Leading Medicine Magazine, Vol. 4, No. 2, 2006

A PUBLICATION OF THE METHODIST HOSPITAL SYSTEM • VOLUME 4 • NUMBER 2 • 2006

Helping athletes shoulder the pain TAKING STRIDES4STROKE CHART YOUR FAMILY MEDICAL HISTORY BIRD FLU: ARE WE PREPARED? BREAST RECONSTRUCTION RESTORES FEMININITY

LEADING MEDICINE LEADING MEDICINE Volume 4, Number 2, 2006

R.G. GIROTTO President & CEO

MARC L. BOOM, MD

Contents

Executive Vice President

JOHN E. HAGALE, CPA Executive Vice President, CFO & Chief Administrative Officer

R AMON “MICK” CANTU, JD Senior Vice President & Chief Legal Officer

H. DIRK SOSTMAN, MD Chief Medical Officer & Chief Academic Officer

MARK E. KIMBELL Senior Vice President & Executive Editor

ERIN R. SKELLEY Director of Marketing

EMMA V. CHAMBERS Managing Editor

DENNY ANGELLE STEFANIE ASIN EMMA V. CHAMBERS ERIN FAIRCHILD AMI FELKER SHESHE GIDDENS MELANIE MCFARLANE GALE SMITH ALLISON WARDZINSKI JUDY YOUNG Contributing Writers

BRIDGETT AKIN / BRI DESIGN, INC. Design

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CEO MESSAGE...........................2 PANCREATIC CANCER Giving patients new hope...........3

Leading Medicine is published by The Methodist Hospital System Corporate Communications Department for patients, physicians, employees and supporters. ©2006 The Methodist Hospital System All rights reserved. Materials may be reproduced with acknowledgement for noncommercial and educational purposes. Permission from the editor required for any other purpose.

Send address corrections and letters to Leading Medicine The Methodist Hospital System Corporate Communications 8060 El Rio Houston, Texas 77054 Tel: 713-790-3333 or esource@tmh.tmc.edu If you wish to cancel your free subscription to Leading Medicine magazine, contact us at 713-790-3333 or esource@tmh.tmc.edu.

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VIABLE OPTIONS Breast reconstruction restores sense of femininity......24 ACCOLADES..............................27

HIDDEN TIME BOMBS Vulnerable plaques........................6 FOUNDATION OF SUPPORT .......................................9

RICARDO MERENDONI Photography

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BUILDING A HEALTHY COMMUNITY Methodist launches five-year stroke awareness campaign ..................10 A HELPING HAND Methodist family practice residents help clinic expand services............................................11 HEALTHY LIVING The family medical history tree .....................................16

SELFLESS SERVICE Physicians honored for commitment to others ...............28 BIRD FLU Fine tuning the plan for a pandemic outbreak..........................................30 NURSING RESEARCH Examining what’s best for the patient................................32 COMMUNITY HOSPITALS San Jacinto Methodist Hospital’s model for emergency service ......................34 MAGAZINE READER SURVEY RESULTS ...............36

SHOULDERING THE PAIN Treating soft tissue injuries .................................20

VOLUME 4, NUMBER 2 1

A MESSAGE FROM THE CEO Dear Readers, Since 1994 when the Methodist community benefits program began, more than $40 million has been given directly to Houston-area nonprofit agencies and hundreds of millions of dollars spent on patients who could not afford to pay for their health care.

This commitment encourages us to look for new and innovative ways to make a significant impact, such as partnering with the Denver Harbor Clinic in family medicine.

In this issue of Leading Medicine, you’ll be introduced to the clinic, an eastside medical facility with a long history of serving its neighborhood.

More than 15 Methodist medical residents work at the clinic, doubling the number of patients that were previously treated there. This story takes you to the clinic, and gives you a peek into the daily operations of such an important

OFFICERS OF THE METHODIST HOSPITAL SYSTEM BOARD OF DIRECTORS JOHN F. BOOKOUT JR. Chair

HON. EWING WERLEIN JR. Vice Chair

ERNEST H. COCKRELL Vice Chair

RONALD G. GIROTTO President & CEO

DAVID M. UNDERWOOD Secretary

EMILY A. CROSSWELL Assistant Secretary

CHARLES W. DUNCAN JR. Treasurer

JACK S. BLANTON Assistant Treasurer

ROBERT K. MOSES Assistant Treasurer

community service.

Also in this edition, you will read about two physicians who have con-

BOARD OF DIRECTORS

tributed their time, skill and compassion in providing health care to those

MORRIE K. ABRAMSON

who need it the most, but cannot afford it. Turn the pages and meet two

CARLTON E. BAUCUM

remarkable physicians, Drs. Eugene Alford and Rafael Espada, and learn what they do for patients in need. Because these two physicians — longtime Methodist doctors — have dedicated themselves to helping others, they

W. EARL BLEDSOE, DD MARY DAFFIN CONNIE DYER GARY EDWARDS

recently were awarded The Methodist Hospital’s Humanitarian Award,

JAMES A. ELKINS III

established by the board of directors this year.

BISHOP JANICE RIGGLE-HUIE

This award honors a physician, individual or organization with a Methodist

SANDRA SMITH JACKSON, ND

relationship that makes significant and continuous contributions to people

VIDAL MARTINEZ

whose health and well-being are at risk. In this article, you will learn why

GREGORY V. NELSON

these physicians are so deserving of this special award.

You also will read about some of the most advanced treatments used for heart disease and pancreatic cancer. These are all examples of how we continue Leading Medicine.

I hope you enjoy this issue as much as I do.

REV. THOMAS PACE MICHAEL J. REARDON, MD PLINY C. SMITH, MD JOSEPH C. WALTER III D. GIBSON WALTON STEPHEN P. WENDE, DD

ADVISORY MEMBERS REV. RICK GOODRICH ROBERT E. JACKSON, MD

R. G. Girotto President Chief Executive Officer The Methodist Hospital System 2 VOLUME 4, NUMBER 2

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PA NC R E AT I C C A N C E R NEW TECHNOLOGIES,

SURGICAL PROCEDURES AND GROUNDBREAKING CLINICAL TRIALS GIVE PATIENTS NEW HOPE

“Researchers are pushing the envelope, trying new things, and that is how science is advanced.”

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s a practicing physician at The Methodist Hospital for more than 40 years, Dr. Dan Jackson ordered thousands of imaging tests to assist in the diagnosis of his patients’ illnesses. In 2004, that same technology detected a small tumor that led to the diagnosis of one of the deadliest forms of cancer. It also saved his life.

Jackson, 88, had a chronic intestinal problem that caused him to be admitted to the hospital on several occasions. A magnetic resonance imaging scan (MRI) revealed a small mass on his pancreas and he was diagnosed with pancreatic cancer.

As a physician, Jackson knows how dangerous this type of tumor can be. “I told myself I was going to be OK,” said the internist, who until

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his retirement in 1992 practiced with his sons, Drs. Robert and Richard Jackson, also internists at Methodist.

“I called it denial.” Jackson was referred to Methodist surgeon Dr. Wade Rosenberg, who has specialized in performing pancreatic cancer surgery in Houston since the 1980s.

He successfully removed the tumor.

Two months later, Jackson began a six-month regimen of chemotherapy and he is now cancer free.

For many years, a diagnosis of pancreatic cancer was one of the worst a patient could receive from a doctor. In more than half of all cases, the cancer has already spread to other parts of the body, usually the liver, by the time the patient visits a doctor with symptoms. The overall

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survival rate has been only about 5 percent.

“Tumors in the body or tail of the pancreas, like Dr. Jackson’s, don’t typically cause a lot of symptoms, so patients have traditionally been diagnosed pretty far into the disease,” Rosenberg said. “For those types of patients, a big advance has been the current imaging technology.”

Pancreatic cancer is often diagnosed earlier because of the widespread use of computed tomography scan (CT) and MRIs. Rosenberg said that this technology affects prognosis — the earlier the cancer is found, the better the chance of treating it successfully.

There also are improved ways of determining if patients are

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VOLUME 4, NUMBER 2 䡲 3

PANCREATIC CANCER

Dr. Wade Rosenberg

candidates for surgery (if the cancer hasn’t spread to other organs and hasn’t affected blood vessels).

Because of high-quality CT scan and ultrasound technologies, surgeons rarely operate on a patient only to discover the cancer can’t be removed, he added.

The pancreas is a small organ located near the lower part of the stomach and the beginning of the small intestine. It produces digestive enzymes and hormones, with insulin being the most important. The pancreas secretes these enzymes — through a system of ducts — into the digestive tract, while also secreting hormones directly into the bloodstream.

Patients who have pancreatic cancer often develop diabetes, but there is no evidence that diabetes causes pancreatic cancer. Jackson did develop diabetes after having

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part of his pancreas removed. He controls the disease with oral medication and diet.

Pancreatic cancer is a genetic disease, meaning it is caused by mutations in the body’s DNA. These changes can be inherited or acquired, either during cell replication or by exposure to cancercausing chemicals, but currently there is no test to determine a person’s risk for the disease.

In addition to imaging technology, groundbreaking clinical trials and surgical procedures are augmenting the treatment arsenal against pancreatic cancer.

“I am very optimistic about the future of care for these patients,” said Dr. Craig Fischer, pancreatic cancer surgeon and researcher at Methodist. Fischer is new to the Methodist team, having become the first academic recruit of Department

of Surgery chair Dr. Barbara Bass. He brings with him one of the country’s most extensive backgrounds in innovative pancreatic cancer surgery and research.

He’s most encouraged about an upcoming clinical trial that offers a novel approach to killing cancer cells in the pancreas by using a combination of gene therapy and radiation. “This is really one of the more exciting advances in cancer care we’ve seen in a decade,” he said.

“We are taking advantage of what has happened in the human genome project (a project designed to identify all the genes in human DNA) and other advances in science that are only two or three years old.”

Fischer said leading-edge research like this is evolving, and is only available at select centers in the country and Methodist is one of them. He added that a virus associated with the common cold is used as a “truck” to deliver a deadly gene directly into a pancreatic tumor. This strengthens the effects of radiation therapy and trains the body’s immune system to search for cancer in other parts of the body, as well.

This work was started at Methodist 10 years ago in prostate cancer, but soon it will be expanded to pancreatic cancer. “We are training our own body’s immune system to recognize cancer as the enemy and then attack only those cells, while leaving the rest of the body alone,” he said.

This new research is greatly needed because 85 to 90 percent of all patients who have a tumor in the pancreas cannot undergo surgery due to the tumor’s size. Surgery, however, is the only cure for the majority of pancreatic tumors.

Albert Bayeh, 50, was one of the lucky patients who did notice

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䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲 䡲

symptoms that caused him to visit the doctor. “I had chronic heartburn that wouldn’t go away when I took medicine for it,” he said. “Then, I noticed my urine was getting darker and darker.”

Once an ultrasound revealed a mass, Bayeh braced for the worst.

“I was prepared to hear him say it was cancer,” he said. “I have stayed positive during this entire process because I had confidence in my doctors and faith that if it was God’s time for me, it was my time.”

Bayeh then went to see Fischer at Methodist. After surgery and a short stay in the hospital, he went home to his family. He is now undergoing chemotherapy and hopes for a complete recovery.

Fischer is an authority in the removal of the blood vessels and use of the jugular vein to bypass them in order to remove all the

MULTIDISCIPLINARY CARE TEAMS USED TO TREAT CANCER, OTHER DISORDERS As health care institutions seek improved approaches to advance patient care, Dr. Barbara Bass, chair of the Department of Surgery at The Methodist Hospital, is developing disease-based teams to treat patients with complex disorders, including cancer.

Medical Illustration Copyright©2006 Nucleus Medical Art. All rights reserved. www.nucleusinc.com

cancer in surgery. He believes Methodist has now become one of the leading institutions in the country in pancreatic cancer care.

“Researchers are pushing the envelope, trying new things, and that is how science is advanced,” he said. “Not all the ideas are successful but innovation in science is made at the edge of the envelope. That’s what is happening at Methodist.” 䡲

Collaboration between health care professionals is not a new concept, but in most cases, it has been underutilized. Bass is working to form these teams to serve as springboards to cultivate more clinical research and basic science research programs at Methodist.

Bass said cancer is a perfect example of a disorder that is optimally treated with the collaborative management of surgeons, medical oncologists, radiation therapy physicians, pathologists and radiologists.

For all cancers, including breast and colon, but especially for complex diseases like pancreatic cancer, rectal, esophageal or lung cancer, multidisciplinary planning and treatment are essential for optimal outcomes.

In addition to the existing cadre of Methodist physicians who have expertise in these areas, Bass, who specializes in endocrine and breast cancer, has recruited several new physicians including Dr. Craig Fischer (see article), Drs. Shanda Blackmon (thoracic surgical oncology) and Bridget Fahy (colorectal surgical oncology). These physicians will work with specialists in other fields to build the diseasebased teams.

Dr. Craig Fischer WWW.METHODISTHEALTH.COM

Bass anticipates that all surgeons who practice will participate in these programs and the department will provide the infrastructure to facilitate their involvement. Once established, these programs will serve as the natural platform for clinical and translational research.

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Hidden Time Bombs:

Methodist Researchers Work to Diffuse Vulnerable Plaques B Y

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Death is often the first sign of heart disease. Seemingly out of the blue, a friend or loved one will have a massive, deadly heart attack.

Without symptoms such as chest pain or fatigue — common telltale signs of an impending heart attack — many patients are unable to foresee the tragedy.

Researchers at the Methodist DeBakey Heart Center and The Methodist Hospital Research Institute (TMHRI) are working to understand how this phenomenon occurs. Interventional cardiologists Dr. Juan Granada and Dr. Albert Raizner are conducting research to uncover why atherosclerotic plaques, which build up inside the arteries, can cause anything from small heart attacks to massive heart attacks and sudden death.

“Many people have blockages in their arteries due to the buildup of plaques,” Granada said. “Some of those plaques are benign, but some may become very dangerous. The challenge is to determine which ones are vulnerable to rupture and cause deadly events.”

Dr. Juan Granada 6 䡲 VOLUME 4, NUMBER 2

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Plaque development is a natural, though not necessarily healthy, process that begins in early childhood and progresses as we age.

When it forms along the inside lining of an artery and ruptures, it produces a clot that blocks blood flow to the heart and deprives it of much-needed oxygen. Granada, Raizner and their research teams are looking at ways to determine, through the validation of several imaging techniques, which plaques are dangerous and susceptible to rupture and which are stable and therefore less likely to cause damage. 䡲 䡲 䡲 䡲 䡲 Methodist has one of the top research facilities in the country for studying vulnerable plaques — those plaques that may not obstruct blood flow or cause symptoms such as chest pain, but suddenly become very unstable, break off and result in deadly clots. A normal stress test may not pick up a vulnerable plaque because these tests look for obstructions and by nature, these lesions may be non-obstructive.

The teams’ research has begun to provide a better understanding of

what makes plaque vulnerable. Thus far, they have learned that inflammation of the artery at the site of the plaque debilitates the region and makes the plaque very soft, compared to stable plaques, which are hard. Also, plaques with high concentrations of cholesterol and debris, and those with a thin lining of scar tissue are more likely to rupture and cause damage.

Through grants from TMHRI, Weill Medical College of Cornell University and the Houston Texans professional football team, and gifts from the community, the interdisciplinary research team from Methodist, Weill Cornell and the University of Houston have many studies under way. Current investigations include cellular and molecular research, imaging and diagnostics and therapeutic studies. (See sidebar.)

“The accurate detection of dangerous plaques in asymptomatic people could have a tremendous impact in public health and economics by preventing many deaths, suffering and disabilities,” Granada said. “As research and technology advance, we’ll be able to use imaging to screen people for these lesions. In the future, as technological

ADDITIONAL MEMBERS OF THE VULNERABLE PLAQUE RESEARCH GROUP Eli Lev, MD, researcher and cardiologist with the Methodist DeBakey Heart

advances allow it, this type of screening may become as common as getting a mammogram or a colonoscopy.”

Granada, Raizner and cardiologist Dr. Greg Kaluza received a grant from the Houston Texans to develop an animal model that emulates human plaque formation so that they can better understand the process by which dangerous plaques evolve. Their study is aimed at speeding the development of new ways to prevent, stabilize and treat them.

Raizner said that while great strides have been made in the past 20 years in the treatment of heart attacks, the events leading up to them are poorly understood and frustratingly unpredictable. “Vulnerable plaques are hidden time bombs.

This is a pattern we hope to stop,” he said.

A promising new treatment for vulnerable plaques also is being studied at Methodist. Kaluza is working on the development of a stent made of material that is absorbed

PLAQUE ARTERY WALL

Center (MDHC), is studying the relationship between platelets and stem cells for strategies to help prevent or heal life-threatening ruptures.

David Wallace-Bradley, a University of Houston research associate on the team, is using catheter-based intravascular ultrasound imaging technology to see inside plaques and identify their cholesterol and inflammatory makeup, to better help determine which plaques are dangerous and in need of treatment.

Ioannis Kakadiaris, PhD, professor at the University of Houston, is developing a method to detect the newly formed vessels around the plaque using intravascular ultrasound.

John Mahmarian, MD, nuclear cardiologist at MDHC, uses noninvasive computer tomography angiography to see the structure of a patient’s plaque.

Shankar Vallabhajosula, PhD, researcher at Weill Medical College of Cornell University, uses positron emission topography and nuclear tracers to detect regions with a high degree of inflammation.

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VOLUME 4, NUMBER 2 䡲 7

VULNERABLE PLAQUE

New Theories, But the Advice Remains the Same Until recently, it was widely believed that most heart attacks were caused by the gradual build up of plaque in the arteries, which restricted blood and oxygen flow to the heart. Now it is believed that most heart attacks may be caused by hidden vulnerable plaque that suddenly ruptures causing clots and blockages. This may explain why some apparently healthy people suffer from heart attacks and strokes.

Once researchers develop a better understanding of vulnerable plaque, new treatments and detection methods may follow.

In the meantime, what can you do to keep your cardiovascular system healthy? Heed your physician’s advice: 䡲 Continue to get regular checkups 䡲 Maintain a healthy weight 䡲 Eat a heart-healthy diet 䡲 Quit smoking 䡲 Control your diabetes, blood pressure and cholesterol 䡲 Get some exercise

Dr. Albert Raizner

Did you know? into the artery over time. If an area in a patient’s artery has been identified as being at risk, this type of stent may stabilize the region, making it less likely to break off and clot.

Methodist also has the only angiographic suite in the Texas Medical Center that is designed for experimental endovascular imaging and tissue characterization for animal research. The suite has experimental cardiac catheterization capabilities at a quality that is robust enough for humans but sized for animals.

This laboratory is one of two labs in the nation with dedicated

intravascular ultrasound software that gives researchers the ability to see inside arteries and determine whether the plaque has characteristics that show it is at risk.

“We’ve assembled an interdisciplinary team of outstanding researchers, in collaboration with Weill Cornell and University of Houston, who have expertise in cardiology, molecular imaging and diagnostic imaging, to conduct some of the most advanced basic, translational and clinical research on vulnerable plaques,” Granada said. “We’re exploring new territory, and we hope to stop this disease in its tracks.” 䡲

A 12- to 13-point reduction in blood pressure can reduce heart attacks by 21 percent, strokes by 37 percent, and all deaths from cardiovascular disease by 25 percent.

During 1999-2002, nearly 25 percent of U.S. adults had high cholesterol levels or were being treated with medication. Only 63 percent of those with high levels were aware of it.

A 10 percent decrease in total blood cholesterol levels may reduce the incidence of coronary heart disease by as much as 30 percent.

For more heart-healthy tips, visit methodisthealth.com 䡲 Data provided by Centers for Disease Control and Prevention

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A FOUNDATION OF SUPPORT

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he Methodist Hospital Foundation experienced tremendous growth last year with five new endowed chairs — the highest one-year total in The Methodist Hospital’s history.

This substantial philanthropy has enabled Methodist to expand the departments of surgery, medicine and biomedical engineering, as well as recruit distinguished chairs to lead them.

Engaging renowned physician-scientists to direct these efforts greatly impacts patient care, medical education and groundbreaking research. Their presence assists in the recruitment of some of the most respected physician-scientists from across the country — establishing a conclave that will lead to Methodist achieving its vision of becoming an academic medical center of the highest caliber, on par with the top health care institutions in America.

Endowments allow the most promising investigators to pursue new research and clinical care initiatives for which no other funding might be available or to bridge their funding while applying for government grants. Endowments currently augment pioneering Parkinson’s and ALS research already being conducted in the Methodist Neurological Institute.

The impact and value that endowed chairs bring to Methodist and our METHODIST MUST INVEST IN community cannot be overstated. OUTSTANDING PHYSICIAN-SCIENTISTS They provide recognition for out- TO ACHIEVE ITS VISION OF BECOMING standing faculty members, demon- ONE OF THE NATION’S PREMIERE strate the institution’s commitment to ACADEMIC MEDICAL CENTERS. their work and represent one of the

highest honors that can be bestowed.

Endowed chairs are an investment in people that pays off richly for our community. A critical element in attracting these leaders in medicine lies in Methodist’s ability to award them with prestigious endowed chairs. Methodist must invest in outstanding physician-scientists to achieve its vision of becoming one of the nation’s premier academic medical centers.

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VOLUME 4, NUMBER 2 9

METHODIST LAUNCHES FIVE-YEAR STROKE AWARENESS CAMPAIGN

.7 million

Ask someone if they know what they can do to lower their risk for heart attack. Chances are they’ll rattle off a number of things, including eat a healthy diet low in cholesterol, exercise and don’t smoke. But if you ask what they can do to lower their risk for stroke, more than likely they’ll be stumped.

A stroke occurs every 45 seconds and kills one of every four victims, making it the third leading cause of death for Americans. It is a major public health threat, and the statistics are even more alarming for Harris County, which has a higher stroke death rate than the national average. The only way to affect this alarming trend is to increase community awareness about this deadly and debilitating disease.

Number of strokes that occur in the United States each year The Methodist Hospital System has launched the comprehensive five-year Taking Strides4Stroke: Community Stroke Awareness Campaign. Led by the Methodist Neurological Institute’s Eddy Scurlock Stroke Center, the campaign targets the diverse age groups and ethnicities in the greater Houston area.

The campaign focuses on educating the public on stroke symptoms, treatment and prevention, and includes activities such as a series of health screenings and Healthy Knowledge seminars.

Healthy communities begin with healthy families so the first major campaign event is designed to bring families together in the fight against stroke.

The Stride4Stroke Walk and Run will be held on the Rice University campus on March 24, 2007.

Houston’s only 5K event dedicated solely to stroke awareness will be a funfilled day of activities for the entire family.

The Taking Strides4Stroke: Community Stroke Awareness Campaign is made possible by the generous support of individuals, corporations and foundations committed to building a healthier Houston community. All proceeds from the event will benefit the Eddy Scurlock Stroke Center, as well as other stroke activities in The Methodist Hospital System. 䡲

5.5 million Number of U.S. stroke survivors alive today

25%

Percentage of strokes that occur in people under age of 65

60%

Percentage of stroke deaths in women

$57 billion Direct and indirect costs associated with stroke in 2005 Sources: Centers for Disease Control and Prevention, American Stroke Association

For more information on the campaign or to request sponsorship materials, please contact Amanda Pilcher at 832-667-5839. 䡲

A stroke occurs when

a blood vessel that brings oxygen and nutrients to the brain bursts or is clogged by a blood clot or some other particle. Because of this rupture or blockage, part of the brain doesn’t get the blood and oxygen it needs. Deprived of oxygen, nerve cells in the affected area of the brain die within minutes.

The risk factors for stroke that you can control or treat are: ❖ High blood pressure ❖ Tobacco use ❖ Diabetes mellitus ❖ Carotid or other artery disease ❖ Atrial fibrillation or other heart disease

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❖ A history of TIAs (“mini strokes”) ❖ A high red blood cell count ❖ Sickle cell anemia ❖ High blood cholesterol

❖ ❖ ❖ ❖

Physical inactivity Overweight and obesity Excessive alcohol intake Some illegal drugs

Source: American Stroke Association

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Neighborhood clinic blossoms with helping hand from Methodist A R T I C L E

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Good morning, Denver Harbor. This neighborhood on Houston’s east side wakes up early and goes to work and school. Somebody is cooking breakfast. As the sun puts a glow into the morning, it doesn’t take much to hear freight cars bumping around in the rail yard or the 18-wheelers roaring along nearby Interstate 10.

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Denver Harbor

“Areas like Denver Harbor blossom when the people who live there put their energies back into the community. This is a real success story.”

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Metro bus hisses to a halt in front of Denver Harbor Clinic. The clinic is nestled in a shady neighborhood just two blocks away from a busy thoroughfare. You would think the buses would take that route, not this quiet residential street. Most of them do, but the Number 11 bus stops right here.

Inside the clinic, 6-year-old Elizabeth Treviño fidgets on the thin white paper of an examination table.

A sore throat bothered this first-grader all weekend. So she is here with her mother, to see a doctor.

Elizabeth is missing the first hours of school. She likes the X-Men and a number game called “math-a-thon” and she would like to get to that.

Dr. Jamir Mireles examines the little girl’s throat and gives her a prescription for the irritation and pain.

The doctor warns April Treviño, Elizabeth’s mom, to keep an eye on the condition so it doesn’t turn into something more serious.

Then it’s off to class — Elizabeth to Raul C. Martinez Elementary school and her mom to the University of Houston-Downtown campus. A

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psychology major, April has a history test today.

Mireles pulls a folder from a pocket on the door of the next examination room. Another patient waits inside.

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or the 28,000 or so residents of the Denver Harbor community, this clinic is the answer to their prayers. Before it was established, no physicians served this low-income, primarily Hispanic community. A group of neighborhood church pastors partnered with local businesses to establish the clinic in 1999.

Since then, it has grown steadily — and earlier this year The Methodist Hospital formed a partnership with Denver Harbor Clinic that will enable the clinic to serve more patients than ever before. Methodist’s family medicine practice, comprised of 17 family practice residents (doctors in training), utilizes the clinic as its sole family medicine clinic site. In addition to providing patient care, the practice has supplied funding and other assistance such as X-rays, immunizations and laboratory tests.

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Six-year-old Elizabeth Treviño discusses her symptoms with Dr. Jamir Mireles, who is a Methodist resident.

2 Deka Gray and her son Corey visit with Dr. Mireles before Corey undergoes a sports physical.

3 Dr. Donald Briscoe, director of Methodist’s Family Medicine Residency Program, reviews a patient chart.

4 Dr. Mireles discusses a case with Dr. Kent Lee, director of women’s health and maternity services at the clinic.

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f patients need more extensive care — to deliver a baby, for example — the medical staff at the clinic has admitting privileges at Methodist. Patients frequently also go to Methodist for testing and other diagnostics.

“We are very lucky that Methodist partnered with us,” said Dr. Donald Briscoe, medical director of the clinic

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and director of Methodist’s Family Medicine Residency Program. “Their assistance has given us a boost that will enable us to see more patients than ever before.”

The clinic also is constructing a new addition to the current facility, with 10 examination rooms in a twostory structure. The additional space and Methodist residents will allow

patient visits to jump from 7,500 this year to an estimated 11,000 by 2007.

When the new expansion opens in the spring of 2007, Briscoe says the current facility may eventually house a dental clinic and possibly a small pharmacy. “The Methodist Hospital’s presence is definitely allowing us to expand our services,” he added.

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Denver Harbor

The current Denver Harbor Clinic building, a pleasant terra-cotta structure with a Southwestern style, was originally a cantina and sports bar that was frequently a trouble spot in the otherwise quiet neighborhood.

The clinic was the vision of local businessman Daniel Montez; not only did it offer much-needed health care to Denver Harbor’s families, it also gave the residents a focal point for redeveloping their depressed community.

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ontez, now the clinic’s CEO, worked to get local churches and their pastors involved. Metro agreed to place a bus stop right at the clinic’s front door, and the groundbreaking ceremony for the new facility in May drew visits from local dignitaries such as city council members Adrian Garcia and Carol Alvarado, and U.S. Rep. Gene Green.

“Areas like Denver Harbor blossom when the people who live there put their energies back into the community,” Briscoe said. “This is a real success story.”

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From left: Denver Harbor CEO Daniel Montez; Methodist board members Jack Blanton and Connie Dyer; Methodist VP of Operations Cathy Easter and Houston City Council Member Adrian Garcia at the clinic expansion groundbreaking ceremony.

FAST FACTS Denver Harbor Clinic is a private, nonprofit community health care center providing quality care to the residents and neighbors in the Denver Harbor community of Houston.

Location: 424 Hahlo Street Houston, Texas 77020-3022 Web: www.hchcdenverharborclinic.org Employees: 17 full-time and 3 part-time

Patient encounters: 2005: 4,200 2006: 7,500 (projected)

Key dates: 1999: 2000: 2003: 2004: 2005: 2006:

Denver Harbor Clinic opens, operating six hours a week in a temporary facility, annual budget: $60,000 Hours expand to 16 hours/week Hours expand to 40 hours/week Permanent 5,600 square foot facility opens at the site of a former cantina Designation as a Federally Qualified Health Clinic (FQHC) Look-Alike awarded, providing eligibility for enhanced Medicaid/Medicare reimbursement Annual budget: $1.2 million 1/1/06 – The Methodist Hospital Family Medicine Residency Program begins with six residents and one attending physician at Denver Harbor Clinic 7/1/06 – Residency program increases its presence at the clinic to 17 residents and four physicians as it makes the clinic its sole family medicine clinic site.

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Mondays are usually the busiest days at the clinic.

About 40 percent of all patients at the clinic are children.

Mondays are usually the busiest days at the clinic. About 40 percent of all patients at the clinic are children. Three or four senior residents typically see patients, then they return to a common doctors’ area to write up each case and have the diagnosis and any treatment approved by a supervising physician/family practice faculty member such as Briscoe.

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oday, the other faculty member present is Dr. Kent Lee, a man with a number of titles at the clinic including director of women’s health and maternity services and coordinator of behavioral sciences.

He is examining and tinkering with a colposcope, an optical magnifying device used in obstetrics and gynecology examinations. The instrument was a gift to the clinic from Dr. Eric Haufrect, an obstetrician/gynecologist at Methodist.

“Across the board, Methodist has been supportive in every thing we’ve done,” Lee said. “We have been able to tap into much more than Methodist’s excellent reputa-

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tion…they have enabled us to take this someplace we have never been before.”

Meanwhile, Mireles taps on the door of another examination room.

Corey Davis, 14, is here for a routine physical before he can enroll in sports at his school. “Cross country, basketball, track…” he said, when asked what sports he’s interested in.

He doesn’t know if he wants to be a sprinter or a long-distance runner.

The doctor gives Corey her approval to participate in sports.

Corey’s mother, Deka Gray, said this is the first time they’ve come to the Denver Harbor Clinic. Briscoe gives her a short survey to answer questions about the service she received.

She hands it back, favorable check marks all down the line.

“This place is beautiful,” she said.

“A real lifesaver for me, that’s for sure.

We will be back, I guarantee it.”

PHYSICIAN SUPPORT Dr. Miguel Quiñones — serves on the clinic’s board of directors Dr. Richard Robbins — collaborating with the clinic to develop research projects Dr. Eugene Toy and Methodist OB/Gyn residency program — assisted in the development of the clinic’s prenatal care program Dr. Robert Jackson — consulted with the clinic’s medical staff to establish process improvements

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HEALTHY LIVING

I

T WAS A BEAUTIFUL SPRING MORNING IN BOSTON, AND THE BRIGHT SUN STREAMING THROUGH THE BUDDING TREES COULDN’T DISPEL THE FEAR IN MY UNCLE’S FACE. MY NEWBORN COUSIN HAD JUST BEEN DIAGNOSED WITH A HEART CONDITION.

THE FAMILY MEDICAL HISTORY TREE:

ONE PATH TO HEALTHY SELF-KNOWLEDGE B Y

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J U D Y

Y O U N G

For the moment, how and why this happened mattered as much to him as what could be done to help his daughter. As I considered how I might offer some measure of comfort, I heard my uncle say the word congenital, and I wondered who among our relatives might have had a similar problem.

At the time, neither of us knew about the condition a number of my aunt’s relatives had inherited for five generations.

While there are no guarantees concerning health or disease, some knowledge of your family’s medical history is important and, potentially, lifesaving. Dr. Peter H. Jones, a physician-scientist affiliated with the Methodist DeBakey Heart Center, advises, “Initially, at least, you can begin a family medical history tree by summarizing the diseases, symptoms, and/or conditions of your immediate family, and then interviewing your extended family (e.g., aunts, uncles, cousins, etc.) to determine the medical histories of three to four generations.

In general, categories of information should include name; relationship of the relative to you; dates of birth and death; past/present health problems and whether they were inherited or developed over time;

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age at, and year of, diagnosis; and age at, and cause of death.”

According to Jones, it also is important to note mental illness, allergies and environmental risk factors, in addition to physiological disease. “Subsequently, this collective medical history can be updated annually, distributed to everyone in the family, and forwarded by each relative to his or her physicians,” Jones concluded.

This year, consider doing a little research into your family’s past in order to pass on a lasting gift to those you love. By assembling an accurate and comprehensive family medical history tree, you can assist your relatives and their physicians in predicting, identifying and treating health risks and hereditary conditions — especially among younger family members. Your physician can assist you in preparing a list of the most important data to collect and provide counsel regarding the appropriateness of genetic testing to identify inherited conditions.

By the way, my cousin’s congenital heart condition was corrected by surgery and she is now 25. She and her husband are planning a family, and I believe you know what I plan to suggest to them in the very near future.

No more excuses. Become a better manager of your own health and that of your family with this basic but important tool.

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For the 16th consecutive year, The Methodist Hospital is ranked among the country’s top centers in U.S.News & World Report’s 2006 annual guide to “America’s Best Hospitals.” The magazine ranked the country’s top 50 hospitals in 17 specialties based on a combination of clinical data, number of discharges and reputation.

Neurology/neurosurgery Urology Ear, nose and throat Psychiatry Ophthalmology* Gynecology

10 16 16 17 15 47

*Baylor College of Medicine’s Cullen Eye Institute housed at The Methodist Hospital

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HEALTHY LIVING

FAMILY MEDICAL HISTORY TREE

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VOLUME 4, NUMBER 2 19

B Y

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M C F A R L A N E

“

Initially, I thought the pain was tendonitis, but after a few weeks of rest, the pain returned and I knew it was more serious.

”

Shouldering the

College standout Joe Savery is considered a prospect for the 2007 Major League Baseball draft. The Rice University junior has racked up numerous accolades in his college career including the 2005 Baseball America National Freshman of the Year, but his future in baseball came into question this past summer when he experienced a sudden sharp pain in his shoulder during practice.

“Initially, I thought the pain was tendonitis, but after a few weeks of rest, the pain returned and I knew it was more serious,” Savery said. The Rice team physician referred Savery to Dr. David Lintner, the head team physician for the Houston Astros.

Lintner, an orthopedic surgeon with The Methodist Hospital since 1992, has focused most of his practice on treating shoulder injuries.

Lintner examined Savery and discovered a tear in his labrum, the rim of cartilage that surrounds the shoulder joint. The tear, which was caused by a bone calcification in Savery’s shoulder, is the most common shoulder injury in people from late adolescence through age 40.

In athletes, the labrum wears down with repetitive overhead use, such as pitching, weight lifting or throwing. The injury also is commonly found in people whose jobs require heavy lifting, such as parcel deliveries; or those who work in industrial or chemical plants, where

PAIN

Joe Savery 20 VOLUME 4, NUMBER 2

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“

Most people notice the pain of a labrum tear when they reach for something overhead or stretch the arm to the side.

”

repetitive turning of valves is involved. “Most people notice the pain of a labrum tear when they reach for something overhead or stretch the arm to the side when reaching into the backseat of a car,” Lintner said.

No age discrimination Shoulder injuries vary with the age of the patient. Children through early adolescence usually experience problems with the growth plates, the area of growing tissue near the end of the long bones, or stress fractures from repetitive use.

The classic example is a Little League pitcher who plays on several teams simultaneously throughout the year.

They tend to develop shoulder pain from a growth plate problem, which will almost always improve with rest.

Unfortunately, many times athletes, coaches or parents are unwilling or not interested in rest for the patient, Lintner said. “Our goal is to make sure that recreational and professional athletes of all ages can enjoy activities that are important to them.

Sometimes this means altering a practice schedule or playing a different position until the shoulder has had time to heal,” he said. Less frequently, the athlete will need to temporarily stop play altogether. In children, relative rest almost always works; in high school age and older, sometimes surgery is needed.

Savery considers himself fortunate that his surgery took place during the off-season. “I really appreciated that Dr. Lintner didn’t rush me into surgery. He took into account that my pitching was important to me,” said Savery, who is now in recovery and visiting the Methodist Center for Sports Medicine twice a week for rehabilitative physical therapy. He said he expects to be pitching at 100 percent before the season starts in January.

A Houston native who has played baseball his entire life, Savery is excited about being a prospect for the pros. “If it weren’t for my surgery with Dr. Lintner, I could have exacerbated the injury and lost my chance at the professional draft next year.

He operated on me with enough time to recover and begin playing next season — just in time for draft picks,” he said.

Dr. Bruce Moseley, a Methodist orthopedic surgeon who specializes in sports medicine, treats many young athletes with shoulder injuries. He explained that while a labrum injury can be treated without surgery, it probably will reoccur if the ligament has been damaged. “In most cases, we will allow the athlete to finish the season with the understanding that their shoulder is unstable. Post-season surgery to repair the ligament and labrum is ideal to remain injury free,” Moseley said.

Dr. David Lintner

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VOLUME 4, NUMBER 2 21

SHOULDER THE PAIN

Labrum injuries are diagnosed with a medical history review and physical exam because X-rays do not show damage to soft tissue. A magnetic resonance imaging scan (MRI) is required to fully reveal the damage.

Labrum treatment options depend on the condition of the rotator cuff — the four muscles and tendons that secure the arm to the shoulder joint and control rotation and stability of the arm. Moseley said that if the rotator cuff is healthy, the patient can often compensate for the injured labrum by strengthening the rotator cuff.

It this fails, the labrum is mended with suture anchors or dissolvable screws to secure the labrum in place.

Following surgery, it is critical to protect the shoulder as it heals and begin gentle physical therapy.

Once the repair is solidified, the patient can undergo more aggressive strengthening therapy and return to regular activity in three months.

Rotator cuff tears Rotator cuff tears typically occur in patients over 40.

Most rotator cuff tears happen when the tendon is pinched between two bones.

“This condition, called impingement, can cause the rotator cuff tendon to naturally deteriorate, tearing fiber by fiber, in much the same way a rope frays,” Moseley said.

“

Our goal is to make sure that recreational and professional athletes of all ages can enjoy activities that are important to them.

”

Dr. Bruce Moseley 22 VOLUME 4, NUMBER 2

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Moseley performed two rotator cuff surgeries on now retired WNBA sensation Cynthia Cooper. “The first injury occurred when I collided with a team player during practice,” said Cooper, who led the Houston Comets to four consecutive WNBA championships. “I experienced a great deal of pain but tried to play through it. The next day I could barely raise my right arm, and I was told surgery was necessary to repair the rotator cuff.”

Most people notice the pain of rotator cuff injuries when lifting their hands over their head, such as shampooing their hair or reaching up to a shelf. Some even experience pain at night, awakening them from their sleep, which can be the most common complaint.

An MRI also is used to diagnose rotator cuff injuries, but Moseley and Lintner recommend surgery sooner rather than later because rotator cuff tears will only enlarge and not heal, and small tears are much easier to repair than larger ones.

Cooper again injured her left shoulder the next year with a rotator cuff tear resulting in the second surgery. “The most difficult part of having successive injuries was not being able to hold my twin baby boys for so long,” said Cooper, who is now in her second year as head coach for the Prairie View A&M University women’s basketball team.

“I’m very thankful the surgeries resulted in a complete recovery,” she said. Moseley added, “Cooper’s injuries were unique in that she had a slight deformity in the shoulder, and when impacted, a bone spur actually split her rotator cuff in half.

We were able to remove the bone spur as well as repair the rotator cuff, to ensure this never happens again.”

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Cynthia Cooper

“

In most cases, we will allow the athlete to finish the season with the understanding that their shoulder is unstable. Post-season surgery to repair the ligament and labrum is ideal to remain injury free.

”

To download a copy of Methodist’s Sports Injury Prevention Guide, logon to www.methodistorthopedics.com.

VOLUME 4, NUMBER 2 23

BREAST RECONSTRUCTI

RESTORI

Lynette Jupp 24 VOLUME 4, NUMBER 2

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ON:

“Besides helping patients choose their most viable option for reconstruction, we must work closely with their oncologists to determine when reconstruction is best for each individual.”

NG Self-esteem to Breast Cancer Survivors B Y

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ach year, physicians and scientists reach significant milestones in the treatments and causes of breast cancer. At The Methodist Hospital, patients are undergoing state-of-the-art diagnoses and cutting-edge treatments that beat the cancer and reconstructive procedures that restore their sense of femininity and self-esteem.

“With new techniques and a better understanding of breast cancer, there is a gamut of ways to reconstruct breasts after mastectomies,” said Dr. Robert Weimer, reconstructive surgeon at Methodist. “Surgeons and patients now have options when choosing what is best for the patient.”

Weimer, and his partner Dr. David Lee, typically perform three types of traditional breast restorations — skin expansion, latissimus dorsi flap and the flap from the abdominal area.

In some women, a simple skin expansion is used, in which the surgeons insert a skin expander for a short period of time, replaced by a breast implant later.

“This outpatient procedure is a very safe alternative and requires much less recovery time,” Lee said.

For many patients, surgeons prefer to use flaps, in which the muscle and tissue on a woman’s upper back or abdominal area is transferred to her chest in order to build a breast mound.

“Our goal, as far as restoration is concerned, is get a nice breast mound to work with. The rest — Dr. David Lee

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Breast Reconstruction perfect symmetry, nipple restoration — is icing on the cake,” Weimer said.

“Besides helping patients choose their most viable option for reconstruction, we must work closely with their oncologists to determine when reconstruction is best for each individual,” Lee said. “Radiation can be detrimental to the restoration process, so we want our patients to beat the cancer before we begin reconstruction.”

“

L

ynette Jupp was completely shaken when doctors found a lump in her left breast in 2004. Not long after her mother, niece and cousin’s diagnoses, Jupp was diagnosed with breast cancer at 54. Tragically, after a lumpectomy and radiation treatments, a followup mammogram at Methodist in August 2005 still showed three suspicious spots in Jupp’s left breast and two in her right. “I could see the mass on the films because it was magnified,” she said. “All I could think was ‘get this out of me.’”

Three months later, Jupp underwent bilateral mastectomies at Methodist, and at the same time, began a three-step restoration process that is only offered at a handful of specialized centers around the country.

“We are essentially rebuilding the patient’s breast with her own tissue, and giving her a tummy tuck at the same time,” said Dr. Aldona Spiegel, who specializes in microsurgical muscle-preserving procedures for breast restoration. “The results have been phenomenal.” Spiegel, who is director of the Center for Breast Restoration at The Methodist Hospital, said it is also possible to restore sensation.

Spiegel usually performs breast reconstruction in a three-stage process. The first step is a tissue transfer that can be performed at

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the same time as a mastectomy, or in patients who already had a mastectomy. A general surgeon removes the nipple and the cancerous tissue from the breast, leaving only the breast skin.

Coinciding with this, Spiegel uses microsurgical techniques to carefully separate the fatty tissue and blood vessels from the abdominal area, while preserving the muscular integrity of the abdominal wall.

Once the general surgeon has removed the cancerous tissue from the breast, Spiegel transfers the abdominal tissue to the breast area, where the small blood vessels and nerves are microsurgically connected. The abdominal tissue is used to restore the volume of the breast and the abdominal skin is used to restore the areola (area around the nipple).

After three to four months of healing, Spiegel performs a second outpatient surgery, in which she sculpts the tissue to establish more symmetry — assuring that both breasts are equal in size, shape and appearance.

Three months later, in an officebased procedure, she reconstructs the nipple using skin from the original surgery. To complete the reconstruction, the patient’s nipples are tattooed a natural color, and within just one year of being diagnosed with breast cancer, her breasts are fully restored.

“I wouldn’t trade my surgery for the world,” said Jupp, who will soon undergo the second step of the reconstructive process. “Amazingly, I still have some of the same sensation in my breasts that I felt before the breast cancer.”

W

ith the cancer behind her, she has taken an active role in assuring that all women are educated about the dangers of breast cancer and the options for screening. As a mother and grandmother, she currently is researching genetic counseling to assure her daughter and granddaughters are well cared for in the future.

Genetic counseling can help determine the likelihood that a patient could have familial breast cancer. Further genetic testing determines if the patient has a specific mutation in her DNA, which could mean up to an 80 percent chance of developing breast cancer.

“I promised my kids that I will provide them with all the education and screening I can find,” she said.

“I want them to have every opportunity to find anything suspicious and take care of it before it becomes a problem.”

Dr. Aldona Spiegel

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Accolades METHODIST ACHIEVES MAGNET NURSING STATUS The Methodist Hospital has received national Magnet status for its second consecutive four-year term, again joining a small group of hospitals around the country recognized for nursing excellence and superior patient outcomes.

Given by the American Nurses Credentialing Center, the award is the highest level of recognition a hospital can receive from the ANCC for excellence in nursing services. Only about 205 of the nation’s hospitals hold this prestigious recognition putting Methodist in this elite category.

BASS NAMED TO NATIONAL PANEL Dr. Barbara Bass, chair of The Methodist Hospital’s surgery department, has been appointed a member of the National Commission on Digestive Diseases, a component of the National Institutes of Health.

The 16-member commission is charged with developing a 10-year strategic plan for NIH digestive diseases research.

ESPADA HONORED FOR COMMUNITY WORK Dr. Rafael Espada, a cardiac surgeon at the Methodist DeBakey Heart Center, has received the Willie Velasquez Hispanic Excellence Award in the category of “Health and Well Being” from local television stations Telemundo and KTRKTV (Channel 13). Espada was honored for “demonstrating outstanding generosity and humanity and always being ready to lend a hand to the community.”

JANICE FLEWELLING, RN, a clinical colleague at The Methodist Hospital, has been named the Brown Foundation Inc. Outstanding Nurse for 2006. She is the 16th nurse at Methodist to receive this award from the Brown Foundation, which has been contributing to community activities since 1951. A nurse for 25 years, she has authored a number of clinical articles and is responsible for numerous presentations on stroke outreach. As a winner of this award, she will receive a $15,000 prize, part of which she plans to give to charity.

METHODIST NAMED AMONG BEST PLACES TO WORK IN HOUSTON The Methodist Hospital System once again has been named one of the Houston Business Journal’s Best Places To Work in Houston. In HBJ’s sixth annual survey, TMHS is one of 40 Houston companies to make the list, out of 160 companies that submitted survey responses. Winners were chosen as a result of an employee survey regarding work environment, personal growth and development, work practices and other related areas.

Methodisthealth.com Visit the newly redesigned and more comprehensive methodisthealth.com.

Whether you are a prospective patient or simply want to learn more about a health topic, Methodist has made it easier for you to find the information you need. Here are just some of the Web site features you will find: Health library — make our health library your first stop for easy to use health information learn about diseases and cutting-edge treatment options complete with animations, test your knowledge about diseases that could affect you and your family, calculate your target heart rate using our health tools, and much more!

Online registration — schedule your hospital procedure from the convenience of your home.

Appointments and referrals — need a physician? Let us do the work for you. Send us your request for appointment or referral and we’ll handle it for you!

E-Greetings — send a free get-well message to a friend or family member staying at Methodist.

Web nursery — view newborns of your family and friends born at Methodist.

Online job opportunities — search for careers at Methodist and join one of FORTUNE Magazine’s “2006 Best Companies to Work For.”

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VOLUME 4, NUMBER 2 27

Dr. Rafael Espada

Humanitarian award winners show medical practice and charitable se B Y

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From the time he was a young boy growing up in a small east Texas town, Dr. Gene Alford’s family instilled in him the importance of giving back to others, especially the less fortunate.

Now an internationally recognized otolaryngologist and facial

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plastic and reconstructive surgeon at The Methodist Hospital, Alford says he is grateful to possess a skill that facilitates the well-being of others.

“I have been blessed with the ability to change lives,” Alford said. “I don’t view what I do as something I should be praised for. I was given

these skills for a reason — this is the way I am intended to serve my fellow man.”

This approach is exactly the reason why Alford and heart surgeon Dr. Rafael Espada were selected as the first recipients of The Methodist Hospital Humanitarian Award. The

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The esteemed physicians were recognized for their commitment to the highest ideals of medicine and for contributions to the community.

Dr. Gene Alford

w passion for ervice award honors a physician, individual or organization related to Methodist, for significant and continuous work on behalf of people whose health and well-being are at risk.

The esteemed physicians were recognized for their commitment to the highest ideals of medicine and

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for contributions to the community.

Each physician received a stainless steel sculpture representing the uplifting of humanity and a $10,000 grant to be donated to the charity of their choice.

Alford donated his grant to the National Face to Face program, an initiative sponsored by a humanitarian branch of the American Academy of Facial and Plastic Reconstructive Surgeons that provides free medical care to those who suffer from facial deformities caused by birth or trauma.

He has been a physician volunteer for the program since its inception in 1994 and, through the program, has treated 17 domestic violence patients, helping them overcome the physical scars of their past relationships.

Along with his treatment of domestic violence survivors through Face to Face, Alford has performed hundreds of operations to transform head and neck deformities of patients affected by cancer.

He also has made significant contributions abroad. Each June, he and his family travel to Honduras to provide free medical and dental care. He performs surgery under local anesthesia in a small village about 40 miles outside of the Tegucigalpa. They also assist with the construction of new housing, mentor students and help with Bible study groups.

Espada, who is a surgeon with the Methodist DeBakey Heart Center, is a national hero in his home country of Guatemala. He travels there each month to provide free cardiovascular services and medical training. He has performed more than 450 heart surgeries, at no cost to the patients, and has trained more than 20 surgeons there to perform the operations.

“Guatemala is my home country and I saw first-hand the suffering and lack of quality health care,” he said. “I also received free medical education in Guatemala and after training and graduating from Baylor College of Medicine, I felt it was my moral obligation to do everything possible to improve the health of Guatemalan citizens, particularly those too poor to pay for these services.”

While in Guatemala, Espada asked the government to provide space and resources to establish a cardiovascular hospital, and he would provide the funds to run it. Unidad Cardiovascular (UNICAR) was officially opened in 1994, and is equipped with three operating rooms, 25 ICU beds, three cardiac catheterization units and 75 adult beds.

In 2003, UNICAR expanded and was renamed after Espada. The hospital performs more than 600 adult cases per year, but he said much more is in store for the future. He plans to further develop services at UNICAR and create the Guatemalan Heart Institute — joining together the government public health system, the military hospital and the social security systems in Guatemala.

He also is expanding and incorporating residency training and the training of other ancillary health care personnel including nurses and dietitians. “We will become the premier heart care center for Central America,” he said.

Espada donated his grant to AMEGESO, his private foundation in Guatemala, which oversees all donations and allocations of funds for purchasing medical equipment and supplies for UNICAR. The money will be used to equip the hospital’s new heart failure clinic.

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W O R S T

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METHODIST PREPARES FOR A

PANDEMIC B Y

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The question is no longer if, but when will the next major flu pandemic strike.

Dr. Jeffrey Kalina

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With the rise in the global spread of bird flu in wild and domesticated birds, and the ease in which people travel from one continent to another, the question is no longer if, but when will the next major flu pandemic strike.

Although no human infections of bird (avian) flu have been reported in the United States, hospitals and government agencies are preparing for the worst case scenario. The last catastrophic flu pandemic struck in 1918, affecting approximately onethird of the world’s population and killing approximately 50 to 100 million people worldwide.

The reason for the great concern is that bird flu is highly lethal. Of the cases reported to the World Health Organization since 2003, more than half have resulted in death because humans have little immunity to bird flu.

Bird flu is caused by avian influenza viruses (there are several subtypes) that occur naturally in wild birds, rarely making them sick.

Infection can easily spread among birds and can make some domesticated birds, such as chickens and

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turkeys, sick and die. In its current state, bird flu does not transfer easily from birds to humans. Human infection usually occurs as a result of a person coming into direct contact with infected birds or their secretions and excretions.

Human-to-human transfer is even rarer, though a few cases have been reported. So far, infection from human-to-human has not continued beyond one person — but like all viruses, bird flu can mutate, and it already has. Bird flu could change into a form that makes it highly contagious, spreading from person-toperson, creating a pandemic, which occurs when there is an outbreak of an infectious disease that spreads worldwide or across a large region.

Dr. Jeffrey Kalina, associate medical director of The Methodist Hospital Emergency Department, believes that we are due for another pandemic, and he has made it his mission to ensure that Methodist and the Texas Medical Center (TMC) are prepared. Kalina, who chairs the Texas Medical Center Disaster Response Committee, says the committee has developed a comprehensive pandemic flu preparedness response plan to address the logistics of dealing with a large-scale response to the looming pandemic.

Methodist and the TMC are taking this opportunity to implement a comprehensive plan that can be used during any natural or manmade disaster.

“The goal is to develop a coordinated response that can be used for any pandemic or disaster, not just for avian flu,” Kalina said. “Every time something happens — such as Sept.

11 and Hurricane Katrina — we find gaps in the system. For instance, Katrina raised the question of what do we do about medical staff who are the sole caregivers for children or elderly parents. With Katrina, we

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offered day care here at the hospital but we would have to find an alternative if a pandemic broke out.”

The plan is divided into six stages.

The first three stages focus on planning and preparation all the way up to the point when there is a confirmed case of human infection in North America. The last three stages address specific measures that need to be taken by hospitals in the TMC from the time of the first human-tohuman transmission in the United States and/or the Houston area to the recovery period.

Issues such as managing security and restricting traffic in and around the TMC, providing public education about flu hygiene and prevention, and establishing triage facilities are all addressed in the plan. Patients too sick to go home, but not sick enough for hospitalization, will be sent to a large-scale ward facility in Houston and the sickest patients will be sent to the TMC. “Unlike Katrina and Rita, we will not get thousands of patients coming in one day. It will be spread out

over months and we will still have to care for patients with other ailments,” Kalina said. “Hospitals should be reserved for the sickest of the sick.”

Hopefully, we will not have to face a bird flu pandemic or any other disaster in the near future. But if we do — when we do — Methodist and the TMC have a plan.

Dr. Kalina, who chairs the Texas Medical Center Disaster Response Committee, says the committee has developed a comprehensive pandemic flu preparedness response plan to address the logistics of dealing with a large-scale response to the looming pandemic.

BY THE NUMBERS Affected areas with confirmed human cases of avian influenza since January 2006 Azerbaijan Cases: 8 Deaths: 5

Egypt Cases: 15 Deaths: 7

Turkey Cases: 12 Deaths: 4

Cambodia Cases: 2 Deaths: 2

Indonesia Cases: 53 Deaths: 43

As of October 31, 2006 Source: World Health Organization

China Cases: 12 Deaths: 8

Iraq Cases: 3 Deaths: 2

Djibouti Cases: 1 Deaths: 0

Thailand Cases: 3 Deaths: 3

Map and statistical data courtesy of the World Health Organization.

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h esearc r m r o s perf Nurse on: the questi to answer

ent? i t a p r the o f t s e b What’s B Y

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dvanced education programs and training have allowed nurses to create new niches for themselves in research as well as patient care.

Over the last five years, nurses at The Methodist Hospital began conducting formal research. A number of projects currently are under way with the goal of improving patient care and outcomes such as an ambulatory cancer pain management study, which explores the feasibility of collecting pain and other symptom data in outpatient centers across multiple institutions in the Texas Medical Center (TMC). The study examines the prevalence and severity of cancer-related pain and identifies other commonly reported symptoms in the outpatient setting.

Methodist nurse practitioner Anne Bross, MSN, RN, FNP-BC, who serves as a co-investigator, has worked for two years with area hospital nurses to lay the groundwork for this multi-institutional study conducted simultaneously at The Methodist Hospital, Baylor Breast Care Center, M.D. Anderson Cancer Center, Michael E. DeBakey VA Medical Center and Memorial Hermann Hospital.

Over a 12-month period, nurse researchers are asking patients with breast, lung, colorectal and prostate cancer in the outpatient area to participate in the study. Patients who agree to participate are given a questionnaire that asks a series of questions related to the severity of pain, symptoms and how it affects their activities over the course of 24 hours. “This information will be used to narrow the knowledge gap regarding pain and pain management,” Bross said. “It will help us develop improved interventions and patient education.”

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Beverly Lamoth, RN

Anne Bross, MSN, RN, FNP-BC

This is only the second time TMC institutions have joined forces on a study of this nature, she said.

“There has not been a lot of collaboration in the past among nurses but it’s gaining momentum,” she said.

“Networking and sharing best practices is for the betterment of the patient. We are patient advocates.

This is where nursing is going.”

E

vidence of nurses conducting research goes as far back as the 19th century when Florence Nightingale, the iconic nurse who lived and worked in the late 1800s, documented sickness and mortality data in European military hospitals. Armed with factual data, she was able

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to institute a number of health care reforms that dramatically improved hospital sanitation practices and lowered mortality rates.

“Florence Nightingale was the prototype for the nurse scientist,” Ann Scanlon McGinity, PhD, RN, said.

“She observed that patients had fewer infections if caregivers washed their hands.

This helped create clean environments.”

Scanlon McGinity, who is a Methodist vice president and chief nursing executive, said the level of sophistication and advancement of nursing research as a science has expanded greatly. She points to a cultural shift as the impetus for the wealth of research being conducted by nurses.

“Nursing research is a joint effort between academia and clinicians,” she said. “The context is that we must look at quality and patient safety. It is the responsibility of nursing to look at and provide the latest in proven patient care protocols.

“Curiosity leads us to ask questions,” she said. “We raise questions and then study them. ‘Why are we doing this?

Is it the best course of action for the patient or are we doing this because it’s the way we’ve always done it?’ The shift is to evaluate what’s best for patients through broad evidence-based practice.”

She used one common practice to illustrate her point.

She said patients are advised not to eat or drink from midnight on the day of anesthetization (NPO) prior to undergoing surgery. However, people who have been involved in serious accidents are immediately taken into surgery and given anesthesia. She said there is no compelling evidence that shows that the problem of keeping patients NPO is necessary in all situations. This would be a study worth pursuing, as many surgical cases are cancelled because the patient drank a cup of coffee.

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F

unding for nursing research, like that of other disciplines, comes from a variety of sources in the public and private sectors. In 2005, Methodist nurses led nine studies, supported by $765,000 in funding.

Bross’ study is funded by the Houston chapter of the Oncology Nursing Society.

Governmental support dates back to the mid-1940s when the Division of Nursing was established within the Office of the Surgeon General. Federal involvement continued over the next two decades. By the mid-1960s, many academic institutions across the nation began to establish predoctoral and postdoctoral fellowship programs to train independent nurse investigators.

The National Institutes of Health established the National Institute of Nursing Research in the mid-1980s to support comprehensive research training and career development programs to prepare nurses with the requisite skills to conduct nursing research in an interdisciplinary setting. When it was founded in 1986, its annual budget was $16 million. Today, the budget is a robust $138 million.

Advanced nursing education and training is critical to nursing research. The number of nurses obtaining masters and doctorate degrees has doubled over the past two decades. Bross, who has been a nurse for more than 30 years, first obtained an associate nursing degree.

She later returned to school to obtain bachelor’s and master’s degrees.

She echoed Scanlon McGinity’s enthusiasm for evidence-based practice. “We need to base nursing on scientific evidence. We use critical thinking skills. I recommend bachelor’s degree programs to those who are considering nursing as a career because there is a lot you just don’t receive in basic two and three-year programs,” she said.

Although nurses are conducting their own research, it is not performed in a vacuum. “We must form interdisciplinary teams to evaluate what’s best for patients,” Scanlon McGinity said.

A nursing research committee has been established to leverage expertise from The Methodist Hospital Research Institute and the Center for Nursing Excellence.

The committee will formulate developmental and operational plans to expand and further nursing research at Methodist. The ultimate goal is to advance the hospital’s nursing research on a national level.

“Nursing, medicine, physical therapy, respiratory therapy and others must be included to provide insight from that discipline’s point of view. That’s the only way we can determine what makes sense,” Scanlon McGinity said. 䡲 VOLUME 4, NUMBER 2 䡲 33

✚ HANDS-ON MEDICINE B Y

D E N N Y

A N G E L L E

W

elcome to the San Jacinto Methodist Hospital Emergency Department.

Ambulances still screech to a halt outside its doors, people drive themselves here for treatment. Inside, doctors and nurses work at a feverish pace to tip the balance between life and death.

But something is different here — some element is missing, something awry that makes this emergency center different from many others, even the ERs you see on TV. What’s missing are the people waiting, waiting, waiting — to see a doctor, to receive treatment for a minor injury or to be admitted into the hospital, if needed.

The reason why is San Jacinto’s new model for emergency service, designed by the department’s health care team and its lead physicians, Drs. Paul Torre and Amir Rassoli.

When a person comes to the emergency department during peak hours, the first hospital representative that person sees is a doctor-nurse team. A cadre of nurses, physicians and nurse practitioners immediately evaluates patients.

“We put the doctor and nurses up front, right where the person walks in,” explained Torre, the emergency department medical director. “As the person tells us the nature of his or her complaint, we’re diagnosing the problem and beginning treatment right there.”

Many of the individual steps that were taking place before a patient was seen by a doctor have now been combined to speed up the treatment process. “If it’s something like an ankle sprain, we can send the patient for X-rays immediately.

If it’s a complaint that can be treated with medication, we can write the prescription right there,” said Rassoli, the assistant medical director. “As we get the patient’s information, the nurse and doctor are working simultaneously… getting vital signs, beginning treatment. Everything happens virtually at once.”

Since the new process began in June 2005, the doctors say the department has been able to reduce a patient’s time from door to doctor. There also has been a sharp 75 percent drop in patients who leave the emergency department without treatment due to long waits.

34 䡲 VOLUME 4, NUMBER 2

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Dr. Amir Rassoli

S

an Jacinto’s emergency department is the busiest of the four hospitals in The Methodist Hospital System. Torre said they treated 57,000 emergency patients at San Jacinto last year. He estimates they will see around 61,000 in 2006. In contrast, the emergency service at The Methodist Hospital in the Texas Medical Center treated 35,000 patients last year.

“We’re busy, and we’re growing,” Torre said. “We have created a center that is able to treat many people effectively, in a reasonable amount of time.”

Which would seem to be one answer to the state of emergency that Houston’s EDs have been in over the past few months. Many of them have encountered overcrowding issues so severe that the Harris County Hospital District created smaller clinics to treat patients who don’t really need emergency care.

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“The popular misconception is that people who have minor problems create a logjam in an emergency room, but that’s not true,” Rassoli said. “In many cases, overcrowding and delays are caused by a lack of space and resources. But the main cause for delay is that doctors are treating the patients with true emergencies.”

So, freeing up space in the emergency department to treat patients who really need emergency care is an idea whose time has come. Torre said the San Jacinto system increases doctor-to-patient ratio in addition to slicing the wait time for patients.

The two physicians, who met while working in another hospital a decade ago, have formed a company — Emergency Physicians PA — that manages the emergency department at San Jacinto Methodist.

The company staffs the San Jacinto emergency department with five doctors and three physician

Dr. Paul Torre

assistants or nurse practitioners a day, and Torre and Rassoli place themselves in the weekly rotation to treat patients.

“Emergency medicine is handson,” said Rassoli, “which is why it makes sense to put the doctor at the front of the line.”

San Jacinto Methodist Hospital’s emergency department recently received a 2006 Press Ganey Compass Award. The company, Press Ganey Associates, tracks satisfied patients and scores hospital departments on the number of patients who respond favorably to the service they received. The Compass Award is given to institutions that have improved their patient satisfaction scores over the past two years.

“This concept of emergency care will continue to improve patient care and customer service,” Torre said.

“We put patients where they need to be, much quicker than before.” 䡲

VOLUME 4, NUMBER 2 䡲 35

By the Numbers:

Results of the 2006 Leading Medicine magazine survey You, our Leading Medicine magazine readers, were asked to provide feedback on the quality and value of the magazine. Here’s what you had to say.

We always welcome your feedback.

How does Leading Medicine magazine compare to other hospital magazines you read?

Better

67%

Do not read others

21

Same

12

Have you ever shared information from the magazine or a copy of the magazine with a family member or friend?

Yes

87%

No

13

RESPONDENTS

BY AGE 65+

25-34

18-24

35-44 2% 10% 14%

25% 23%

64% of survey respondents were female Articles in Leading Medicine are interesting: Most of the time

80%

Some of the time

20

Articles in Leading Medicine are informative: Most of the time

85%

Some of the time

15

Would you say the majority of articles in Leading Medicine are:

26%

55-64 45-54

Would you say that, overall, the way photos and art are used in Leading Medicine are:

Easy to understand and follow Somewhat easy to understand and follow

80%

71%

Sometimes makes the articles more interesting and easy to understand

Which types of articles would you prefer reading in future issues of Leading Medicine?

29

A mix of both short and long articles

69%

Short, concise articles

27

Longer, detailed articles

Yes

26%

No

74

20

Always makes the articles more interesting and easy to understand

36 䡲 VOLUME 4, NUMBER 2

Have you or a family member or friend ever sought attention at The Methodist Hospital as a result of what you read in Leading Medicine?

87% have shared info from the magazine 4 WWW.METHODISTHEALTH.COM

LEADING MEDICINE

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