patients who have multiple problems with the respiratory tract and the upper part of the digestive tract, including the lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus and windpipe.

“Having a team like this is very important for patients such as Harlow,” Mehta said. “The expertise and coordinated care we provide really makes a difference.”

For Harlow, it meant life without a tracheostomy tube. In order to remove the tube, Mehta first had to fix the problem she was diagnosed with when she was born. To do that, he and his surgical team took a bone graft from Harlow’s rib and placed it in-between her vocal cords to widen them and allow her to breathe on her own. Mehta and the surgical team also had to correct a problem in Harlow that had never been detected – a laryngeal cleft, which prevented the toddler from swallowing.

After the more than five-hour surgery concluded, members of Texas Children’s Pediatric Intensive Care Unit kept Harlow asleep for a week so that she could properly heal. Within about 10 days, the brown-eyed, curly-haired girl was eating, drinking and talking like she had never done before.

“She used to not want to eat anything, not put anything in her mouth,” Harper said. “Now, we can’t keep her out of the kitchen.”

Mehta said Harlow will need some therapy over the next few months so that her swallowing can get even better and her speech can get even stronger. After that, he said she should go on to lead a normal life.

To watch a story KPRC News 2 did on Mehta and Harlow, click here.


Texas Children’s recently won the ECRI Institute’s 10th Annual Health Devices Achievement Award for demonstrating excellence in health technology management and patient safety.

The award-winning submission, “Alarm Management Reboot,” describes Texas Children’s successful effort to improve patient safety by incorporating enterprise-wide alarm management practices to make alarms more meaningful and actionable while eliminating alarm fatigue within patient units.

Texas Children’s alarm management steering team began with a baseline analysis of the organization’s current alarm management program. The team also laid out the Joint Commission’s National Patient Safety Goal into an action plan which designated specific operations necessary to meet the phases of the patient safety goal. Texas Children’s partnered with an outside organization to develop an alarm dashboard to enable the team to collect and analyze alarm data by care area, nurse and patient. Simple changes progressed to patient-specific alarm dashboards that helped the care team make decisions around alarm settings.

“Substantive changes were needed to shift focus from the number of alarms to actionable information based on an analytic dashboard,” said John Weimert, director of biomedical engineering at Texas Children’s. “This project aligned people, technology and governance to meet the common goal of improving patient safety.”

For the initiative’s pilot, the team targeted the progressive care unit (PCU), a step-down unit from the pediatric intensive care unit that treats critically and chronically ill patients. It was an ideal place to start because PCU patients depend on technological support and heavy monitoring, resulting in frequent alarms on the unit.

Data collected from patient monitors showed that nurses received an overwhelming number of alarms – approximately 180 per 12-hour shift. A closer look revealed that low oxygen saturation alarms made up nearly half of the total. Rarely were levels dangerously low, just small dips below that unit’s standard level of 93 percent oxygen saturation. Frequent fluctuations in oxygen saturation set off alarms constantly.

To fix the problem, the team lowered oxygen saturation alarm levels to 90 percent. The new standard was tested over a 28-day trial, during which patients also were monitored for adverse event. At the end of the trial, alarms related to low oxygen saturation levels had decreased by 10 percent, and the time patients spent in an alarm state, decreased by 9 percent. No adverse health events were reported.

Additionally, alarms data and insight from nurses revealed other small factors that made a huge impact. For example, nurses noticed that metal trash cans in shared hospital rooms made a loud noise when opened causing patients’ heart rates to spike. By replacing noisy trashcans with quieter ones, the average daily alarm time was reduced by 3 percent. The threshold for the unit’s centralized alarms notification system located in nursing stations was also adjusted from 10 seconds to one minute. Due to these changes, the unit is quieter with noise levels improving from 80 decibels – the sound of an alarm clock two feet away – to less than ambient noise level.

“The partnership among all the disciplines involved in this work was key to changing the conversation around alarms,” said Jennifer Sanders, director of Clinical Support Operations, who co-led the initiative with leaders from Information Services and Biomedical Engineering. “Without robust data and collaboration between the clinical nursing and physician staff, these improvements would not have been possible.”

Based on the initiative’s success in reducing alarm fatigue in the PCU, Sanders says the alarms management initiative has the potential to benefit other hospital units.

“The team did an admirable job of revamping their alarm management program with an in-depth assessment of the environment at the patient’s bedside,” said ECRI Institute’s David Jamison, executive director of health technology evaluation and safety. “The actionable approach Texas Children’s took to stop alarm fatigue provides a good example for hospitals nationwide.”

Click here to read the ECRI Institute’s article about Texas Children’s award-winning alarm management strategy.

4616childabuseinside640For the 10th consecutive year, Texas Children’s employees took a moment out of their day on April 1 to remember the more than 1,500 children evaluated last year by Texas Children’s Hospital’s Child Abuse Pediatrics Team for possible child abuse.

After listening to presentations on the causes of child abuse and the stress of taking care of those who have been abused, employees walked to the Texas Children’s Hospital Playground and tied blue and black ribbons to the iron fence that surrounds the slides and swings.

Each ribbon represents a child evaluated at Texas Children’s Hospital for suspected child abuse or neglect over the past year. The black ribbons represent children who died as a result of suspected abuse or neglect during that same period.

The ribbons will remain on the fence for the month of April, which is Child Abuse Awareness and Prevention Month.

“We are here today to give these children the dignity they deserve,” said Texas Children’s Chaplain James Denham. “We also are here to recognize the caregivers who have placed gentle hands on them in their time of need.”

At Texas Children’s, the Child Abuse Pediatrics or CAP team is responsible for assessing and ensuring the safety of children where child maltreatment is suspected. The CAP team comprises physicians, nurse practitioners, nurses, forensic nurses and social workers, and evaluates hundreds of cases a week at Texas Children’s Hospital and the sexual abuse clinic at the Children’s Assessment Center. In 2015, Texas Children’s Hospital’s Child Abuse Pediatrics Team evaluated more than 1,500 children for possible maltreatment.

Every year about 65,000 children in Texas are victims of child maltreatment with more than 200 deaths directly attributed to this abuse and/or neglect across the state. The Texas Children’s Emergency Center team sees almost 2,500 of these child abuse cases each year.

“I urge everyone to make a difference in a child’s life by standing up for the safety and well-being of all children,” Denham said on Friday. “We all can make a difference even if it’s just opening our eyes to the injustice of child abuse.”

To learn more about child abuse and its widespread affects, Texas Children’s Section of Public Health Pediatrics will introduce upstream risk factors that influence a child’s health and the healthcare professional’s role to mitigate these risks through screening, early recognition, and connecting families to resources. By doing this, we will serve as advocates for healthy children and families. We encourage our colleagues to join us not only in our April events, but year-round to keep children resilient and safe.

Friday, April 8, noon to 1 p.m.
Child Abuse Awareness & Prevention Month Lecture Series
Judith McFarlane, DrPH, RN The Role of the Healthcare Professional in Household Violence Texas Children’s Hospital auditorium

Wednesday, April 13, 11 a.m. to 1 p.m.
Child Abuse Awareness & Prevention Month Bridge Event
Celebrating Community Partners that support healthy families
The Auxiliary Bridge (between CCC and WT)

Friday, April 15
All day Go Blue Day
Wear Child Abuse Prevention T-Shirt and Jeans

Friday, April 15, noon to 1 p.m.
Child Abuse Awareness & Prevention Month Lecture Series
Dr. Claire Bocchini
The Role of the Healthcare Professional in Advocacy 
Children’s Nutrition Research Center, Howland Auditorium

Monday, April 18, noon to 1 p.m.
Child Abuse Awareness & Prevention Month Lecture Series
Jeff Temple, PhD
Dating it Safe: Understanding & Preventing Teen Dating Violence
Children’s Nutrition Research Center, Howland Auditorium

Friday, April 29, noon to 1 p.m.
Child Abuse Awareness & Prevention Month Lecture Series
Shreela Sharma, PhD
The Role of the Healthcare Professional in Food Insecurity 
Children’s Nutrition Research Center, Howland Auditorium

4616GirijaBabu175Girija Babu of Texas Children’s Pavilion for Women’s Mother/Baby Unit is the latest Texas Children’s Super Star employee. “Leadership in my definition is not just someone who leads a group but someone who works along with their group and helps them through their problems like their own family member,” Babu said. Read more of Babu’s interview and find out how you can nominate a Super Star.

Q&A: Girija Babu, November 2015

Your name, title and department. How long have you worked here?
Girija Babu, Registered Nurse in Pavilion for Women Mother/Baby Unit. I have been working at Texas Children’s Hospital for the past six years.

What month are you Super Star for?
November 2015.

Tell us how you found out you won a super star award.
Through an amazing surprise party arranged by my nursing leadership and my coworkers.

What does it mean to be recognized for the hard work you do? How has the organization helped you achieve your personal and professional goals?
I feel honored to know my work has made an impact on the lives of others, allowing them to choose me as their super star. It is a very pleasant news to me. This organization has allowed me to achieve the goal in my career through the support and guidance of my leadership, the team work of my colleagues, and the trust and encouragement of doctors. It is very fortunate to work with them. Without the support of them I wouldn’t have received this award.

What do you think makes someone at Texas Children’s a super star?
I think we all are super stars in one way or another. Those who are hardworking, passionate towards the work, and enjoy what they do has to be appreciated.

What is your motivation for going above and beyond every day at work?
My motivation is my family and my coworkers. Those who I believe have believed in me, more than I do at times. They have allowed me to be a better person at my work and even in my personal life.

What is the best thing about working at Texas Children’s?
I cannot just choose one thing I believe is the best about Texas Children’s. Everything the hospital offers me is the best I have ever had. The wonderful people whom I work with everyday are the reason behind my smile at work.

What does it mean to you that everyone at Texas Children’s is considered a leader? What is your leadership definition?
The friendly faculty at Texas Children’s all have great qualities of a leader. Each one of them has done a tremendous amount of great deeds to be considered as a great leader. Leadership in my definition is not just someone who leads a group but someone who works along with their group and helps them through their problems like their own family member.

Anything else you want to share?
I want to thank Texas Children’s for always being a second family for me and recognizing me with the Super Star award. I would like to thank the wonderful people I work with every day, who helped me achieve this award. Special thanks to the Neo team for their trust in me, the continuous support, and encouragement. Being the Super Star motivates me to do more and work harder. Thank you.

4616friedman175An instructional video from pediatric otolaryngologist Dr. Ellen Friedman was recently showcased in the New England Journal of Medicine (NEJM) online feature on Videos in Clinical Medicine.

In the 15-minute video, Friedman outlines the best approaches and techniques for “Removal of Foreign Bodies from the Ear and Nose.” Subscribers to the journal can view the video on NEJM.org.

“The readership of the NEJM is very broad, and their section on Videos in Clinical Medicine is very popular,” Friedman said. “Since the removal of foreign bodies of the ear and nose takes place around the world in emergency rooms and clinics – usually by primary care physicians – I hope that this instructional video will be helpful.”

Chief of Otolaryngology Dr. Ellis Arjmand said Friedman is one of the best known pediatric otolaryngologists in the country and is a true leader in the field. Through the video on NEJM.org, Arjmand said many physicians will have the opportunity to benefit from Friedman’s knowledge and experience.

In addition to her duties at Texas Children’s, Friedman is director of the Center for Professionalism in Medicine and a professor of Otolaryngology at Baylor College of Medicine.

4616miloh175Texas Children’s Hospital is proud to announce Dr. Tamir Miloh as director of pediatric hepatology and liver transplant medicine.

“I am thrilled to welcome Dr. Miloh to our team,” said Dr. John Goss, medical director of transplant services and professor of surgery and chief of the division of abdominal transplantation at Baylor College of Medicine. “His diverse background and specialized training will prove to be an invaluable asset to our transplant patients and their families.”

Miloh’s research interests include the investigation of liver transplantation and various pediatric liver diseases such as primary sclerosing cholangitis (PSC), autoimmune hepatitis, Wilson’s disease, metabolic diseases, biliary atresia, nonalcoholic fatty liver disease (NAFLD) and acute liver failure. In addition to his clinical role, he is invested in education in the field of pediatric hepatology and has established an ACGME accredited advanced transplant hepatology program at Texas Children’s.

Miloh, who also serves as an associate professor of pediatrics-gastroenterology at Baylor, earned his undergraduate and medical degrees from Sackler School of Medicine in Tel Aviv, Israel. He did his residency training at Wolfson Hospital in Holon, Israel as well as St. Christopher Hospital for Children in Philadelphia. Miloh completed a fellowship in pediatric gastroenterology and a one-year fellowship in pediatric hepatology and transplant at Mount Sinai Hospital in New York and has earned Certificate of Added Qualification in pediatric liver transplanation.

Miloh is a member of the American Association of Gastroenterology, American Association of the Study of Liver Disease, North American Society of Gastroenterology and Nutrition Hepatology Committee and International Pediatric Transplant Association, among others.

Each year, more than 20,000 children visit the Gastroenterology, and Nutrition service at Texas Children’s. Specialists provide treatment for these patients with a broad spectrum of intestinal, liver and nutritional disorders. The first liver was transplanted at Texas Children’s in 1988 and in 2015, the expert team performed 30 liver transplants.