April 22, 2014

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The Spring 2014 graduates of the Texas Children’s Hospital Lean Six Sigma Green Belt program received their certifications at a ceremony on March 31. Since February 2009, the Department of Business Process Transformation has trained more than 150 employees including physicians, directors, managers and other informal leaders including front line staff members on the Lean Six Sigma process improvement methodology. More than 80 percent of the candidates trained in the program went on to complete the requirements for certification, with more students approaching their project close dates this summer.

The Texas Children’s certification recognizes candidates who provide statistically significant evidence that their process improvement project resulted in positive outcomes in quality, cost or cycle time metrics. Certified Green Belts at Texas Children’s include representation from inpatient/outpatient areas, ancillary departments, Texas Children’s Health Plan (TCHP), Texas Children’s Pediatrics, Baylor and Texas Children’s Physician Service Organization (TCPSO). The certification ceremonies are held annually each spring.

The Department of Business Process Transformation offers Lean Belt Training (a prerequisite for Green Belt) now available for enrollment through the Learning Academy.

Dr. Huda Zoghbi, director of the Jan and Dan Duncan Neurological Research Institute (NRI), will receive the 2014 March of Dimes Prize in Developmental biology at a ceremony held in Vancouver on May 5. The award, given annually, honors investigators whose research has profoundly advanced the science that underlies the understanding of birth defects.

Zoghbi’s best known for her pioneering work on Rett syndrome, a cause she first became passionate about after encountering children with the disease during her residency. She’s since been tireless in her efforts to find the genetic cause of the syndrome. In 1999, she was successful in identifying the Rett gene, providing a definitive genetic diagnoses for the condition and allowing a biological understanding and search for treatment.

“Dr. Zoghbi’s contributions to our understanding of several entirely different neurological disorders, including her finding of the genetic basis of Rett syndrome, have opened new areas of research,” says Dr. Joe Leigh Simpson, senior vice president for Research and Global Programs at the March of Dimes. “Her work influences the entire field of autism and other neuropsychiatric disorders.”

Rett syndrome is a genetic neurological disease that affects young girls who are born with the disease and develop normally for one to two years until they show progressive loss of motor skills, speech and cognitive abilities. Males with the condition usually die in infancy.

Zoghbi will deliver the 19th annual March of Dimes Lecture titled “Rett Syndrome and MECP2 Disorders: From the Clinic to Genes and Neurobiology,” during the Pediatric Academy Societies annual meeting. She will receive the March of Dimes Prize in Developmental Biology in a special award ceremony held during the meeting. Given annually, the March of Dimes Foundation created the prize in 1995 as a tribute to Dr. Jonas Salk, a pioneer in the development of the polio vaccine.
The March of Dimes Foundation is the leading nonprofit organization for pregnancy and baby health.

April 15, 2014

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On April 5, more than 3,000 Houston-area residents participated in the Texas Children’s Hospital and Houston Marathon Foundation Family Fun Run. The race, held at Texas Children’s Hospital West Campus, included non-competitive 1K and 3K races.

Following the race, families enjoyed the post-race Family Fun Zone, sponsored by H-E-B, which included food, refreshments, activities and games. This race, formerly known as the Kids’ Fun Run, has a rich history of more than 15 years. The event’s goal was to help educate and encourage Houston-area children and their families to adopt active, healthy lifestyles.

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The Texas Children’s Fetal Center proudly announces the birth of baby Cabellotrejo, a boy born healthy at Texas Children’s Pavilion for Women following a complex pregnancy that included open fetal surgery. Early in the pregnancy, doctors diagnosed baby boy Cabellotrejo with a large lung mass, called congenital cystic adenomatoid malformation, or CCAM. Mom and baby were transferred from their hometown of Austin, where the team at the Fetal Center intervened with an open fetal surgery that saved the baby’s life.

During the procedure, which took place on January 16, 2014, the Fetal Center team partially removed the baby from her mother’s womb, opened the baby’s chest and removed the giant mass, returning him safely back into his mother’s womb less than 30 minutes later. The fetal heart failure resolved, and the baby and mother subsequently recovered smoothly; mom remained pregnant for 11(+) weeks before she delivered her health baby boy.

A CCAM is an abnormal growth of malformed lung tissue that is the result of abnormal organ development. The adenomatous overgrowth of terminal bronchioles and reduced number of normal alveoli may cause significant pulmonary effects. It is incredibly rare for these malformations to grow to such a large size as to lead to fetal heart failure, a condition that is very difficult to treat prenatally. The fetus continued to deteriorate despite medical treatment.

“Fetal surgery was the only hope for this baby boy who was sure to die without surgical intervention. The good outcome achieved in this case is the result of great teamwork, including the contributions by our expert fetal radiologists, cardiologists and maternal fetal surgery team. I am so pleased this baby has recovered fully and now has the hope of a completely normal life,” said Dr. Cass, co-director of Texas Children’s Fetal Center, and lead surgeon on this case.

In addition to an expert OR team, nurse coordinators and pediatric anesthesiologists, a multidisciplinary team of specialists, including: Dr. Darrell Cass, Dr. Oluyinka O. Olutoye, Dr. Wesley Lee, Dr. Michael Belfort, Dr. Nancy Ayres, Dr. Rodrigo Ruano, Dr. Christopher Cassady and Dr. Alireza Shamshirsaz worked together on the case.

To date, only two other centers in the world have been successful at treating this rare and complex medical condition. Texas Children’s Hospital has performed 59 open fetal surgeries since 2003, but seeing that healthy baby enter the world never gets old.

“Baby Cabellotrejo is a fighter and a survivor. We are ecstatic that his parents have delivered a healthy baby boy,” said Cass, of the Fetal Center’s latest patient success.

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Fifty two nurses sat in a Pavilion conference room attentive and ready to hear from their leader. As Chief Nursing Office Lori Armstrong greeted each table of new RNs, you could feel the excitement and anticipation in the room for “lunches with Lori” which this month was a graduate nurse welcome lunch for this special group.

“You are the largest new graduate nurse class Texas Children’s has ever had,” said Armstrong.

The comment was met with applause by the RNs who graduated nursing schools in December. They were among hundreds who applied for the latest batch of nursing positions that have been added since Armstrong and her nursing leadership team launched the reinvention of nursing in November. Since then, 212 new RNs have been hired filling vacancies as well as new full time employee positions that were added to combat the staffing needs throughout the organization. These grads are among the best and brightest according to Armstrong. Each was required to not only graduate from nursing school, but have a 3.5 grade point average or higher, complete the application with two letters of recommendation as well as write mission and vision statements. The rigorous new requirements and hiring process are meant to determine not only if the nurses are the right fit for the organization, but if we’re the right fit for them.

“Our culture is one where we would do anything for our patients,” Armstrong told the excited crowd. “Your first job is a time you will never forget and I’m so happy you chose to be here for that.”

The group shared their own excitement in their new positions.

“I’ve been at a lot of companies at different levels and I’ve yet to see this level of satisfaction at every level from janitors to staff, nurses and doctors,” said Aaron Clay, RN.

“I started at a Texas Children’s Pediatrics office, moved to hospital as I entered nursing school and now I’m a nurse so that’s growth,” said Jeanette Costilla, RN.

For the nursing department, the new hires are just a small step toward the bigger picture of reinventing the role of nurses across the organization with hopes of attracting nurses from top nursing schools across the U.S. Growing the educated nursing population is not just a priority at Texas Children’s, but across the nation. Evidence shows nurses that have at least a Bachelor of Science in Nursing significantly impact morbidity rates and infection rates.

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New study puts spotlight on tuberculosis in children

A recent article in the Wall Street Journal featured a study from researchers at Brigham and Women’s Hospital and Harvard Medical School suggesting that Tuberculosis (TB) affects about one million children worldwide, twice as many as previously estimated. At Texas Children’s, TB experts identified this major pediatric health issue years ago, stressing that children are much more likely to develop TB disease following infection than adults and bear a relatively larger share of morbidity and mortality than adults.

According to Dr. Jeffrey Starke, director of the Children’s Tuberculosis Clinic at Texas Children’s, these new numbers are a reflection of more sophisticated and accurate diagnostic methods, since TB is difficult to confirm microbiologically in children (the traditional methodology of diagnosis in adults). In addition, it wasn’t until 2012 that the World Health Organization (WHO) released its first ever estimate of children with TB.

Having accurate numbers for pediatric TB is critical for funding purposes, and the new estimates will help shed light on this epidemic. “People interested in child survival and the Millennium Development Goals are going to look for what diseases are causing most morbidity and mortality in the world,” said Starke.

Texas Children’s Global Health Initiative has been working to actively address barriers to the care of childhood TB and to expand the spectrum of services available to children with TB through the Children’s Tuberculosis Initiative at Texas Children’s. The program aims to use the tools of research, education and advocacy to prevent, diagnose and treat tuberculosis in children, in order to support an ultimate goal of TB elimination.

“TB in children is often missed or overlooked,” said Dr. Anna Mandalakas, director of the Global Tuberculosis Program at Texas Children’s. “TB is a preventable and curable disease, but child health care providers in the US and abroad often miss opportunities to prevent TB and often diagnose pediatric TB late, making treatment more difficult.”

The Global Tuberculosis Program is implementing two TB REACH projects funded by the Stop TB Partnership as a part of the WHO, with the objective to improve TB case finding in Lesotho and Swaziland. The projects use a GeneXpert-Rif technology, a relatively new diagnostic near-point-of-case test that has become an important tool for improving TB diagnosis in children.

Globally, up to 50 percent of children less than 12 months of age develop the disease and every day up to 200 children die from the disease. Young children, malnourished children, and children whose immune systems are weak, such as those with HIV infection, have an exceptionally high risk of developing severe and life threatening disease following infection. In areas of high HIV prevalence, tuberculosis is thought to be the main killer of HIV-infected persons.

Since children with HIV-infection are at increased risk of TB disease, the Global TB Program is working closely with Baylor International Pediatric Aids Initiative (BIPAI) to enhance TB clinical programs. Information learned from the BIPAI network promises to fill major gaps regarding the burden of TB disease in HIV infected children and adolescents.

“HIV has changed the landscape dramatically,” said Mandalakas. “The TB-HIV co-infection is a deadly combination leading to an increase in morbidity and mortality in children globally.”

But TB is not just a global problem. Tuberculosis remains an issue in industrialized nations too. In 2010, more than 11,000 cases of tuberculosis disease were reported in the United States, with an estimated incidence of 3.8 cases per 100,000 persons. Texas comprised 12 percent of all TB cases in the United States (the second highest burden of childhood TB among US states). And within the state, Harris County had more TB cases than any other county in 2012. This may be explained by the large population of immigrants in the area, as children with the greatest risk of having TB include those who were born in or have lived in another country, or those who have a parent that was born outside of the US.

“We had one day in our TB clinic where we spoke seven different languages,” said Starke. “We see people from all over the world, both people who developed TB after coming to the US, and those were infected with TB in their home country. Most children who immigrate to the US receive no testing and no screening for TB and many of them are coming from an environment where TB is common and can easily be spread.”

According to Mandalakas, any child who is exposed to an adult with TB should complete a detailed evaluation to make sure that they do not have TB. If TB is not diagnosed, TB-exposed children can reduce their risk of developing TB to negligible levels by taking TB preventive medicines.

“We can’t look at TB in isolation,” said Starke. “We have to look at the bigger picture, the people they are around, the community and the circumstances.”

“I’m pregnant!” I thought to myself excitedly in December, but the excitement quickly dissipated when I flashed forward to the anxiety laden weeks ahead.

Pregnancy after a miscarriage is scary. Exciting, but scary. It’s filled with the unknowns and the “what ifs.” For me, finding out I was pregnant again, after many losses left me with a roller coaster of emotions. Each little ache and pain I had stirred a barrage of questions in my head. Adding to the anxiety was deciding on when to tell others, which felt like the most momentous decision ever. It’s not that you’re trying to hide anything; it’s just a self-protective measure. Why allow yourself and others to get excited, knowing what the outcome has been so many times before…right? My husband and I were to the point that we would just laugh and tell each other we’d see how long this one lasted. You realize you become desensitized to the whole situation and develop some odd ways of coping with the uncertainty. Unfortunately, pregnancy loss takes the innocence out of being pregnant.

Over the past year and a half, for mine and my family’s sake, I had to start placing less emphasis on my losses and more on what I do have in life. The last step for us was to seek some medical advice on what else could be causing our losses. So in the pursuit to find answers and make some decisions, my husband and I were presented with some fertility options that were too outside of our comfort zone. At that time we decided if we only had our son Dillon, he would be more of a blessing than we ever deserve. So I kept myself busy and resigned to the “que sera sera” mantra regarding the whole pregnancy thing. Well, wouldn’t you know, lo and behold, a whole week later, I found out I was pregnant! I told my husband New Year’s Day and so far 2014 has been good to us. With each ultrasound and flutter of movement I feel, I get more excited and more hopeful. I am now 17 weeks along and things are going great.

41614BWfamily640After my fist loss at 16 weeks, I was connected with the Woman’s Place at the Pavilion which offers assistance during reproductive loss and grief.  After my subsequent losses at nine weeks and three at only five weeks, I was referred to the Maternal Fetal Medicine Department for further testing, where everything checked out ok.  Along my journey to this pregnancy, I have had the best care from the Pavilion. From the Family Fertility Center, to the additional ultrasounds with the Maternal Fetal Medicine department, they have all helped put my mind at ease that much more.  Knowing the care I need is literally around the corner is so comforting.

The reason I wanted to share my story was to try and offer hope to the many women out there whose stories are like mine and need some encouragement. I wanted to let these women know there is hope, and they should never feel ashamed, or feel like a failure for a pregnancy not going to term. It took me many months to figure this out and to start letting go of some of the guilt, sadness, anger, and heartbreak that are common after a miscarriage. My healing came through reading the stories of women online, or talking with coworkers who suffered miscarriages and know what pregnancy loss feels like. That it feels like the loss of hopes and dreams you’ve made for your baby, or the loss of a bond you formed the moment you knew you were going to be a mom. Please know time will make the pain easier but never make you forget, and that’s ok…why would you want to forget about your baby? Above all else, I wrote this post so women will know there is hope after loss…if they choose to keep their heart open to the possibility.

So how do you handle being pregnant again after a loss? For me, it’s getting through one day and one milestone at a time. Surpassing the time of my first miscarriage was the biggest challenge of all, and now that I have, I can take a deep breath and enjoy this pregnancy. I think about how differently this pregnancy feels, and try to focus on that. I don’t know what the future holds, but I know worrying all the time won’t help my little one. So therefore, I choose to accept each day with this baby as a gift; a very special gift that has the ability to make the heartache less and less, and make my heart fill abundantly with joy being it’s mommy.

Rhea HoSang Celestin is a staff nurse in the Clinical Care Center.