March 18, 2014

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Texas Children’s Hospital has established a new, first-of-its-kind Pediatric Surgery Physician Assistant Fellowship program. The inaugural class of four physician assistants – Lesley Davies, Jackie Guarino, Caitlin Justus and Cassie Mueller – officially started their fellowship on January 20.

The fellowship is a 12-month didactic and clinical program designed to extensively train physician assistants to become leaders in all areas of pediatric surgery.

The fellows’ two-week orientation period has featured training sessions, discussions about patient satisfaction, quality outcomes, research and child abuse awareness and special meetings with Mark A. Wallace, president and CEO, Charles D. Fraser, surgeon-in-chief, and the surgical faculty, among others.

On February 3, the fellows started their month-long rotations through each of the full spectrum of pediatric surgical subspecialties including: cardiovascular surgery, neurosurgery, orthopedics, general surgery, urology, otolaryngology, plastic and craniofacial surgery, as well as trauma services. After completing nine rotations, the fellows will have the opportunity to select the one area they want to focus on and will receive two additional months of training in that field.

In addition, the fellows will complete one month of research and participate in multiple community outreach projects, including career fairs at schools, wellness fairs and community service programs, such as Habitat for Humanity.

Leading the program is Dr. Larry Hollier, chief of plastic surgery at Texas Children’s Hospital and medical director of the fellowship program, Ryan Krasnosky, program director, and Brenda J. Davis, fellowship coordinator.

Lesley Warriner Davies, MPAS, PA-C:
Lesley is excited to be team leader of the first class of Pediatric Surgery Physician Assistant Fellowship program. She received her B.F.A in Ballet Pedagogy from the University of Oklahoma in 2006 and danced professionally in Dallas and Austin. She then obtained her Master’s degree in Physician Assistant Studies from the University of Texas Medical Branch at Galveston in 2013. Lesley is from the Houston area and currently lives in Dickinson with her husband where they enjoy cycling and spending time with family and friends. She is a member of the Texas Academy of Physician Assistants and the American Academy of Physician Assistants.

Jackie Guarino, MPAS, PA-C:
Jackie is a fourth generation Houstonian and a 2009 Summa Cum Laude graduate of the University of Houston. She completed her B.S. in Allied Health in three years and obtained her Master’s degree in Physician Assistant Studies from Baylor College of Medicine (BCM) in 2013. During her clinical years at BCM, Jackie rotated through Texas Children’s Hospital in General Surgery and GI/Liver service and is excited to be back as a member of the first class of the Pediatric Surgery Physician Assistant Fellowship program. Jackie currently resides in Houston and enjoys spending time with her large family and friends and her chocolate and yellow lab dogs, cooking, Crossfit and volunteering.

Caitlin Justus, MPAS, PA-C:
Caitlin graduated from Texas A&M University at College Station in 2011 with a B.S. in Allied Health, graduating cum laude. She received her Master’s degree in Physician Assistant Studies from the University of Texas Medical Branch at Galveston in 2013. She is a member of the American Academy of Physician Assistants and the Texas Academy of Physician Assistants. Caitlin currently resides in West Houston with her husband and enjoys activities with her church, exercising, reading and serving others. She is a proud member of the first class of the Pediatric Surgery Physician Assistant Fellowship program and looks forward to an exciting year ahead.

Cassandra Mueller, MPAS, PA-C:
Cassie is originally from Andover, Minnesota, and received her B.A. in physiology from the University of Minnesota in 2010. Cassie graduated from the Interservice Physician Assistant Program of Fort Sam Houston in 2013 (the U.S. Military’s Physician Assistant Program). She continues to serve in the Minnesota National Guard as a physician assistant and enjoys running marathons. She is excited about the opportunity to be in the first Pediatric Surgery Physician Assistant Fellowship program and looks forward to becoming a Texan.

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For a first time pregnant woman (not calling myself a mom yet) pregnancy is a beautiful thing. Yet, there are things about pregnancy that no one cared to share. They are the mishaps that I shared (unfortunately) with my patient and saint-like husband. Thankfully, it has made our marriage stronger than ever to go through it all together. Here is an inside look at the unexpected journey of the first trimester. The things friends don’t tell you and books don’t explain (or maybe they do and I haven’t read the right ones yet).

I’ve cried through a sad movie or two pre-pregnancy. However nothing warned me about the emotional changes that happen during pregnancy. Let me give you two fun examples.

Example #1: I love cream cheese, even more now that Baby Calderwood loves cream cheese. I could eat it on anything, in a box, with a fox, you name it! Cream cheese (in my household) may be the solution to finding world peace. I was dancing happily, waiting for my toaster to pop out these two golden brown, crispy and crunchy bagel slices – when I danced over to the refrigerator. I opened the door and took my first look… No cream cheese? Don’t panic. The world is still spinning. Let’s thoroughly investigate every shelf and drawer. No cream cheese! It was in this exact moment that the world, as I knew it, came crashing down. My poor husband must have thought a tragic event was taking place, well it was – we didn’t have any cream cheese for my golden, crispy, crunchy bagel. I cannot begin to describe the massive alligator tears that streamed down my face. The inconsolable sobbing and mourning of my dear cream cheese. I was crying so hard – I could barely breathe. My husband stood in the door way of our kitchen, with this stupid smirk on his face and said “Babe – just put some butter on the bagel, we can get some cream cheese in the morning.” That’s when the tears instantly turned to rage. Who did he think he was? The master of bagel making? Without stopping the vocal force in my throat, I let out a “LEAVE ME ALONE.” The screaming sob could be compared to a toddler. I should have thrown myself on the floor for a more dramatic appeal. Hindsight is 20/20. To sum up the story – pregnancy and hormone changes can rear their little heads at any given moment. You must be prepared. In my case, we keep cream cheese stocked like our kitchen is an Einstein Bagel joint.

Example #2: (this one’s for the husbands). Pregnancy can make a woman crazy lovey-dovey. There have been moments when I look at my husband and I could squeeze him so hard, just because I love him so much. He’s my perfection. One evening, while watching TV, we sat side by side on our couch, in our ‘reserved seating.’ He was reading on his iPad, I was flipping back and forth from the Olympics and a Law & Order Marathon. I noticed him out of the corner of my eye, and found myself oogly eyed staring at him. I reached out my hand and sheepishly said “Do you want to hold my hand?” and I gave him my best smile…. His reply… “Not really.” The emotions instantaneously boiled behind my eyeballs and alligator tears shot out like firing missiles. Hysterically, I sobbed and said “All I want to do was hold your hand because I love you and I think you are so special to me and I can’t believe you don’t want to hold my hand and I’m tired and going to bed” – All like that, all in one glorious run on sentence. He stared at me in disbelief and started to nervously giggle. He said, “Oh hun – don’t cry I just didn’t want to hold your hand, I’m reading. Why are you crying?” All I could say between hyperventilating sobs was “BECAUSE I LOVE YOU,” and then, within minutes I was asleep. I am convinced that my husband thinks I am an impersonator who escaped a mental institution. Moral of the story: If your highly emotional pregnant wife wants to hold your hand on the couch. Do it.

So moral of my two fun fact stories? The first trimester brings on a whole new level of sensitivity, tears and sleepiness. Tears that haven’t been produced by my tear ducts since I was 4 years old and I couldn’t get a toy in the checkout line. And naps consistent with a 1 week old or a narcoleptic.

I’m excited to experience this pregnancy and share it with all of you on Bump Watch. I know many of you have had the “Pavilion experience” and I am eager to experience it for myself. Let me know if you have any suggestions for when I get there! For now, let’s see what the second trimester brings!

March 11, 2014

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As a pediatric plastic surgeon, Dr. Edward Buchanan has seen his share of ailments in children. What he’s observed throughout the countless cases he’s treated is the best treatment in any case is a positive mental attitude.

That’s the inspiration behind his first children’s book, The Adventures of the Prickly Pear and the Happy Hoglet which was illustrated by his brother, Mathew. Buchanan said the book is about looking beyond the difficulties we each face to spot the silver lining.

The book chronicles two best friends who are met with similar obstacles throughout their day. The difference between how each copes is their individual attitudes in each situation. Buchanan hopes it inspires all Texas Children’s patients as well as other kids to always look on the bright side.

Patients as well as the plastic surgery clinic staff were invited to a book signing and reading by Buchanan at the Pi Beta Phi Patient/Family Library. Each received a signed copy of the book. Dr. Larry Hollier, chief of plastic surgery, purchased 250 copies of the book for patients in the clinic and copies are also available to borrow through the library on 16 West Tower. Buchanan hopes to continue sharing this inspirational message in subsequent books.

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The 2nd Annual Texas Children’s Family Fun Run, in partnership with the Houston Marathon Foundation, will be Saturday, April 5. The race will begin and end at our very own Texas Children’s Hospital West Campus, with a specially designed 3K and 1K race for children and families of all abilities (wheelchairs and strollers are welcome).

After the race, there will be a Family Fun Zone complete with food and refreshments generously donated by H-E-B, activities, games and more. The race will begin at 9 a.m., with post-race activities running through noon.

Texas Children’s Family Fun Run will be open to entire families throughout our community, enabling us to reach an even broader audience. Texas Children’s will provide participants with a fun, unique training guide, developed by Dr. Al Hergenroeder, Dr. Joe Chorley, Roberta Anding and our sports medicine team. The supporting marketing and materials, as well as the race day activities, will all be great promotion for Texas Children’s entire system.

Come out and run (or walk) with us. To register, please visit www.texaschildrens.org/funrun.

Registration closes on Sunday, March 23, so don’t delay. Everyone’s involvement is welcome!

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The Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital (BIPAI) recently announced its partnership with Chevron and the global health nonprofit AmeriCares by accepting a grant to address the gap in health care resources in Romania.

AmeriCares has been providing lifesaving anti-retroviral medications, anti-infectives and nutritional supplements to families receiving care at BIPAI’s Romanian NGO affiliate, the Baylor College of Medicine Black Sea Foundation, since 2004. Now, Chevron Romania has made a multi-year commitment to increase the availability of medications and medical supplies at selected public and private hospitals in Romania through AmeriCares and the Baylor College of Medicine Black Sea Foundation.

According to Michael Mizwa, chief operating officer of BIPAI, the partnership will provide support for our global health initiatives, specifically for care, treatment and capacity building in Romania. Funds will be allotted to help bolster our inventory of medical and pharmaceutical supplies to specific hospitals and clinics serving disenfranchised populations in Romania.

Since being founded in 1996 by Dr. Mark W. Kline, BIPAI has grown into a network of state-of-the-art clinical centers in Romania and across southern and East Africa. BIPAI-affiliated organizations provide care and treatment to more than 180,000 HIV-infected children and their family members, which is believed to be more than any other program in the world. BIPAI is now part of Texas Children’s overall global health initiative, which includes the largest collection of pediatricians and pediatric specialists in the world.

With the new Chevron partnership, BIPAI and AmeriCares will expand the donation of medication and medical supplies to a network of qualified health care institutions across Romania, by increasing BIPAI-Romania’s capacity to manage larger quantities of donations on behalf of its own clinical center as well as additional health care institutions with identified resource needs throughout Romania.

“Our partnership with Chevron will take our humanitarian partnership to a higher level of expanded outreach across Romania,” said Tammy Allen, director of AmeriCares programs in Asia and Eurasia.

To date, AmeriCares has supported BIPAI-Romania’s health care programs with gift-in-kind donations valued at $41 million.

ICD10a

When the American Medical Association (AMA) petitioned the government on February 12 to delay the start of ICD-10 many wondered what would happen. What will happen at Texas Children’s is pretty clear – the conversion to ICD-10 will go live October 1.

“Here at Texas Children’s, we started working on this process more than a year ago,” said Myra Davis, senior vice president of Information Services. “We’re making the necessary changes to our systems, as well as implementing an education program for providers and coding staff that will make the transition as smooth as possible.”

On October 1, Texas Children’s and health care organizations nationwide will transition to ICD-10, the coding system used to report and code diagnoses, injuries, impairments and other health problems and their manifestations. It will replace ICD-9, the current coding system used at Texas Children’s.

Everyone has acknowledged that implementing a new coding system won’t be easy. In fact, the AMA estimates that even small physician practices can expect to spend between $57,000 and $226,000 to get ready for the change. But everyone agrees that the result will be better data for providers, patients and researchers.

While the AMA continues to seek a repeal of ICD-10, it nonetheless remains a federal mandate and physicians are urged to prepare for the October 1, 2014 compliance deadline.

On February 27, the head of the Centers for Medicare and Medicaid Services (CMS) said that nothing has changed with the ICD-10 deadline. Marilyn Tavenners spoke to a group of IT professionals at a national conference when she made that announcement.

“There are no more delays, and the system will go live on October 1,” Tavenner said. “We’ve delayed this several times, and it’s time to move on.”

A quick timeline

In 2008, the U.S. government agreed that America should join with other nations in implementing ICD-10. They originally set October 1, 2013, as the deadline, but that was extended to 2014. The new codes will impact the hospital’s electronic medical record (EMR) and affect codes for both diagnoses and procedures. All told, the number of diagnosis codes will increase from 14,000 to 69,000, while the number of procedure codes will grow from 14,000 to 71,000.

The last time the U.S. changed its national coding system was in 1979. That’s when hospitals and providers moved from ICD-8 to ICD-9. People who favor the next move to ICD-10 point out that when ICD-9 first was implemented, people still could smoke in hospitals.

“Medicine has evolved so much, it only makes sense to update our systems,” Davis said. “Think of how many new treatments have been developed in the last 25 years. The old code set wasn’t designed to capture those innovations, while the new code set better describes what’s happening in medicine today.”

In the end, Texas Children’s is committed to meeting the October 1 deadline to implement ICD-10, no matter what the chatter is in the industry.

For more information
ICD-10 Fact Sheet
ICD-10 Industry Updates
ICD-10 Myths and Facts

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March 12 is Registered Dietitians Day, a day established by the Academy of Nutrition and Dietetics to increase the awareness of the registered dietitian as the most valuable and credible source of scientifically based food and nutrition information and to recognize them for their commitment to helping people enjoy healthy lives. Texas Children’s salutes its many dietitians and diet technicians as they impact the lives of patients throughout its system. The dietitians are clinicians, administrators, educators and researchers providing services in the hospitals, clinics, research facilities and community centers. They also are helping to promote the reputation and expertise of Texas Children’s with exciting accomplishments in the field of nutrition.

Here are a few of the highlights from 2013:

  • Kristi King, senior clinical dietitian, was named media spokesperson for the Academy of Nutrition and Dietetics and was interviewed for many local and national media.
  • The Academy’s of Nutrition and Dietetics Food and Nutrition Conference and Expo was hosted for the first time in Houston. Texas Children’s dietitians were the host of two Pre-FNCE events that spotlighted Texas Children’s Simulation Center and Pavilion for Women. The Texas Children’s Eating Disorders program and its clinical nutrition staff members also were key speakers at another FNCE event along with seven poster presentations and one conference presentation. Texas Children’s had an impactful presence in the home town national conference.
  • The 10th edition of the Pediatric Nutrition Reference Guide, which is internationally renown, was published. This year marked the first electronic version of the book as it became an ebook available through Amazon.

Texas Children’s acknowledges the many contributions of its nutrition team and the impact they have on the many programs and medical services at Texas Children’s.