September 17, 2019

As one of the best pediatric cancer centers in the nation, experts at Texas Children’s Cancer Center are on the forefront of cutting-edge basic, translational and clinical research. The center’s world-renowned faculty have pioneered many of the now standard protocols for treating and curing children with cancer.

Scientists and clinical experts at the center are conducting more than 250 clinical trials – more than the majority of pediatric cancer centers in the nation. In addition, the center’s Developmental Therapeutics Program and its Cell and Gene Therapy Program have been leaders in the study of novel agents and immunotherapies, respectively, for the treatment of childhood cancer.

“Our physicians employ evidence-based guidelines and the most advanced clinical trials in the delivery of oncology care,” said Cancer Center Director Dr. Susan Blaney. “Our vast expertise in the development of new therapeutics means our patients have access to the most advanced and innovative therapies.”

Dr. Andras Heczey, one of the Cancer Center’s physician scientists and a member of the newly-formed Sky High Immunotherapy Center, is working with colleagues in his laboratory to develop novel treatments for children with solid tumors. His work is a prime example of what the Cancer Center is doing to advance treatments and ultimately find a cure for a disease that remains the leading cause of non-accidental death in children.

In honor of National Childhood Cancer Awareness Month, we interviewed Heczey about his research and why he thinks such work is so important to enhanced patient care.

What is the focus of your research?
My research focuses on redirecting the normal immune system to attack cancer cells. T cells are a type of white blood cell that participate in the immune response. I am using genetically engineered T cells to treat liver tumors in children and Natural Killer T (NK-T) cells to treat neuroblastoma, a childhood tumor that most commonly involves the adrenal gland.

How exactly does this work?
We take patients’ white blood cells from a simple blood draw, modify them in the test tube to recognize and kill tumor cells, and then re-infuse these genetically engineered (modified) cells into the patient’s blood stream. The idea is that we train the immune system to kill the cancer cells. In patients with neuroblastoma, we modify Natural Killer T cells to express a protein called chimeric antigen receptor (CAR for short) that targets GD2, a molecule on tumor cells but not on normal tissues. When the Natural Killer T cells arrive at the neuroblastoma tissue, they recognize the GD2 molecule and kill the cancer cells. In liver cancer patients, we are using a similar strategy using T cells that express CAR targeting a molecule called Glypican-3, which is primarily expresses on liver cancer cells.

Have you used these treatments in children at Texas Children’s?
Last summer, we started our first human clinical study in children who have relapsed or have refractory high-risk neuroblastoma. So far, three children have been treated. The results we have observed thus far are very promising. We also have started our first human clinical study in children with relapsed or refractory liver cancer. The first patient was recently treated and we are eagerly waiting for the results.

What else are you studying in your laboratory?
In addition to developing strategies to kill the tumor cell, we are also closely studying the tumor environment. We know that when genetically engineered cells enter the tumor, the cancer cells and other cells within the tumor will fight back. We don’t really know how this happens. We have some ideas, but we and others in the field are closely evaluating what happens in human tumors after the engineered cells are infused. This is really important because we want to make sure our cell therapies are effective and that the responses are sustained and the patients are cured. Ultimately, we’ll also need to develop techniques to engineer the cells inside the body. Right now, we have to grow and test the cells before infusing them into the patient. This typically takes four to six weeks, depending on the product and how many cells needed to be manufactured. A patient cannot always wait that long. In the future, we envision strategies where a patient’s immune cells are engineered inside their body to quickly redirect them against the growing tumor cells.

Are you encouraged by what you are finding?
Yes, I am very encouraged. We are getting closer each and every day to finding a cure for some forms of childhood cancer.

Click here to view a preview of the next installment of “This is Cancer: Reflections from our patients.” This installment focuses on Tajah, who was diagnosed with osteosarcoma after visiting Texas Children’s Emergency Center with intense knee pain. The 13-year-old had to have her knee and femur removed. Surgeons replaced them with a metal extendable one, which will prevent her from undergoing several additional surgeries as she grows. The “This is Cancer” series documents the journeys of several families receiving care at Texas Children’s Cancer and Hematology Center. Their stories illustrate in intimate detail what they’re experiencing and how to better support them. Click here to learn more.

The Urology Division at Texas Children’s Hospital offers the most advanced surgical care for routine urological needs as well as complex genitourinary problems related to congenital birth defects, trauma and a range of other medical conditions. Our urologists have experience successfully carrying out to most extreme procedures on the most delicate patients. Those success rates are evident through nation-wide recognition.

For the first time, Texas Children’s is ranked in the top 10 in each of the U.S. News & World Report-recognized pediatric sub-specialties and this year Urology ranked No. 6.

“Now is the time to show that we can elevate to an even higher level of patient care and do even better than we already have,” Urology Chief of Service Dr. Paul Austin said. “We have to strive to be on the cutting edge of advancement and I envision our reputation factor only increasing further in urology.”

The U.S. News rankings uses an approach that analyzes quality of health care and patient outcomes data from thousands of medical institutions across the country. This includes measuring specialized clinics and programs, external accreditations and compliance with best practices. Improved rankings determine a health care organization’s commitment to not only providing high-quality care, but also to identifying gaps where improvements are needed.

“We’re not going to slow down when it comes to advancing in the areas where we have room for improvement,” Urology Physician Dr. Nicolette Janzen said. “We are going to continue to work toward providing the best care for our patients.”

Big wins for patients and families

This last year, Urology exceeded their yearly goals and executed additional initiatives to increase transparency, reduce risk of infection, and improve the quality of care.

  • Exceed threshold for Percent revision surgery for pyeloplasty
    Pyeloplasty is the surgical reconstruction of a portion of urinary drainage system. This is a procedure that has a national average success rate of over 90 percent. Our Urology team is trained to successfully carry out various approaches to pyeloplasty including robotic-assisted laparoscopic and open. Having this broad range of skill for this procedure ensures the ability to tailor the approach for every patient from babies to teenagers.
  • Significantly decreased unplanned hospital admissions for a urologic issue within 30 days of inpatient urological surgery
    A patient may be re-admitted to the hospital for a urologic issue subsequent to a surgical procedure. Urology has been able to minimize this by analyzing the data from previously re-admitted patients, determining areas for improvement, and applying these improvements to future patients. One successful initiative has been the implementation of “Enhanced Recovery After Surgery” (ERAS). These are protocols for perioperative care pathways provided to advance practice providers (APP), physicians, and nurses as they work together to care for our patients. Lastly, making sure the patient families are educated on how to maintain the child’s health at home helps prevent re-admission.
  • Increased patient volume seen by a pediatric urologist in your Oncofertility program
    Texas Children’s Cancer Center is one of the busiest centers nationally and is on the cutting edge of therapies for cancer patients. An important consideration as patients undergo chemotherapy and radiation therapy for various cancers is fertility preservation. Our urologists are committed to this endeavor. Through our partnership with Baylor College of Medicine (BCM), patients have access to extensive resources for fertility preservation and appropriate counseling. According to Janzen, improving the communication between all services involved with these families has helped to improve access to fertility preservation services.
  • Have closed out 70 percent of gaps
    Gap closure is the result of successful yearly strategies that improves quality outcomes. One of those objectives focuses on preventing infections, more specifically as it relates to Catheter Associated Urinary Tract Infection. Urology’s prevention of gaps in care is a combined effort with the hospital’s system-wide infection control initiatives as we work tirelessly to provide high quality care to our patients.

Click here to learn more about our Urology services at Texas Children’s Hospital.

September 16, 2019

More than 1 million patients are harmed each year in the United States because of medical errors. The most common, yet preventable types of medical errors are those involving patient misidentification.

Collecting blood specimen and other lab results from patients is more than just placing a label on a tube. It’s a complex, multi-step process that involves meticulously checking and re-checking to ensure that the specimen being collected, labeled, processed and handled matches the right patient, every time.

“We know that safe, quality care for every patient at Texas Children’s is the most important responsibility of each staff member and employee here,” said Texas Children’s Vice President Trudy Leidich. “While no hospital is completely immune to medical errors, Texas Children’s continues to take proactive steps to improve the positive patient identification process in order to eliminate preventable harm to our patients.”

In conjunction with World Patient Safety Day on September 17, Texas Children’s has launched a new campaign – Don’t Skip the Check: ID every patient, every time – to engage our employees system wide around PPID efforts and to ensure error prevention alertness and accountability are always top of mind.

“We have several teams anchored around specific PPID goals,” said Denise Tanner-Brown, Director of Patient Care Services at Texas Children’s Hospital West Campus. “They’ve helped us assess and refine our PPID processes and develop learning principles that translate into safe practice at the point of care.”

Since one of the top safety risks nationwide is misidentification, Texas Children’s PPID leaders took an introspective look at our organization to re-assess and identify our potential safety risks. As part of our PPID improvement efforts, the Quality and Safety teams reviewed safety scoops from March 2018 to February 2019, and found that mislabeled specimens was by far the greatest risk of preventable harm.

“Our review of near miss safety events were invaluable lessons for us,” said Nicole Crews, a nurse practitioner in Pathology and Transfusion Safety Officer for the PPID Leadership Team. “By comparing these data trends, we saw what areas we’ve improved upon and what areas need more reinforcement, which subsequently has helped us proactively address these issues and remove barriers to success.”

PPID education roll-out plan – what to expect

The PPID education roll-out initiative will be conducted in several phases across the organization for clinical staff as well as nonclinical employees who have direct encounters with patients and their families.

The training modules accessible via Health Stream include an overview of Texas Children’s PPID policies and processes during blood specimen collection, processing and blood product handling. The modules also include patient families’ stories about misidentification to underscore the important role each of us play in helping to cultivate a harm-free environment for our patients and families at Texas Children’s.

To further drive home this message, the PPID Leadership team collaborated with Marketing to produce electronic slides and screen savers with our call-to-action messaging – Don’t skip the check: ID every patient, every time – that will be used across our three hospital campuses to keep positive patient identification top of mind. Posters will also be placed in our patient units to serve as a visible reminder.

In addition to this, Texas Children’s PPID campaign also includes efforts to educate our patients and families about the importance of wearing ID bands at all times while in our care to ensure their safety.

“September 17 marks a cultural revolution at Texas Children’s Hospital,” said Associate Chief Nursing Officer Jackie Ward, and executive co-sponsor of the PPID Initiative. “We want to ensure every patient has a positive PPID experience and that we’re providing the right care to the right patient every time.”

By just saying, “Alexa, open Texas Children’s Urgent Care,” you will now be able to access wait times and available hours immediately from your Amazon smart device. The feature was developed to make retrieving information about your local urgent care more convenient and hands-free.

Alexa is a widely popular digital assistant built into smart devices, answering questions and performing a multitude of tasks in millions of homes across the country.

Paola Alvarez-Malo, Vice President of Innovation, wanted to explore how to leverage the popularity of Alexa and connected with Information Services Applications Architect Brian Warwick.

“It gets information that’s already out there, and it’s quick, easy and very helpful,” Alvarez-Malo said. “Innovative ideas often come from two people with a common interest connecting and helping each other think through the possibilities. The partnership with IS and Texas Children’s Urgent Care is a great example of how we can work together to bring new ideas to life.”

Warwick had previously built the online Texas Children’s Urgent Care wait times and had already begun to explore how to extend that build to Alexa as a means to demonstrate the use of new technologies.

“I think it’s something that definitely sets us apart from other children’s hospitals and what’s being offered right now,” Warwick said. “I believe we are the only one that is actually pulling real time Epic data, so I’m pretty proud of it.”

By just saying, “Alexa, open Texas Children’s Urgent Care,” you will be able to access wait times and available hours.

“This skill is another way that Texas Children’s is enhancing patient experience through innovative tactics,” President of Texas Children’s Pediatrics and Urgent Care Kay Tittle said. “We look forward to its expansion and how this skill will allow our urgent cares to provide even more efficient services.”

As the first phase of this process rolls out, the information services team plans to include more features and add more locations to the skill. We would love your feedback to determine how we can make Alexa more effective for all patients.

Click here to take our survey and let us know your thoughts.

Texas Children’s Health Plan insures the medical needs of some of the sickest children. But what happens when these children grow up healthy and are ready to contribute to society?

For most members, this isn’t an issue. However, for children who have significant disabilities, this is a top concern.

This concern is what sparked Texas Children’s Health Plan to form a partnership with Project Search, a national organization dedicated to helping people with disabilities find employment. Project Search makes it possible for an annual class of interns to earn valuable work experience each year.

Seeking new opportunities at Texas Children’s Hospital

For the past three years all of those internships have been within the walls of The Health Plan. But this year the program’s leaders are looking to offer more opportunities at Texas Children’s Hospital.

“Our main goal is to ensure that our students complete their time with us and are able to land a job,” said Aracely Olmeda, project search program coordinator. “As the host site, we work hard to teach hands-on skills here at The Health Plan, but we are also interested in expanding our offerings and would love to partner with departments at the hospital. The more robust and inclusive an experience we can provide, the higher quality our program will be.”

The class of interns are ready to work and are capable of a variety of tasks; including but not limited to:

  • Data entry and other basic computing
  • Filing and organizing
  • Food service
  • Front desk responsibilities

Olmeda says that Houston Independent School District instructor Lisa Mangum and Texas Workforce Commission job coach and job skills trainer Daphne Wills, lead the efforts and offer full support to Texas Children’s employees who provide opportunities to the interns.

If your department is interested in partnering with a project search intern, please reach out to Aracely Olmeda at anolmeda@texaschildrens.org. Job coaches will train the students on the skills needed for the position.

Want to know more about project search?

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Nurse research scientist Krisanne Graves shares the many opportunities available to our nurses to be at the forefront of nursing research and impact the care they provide to patients and their families. Read more

The Jan and Dan Duncan Neurological Research Institute (NRI) at Texas Children’s Hospital recently hosted the first-ever family conference for EBF3-HADD (Hypotonia, ataxia and delayed development) syndrome (HADDS). Medical residents, genetics counseling students and research scientists joined more than 20 families from across North America that attended in person and 13 families that participated via live-streaming services from countries around the world – including Ireland and Australia – making it a truly international event.

The conference was organized by the EBF3-HADDS Foundation, a nonprofit organization created in 2018 by families to promote awareness, research and support for this genetic syndrome. The foundation was co-founded by Ashley LeMaire and her husband, Mark. After one of their children was diagnosed with HADDS in 2016, the LeMaires started a Facebook group for HADDS families. In just two years, that group has grown into an international community and was the impetus behind the foundation’s creation.

“Our HADDS community is a motivated and talented group of families dedicated to supporting research, education and advocacy efforts for HADDS patients, and we support each other on this journey,” said LeMaire, who is a clinical neuropsychologist at the Menninger Clinic, assistant professor of Psychiatry & Behavioral Sciences at Baylor College of Medicine, and also board member of the EBF3-HADDS Foundation. “There is still much to learn about HADDS, but when you have such a dedicated team of physicians and researchers collaborating with families to learn about the condition and provide needed support, it fosters so much hope for our families.”

During the conference, guests attended presentations on a variety of HADDS-related topics given by NRI researchers Drs. Hsiao-Tuan Chao and Michael Wangler; pediatric urologist Dr. Irina Stanasel, a former Texas Children’s fellow; Texas Children’s genetic counselor Pilar Magoulas; and Geraldine Bliss, research director of the Phelan-McDermid Foundation. Additionally, Chao and Wangler offered clinical evaluations for patients, and attendees were also able to tour research labs and facilities at the NRI, where one of the first genetic discoveries for HADDS was made in 2016, and the first lab (Chao’s) devoted to understanding the biology of this disorder.

A search for answers

If you’ve never heard of HADDS, there’s a good reason. The rare genetic disorder, caused by a mutation in the EBF3 gene, was only discovered in 2016 by Chao and Wangler when they were training in NRI investigator Dr. Hugo Bellen’s lab, in collaboration with colleagues at the Undiagnosed Diseases Network (UDN) and New York University Langone Health.

The UDN had been stumped by a case in which a child exhibited symptoms including impaired speech and cognition, low muscle tone, balance and gait issues, reduced ability to feel physical pain, and an inability to show facial emotional expressions. Though earlier DNA sequencing had yielded a few candidate genes, there wasn’t a significant patient cohort or research to help determine which gene was responsible for the symptoms.

Researchers selected EBF3 as the most likely candidate gene. Chao then used fruit flies to mimic mutations to better understand EBF3’s role, and within a few months three patients were found who presented with similar symptoms and similar mutations in the EBF3 gene.

As result of those efforts, more than 200 patients with HADDS have been identified to date.

“The gene discovery of EBF3 illustrates the ‘Power of One’ in medicine and biomedical research, how a single patient with an undiagnosed disorder – a ‘medical mystery’ – can lead to the discovery of a gene responsible for a previously unknown disorder,” Chao said. “This becomes the starting point to develop the diagnostic tests and therapies that can transform the lives of many patients and their families.”

Since 2017 Chao and Wangler have offered monthly clinical evaluations for HADDS patients at Texas Children’s and have now seen the largest number of such patients at any single institution worldwide. They are also enrolling patients in a study to better understand the condition and to help translate research into potential clinical interventions in the future.

The conference was a testament to the power of teamwork and collaboration in research, and also shows how dedicated parents and volunteers from across the globe can work together to build a community of support.