Optimization – Page 20 – Texas Children's News

January 19, 2016

At Texas Children’s Hospital, we go above and beyond to create a positive experience for our patients and their families. That experience includes everything from receiving excellent patient care to being able to navigate our facilities with ease.

The latter is becoming more challenging with our continued growth, making it exceedingly important for our employees to help those who might be lost or having a hard time finding their way around our halls. To assist patients and families, digital directories have been placed in two of the busiest areas of the hospital – the first and third floors of the Clinical Care Center.

On the first floor, a 48-inch monitor has been set up next to the information desk. On the third floor, three of the same size monitors are mounted on the wall between The Auxiliary Bridge and the information desk. All three monitors are touch-screen activated and feature a map of Main Campus, step-by-step directions to various locations throughout Main Campus, and information on our services throughout the Houston area.

Technology used to power the directories track usage, data which Facilities Planning and Development will use to evaluate feedback and overall performance of the information. If the feedback is positive and the data points to the signs as being useful, more will be placed in high-traffic areas throughout the organization.

In the meantime, please continue to help our patients and their families find their way to wherever they are going whether that be to an appointment, a parking garage or to grab a bite to eat. Your help truly makes a difference.

The American Society of Hematology (ASH) recognized three researchers from Texas Children’s Cancer Center and Baylor College of Medicine for their work in advancing our understanding of disease pathogenesis and exploring novel innovative approaches for the treatment of pediatric cancers.

Dr. Rikhia Chakraborty, instructor of pediatrics and part of the Histiocytosis Research Lab at the Cancer Center, received a 2016 Basic Junior Faculty Scholar Award for her study investigating disease pathogenesis of Langerhans Cell Histiocytosis, a disease that occurs when the body accumulates too many immature Langerhans cells, a type of white blood cell that normally helps the body fight infection. Scholar awards support fellow and junior faculty dedicated to careers in hematology research as they transition from training programs to careers as independent investigators. The award is for $150,000 over two to three years.

Dr. Maksim Mamonkin, a postdoctoral associate in the Center for Cell and Gene Therapy, received a 2016 Basic Research Fellow Scholar Award for his study on developing targeted therapy to treat T cell malignancies. This research award will provide $100,000 over two to three years and will support transition from training programs to an independent investigator career.

Dr. Rayne Rouce, instructor in the Center for Cell and Gene Therapy, has been named a 2016 award winner of the ASH and the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation. She delivered a presentation on her work, which focuses on immunotherapy for the treatment of pediatric cancer. She will also receive a $400,000, four-year grant to further her work.

January 12, 2016

From exploring the metabolic factors impacting egg quality to the genetics of embryo implantation, researchers at the Family Fertility Center at Texas Children’s Pavilion for Women are engaged in several studies to help infertile couples achieve successful pregnancy outcomes.

For couples struggling to get pregnant, often times their only hope is through in vitro fertilization (IVF) in which a healthy embryo is transferred to the uterus for implantation. If the window of implantation has passed – the crucial time when the endometrium or inner uterine lining releases chemical signals that allow the embryo to attach – the chances of getting pregnant are very slim.

“Until now, the endometrium was kind of a black box,” said Dr. William Gibbons, director of the Family Fertility Center and chief of reproductive endocrinology at Texas Children’s Pavilion for Women. “While studies have been done on embryos, limited research has focused on the important role of endometrial receptivity prior to implantation. With advanced technology, we can uncover innovative techniques to improve IVF success rates.”

In collaboration with Dr. Carlos Simon from the University of Valencia, Spain, Drs. Gibbons, Paul Zarutskie and Cecilia Valdes are exploring the use of Endometrial Receptivity Array (ERA), a biopsy that analyzes the DNA patterns of more than 240 genes in the endometrium to determine when it is the most receptive to obtain a successful embryo transplant. For some women, this fertility window can be earlier or later than the typical window of implantation.

“The cells in the uterine lining are constantly changing,” Zarutskie said. “No matter how healthy the embryo appears, if the embryo transfer happens when the endometrium is not fully prepared or has passed its peak receptivity, implantation will not occur. In this study, approximately 70 percent of women who failed to get pregnant after an IVF transfer of a genetically normal embryo were not at the implantation window.”

In addition to ERA, Dr. Neil Chappell is spearheading a study to see if marker proteins in cervical mucus can evaluate the optimal timing of the implantation window.

“As the lining of the uterus changes in the phase where it receives the embryo, changes in the expression of genes and proteins are evaluated via ultrasound or by doing a biopsy of the endometrium,” Chappell said. “Hopefully by examining cervical mucus proteins, we can eventually develop assays that can be performed in the office in a matter of minutes through a very low risk procedure like a pelvic exam.”

Additional research studies are exploring the impact of metabolism on egg quality and development:

Drs. Amy Schutt, Cecilia Valdes, Chandra Yallampalli and Farook Jahoor will examine the effects of protein restriction on egg quality before pregnancy occurs. In rats, a diet low in protein appears to reduce the egg’s ability to protect itself from damage by affecting the metabolic pathway responsible for producing antioxidants. This study will determine whether a diet rich in protein optimizes egg health and development.
Drs. Schutt and Jahoor will investigate the effects of obesity on female fertility by studying the granulosa cells collected during IVF. These cells feed signals to the egg during the maturation process. Their hypothesis is that obesity-induced inflammation and oxidative stress markers are increased in obese women compared to normal weight women, which may affect female fertility.
Drs. Zarutskie and Jessie Rubin will examine the impact of insulin and carbohydrate metabolism on the well-being of women in general, and specifically on their potential for fertility. Previous studies show insulin resistance can be present in lean and obese women with polycystic ovarian syndrome, indicating other factors may impact the imbalance in the insulin/glucose mechanism.

For women diagnosed with cancer, deciding whether or not to proceed with fertility-saving procedures before chemotherapy or radiation treatment can be difficult.

Dr. Terri Woodard, a fertility specialist known for her extensive work in fertility preservation, is developing an interactive computer-based decision aid for women with cancer. The website’s content will be driven by patient feedback obtained from focus groups and individual qualitative interviews, as well as feedback from oncologists.

“The website will contain basic information about different options that are available to help patients navigate through this delicate process,” said Woodward, who also sees patients at MD Anderson. “Even if patients decide not to do anything about their fertility prior to cancer treatment, just addressing these quality of life issues is crucial to ensure they make the right decision. This tool will help in this process.”

While these are snippets of fascinating research underway, click here to learn more about our Family Fertility Center at the Pavilion for Women.

Dr. Sanjiv Harpavat, a pediatric gastroenterologist at Texas Children’s and Baylor College of Medicine, received the 2015 Jan Albrecht Clinical and Translational Research Award in Liver Diseases from the American Association for the Study of Liver Diseases (AASLD) Foundation.

His study titled, “Assessment of a Novel Newborn Screening Tool for Biliary Atresia,” explores a new strategy to detect infants with biliary atresia earlier.

Biliary atresia is the most common indication for pediatric liver transplantation in the United States and worldwide. The only proven treatment for the disease is the Kasai portoenterostomy but this treatment has variable success in preventing or delaying need for transplantation.

One way to improve the success of the Kasai operation is to perform it earlier, with Kasai operations performed in the first 30 days of life correlating with the best outcomes. Unfortunately, infants with biliary atresia may appear normal in the first weeks of life and are difficult to detect. Because of this, in the United States, infants with biliary atresia are diagnosed and treated after 60 days of life on average.

Previously Harpavat and colleagues showed that all infants with biliary atresia have high direct or conjugated bilirubin measurements at birth. Using retrospective data, they predicted the test could be very sensitive and specific for biliary atresia.

Now Harpavat and colleagues hypothesize that universal newborn screening with direct or conjugated bilirubin measurements could be an effective way to identify biliary atresia earlier. They will prospectively screen all newborns from 10 hospitals in the Houston area and south Texas to determine the test’s sensitivity and specificity. They will also perform a cost-effective analysis using data obtained from the screen. Finally, they will assay easier ways to perform direct or conjugated bilirubin measurements, using a heel stick instead of venipuncture, for example.

Harpavat’s research study represents a broad collaboration among many divisions at Texas Children’s Hospital and Baylor College of Medicine, including investigators from Gastroenterology/Hepatology, Neonatology, Pediatric Surgery, Interventional Radiology, and Pathology. In addition, the group is working with public health experts at the University of Texas School of Public Health and clinicians at a large birth hospital in south Texas.

“Our goal is to improve outcomes in biliary atresia,” Harpavat said. “We are evaluating an affordable, widely-available, easily-interpretable test, that has the potential to hasten diagnostic times for infants with this serious disease.”

January 5, 2016

Bench and Bedside is a digest of the previous month’s stories about the clinical and academic activities of our physicians and scientists. We welcome your submissions and feedback.

December 1

Texas Children’s Fetal Center celebrates 400 miracles at patient reunion

Hundreds of families from around the country traveled to Houston to attend Texas Children’s Fetal Center family reunion. Since its inaugural event in 2007, the reunion provided an opportunity for physicians and staff to reunite with patient families who received life-saving medical and surgical care at our fetal center.

December 1

Texas Children’s awards pediatric pilot grants to 10 promising researchers

Ten promising researchers received the 2015 Pediatric Pilot Awards Research grants worth up to $50,000. The grants will provide initial start-up funding for research projects that have the ultimate goal of enhancing patient outcomes.

December 8

Dr. Mary Brandt elected to ACS Medical Student Education Committee

Dr. Mary Brandt, pediatric surgeon and director of the Adolescent Bariatric Surgery Program and the Anorectal Malformation Clinic at Texas Children’s, has been elected to the Medical Student Education Committee of the American College of Surgeons, which addresses the educational needs in surgery for medical students during all four years of medical school.

December 15

Texas Children’s Special Isolation Unit earns award from Texas Department of Health Services

Texas Children’s Special Isolation Unit, the only pediatric-focused unit of its kind in Texas and the Southwest, was recently awarded the Texas Department of Health Services 2015 Texas Preparedness Leadership Award. The annual award recognizes exceptionally meritorious achievements in local, regional or state Public Health Emergency Preparedness and Healthcare Systems Preparedness Programs.

December 15

Texas Children’s Main Campus Urgent Care opens

Texas Children’s recently opened a 4,100-square-foot urgent care clinic on the second floor of the Abercrombie Building, creating a system-wide solution to effectively manage the Emergency Center’s (EC) low acuity patient population. The clinic has a dedicated staff of physicians, advanced practice providers, nurses and clinical support staff. The new urgent care has already helped lighten the load of the EC, seeing about 30 patients a day, or 25 percent of the EC’s daily patient volume. Wait times for patients with low-acuity illnesses also have decreased significantly.

December 15

Texas Children’s oncologists contribute to leading textbook in field

Dr. David Poplack, director of Texas Children’s Cancer and Hematology Centers, and numerous members of his medical staff helped write the recently published, 7th edition of Principles and Practice in Pediatric Oncology. This leading textbook provides the most comprehensive resource on the biology and genetics of childhood cancers.

December 15

Spotlight on Adult Congenital Heart Disease Program

About 40,000 babies are born each year with a congenital heart disease, the most common birth defect. These children grow up with their conditions and are part of a growing population of adults with congenital heart disease. Texas Children’s Adult Congenital Heart Disease Program allows patients to continue their care at their childhood medical home as adults.

December 22

Heart Center experts present at Pediatric Cardiac Intensive Care Society 11th International Meeting

Intensivists, cardiologists, cardiovascular surgeons, nurses, and outcomes and quality experts from Texas Children’s Heart Center and Baylor College of Medicine served as presenters and moderators during the Pediatric Cardiac Intensive Care Society (PCICS) 11th International Meeting held December 9 through 11 in Houston.

December 22

Surgical Research Day 2016 to feature new poster session

Plans are underway for the sixth annual Edmond T. Gonzales, Jr., Surgical Research Day which will be held on May 6, 2016. At this session, poster authors will have an opportunity to present their research to reviewers as scoring takes place.

December 22

L. E. Simmons Chair in Orthopedics awarded to Dr. John Dormans

Chief of Orthopedics Dr. John Dormans was recently awarded the L.E. Simmons Chair in Orthopedics. Provided by the Houston Endowment in recognition of Simmons, who served as chairman of Texas Children’s Board of Trustees from 2003-2004, the purpose of this chair is to support orthopedic research, education, clinic program development and advocacy at Texas Children’s.

December 22, 2015

On New Year’s Day, 13-year old Peyton Richardson and her family will ride on a float at the 127th Rose Parade for Northwestern Mutual, the presenting sponsor for the 2016 Rose Bowl game in Pasadena, CA. The theme of this year’s parade is Find your Adventure.

Peyton, who was diagnosed with acute lymphocytic leukemia in January 2015, is an aspiring ballerina who dreams of traveling around the world to visit the greatest ballet companies and to take a class with each of their principal dancers.

When Dr. Zoann Dreyer, her doctor at Texas Children’s Cancer Center, introduced her to Northwestern Mutual’s video contest, Peyton jumped at the opportunity to share her greatest adventure. Using her mother’s cell phone, she and her mom produced a video at home in their backyard.

After receiving numerous submissions from across the country, Northwestern Mutual selected Peyton’s video. Her greatest adventure and powerful message about not letting leukemia stop her from dreaming big are the inspiration for Northwestern Mutual’s float design aimed at raising awareness about childhood cancer.

“Cancer can take my hair. Cancer can take my school. Cancer can take some friends, but cancer is not going to take ballet,” said Carrie Richardson, as she recalled her daughter’s video message. “It was so powerful that Northwestern Mutual’s contest selection team fell in love with her.”

With the help of the Richardson family, Northwestern Mutual unveiled its float design that Peyton inspired for the 2016 Rose Parade during a special event at Texas Children’s Cancer Center on December 3, which also included a $25,000 check presentation from Northwestern Mutual to the Cancer Center.

“The name of the float is Dancing into Adventure,” Peyton said. “The swans have gold cancer ribbons around their necks because gold is childhood cancer awareness. On the music box with the ballerina, there’s the Australian ballet, the New York City ballet and the Royal Ballet. Those are the landmarks where I want to visit.”

The float will also be decorated with red roses that will be placed in green vials and affixed to the float. The vials contain signatures from Texas Children’s patients and their families. Everyone who signed the vials can “ride” on the float with Peyton.

“It’s really this link together through Peyton and Northwestern Mutual to bring awareness to childhood cancer and the need for research funds, and really to show that children with cancer can live and survive and have wonderful and meaningful lives,” Dreyer said. “There is a huge message in that float.”

Besides helping to design the float, Peyton will wear a beautiful Tiffany blue costume at the Rose Parade assembled by the Houston Ballet’s lead costume designer.

With just days away until her greatest adventure comes alive on national television, Peyton’s excitement is building.

“Once we are on the plane and we land, I think I am going to be like, “Wow, this is really happening. I’m going to be in the Rose Parade,” Peyton said. “I can’t wait.”

Neither can her mom.

“For us to be there, it’s like the end of a very long and hard year for her and our family,” Carrie said. “We’re very excited.”

Watch Peyton and her family ride on the Northwestern Mutual float in the Rose Parade on New Year’s Day. The parade will be broadcast on NBC at 10 a.m.

Nearly 300 cardiovascular experts from 13 countries met during the two-day multidisciplinary, interactive conference, which includes cutting-edge research presentations and panel discussions. PCICS is an international professional forum for promoting excellence in pediatric cardiac critical care medicine. Through programs, meetings and educational curriculums, the society has a large role in vital research and training that will improve the level of care of pediatric patients with congenital heart disease and acquired cardiovascular disease.

“I’m thrilled so many of our leading Heart Center experts presented and moderated at this year’s conference in front of an international audience,” said Dr. Paul Checchia, medical director of the Cardiovascular Intensive Care Unit (CVICU) at Texas Children’s and president of the PCICS.

Checchia, who also serves as a professor of pediatrics-critical care and cardiology at Baylor, and Dr. Lara Shekerdemian, chief of critical care medicine at Texas Children’s and professor of pediatrics-critical care and cardiology at Baylor, were program directors of the meeting. The 11 Texas Children’s Heart Center experts who presented or moderated throughout the meeting include:

Dr. Patricia Bastero, pediatric intensive care physician at Texas Children’s and associate professor of pediatrics-critical care at Baylor, presented: Lessons Learned from Simulation: How to Keep a Safe Environment for Real Life Event Debriefings.
Kathleen Carberry, director of the Texas Children’s Hospital Outcomes and Impact Service, moderated: Wave the Magic Wand: What do Bedside Nurses Need to Create a Safer Culture?
Dr. Charles D. Fraser Jr., surgeon-in-chief and chief of congenital heart surgery at Texas Children’s and professor of surgery and chief of the division of congenital heart surgery at Baylor, moderated: The Risks We Used to Take: Panel of Innovators.
Trudy Leidich, director of quality and safety at Texas Children’s, presented: Reassurance vs. Criminal Charges, How Do We Handle/Talk About Errors?
Dr. Carlos Mery, congenital heart surgeon at Texas Children’s and assistant professor of surgery-congenital heart surgery at Baylor, presented: Congenital Heart Disease in Mexico: Building Programs and Changing Paradigms.
Dr. Jack Price, pediatric cardiologist at Texas Children’s and associate professor of pediatrics-cardiology at Baylor, presented: Candidate Selection: Different Views from Across the Spectrum – Medical.
Dr. Craig Rusin, cardiology research core, physiological signal processing and algorithm development at Texas Children’s and assistant professor of pediatrics-cardiology at Baylor, presented: Capturing Data in CVICU: When is Enough, Enough?
Kerry Sembera, CVICU nurse at Texas Children’s, served on the panel: Wave the Magic Wand: What do Bedside Nurses Need to Create a Safer Culture? and presented: Improving Patient Outcomes: Just in Time!
Shekerdemian moderated: The Future is Now: Updates on Trials and Research and present: PHN/NIH Update.
Dr. James Thomas, pediatric intensive care physician at Texas Children’s and professor of pediatrics-critical care at Baylor, presented: Ethics in ECMO: How to Handle Difficult Cases.
Dr. Eric Williams, medical director of quality at Texas Children’s and associate professor of pediatrics-critical care at Baylor, presented: Being Resilient: The Cardiac ICU as a Complex Socio-Technical System.

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