Vital Record » Medicine Your source for health news from the Texas A&M Health Science Center Tue, 24 Nov 2015 23:05:05 +0000 en-US hourly 1 Fast Facts: What you should know about Chagas disease Tue, 24 Nov 2015 23:05:05 +0000 Chagas disease, also known as American trypanosomiasis, is a potentially life-threating condition transmitted by triatomine bugs, or “kissing bugs.” While Chagas disease is more prevalent in the tropics and Latin America, Texas state health officials are concerned about its recent emergence in Texas]]>

Chagas disease, also known as American trypanosomiasis, is a potentially life-threating condition transmitted by triatomine bugs, or “kissing bugs.” While Chagas disease is more prevalent in the tropics and Latin America, Texas state health officials are concerned about its recent emergence in Texas.

 1. What is Chagas disease?

 Kissing bugs (or the triatomine bug)—aptly named for the region they bite (around the eyes and mouth)—carry the parasite Trypanosoma cruzi (T.cruzi), which causes Chagas. The disease is known as a “silent killer” because the infection can remain dormant in the bloodstream for decades. However, around 30 percent of people with the disease may eventually suffer from serious cardiac or intestinal complications.

2. How is it contracted?

 Transmission is mostly due to a bite from the triatomine bug or “kissing bug.” Kissing bugs become a vector for Chagas after they feed on an animal or person infected with the T. cruzi parasite. At night, they become active and feed on human blood. Kissing bugs normally bite an exposed area of skin, such as the face and then defecate close to the bite. T.cruzi parasites enter the body when a person instinctively smears the bug feces into the bite, the eyes, the mouth or into any skin break. T.cruzi can also be spread through:

  • consumption of food contaminated with T. cruzi through contact with infected triatomine bug feces,
  • blood transfusion from infected donors,
  • passage from an infected mother to her newborn during pregnancy or childbirth,
  • organ transplants using organs from infected donors, and
  • laboratory accidents

3. What are the symptoms of Chagas disease?

 Chagas disease presents in two phases: the acute phase and the chronic phase. Both phases can be symptom free or life threatening.

The acute phase lasts for the first few weeks or months of infection. It usually goes unnoticed because it is symptom free or exhibits only mild symptoms and signs that are not unique to Chagas disease. The symptoms can include:

  • fever
  • fatigue,
  • body aches,
  • headache,
  • rash,
  • loss of appetite,
  • diarrhea,
  • and vomiting.

The signs on physical examination can include mild enlargement of the liver or spleen, swollen glands, and local swelling (a chagoma) where the parasite entered the body. The most recognized marker of acute Chagas disease is called Romaña’s sign, which includes swelling of the eyelids on the side of the face near the bite wound, or where the bug feces were deposited or accidentally rubbed into the eye. Even if symptoms develop during the acute phase, they usually fade away on their own, within a few weeks or months. Although the symptoms resolve, the infection will persist if left untreated.

During the chronic phase, the infection may remain silent. However, some people develop:

  • cardiac complications, which can include an enlarged heart (cardiomyopathy), heart failure, altered heart rate or rhythm, and cardiac arrest (sudden death); and/or
  • intestinal complications, which can include an enlarged esophagus (megaesophagus) or colon (megacolon) and can lead to difficulties with eating or with passing stool.

The average life-time risk of developing one or more of these complications is about 30 percent.

4. Can it be treated?

There are two approaches to therapy, both of which can be life-saving:

  • antiparasitic treatment, to kill the parasite; and
  • symptomatic treatment, to manage the symptoms and signs of infection.

 Antiparasitic treatment is most effective early in the course of infection but is not limited to cases in the acute phase. In the United States, this type of treatment is available through Centers for Disease Control and Prevention (CDC). Your health care provider can talk with CDC staff about whether and how you should be treated. Most people do not need to be hospitalized during treatment.

 Symptomatic treatment may help people who have cardiac or intestinal problems from Chagas disease. For example, pacemakers and medications for irregular heartbeats may be life saving for some patients with chronic cardiac disease.

5. What should I do if I think I have Chagas disease?

You should discuss your concerns with your health care provider, who will examine you and ask you questions (for example, about your health and where you have lived). Chagas disease is diagnosed by blood tests. If you are found to have Chagas disease, you should have a heart tracing test (electrocardiogram), even if you feel fine. You might be referred to a specialist for more tests and for treatment.

6. How do I keep kissing bugs out of my home?

 Kissing bugs typically live in the cracks of poorly constructed homes in rural or suburban areas, but they are also found beneath porches, between rocky structures, in wood or brush piles, and in outdoor dog houses and kennels or chicken coops.

 Long lasting insecticide treated bednets and curtains have been show to kill these bugs. In the United States, a licensed pest-control operator should be consulted if considering the use of insecticides around the home. Roach motels or other “bait” traps do not work against kissing bugs.

Experts stress if a kissing bug is found in your home you should never handle it with your bare hands.

Other precautions to prevent a house infestation include:

  • Sealing cracks and gaps around windows, walls, roofs, and doors
  • Removing wood, brush, and rock piles near your house
  • Using screens on doors and windows and repairing any holes or tears
  • If possible, making sure yard lights are not close to your house (lights can attract the bugs)
  • Sealing holes and cracks leading to the attic, crawl spaces below the house, and to the outside
  • Having pets sleep indoors, especially at night
  • Keeping your house and any outdoor pet resting areas clean, in addition to periodically checking both areas for the presence of bugs

To learn more about how to safely identify kissing bugs visit This site features an interactive map on their whereabouts in Texas and posts updates and precautions associated with kissing bugs and Chagas disease.

For more information about Chagas disease, visit these fact pages from The Centers for Disease Control and Prevention and The World Health Organization.

Scott Lillibridge, M.D., is a professor at the Texas A&M Health Science Center School of Public Health and deputy principal investigator and chief scientist for the Texas A&M Center for Innovation in Advanced Development and Manufacturing. Dr. Lillibridge is a 30-year veteran in medical and public health preparedness who previously served as founding director of the Centers for Disease Control and Prevention Bioterrorism Preparedness and Response Program and also worked as Special Assistant to the Secretary for the U.S. Department of Health and Human Services. Dr. Lillibridge served as Medical Director of the U.S. Office of Foreign Disaster Assistance. He currently serves on the Institute of Medicine’s Health Threats Resilience Sub-Committee, offering expertise in refugee health and civil conflict, biodefense and bioterrorism, public health preparedness and response, and global health and development. He also serves on the Texas Task Force on Infectious Disease Preparedness and Response, which was created in response to the Ebola outbreak in the U.S.

Featured image credit: Gabriel L. Hamer

]]> 0
Innovative colorectal cancer screening program meets quality standards Tue, 24 Nov 2015 14:43:13 +0000 New research from the Texas A&M Health Science Center indicates that colonoscopy in a family medicine residency met or exceeded recommended quality standards set forth by the American Society for Gastrointestinal Endoscopy and was therefore, comparable to those of specialists]]>
Providing colonoscopy training to family medicine resident physicians increases access while maintaining quality care

New research from the Texas A&M Health Science Center indicates that colonoscopy in a family medicine residency met or exceeded recommended quality standards set forth by the American Society for Gastrointestinal Endoscopy and was therefore, comparable to those of specialists.

In the U.S., relatively few primary care physicians perform colonoscopies, and only a fraction of family medicine residencies train residents to conduct colonoscopies, though trust in a primary care physician is associated with patients adhering to Colorectal Cancer (CRC) screening compliance. CRC usually results from malignant transformation of polyps, unwanted growths that over time, develop into cancerous cells. Approximately 28 million Americans are not up to date on colorectal screenings though CRC remains the second most common cause of cancer mortality for both men and women combined.

Through an innovative partnership between the Texas A&M College of Medicine’s family medicine residency program and the Texas A&M School of Public Health, with funding from the Cancer Prevention and Research Institute of Texas (CPRIT), increased access to affordable colonoscopies for underinsured or uninsured residents was made available while providing colonoscopy training to family medicine resident physicians. Targeting seven counties in central Texas, six of which are rural, a total of 1155 colonoscopies were performed over a 3-year period supervised by four board-certified family physicians. Polyps were discovered in 275 people and 11 cases of cancer were found, nine of which were rural residents.

CPRIT funding enabled the Texas A&M Family Medicine residency program to purchase equipment needed for training. The Texas A&M School of Public Health was responsible for grant administrative requirements and outreach to inform community members and health care providers about the available services. The partnership resulted in about 50 clinical partners who keep an eye out for patients who might need colorectal screenings. Over 200 community partners such as churches and social service agencies helped get the word out about the availability of the free colorectal screenings and bilingual community health workers were employed to provide culturally relevant community outreach and patient navigation services.

Expanding Access to Colorectal Cancer Screening: Benchmarking Quality Indicators in a Primary Care Colonoscopy Program,” published this month in the Journal of the American Board of Family Medicine, reports quality indicators from colonoscopy procedures performed by family medicine physicians met or exceed the American Society for Gastrointestinal Endoscopy standards.

“It is our hope that this program will serve as a national model for reducing the incidence of colon cancer, as well as incorporating cancer prevention, screening and education into family medicine residency training programs,” said David McClellan, M.D., an assistant professor of family and community medicine in the Texas A&M College of Medicine and co-PI on the project.

The Centers for Disease Control and Prevention estimate that CRC-related mortality can be reduced by 60 percent if age-eligible adults adhere to screening recommendations.

“Since primary care physicians are more likely to practice in rural and less affluent areas than their specialist counterparts, training and equipping primary care physicians to perform colonoscopies should be explored as means of increasing colonoscopy capacity, especially among underserved populations,” said Jane Bolin, Ph.D., J.D., B.S., professor at the Texas A&M School of Public Health and co-PI on the project.

Other members of the Texas A&M research team include Chinedum Ojinnaka, M.B.B.S., M.P.H., Robert Pope, M.D., Katie Pekarek, D.O., Andrew Richardson, M.D., Janet Helduser, M.A., and Marcia Ory, Ph.D., M.P.H.

]]> 0
College of Medicine researcher elected Fellow of the American Association for the Advancement of Science (AAAS) Tue, 24 Nov 2015 14:41:28 +0000 Samba Reddy, Ph.D., R.Ph., professor of neuroscience and experimental therapeutics and National Institute of Health (NIH) CounterACT Investigator at Texas A&M Health Science Center College of Medicine, has been recognized as a Fellow of the American Association for the Advancement of Science (AAAS)]]>

Samba Reddy, Ph.D., R.Ph., professor of neuroscience and experimental therapeutics and National Institute of Health (NIH) CounterACT Investigator at Texas A&M Health Science Center College of Medicine, has been recognized as a Fellow of the American Association for the Advancement of Science (AAAS). Reddy earned this prestigious honor on account of his scientifically and socially distinguished efforts to advance science and its applications. Since 1962, only 26 other current or former Texas A&M faculty members have been inducted as AAAS Fellows.

Reddy is honored by AAAS specifically for “pioneering contributions to the field of pharmacology as exemplified by sustained discoveries of substantial impact in medical/pharmaceutical sciences.”

Reddy helped discover many preclinical models, novel mechanism-based treatment strategies, and successful “first-in-class” medicines for complex brain disorders such as epilepsy, brain injury and chemical neurotoxicity. His work for the past two decades has contributed greatly to fundamental understanding of epilepsy neuroscience. His translational research has resulted in exceptional advances in the field, including two lead compounds advancing into the clinical stage. Reddy also introduced the neurosteroid replacement therapy for epilepsy. In addition, his invention of specific neurotoxic countermeasures has national significance in the biodefense field.

“I am honored to be elected to the rank of an AAAS Fellow. The success of innovative therapies for epilepsy made in my lab has truly been a team effort with many of my talented younger colleagues,” Reddy said, who has received many scientific awards for his career, including the coveted Fellow title from the American Association of Pharmaceutical Scientists (AAPS) in 2014.

Reddy earned his pharmacy and doctorate degrees from Kakatiya University and Panjab University in India. He spent three years at the NIH as a Postdoctoral Fellow and six years at North Carolina State before joining Texas A&M in 2008.

“Congratulations to Dr. Reddy on this achievement to be an AAAS Fellow. This is a truly fantastic honor. We are very proud of him and thank him for all he do for us and society,” said Karan Watson, Ph.D., provost and executive vice-president of Texas A&M University.

“It is highly gratifying to have Dr. Reddy receive this high honor bestowed by AAAS, one of the most prestigious scientific organizations in the world,” said Paul Ogden, M.D., interim senior vice president for the Texas A&M Health Science Center and interim dean of the College of Medicine. “The Fellow designation is a well-deserved recognition for his exceptional academic accomplishments. I heartily congratulate Dr. Reddy and commend him for contributing to Texas A&M’s excellence in research, teaching and service.”

The 2015 class of AAAS Fellows will be formally announced in the “News & Notes” section of the November 27 edition of the journal Science. Reddy will be inducted as an AAAS Fellow and presented with an official certificate on Saturday, February 13 at the 2016 AAAS Annual Meeting in Washington, DC.

To learn more about the American Association for the Advancement of Science, visit

]]> 0
Healthy legs: Preventing circulation problems on the job Fri, 20 Nov 2015 15:23:48 +0000 Our legs go under cover as the weather turns colder – but that doesn’t mean you shouldn’t give them a second glance this fall and winter. Symptoms of poor circulation normally begin with your legs. Here’s why “getting your blood going” is so important for your health]]>

Our legs go under cover as the weather turns colder – but that doesn’t mean you shouldn’t give them a second glance this fall and winter. Symptoms of poor circulation normally begin with your legs. Here’s why “getting your blood going” is so important for your health.

According to Ruth Bush, M.D., J.D., M.P.H., vice dean for academic affairs and professor of surgery at the Texas A&M Health Science Center College of Medicine, there are many reasons behind poor circulation, and luckily, a lot of healthy ways to combat it—especially on the job.

Don’t be chained to your desk

“Working at a desk all day gets a bad rap, and for good reason,” Bush said. “Sitting for extended periods of time has been linked to heart disease, high blood pressure, obesity, poor posture and more. Sitting in the same position for hours, like in a chair where the body is bent at the hips and knees, can block blood from getting back to the heart, and may even cause your legs to become swollen.”

But, even if you stand most of the day that doesn’t mean you’re out of the woods.

While standing desks are a popular way to fight the sitting epidemic, Bush said the goal shouldn’t be for a person to stand all day – instead, focus on not sitting for the majority of the workday.

“Standing desks are great for posture, but even people who stand should remember to take breaks,” she said.

To prevent poor circulation, Bush suggests leaving the desk and walking around periodically–about every 45 minutes. “This is a good chance for you to say hello to co-workers, grab coffee or use the restroom,” she said. “These breaks give both your mind and body a reprieve.” She said propping your feet up throughout the day will also increase circulation.

Planes, trains, automobiles and veins

Traveling and long commutes to work have become a norm, but sitting for hours on end in planes, trains and automobiles causes more than jet lag and stiff limbs.

Deep vein thrombosis (DVT), also known as economy class syndrome, is the development of a blood clot in the deep veins of your thighs or calves, which can result in muscle pain, swelling, tenderness and redness.

“These kind of clots are not usually dangerous unless the clot travels to your lungs causing a pulmonary embolism resulting in chest pains, trouble breathing and in extreme cases death,” Bush said.

To guard against deep vein thrombosis, follow these tips on your next long trip:

  • Wear travel compression socks, which can help blood flow and prevent clotting
  • Get up and walk around at least every two hours, whether that means getting up to go to the bathroom, to stretch your legs when the plane is cruising, or stopping at a gas station for a snack
  • Drink plenty of water and avoid alcoholic and caffeinated drinks that are dehydrating

In the same vein–spider and varicose veins

Sitting or standing all day at work–whether you’re traveling or not has another unwelcome side effect: spider veins and varicose veins

Spider veins are the less serious version of the condition and merely a cosmetic annoyance, but varicose veins are bigger and can be painful.

Varicose veins are defined as abnormally enlarged veins with faulty valves. When these valves fail to work, blood tends to pool, causing increased pressure and stretching of the veins–giving them a ropy appearance.

Working women love their high heels, however, this fashion choice could be a mistake in the long run. High heels can contribute to the risk of developing spider veins by forcing the ankles to bend forward and restrict blood flow to the legs. This doesn’t mean you can’t ever wear high heels, but women who wear them daily may want to consider giving their legs a much-needed break.

Surprisingly, Bush found another working group susceptible to the development of varicose veins at an early age: Deployed soldiers and combat veterans.

“At the United States Department of Veterans Affairs (VA) hospitals, we found young veterans who were oversees in Iraq and Afghanistan developed this condition early,” she said. “This could be because they often wore heavy gear–up to 100 pounds of equipment.”

This is the same reason that people who are overweight or are pregnant are more at risk, because the increase of weight on your legs increases the volume in your blood vessels.

To help reduce your risk of developing varicose veins, Bush recommends exercising, eating healthy and maintaining an ideal weight. “When you exercise you are squeezing those muscles and as they are contracting they are pumping blood back to your heart, which improves your blood flow in your legs.”

“It doesn’t matter if you work a desk job, travel the world for a living, or are on your feet all day –we all need to be aware of the symptoms and consequences of poor circulation. ‘Getting your blood pumping’ is more than just an old adage, it’s a healthy living practice,” she said.

]]> 0
Palliative care: Putting power in the hands of patients Tue, 17 Nov 2015 19:48:41 +0000 Sometimes there is no cure. In these instances, palliative care offers a different type of treatment and communication, and is revolutionizing the health care landscape by promoting a holistic, patient-focused model with the potential to drastically lower industry costs]]>

When it comes to advance care planning, patients should be in charge of what they want in terms of quality of life and treatment. Palliative care is beginning to transform the health care environment by promoting a holistic, patient-focused model with the potential to drastically lower industry costs.

Also known as comfort care, palliative care helps relieve symptoms associated with a chronic illness, such as cancer, cardiac disease or Alzheimer’s. Palliative care teams—which may include specially trained physicians, nurses, social workers and others—provide an extra layer of care for people facing serious health issues. The ultimate goal is to surround patients and their families with resources needed to assist with decision-making, and keep patients home and out of the hospital, while maintaining quality of life.

“Palliative care puts the power back into the hands of patients and allows them to be in control of their treatments,” said Craig Borchardt, Ph.D., assistant professor in the Department of Humanities in Medicine at the Texas A&M Health Science Center College of Medicine and president and CEO of Hospice Brazos Valley. “Palliative care seeks to slow the pace of the decision making process, giving patients time to think through treatment options related to chronic illness.”

In 2014, the Institute of Medicine called for a major reform to end-of-life care and the effects are already being seen. Thanks to a new Medicare rule that takes effect in January, physicians and other qualified health care professionals will now be reimbursed to discuss end-of-life wishes with Medicare patients. “This is an important development for advance-care planning,” Borchardt said. “It has the potential to prompt more physicians to engage patients in these discussions about their preferences much earlier in the disease process, perhaps before an illness progresses to a terminal diagnosis.”

Statistics show some 28 percent of Medicare dollars—an annual $170 billion—are spent during a patient’s last six months of life, often on futile treatments that lead to suffering. Borchardt believes palliative care teams will aid in eliminating repetitive emergency room visits and hospital stays—a significant reason why medical costs are skyrocketing. If palliative care were fully penetrated into the nation’s hospitals, total savings could amount to $6 billion per year.

“If a patient has a crisis at home, the palliative care team will be called instead of rushing the patient to the hospital,” Borchardt said. “As we move toward providing care in the home, this will lower insurance payments and reduce hospital stays.”

“The palliative care model will be integral as health care moves toward getting people out of the hospital faster,” he added. “If we can focus on providing quality care outside of these settings it will be much more cost-effective for both the patient and insurer.”

Worth noting, Borchardt believes in the current health care arena, insurance companies will be looking to maximize reimbursements and cut their costs. “Palliative care will be looked at heavily because of the potential savings,” he said.

According to Borchardt, palliative care could also provide an extension of care for physicians and lower the amount of time patients spend in the doctor’s office. “Palliative care teams can provide an extra set of eyes and ears for physicians and assist in the development of care plans to reduce patient visits to primary care offices. This allows patient-care to be more focused without necessarily having to be in a doctor’s office all the time,” he said.

As the health care arena continues to change, palliative care has the unique opportunity to enrich communication channels in the medical field. “Palliative care will build teamwork in health care and break down the silos we practice in,” Borchardt said. “The system at times is dysfunctional because physicians often don’t communicate with each other. Palliative care can bridge these gaps between physicians and their patients.” While it’s an attractive option for health care reform, many worry about the specialty’s future.

There is already a national shortage of palliative care physicians (between 8,000 to 10,000) and demand will likely grow as the number of Americans 65 and older increases (projected to reach 88.5 million in 2050, according to the Department of Health and Human Services’ Administration on Aging) and the number of people living with chronic conditions continues to climb.

“A growing body of medical research documents the benefits of palliative care—for patients, families, hospitals, payers and the health care system as a whole—but we must have a sufficient number of health care professionals trained to provide such care,” Borchardt said.

That’s why many medical schools, including the Texas A&M College of Medicine, are including palliative and hospice care within their curriculum.

“Our students are taught hospice and palliative medicine in a variety of ways,” Borchardt said. “Years one and two consist of lectures and exercises with simulated patients in the Clinical Learning Resource Center (a simulated learning hospital), in which students must break bad news to simulated patients facing death.

“In the third year, students round with hospice and palliative physicians, visit patients in their homes—including nursing homes and assisted living facilities—and fourth years may take an elective in palliative medicine where they complete a two-week palliative and hospice rotation as a member of a palliative care team.”

Borchardt believes palliative-care training is crucial for medical school graduates. “Integrating palliative medicine into the medical school curriculum provides an early opportunity for future physicians to grasp the concept of patient-centered medicine, as well as the understanding that the role of being a physician is to take care of the patient,” he said. “Sometimes that means curing the patient; when a cure is not possible, it means healing the patient through palliative care.”

“Palliative care has the ability to cut costs and help patients have better access to all their resources,” Borchardt said. “It has become a vehicle to help patients access all the medical resources at their disposal, while proving beneficial for all parties involved. I think we’ll begin seeing palliative care integrated into routine care more and more.”

]]> 0
New CDC study: Nearly half of U.S. women gain too much weight while pregnant Fri, 13 Nov 2015 17:02:13 +0000 For many pregnant women, the old adage “eating for two” may not be the best advice to follow. A new CDC study found nearly half of U.S. mothers gain too much weight during pregnancy. Is it time for moms-to-be to replace eating “twice as much” with eating “twice as healthy?”]]>
pregnant woman

Is it time for moms-to-be to replace eating “twice as much” with “twice as healthy?”

For many pregnant women, the old adage “eating for two” may not be the best advice to follow. A new CDC study found nearly half of U.S. mothers gain too much weight during pregnancy. Is it time for moms-to-be to replace eating “twice as much” with eating “twice as healthy?”

“In a perfect world, each patient would be told at their first visit how much she should gain and how most of that weight gain occurs in the latter half of pregnancy,” said Ingrid Brown, M.D., FACOG, clinical assistant professor at the Texas A&M Health Science College of Medicine, a board certified OB/GYN and fellow of the American College of Obstetricians and Gynecologists.

Results of the study concluded only a third of women gain the recommended amount of weight, and a fifth gained too little weight. Overweight and obese women were most likely to surpass the guidelines.

Researchers at the CDC’s Division of Reproductive Health examined birth certificates from almost three million women in 46 states and the District of Columbia, in order to determine the mothers’ height and weight before and after their pregnancies. Their research found the number of women who gained too much weight was higher in almost every single state.

According to Brown, most women don’t gain excessive weight in the first trimester but that doesn’t mean it won’t happen later. “Pregnant women need to be cautious about their eating habits and exercise regularly to manage weight gain,” she said.

Women should consume extra calories while pregnant, although not too many – only about 350-450 more during their second or third trimester. The American Congress of Obstetricians and Gynecologists recommend women with a normal body mass index gain 28 to 40 pounds during pregnancy. According to the guidelines, overweight women should gain 15 to 25 pounds and obese women should only gain 11 to 20 pounds. Women who are underweight should gain 28 to 40 pounds.

Being underweight increases the risk the baby will be born very small while too much weight can lead to obesity and other health problems in the mother. Excessive weight gain also raises the risk for the baby to become obese or diabetic.

The CDC authors say it’s never too early for health care providers and their pregnant patients to begin keeping track of weight­–it’s better for mom and for baby.

]]> 0
Interprofessional Education: More than learning together Thu, 12 Nov 2015 18:32:19 +0000 Chances are that if you’ve been treated in a hospital lately, you’ve experienced the help of a health care team. Physicians, nurses, physician assistants and pharmacists probably all played a role in making sure you received the best possible outcome. The Texas A&M Health Science Center ... ]]>

Chances are that if you’ve been treated in a hospital lately, you’ve experienced the help of a health care team. Physicians, nurses, physician assistants and pharmacists probably all played a role in making sure you received the best possible outcome.

The Texas A&M Health Science Center is working to make sure its graduates are as well prepared as possible to work with each other – and won’t have to learn this team work, “on the fly,” when they reach the hospital setting. It’s an approach called Interprofessional Education (IPE)-where students from different professions learn with, from and about each other. It’s more than just putting students from different professions in a room together, it’s a comprehensive approach to education.

The Health Science Center even has a 27,000-square-foot, realistic hospital setting with the latest tools and technology to enhance that learning. It’s called the Clinical Learning Resource Center (CLRC), and it’s a space for medical, pharmacy, public health, veterinary, and nursing students to interact with simulated patients and mannequins before entering a hospital setting with real patients, human and animal.

By moving beyond the profession-specific educational efforts, and engaging students through interactive learning with each other, students are prepped for the ever-changing health care landscape, a place where health care professionals will work increasingly in team settings.

The rising cost of health care and an increasingly precarious physician shortage (the Association for American Medical Colleges (AAMC) says the nation will face a shortage of between 46,000-90,000 physicians by 2025), is making the team approach not only best for the health care system, but best for the patient.

“While part of our student’s education occurs in the same room and same simulated experience, what we really want to do is change the way our graduates think about team medicine and how they approach and embrace the concept of the team approach,” said Regina Bentley, R.N., Ed.D., CNE, associate dean for Academic Affairs and Accreditation at the College of Medicine.

“We’re also working to break down any stereotypes students have of other professions so they enter the workforce both ready and willing to work together,” Bentley stated. “Each of our academic programs have accreditation requirements for interprofessional collaboration. It is imperative that we educate our students in this manner.”

Bentley is uniquely suited to lead IPE efforts at the College of Medicine as she has been a registered nurse for forty years and an educator for 32 years. Currently, in collaboration with nursing, the medical students are receiving the Fundamental of TeamSTEPPS Training program of which Bentley and Jerry Livingston, R.N., Ph.D., assistant professor, (also a nurse employed by the College of Medicine) are both Master Trainers. This is a well-researched evidenced based team training program which provides the students opportunity and knowledge of practicing in a team.

In a recent simulated scenario, nursing and medical students practiced IPE to deliver a healthy baby boy and reacted to the mother’s uterine hemorrhage that required an emergency hysterectomy.

“I’ve learned that every moment is filled with opportunity, and it’s what I do with those opportunities that define the outcome of my actions,” said Patty de Veyra, a nursing student in the class of ’16. “There was no barrier between the two professions, and they definitely made the team stronger.”

“The number one cause of sentinel events—ending in death or serious injury not related to the natural course of patient illness—is a lack of communication and leadership,” explained Shelley White-Corey, RNC, WHNP, a clinical assistant professor in the College of Nursing. “Study after study supports the conclusion that practicing as a team results in better communication, so we are really dedicating a great deal of effort to teach this correctly–because its more than a theory–we’re doing everything we can to save lives.”

The Institute of Medicine agrees, saying “it is clear that how care is delivered is as important as what care is delivered.” And that “developing effective teams and redesigned systems is critical to achieving care that is patient-centered, safer, timelier, and more effective, efficient, and equitable.”

It would seem like a pretty logical approach to medical education: teaching students together who will one day work together. But this hasn’t always been the case, and it’s more complex than just practicing scenarios together. IPE has often been defined as enhanced collaboration, where each professional’s contribution is equally valued.

Increased use of technology (simulations, web-based education, e-health), communities of practice, and funding initiatives for clinical education have helped expand the established use of IPE.

While IPE is becoming more and more common in the CLRC, Texas A&M also hosts one of the largest disaster simulations in the country. Aptly named “Disaster Day” this event brings together medical students, nursing students, pharmacy students and even students from the College of Veterinary Medicine and Biomedical Sciences. Also, Blinn College nursing and EMT students have participated. It is an event that not only serves as an excellent IPE training ground, but provides great data to improve IPE research.

The Texas A&M Health Science Center is now partnered with Baylor College of Medicine on a National Institutes for Health (NIH) grant. The intent of both schools is to transform curriculum to reflect an ideal balance in content among behavioral, biomedical and social sciences. Gaps in the behavioral and social sciences discovered the “hidden curriculum’s” significance, referring to the informal interactions among students, teachers and residents. Specific aims of the grant are related to IPE. Members of the grant from Texas A&M are from both the College of Medicine (Lori Graham, Ph.D., principle investigator and Courtney West, Ph.D., co-investigator) and from the College of Nursing (Karen Landry, Ph.D., co-investigator). The team created three instruments based on IPE competencies to evaluate team based collaborative care during the annual disaster day event and measure IPE communication, roles and responsibilities, values and ethics, teams and teamwork.

“The development of interprofessional education requires moving beyond these profession-specific educational efforts to engage students of different professions in interactive learning with each other,” West said. “Being able to work effectively as members of clinical teams while students is a fundamental part of that learning.”

The intention was to frame interventions as “relationship-centered,” where, rather than marginalize the hidden behavioral and social sciences, faculty are actively looking for constructive hidden curriculum that shapes the teacher-student, teacher-teacher, and student-student interactions. The model of the study now includes health professionals, other health care providers and public health. Both Baylor and Texas A&M have sought to discover strengths in each school’s efforts and to share those to benefit both institutions.

“In the end, we are doing this for the patient,” Bentley explained. “By starting with professionals’ education, the foundation are building through fundamentals, we are helping our graduates to give the best care possible to patients and improve the health care system.”


]]> 0
New mammogram recs: What you should know Mon, 09 Nov 2015 15:18:50 +0000 How different are the new breast cancer screening guidelines issued by the American Cancer Society? Texas A&M professor of radiology explains what the new guidelines say about when women should start having yearly mammograms]]>

In October, the American Cancer Society (ACS) updated its guidelines for when women at average risk should be screened for breast cancer. These new recommendations are less straightforward than past versions, resulting in confusion among the press, physicians and women.

In the past few weeks, you might have seen stories in the media about how these new guidelines “urge later, less frequent mammograms,” or “recommend fewer mammograms.”

The new guidelines are being portrayed as a departure from previous versions that recommended women start getting mammograms at 40. An article in The New York Times said:

that women with an average risk of breast cancer start having mammograms at 45 and continue once a year until 54, then every other year for as long as they are healthy and likely to live another 10 years.

But, the new guidelines are clear on the benefits of beginning yearly mammograms at 40. The difference is how the American Cancer Society has described its recommendations, and that’s what’s led to this confusion.

What has changed in the ACS guidelines?

The previous ACS recommendation, issued in 2003, for annual mammographic screening starting at age 40 was based on extensive research showing that mammography screening results in significant breast cancer mortality reduction for women age 40 and older. The 2003 guidelines stated this in a clearer way than the new guidelines do.

The new guidelines state that women age 40-44 with an average risk of breast cancer should have the opportunity to begin annual screening (this came with qualified recommendation) and that women should undergo regular screening mammography starting at age 45 (with a strong recommendation).

That can make it seem like the ACS says that women can delay having mammograms until they are 45, but let’s take a closer look at what a “qualified recommendation” means. In ACS-speak, that means there is “clear evidence of benefit of screening but less certainty about the balance of benefits and harms” and that “the majority of individuals in this situation would want the suggested course of action.”

In translation: the ACS does not recommend abandoning beginning mammography screening at age 40. Their findings suggest that the majority of women would and should choose this option and be screened annually starting at age 40. The difference is that the new guidelines leave women under 45 to weigh benefits and harms. So let’s take a look at what they are.

The benefits of mammography screening

Breast cancer is the most common cancer among women worldwide and the leading cause of premature mortality among women in the United States. In 2015, approximately 231,840 women will be diagnosed with breast cancer and 40,290 women will die in the US alone. Mammography screening has resulted in a significant reduction in breast cancer mortality.

Contrary to press reports, breast cancer incidence rises sharply at age 40, not age 45. The breast cancer incidence rate for ages 40-44 is twice that for ages 35-39 and life-years lost to breast cancer is the same or higher in the 40-44 age group than any other five-year period over the age of 54.

Mammography screening has consistently been shown to significantly reduce a woman’s risk of dying from breast cancer, though the amount of benefit varies depending on the design of the study.

The best way to see how mammography works is to actually use it in large populations of individuals. This has been done extensively in Europe and Canada. The most recently reported large scale observational trial in Canada, the Pan-Canadian Study, included more than 2.7 million women. It showed that mammography screening decreased breast cancer mortality by 40%. This was true of all age groups. Estimates of breast cancer mortality reduction for women who are actually screened are 48% reduction in case control studies and 38% reduction in cohort studies. Use of mammography also results in a substantial reduction in late-stage breast cancer (37% decrease).

Overall, women age 40 and older who choose mammography screening can expect to decrease their chance of dying from breast cancer by about 40%.

Risks of mammographic screening

The main risk of having a mammogram is that a woman may be called back to evaluate something further. This occurs for about 10% of women screened annually. The majority of the time, this means a few extra images or an ultrasound, nothing more. About 1%-2% of women will be recommended to have a biopsy, which usually can be done by needle biopsy (a minimally invasive technique).

Overdiagnosis, which is the detection of a tumor that would not have affected a woman clinically, is likely very low. Studies that suggest large amounts of overdiagnosis fail to account for tumor lead time and underlying cancer incidence rates.

And reports suggesting that invasive tumors might not need treatment are incorrect. Invasive breast cancer will be lethal if left untreated. For the low amount of overdiagnosis that actually exists, the issue is ductal carcinoma in situ (DCIS), in which the tumor cells are confined to the ducts in the breast. High-grade DCIS behaves similarly to invasive disease but there is debate about how aggressively to treat low grade DCIS.

Comparing benefit and risk

Overall, women need to weigh the benefits of decreasing their chance of dying of breast cancer against the possible harms of being recalled for additional imaging and the small possibility of having a needle biopsy. For most women the benefits outweigh the risks.

False positive rates are similar whether a woman starts screening in her 40’s or in her 50’s, but the lifetime risk of having a false positive is higher if screening is started at a younger age because the woman will have more mammograms over a lifetime.

Similarly, older women can decrease false positives by having every other year mammograms but they will sacrifice some of the mortality reduction benefit. The new ACS guidelines also address this, saying that women age 55 and older should transition to screening every other year, or have the opportunity to continue yearly mammography (with a qualified recommendation, with the same definition noted above).

Data suggests that annual screening from age 40-84 gives a 40% mortality reduction while the new ACS recommendations would result in a 33% mortality reduction. The United States Preventative Services Task Force (USPTSF) draft recommendations suggest screening only women age 50-74 every other year would result in a 23% mortality reduction. These differences in mortality reduction from yearly screening to alternate year screening translate into thousands of lives.

Debra Monticciolo, M.D., is a professor of radiology at the Texas A&M Health Science Center College of Medicine and chair of the Breast Imaging Commission of the American College of Radiology.

This op-ed originally appeared in The Conversation

]]> 0
How do environmental toxins affect the heart? Mon, 09 Nov 2015 14:00:09 +0000 What impact do environmental chemicals have on heart health? A new Texas A&M study seeks to find out, and in turn, help United States Environmental Protection Agency (EPA) make decisions on which chemicals to regulate and how. ]]>

Gloved hand holding up toy heart, background shows chemicals. Even though the World Health Organization (WHO) estimates that up to 23 percent of the global burden of cardiovascular diseases—the leading cause of death worldwide—can be attributed to environmental chemicals, we really don’t know much about these substances.

David Threadgill, Ph.D., a university distinguished professor in the Department of Molecular & Cellular Medicine at the Texas A&M Health Science Center, had been thinking about the problem and possible ways to approach the research, so when the United States Environmental Protection Agency (EPA) put out a call for proposals to study toxicity using “organoids,” three-dimensional organlike structures grown in cell culture, he and his collaborators jumped at the opportunity. An organoid has multiple types of cells, just like a real organ does, but it lives entirely within a dish and it is far easier to use for chemical testing. They are thought of as a kind of bridge between conventional, single-layer cell cultures and whole-animal systems.

Together with his long-term collaborator, Ivan Rusyn, M.D., Ph.D., professor of veterinary integrative biosciences at the Texas A&M College of Veterinary Medicine & Biomedical Sciences (CVM), Threadgill was awarded a $6 million grant by the EPA to fund a multi-institutional collaboration to study how heart cells react to different chemicals. The long and growing list of substances used in industry that get into the environment was what prompted the EPA to seek research that would study their toxicity. Without this information, the EPA cannot make good decisions about which substances to regulate, let alone how. This lack of regulation could turn out to have major public health implications if it is later discovered that the chemicals are harmful.

“Some of us had already been thinking about organoids and how we could use those as sensors for environmental chemicals,” said Threadgill, who is also a professor in the Department of Veterinary Pathobiology at the CVM, “and we decided to focus on cardiotoxicity, because we knew that the heart is the organ second-most (after the liver) influenced by toxins, but the one that we know least about.” Threadgill had some experience looking at cardiotoxicity in drug studies, but this was the first time he applied those techniques to chemicals in the environment—and very few other people have either. Methods for assessment of cardiac safety of non-pharmaceutical agents are lagging behind the traditional health hazards of concern to human health.

Recent advances in using stem cells to develop models of functional cardiac muscle cells has led to new prospects for simulating complex chemical outcome pathways in the beating heart. Threadgill’s lab will use induced pluripotent stem (iPS) cells to create little beating organoid “hearts” in culture, with iPS cells coming from 100 different strains of the animal model—creating variation similar to what you would see in the human population.

“We’re looking at population-level exposure,” Threadgill said. “Does everyone respond the same way, or are some people more sensitive?”

Threadgill will then test what happens to the rhythm of the organoids’ “heartbeat” after they are exposed to the nearly 200 environmental chemicals. Those chemicals that seem to have cardiotoxicity will then be tested in the actual animal models, an approach called in vitro to in vivo extrapolation modeling. If they match, that would give the researchers confidence that the data they get from cell cultures is valid.

“What we hope to be able to show—which has never been formally proven—is that all of this effort to use cultured cells or very simple systems to screen for toxicity is informative for what happens in the whole animal, with its very complex systems,” Threadgill said. “If it is indeed the case that it is predictive, we will have much greater confidence in the results coming out of cell-based research.”

Meanwhile, Rusyn will be working with human iPS cells from about 100 different adult donors to test the same chemicals, but since he can’t go back and compare his results to tests done in the donors, he will rely on Threadgill’s animal models to validate his results.

“We hope to be able to screen for a large number of chemicals that we’re all being exposed to all the time,” Threadgill said, “and the goal would be to be able to do this in cultured cells or organoids, which would be a much quicker and more efficient way of going about it.”

The other principal investigator on the project is Fred Wright, professor of statistics at the Bioinformatics Research Center at North Carolina State University (NCSU), who will be doing the computational modeling for the project.

]]> 0