Vital Record Your source for health news from the Texas A&M Health Science Center 2015-07-02T13:47:41Z http://news.tamhsc.edu/feed/atom/ Madison Matous <![CDATA[Training tomorrow’s doctors: How to help when the healing stops]]> http://news.tamhsc.edu/?post_type=post&p=23764 2015-07-02T13:45:42Z 2015-07-02T13:00:31Z The College of Medicine has been instructing students on palliative, or “end-of-life” care, the care patients receive for terminal conditions where the goal is to comfort and ease pain rather than to cure, for years. But with the help of students, the college now offers the chance to practice the doctor’s challenging role in such care: Delivering devastating news to patients and their loved ones, and telling patients what comes next when there is no curative path forward]]>

Texas A&M student comforting an elderly patient who just found out that there is nothing more they can do for her except make her comfortable.Twenty or so second-year students, or M2s, sat around four pushed-together tables in a training room at the Texas A&M Health Science Center Clinical Learning Resource Center in Bryan. The air was relaxed but expectant; this was not a test but a training opportunity, and a “rough draft” at that.

The College of Medicine has been instructing students on palliative, or “end-of-life” care, the care patients receive for terminal conditions where the goal is to comfort and ease pain rather than to cure, for years. But with the help of second-year students Charis Santini and Georgina De la Garza, the college now offers students the chance to practice the doctor’s challenging role in such care: Delivering devastating news to patients and their loved ones, and telling patients what comes next when there is no curative path forward.

(You can learn how a real-life caregiving challenge sparked De La Garza’s interest in developing palliative care training, and how she and Santini tackled the challenge, in Part 1 of this series.)

The ground rules were drawn out through the students’ questions. How thorough should their examination be? (A “focused head-to-toe.”) Should they state out loud whatever they’re observing or concluding during diagnosis, so the observers monitoring them on the video feed can assess their history-taking? (Yes.) How long will they have? (Ten minutes.) Their primary concerns were logistical and fact-based.

Dr. Craig Borchardt, assistant professor in the Texas A&M College of Medicine’s Department of Humanities in Medicine and the head of Hospice Brazos Valley, cautioned them that the hardest part of this exercise, and its real-world counterpart, would be dealing with a patient’s emotions and managing their own emotional response. “What you will be dealing with is people who are transitioning from hope to grief,” he told them.

In another training room, Dr. Steve Moore, a hospice volunteer and physician, spoke to another group of M2s about how to deliver news to a terminally ill patient, or to a family member whose loved one has died in the hospital. His advice is a checklist of a dozen or more hard-won truths learned from years of grief counseling, as well as the intimate, personal experiences of loss that separate most of the old from most of the young.

If they are giving notice of a death, “no euphemisms,” Dr. Moore said firmly. “Someone has died. We also need to be culturally sensitive. Not everyone who comes into the hospital and dies is Judeo-Christian. Euphemisms like ‘passed on’ presume a certain range of beliefs and comforts. Don’t make assumptions.”

He ticked off a few more items, and warns against “trying to comfort by explaining what you don’t know”—reminding students they may have to deliver bad news even when they weren’t on scene when it happened. “We don’t always know why people die,” he said. “We may know that they had a particular illness and that they weren’t responsive to a particular medication… But don’t extrapolate beyond what we really know. Don’t make up an answer.”

He told them to locate the box of tissues in the room, and get it before sitting down. “You don’t want to get up and walk across the room after delivering the news.”

A student tentatively raised a hand. “Do we really want to walk across the room and bring the Kleenex back and set it in front of them before we tell them what happened?”

Students laughed, but Dr. Moore doesn’t crack a smile. “I wouldn’t put it in front of them, but I would get it,” he said.

And with that, students paired off and began heading to the examination rooms, where their patient interactions were observed by a team of nurses, chaplains and hospice workers and written feedback was given on their performance.

As students finished sessions in teams of two, they wandered back to the training room, where they waited with those who hadn’t yet completed the scenario. They reported to the mentors on the few bugs several groups seemed to be encountering—where a folder is placed and how it should be used, or running out of time before they’ve even completed their exam. They avoided discussing their patients in detail but shared tips, spoke in small clusters, and swapped impressions.

“She said ‘So I have six months to live?’” said one student. “I didn’t really know how to answer that. ‘Statistically, yes?’”

“I told my patient the prognosis was just a guess,” another student chimed in from a few seats away. “I also told him that you might live longer, and that hospice patients do tend to live longer.”

“That’s good,” the first said.

“My patient was almost more concerned about her husband than about herself,” said Antonio Toribio. “She was so concerned about how he’d react. So I offered to talk to her husband—we set up an appointment for next week, for him to come back with her and I could walk them both through it all, so she wouldn’t have to go home and fight with him about it.”

In the observation room, chaplain Skip Stutts watched a medical student stumble through giving a death notice to a patient’s family member. “How they handle themselves instinctually in this situation is as much about them, the doctor, as it is about the patient.”

Students have to self-reflect to gauge their own emotional and linguistic crutches and compensate for them. They also have to work out the practical mechanics, the rhythm, of delivering bad news—what words to use, in what order, and how and when to offer a comforting touch. Some students talk for so long about the details leading up to the death before even saying the patient had died, it seems as though they’re subconsciously avoiding it. Others blurt it out as they’re sitting down, and then struggle to provide needed detail after the patient has started crying or turning inward.

Although De la Garza and Santini wrote the scenarios, Laura Livingston, who manages the Clinical Learning Resource Center, scripted the emotional responses in broad strokes for the patient actors to interpret. One woman, told the students that her preschool daughter died in the hospital after she’d been told it was safe for her to leave for an hour or two, retreated to a corner of the room and crouched to the floor, sobbing. Watching this scenario several times yielded multiple student responses: some hover, or pace, or sit awkwardly nearby, while others instinctively crouch down next to her, hold her and reestablish eye contact.

“It’s really about overcoming your own boundaries to be there for the person,” one student said afterward. “I don’t personally like a lot of touch, but this isn’t about me. It makes me come a little out of my shell to be there for the person at their level.”

“Each person needs support in a different way,” agreed Sunaina Suhog. “We’re learning to read these things.”

At the end of the exercise, students and patients alike were debriefed, in separate groups. For students, the challenge remained largely technical; they learned a lot today, but the harshest instruction will come when they receive written feedback and review their recorded encounters. Patients’ debrief was largely an emotional check-in; after acting out the same trauma 10 times over in a few hours, Livingston said, “It can take an emotional toll. We have to be pretty careful.”

De la Garza and Santini seemed pleased with the experiment. De la Garza said the exercises were challenging for them, too—they had written so many cases, and there’s a big difference between imagining how you’d like to respond and doing it. They also had no idea how patients would react to the news. “Being there in that room, every reaction is so unexpected,” De la Garza says.

She had come a long way since her grandmother’s death the previous summer. She surveyed the room of students and staff and reflected on what she and Santini had accomplished with the hospice team. Abuela would have been proud. “I believe every physician, regardless of specialty, should be able to determine when they’re doing more harm than good and refer their patients to get palliative care,” De la Garza said. “Everyone deserves to have a dignified death.”

Story by Jeremiah McNichols

Read Part 1 of this two-part story.

]]>
0
Holly Shive <![CDATA[DeTar, Texas A&M break ground on new family medicine clinic]]> http://news.tamhsc.edu/?post_type=post&p=23831 2015-07-01T17:01:31Z 2015-07-01T17:01:31Z DeTar Healthcare System, along with the Texas A&M Health Science Center, recently broke ground on the DeTar Family Medicine Center, where physician faculty and residents will improve the health of the Victoria community. ]]>

DeTar Healthcare System, along with the Texas A&M Health Science Center, recently broke ground on the DeTar Family Medicine Center in Victoria, where physician faculty will train residents and ultimately improve access to health care for community members. The clinic will eventually will be home to 21 physicians, including faculty and residents.

Graduate medical student learns from faculty physician

DeTar and Texas A&M Health Science Center broke ground on the new DeTar Family Medicine Center, where physician faculty will train residents and ultimately improve health for residents of the South Texas community.

“For decades, the land we are standing on housed education facilities,” said William R. Blanchard, chief executive officer for the DeTar Healthcare System. “DeTar is proud to continue that tradition of learning with the opening of the DeTar Family Medicine Clinic, where physician faculty will guide residents in caring for residents of our community.”

Cliff Thomas, Chair of The Texas A&M University System Board of Regents, added his thanks to both the Texas A&M Health Science Center and De Tar Healthcare System. “I’m a native of Victoria and a member of this community, so I know exactly how important this Family Medicine Center will be. Thank you to everyone at DeTar and the Texas A&M Health Science Center who made this innovative approach possible; it will provide long-term benefits to our region and our state and I could not be prouder of this effort.”

The DeTar Family Medicine Center is part of the DeTar Family Medicine Residency Program, a collaboration DeTar entered into with Texas A&M College of Medicine in 2014. The collaboration will address a critical need for primary care physicians in South Texas and will play a key role in the development of a comprehensive physician workforce solution for the state.

“It is always a proud day when Texas A&M can be part of an endeavor that will change people’s lives for the better,” said John Sharp, Chancellor of The Texas A&M University System. “We are honored to join DeTar Healthcare System in helping to improve access to primary care physicians.”

Patients will begin receiving care at the site when the new DeTar Family Medicine Center opens its doors in early 2016. The center will serve as the medical offices for local family medicine physicians, Sidney Ontai, M.D., M.B.A., DeTar Family Medicine Residency program director and assistant professor at the Texas A&M College of Medicine; Edward Nwanegbo, M.D., M.P.H.; and Mark Stevens, M.D., who are both assistant professors at the Texas A&M College of Medicine.

“Throughout the healthcare industry, you’ll find access to primary care physicians tops the list of concerns for providers and consumers,” said Dr. Ontai. “Recent legislative decisions to open more training programs like the one at DeTar are part of the solution, and the foundation of the DeTar Family Medicine Center improves our ability to attract and retain qualified physicians to our community.”

The new clinic is designed to increase access to care with local providers offering care in the DeTar Family Medicine Center at least six days each week.

“Dr. Nwanegbo, Dr. Stevens and I currently see patients each day in our clinic,” added Dr. Ontai. “One of us is always available on Saturdays. This is how we will train the physicians in our tutelage. As physicians, our duty is to care for patients; we must meet them where they are—and that is not always Monday through Friday from eight to five.”

The 7,500 square foot clinic will have 18 exam rooms where physicians provide comprehensive care for the entire family in all phases of life, from birth through the senior years.

Services include:

  • Care for acute and chronic medical problems
  • Care for expectant mothers
  • Well-baby and well-child visits and immunizations
  • School sports physicals
  • Annual check-ups
  • Family planning

In addition to the faculty and residents, the DeTar Family Medicine Center creates openings for two new clerical and three nursing positions.

 

]]>
0
Jennifer Fuentes <![CDATA[Enrichment program opens doors to international collaboration]]> http://news.tamhsc.edu/?post_type=post&p=23814 2015-07-01T13:33:24Z 2015-07-01T13:33:24Z Meet Hessa. There’s not a whole lot this young girl doesn’t do: She’s just as likely to cough or sneeze during appointments as she is to close her mouth in fatigue, hyperventilate, or simply complain of a hurting tooth. Her behaviors help second-year dental students feel more comfortable with practical skills and chairside manner before they begin seeing patients in clinic. There’s one more thing: Hessa is a robot]]>
A student from Princess Nourah bint Abdulrahman University (PNU) College of Dentistry in Riyadh, Saudi Arabia, completes a lab activity during the monthlong enrichment program at TAMBCD in Dallas.

A student from Princess Nourah bint Abdulrahman University (PNU) College of Dentistry in Riyadh, Saudi Arabia, completes a lab activity during the monthlong enrichment program at TAMBCD in Dallas.

Meet Hessa. There’s not a whole lot this young girl doesn’t do: She’s just as likely to cough or sneeze during appointments as she is to close her mouth in fatigue, hyperventilate, or simply complain of a hurting tooth. Her behaviors help second-year dental students feel more comfortable with practical skills and chairside manner before they begin seeing patients in clinic. There’s one more thing: Hessa is a robot.

Hessa, a dental simulator, can be found at the Princess Nourah bint Abdulrahman University (PNU) College of Dentistry in Riyadh, Saudi Arabia, which opened in 2012 and is one of 15 colleges within PNU, an all-female university with more than 50,000 students. At the PNU dental school, Hessa is right at home in bright, state-of-the art clinics and labs replete with state-of-the-art technology, including Moog dental training simulation systems.

Since PNU is a new school, it is still building its patient pool, something that takes time. An established patient base and diverse array of cases is one of the factors that sparked PNU leaders’ interest in pursuing an international partnership with Texas A&M University Baylor College of Dentistry. This way, PNU dental students can be exposed to as many oral conditions and treatment modalities as possible while their own program is in its infancy.

It should come as no surprise that observation in TAMBCD clinics has been a highlight during the four-week International Dental Student Summer Enrichment Program, which started June 1 in Dallas.

“I remember the first day in the oral diagnosis clinic. I was amazed by the amount of different cases I saw, such as pleomorphic adenoma (salivary gland tumors), Stafne bone defect (asymptomatic lingual bone depression of the lower jaw), gunshot cases and bone graft surgery,” says Mehdiya Haider, a fourth-year dental student at PNU and one of 15 participants in the enrichment program. “Every day during rotations I learned something new; all the doctors had their own techniques, and they loved sharing them with us,” she adds. It’s a deviation from Haider’s typical patient base; she, like her classmates, treats mostly fellow PNU students.

Participants’ experiences are not limited to the clinic. They have received lecture and hands-on instruction ranging from ethics to onlay casting, crown and bridge preparation, and mouthguard fabrication. The program represents two years of planning between TAMBCD and PNU, with preparations already in the works for next year, says Dr. Loulou Moore, associate professor in restorative sciences and director of the summer enrichment program. There may be potential to develop a faculty exchange program with visiting professorships.

Hoda Abdellatif, B.D.S., M.P.H., Ph.D., Vice Dean of Students Affairs at PNU as well as an adjunct professor at TAMBCD, helped facilitate planning for the program starting in 2013, shortly after joining the PNU College of Dentistry.

“Such a program will expose the PNU students to learn from the differences in clinical care, dental education and culture at the TAMBCD institution, and it will also create a student network between PNU and TAMBCD dental students,” says Abdellatif. “This is hopefully the starting point for further collaboration between the two institutions.”

The exchange program also offers the chance for dental students to see how disease patterns vary in different areas of the world, says Ebtissam Al-Madi, Ph.D., who is dean of PNU College of Dentistry.

“It impacts dentistry first of all by breaking some barriers, especially with our faculty or students who might think that dentistry is performed differently in the U.S.,” Al-Madi says. “It shows them that dentistry is dentistry wherever you are in the world. It gives them a little addition in terms of seeing the patterns of disease in the States compared with Saudi Arabia,” she added, explaining that the program at TAMBCD may reveal more to PNU students about geriatric dentistry concerns, as the majority of their patient base consists of young, college-age adults. It mirrors the nation’s demographics a whole, as 48.6 percent of the population in Saudi Arabia is 25 years old or younger, according to the PNU dental school website. Al-Madi observes an interesting trend among this population in Saudi Arabia: high rates of dental decay among young adults from high and low socioeconomic groups because of lack of awareness of good oral hygiene coupled with a shift toward diets containing more sugar than in generations past.

Faculty and students agree that the importance of partnerships like the one between TAMBCD and PNU is highlighted as our world becomes increasingly connected.

“This program is an open channel for exchanging knowledge, and it’s good to collaborate,” says participant Tolean Jundieh, who is beginning her third year in PNU’s five-year curriculum. “We are one world now; and there is globalization in all levels, even in dentistry.”

]]>
0
Elizabeth Grimm <![CDATA[When “healthy” is unhealthy: Tips for making the right choice at the store]]> http://news.tamhsc.edu/?post_type=post&p=23276 2015-07-01T13:38:02Z 2015-07-01T13:00:50Z Take a stroll around your local grocery store and it’s evident that healthy is “in.” As the public becomes more aware that overall health starts with what we put into our bodies, food producers and manufacturers have begun marketing their products with enticing labels such as “good source of fiber,” “low fat” and “sugar free.” While these words seem like good indicators that we’re making health-conscious choices, they can also be red herrings]]>

Take a stroll around your local grocery store and it’s evident that healthy is “in.” As the public becomes more aware that overall health starts with what we put into our bodies, food producers and manufacturers have begun marketing their products with enticing labels such as “good source of fiber,” “low fat” and “sugar free.” While these words seem like good indicators that we’re making health-conscious choices, they can also be red herrings.

“It can be frustrating to wade through all of the misinformation about nutrition and selecting healthy foods when you’re at the store,” said Brenda Bustillos, registered dietitian nutritionist (R.D.N.) and doctoral candidate at the Texas A&M Health Science Center School of Public Health. “Many people look at these words and think that they’re making nutritious choices, but sometimes these foods have a better reputation than they should.”

To help you sort through all of those confusing and misleading labels, Bustillos offers the following criteria for evaluating if a “healthy” food is actually nutritious.

A bowl of granola cereal, with berries on top

Even seemingly healthy foods can be loaded with sugar or fats. When deciding if a particular food is healthy or not, look at the nutrition label to see if its contents align with your nutritional goals.

Keep it natural

“When in doubt, the healthiest food is its most natural, least processed form,” Bustillos said. Whenever you can, buy fresh fruit and vegetables to use in your meals.

When considering more processed foods, take a look at the ingredients section.

“The first ingredient listed is the largest component in the product. For example, if the one of first ingredient in a loaf of bread is something like high-fructose corn syrup—even if the packaging claims to be multigrain or something equally healthy sounding—then you know that it’s probably not the most nutritious item on the shelves,” Bustillos explained.

Processed food tends to add a lot of preservatives, like sodium, to extend the shelf life of the product. It’s an unfortunate trade-off, but the more natural (and nutritious) options are more perishable.

For breads and grains, try to look for 100 percent whole-wheat options; these items will have whole wheat listed as their primary ingredient. Take the time to see what ingredients are going into your foods and, ultimately, your body. You may be surprised that the main ingredient isn’t what you think.

Beware of those “healthy” words

It’s hard to walk down a grocery aisle without the phrases “low fat” and “sugar free” jumping out at you. Naturally, we gravitate towards these appealing words, thinking that they’re healthier than their regular counterparts, but these products could be just as unhealthy.

“Usually with products that advertise that they’re low in some undesirable ingredient, the product is subsidized with another ingredient to make it taste the same as the regular option. If you’re not careful, you could be consuming more sugar, fat or sodium than if you’d bought the regular item,” Bustillos cautioned.

Always check the nutrition label

Some foods have received the reputation of being “health foods,” without having any significant nutrition. Always look at the nutrition label of any food you buy, even if you think it’s healthy.

Those energy and protein bars you might pick up to fuel your workouts, or the granola you munch on as a snack, could actually be sugar bombs. Try to select foods with low sugar and sodium content, and avoid foods with high amounts of saturated and trans fats.

Bustillos also recommends keeping an eye on serving sizes. One of the most common mistakes is thinking an appropriate serving is larger than it actually is. This could lead to consuming more than your body actually requires.

“Just because a food is marketed as and believed to be healthy, doesn’t mean it is. Know exactly what you’re buying before putting it into your body,” Bustillos said.

For more tips on selecting the right options at the store and meeting your nutritional needs, visit the Academy of Nutrition and Dietetics’ website or meet with a R.D.N. in your area.

]]>
0
Jennifer Fuentes <![CDATA[Basics of a healthy lunch box]]> http://news.tamhsc.edu/?p=11318 2015-06-19T16:15:55Z 2015-07-01T13:00:22Z Outfit for the first day? Check. Backpack? Check. Lunch box? Check. A nutritious lunch to pack in that new lunch box? Oops. Don’t worry; you’re not alone. But with childhood obesity levels more than tripling in the last 30 years, packing a nutritious lunch is becoming more and more essential, says the Texas A&M Health Science Center College of Nursing. ]]>
healthy lunch

With childhood obesity levels more than tripling in the last 30 years, packing a nutritious lunch is becoming more and more essential.

Outfit for the first day? Check. Backpack? Check. Lunch box? Check. A nutritious lunch to pack in that new lunch box? Oops.

Don’t worry; you’re not alone. But with childhood obesity levels more than tripling in the last 30 years, packing a nutritious lunch is becoming more and more essential.

“Packing a healthy lunch is a great way to provide children with the proper nutrition they need to perform well in school. Unfortunately, lunch boxes are often crammed with prepackaged foods full of calories, sugar and sodium,” says Alison Pittman, M.S.N., RN, CPN, assistant professor in the Texas A&M Health Science Center College of Nursing. “This excess can leave kids feeling lethargic and unmotivated by mid-afternoon and ultimately contributes to long-term health problems like obesity, diabetes and heart disease.”

When packing a lunch, one of the easiest ways to stay healthy is to follow the MyPlate guidelines from the U.S. Department of Agriculture, Pittman says. MyPlate can serve as a guide for packing lunches that taste good and provide the energy and nutrients children need to excel during the school day.

The following are major recommendations from MyPlate that will help you pack a lunch your child will enjoy:

  • Make half of your child’s lunch consist of fruits and vegetables. Have your child help pick out fresh fruits and vegetables at the store or farmer’s market and then help prepare lunch the night before. Preparing lunch may encourage your child to taste what he or she is creating. Kids love to “dip” foods, so try providing a small container of dip such as ranch dressing, peanut butter or hummus.
  • Make sure half the grains in your child’s diet are whole grains. This is becoming easier as more whole grain breads, crackers, bagels and even pretzels show up on store shelves. Try brown rice instead of white rice, or whole grain noodles instead of traditional pasta.
  • Pack water or low-fat, unflavored milk instead of sugary sodas and juice drinks. Pack a water bottle with lots of ice in his/her lunch box so it will still be cool at lunchtime. If you do provide juice, make sure it is 100 percent fruit juice and limit to eight to 12 ounces per day for the school-age child (four to six ounces for preschoolers).
  • Watch the sodium content. The updated USDA guidelines recommend 1,500 milligrams of sodium per day for children. When you consider that most fast food kids’ meals contain over half this amount, it’s easy to exceed this guideline. Foods prepared at home are often lower in sodium (and fat and calories, for that matter) than commercially prepared foods.

“With a little planning, creativity and input from your child, packing a healthy lunch that includes the essential food groups will become more of a routine than a daunting chore for parents,” Pittman says.

For more information, including helpful posters for the fridge, sample lunch and snack ideas, and other tips, visit the MyPlate website.

]]>
0
Jennifer Fuentes <![CDATA[Dentist, surgeon begins new era in treating head and neck cancers]]> https://news.tamhsc.edu/?post_type=post&p=18995 2015-07-01T13:38:55Z 2015-06-29T13:00:34Z Dr. David Kang, assistant professor in oral and maxillofacial surgery, joined Texas A&M University Baylor College of Dentistry as its first head and neck oncologic and microvascular reconstructive surgeon. ]]>

David R. Kang, M.D., D.D.S., assistant professor in oral and maxillofacial surgery, joined Texas A&M University Baylor College of Dentistry as its first head and neck oncologic and microvascular reconstructive surgeon. His job description is complex, but the meaning isn’t lost on patients with oral cancer facing the reality of surgery.

Dr. David Kang is the Texas A&M University Baylor College of Dentistry's first head and neck oncologic and microvascular reconstructive surgeon.

Dr. David Kang is the Texas A&M University Baylor College of Dentistry’s first head and neck oncologic and microvascular reconstructive surgeon.

This dual-trained dentist and physician spent an additional year after his oral and maxillofacial surgery residency to complete a fellowship in head and neck oncologic surgery at the University of Michigan. He returned to Dallas with the in-depth training he needed to not only remove cancerous head and neck tumors but to also reconstruct the entire surgical area with free tissue transfer– providing a critical step in a patient’s return to normalcy following a life-altering diagnosis and treatment.

A multidisciplinary approach to caring for cancer patients is required with various specialists involved in their treatment including radiation oncologists, medical oncologists, pathologists, maxillofacial prosthodontics, anaplastologists, speech therapists, physical therapists and occupational therapists who also specialize in the management of lymphedema.

“Our patients are frequently presented to the Head and Neck Tumor Board, which meets twice a month to discuss treatment options including surgery, radiation therapy and chemotherapy,” Kang said.

Many of the patients Kang treats are dealing with the side effects of radiation – a treatment that, while often effective at combating cancer, is notorious for wreaking havoc on the healthy areas of the body through which it passes. He takes special steps to ensure that his patients’ reconstructions hold up to the radiation that may occur post-surgery.

“In the past, post-surgery radiation treatment led to a decreased quality of life,” Kang said. “But now, with intensity modulated radiation therapy (IMRT), and the ability to harvest vascularized tissue from any area on the patient’s body, we can tailor the reconstruction to the patient’s needs.”

This free tissue transfer approach—or free flap—returns form and function to the patient by using skin, fascia, muscle, nerve or bone tissue to reconstruct any defect, regardless of the size. After microvascular anastomosis, where vessels sometimes less than one millimeter in size are sutured together, the procedure provides immediate blood flow to the reconstructed tissue and allows the surgical site to heal rapidly, allowing patients to begin radiation treatment within four to six weeks. The free flap approach, Kang notes, has become the gold standard in reconstruction of the oral cavity.

In the short time Kang has been at Texas A&M Baylor College of Dentistry, he and his team have treated hundreds of patients with malignant disease as well as trauma, but especially those patients with squamous cell carcinoma. He has also successfully treated extremely rare tumors such as adenoid cystic carcinoma, ameloblastic carcinoma, and mucosal melanomas, not only removing the tumors, but successfully restoring facial aesthetics and function to the oral cavity. While the free flap procedure is impressive, it may not be the ideal choice for all patients, Kang says. With longer operating and hospitalization times, it can be an additional risk for patients with medical comorbidities.

“When a less invasive option is in order for maxillary defects, we will often opt for placement of an obturator, which is very similar to a denture and closes off the defect and restores facial contour,” Kang said. “As with any treatment, we work in collaboration with other health care professionals to find the best treatment plan possible for each individual patient.”

]]>
0
Rae Lynn Mitchell <![CDATA[Behavioral health interventions: The importance of communication and new technology]]> https://news.tamhsc.edu/?post_type=post&p=20642 2015-07-01T13:38:44Z 2015-06-26T13:00:11Z As we move toward a more patient-centered form of health care and physicians begin to focus more on specific patient behaviors it has become all the more evident that patient lifestyle choices contribute significantly to our overall health. ]]>
woman in a doctor's office, being shown a health app on a smartphone by her health care provider

Recent studies show mobile devices as a positive means of collecting information from patients and improving communication between provider and patient.

As we move toward a more patient-centered form of health care, health care providers now are beginning to focus more on specific patient behaviors and how lifestyle contributes to overall health. This makes transparency and effective communication between patients and physicians an essential component to a doctor’s ability to provide quality care.

“Unfortunately, patients as well as doctors can be leery of discussing particular topics they are either uncomfortable with or that are of a sensitive nature,” says Regents and Distinguished Professor Marcia G. Ory, Ph.D., with the Texas A&M Health Science Center School of Public Health. “Some topics may even cause patients to become defensive when questioned about them, such as substance abuse, eating disorders, or mental health.”

Ory notes that clinicians are sometimes reluctant to bring up emotional health issues for fear that they won’t have time to respond. In reality, not dealing with such issues is often counterproductive because anxious or depressed patients often have more trouble managing their health conditions and end up taking more of a clinician’s time.

So how do clinicians bring up need-to-alter behaviors in a way that is motivating and non-judgmental?

This is the question behind new research regarding strategies health care providers can implement to encourage open communication and collaboration with patients.

Marcia G. Ory, Ph.D., regents and distinguished professor at Texas A&M School of Public Health.

Marcia G. Ory, Ph.D., regents and distinguished professor at Texas A&M School of Public Health.

Recent studies have emphasized the use of mobile devices as a means of collecting information from patients. As mobile devices have flooded daily use, they have become increasingly popular as a way to increase patient-physician communication. With the help of new research, these innovative technologies are now being used as a way to collect and analyze patient data securely, define patient goals, create support networks, and monitor health improvement progress.

Recently, Ory,  Yan Alicia Hong, Ph.D., associate professor at the Texas A&M School of Public Health, and several other researchers at Baylor Scott and White HealthCare published an article online in the Journal of Medical Internet Research Mhealth and Uhealth on the use of mobile devices by primary care physicians and their patients. This particular study examined the usability of mobile devices to promote healthy behaviors and chronic disease prevention for such health issues as diabetes and obesity.

In “Using the iPod touch for Patient Health Behavior Assessment and Health Promotion in Primary Care,” researchers concluded that patients were able to complete a health behavior assessment from their doctor’s office using the iPod touch with relative ease. In addition, researchers found that when physicians engaged their patients on the report generated by the assessment, patients were much more likely to put into practice the behavioral changes suggested by their physicians than those who did not. This tool provided patients with the opportunity to engage with their physician in a one-on-one setting, while receiving individualized healthcare suggestions that facilitate effective behavioral change.

“The vast majority of patients found the device extremely user-friendly,” said Samuel N. Forjuoh, Dr.P.H., M.D., Ph.D., the principal investigator of the project. “In addition, the iPod touch minimizes survey response error, is reliable in eliciting sensitive data in a private and confidential manner, provides easy data storage and transportation, and is a promising device to assist behavioral change within a diverse population of varying age groups, genders, ethnicities, and health status.”

The ways through which clinicians practice health care continues to change. Knowing a patient’s behavior patterns and emotional state can create better informed physicians and allow for more individualized care. Whether through one-on-one discussion or through mobile technology, it is important for health care providers to find ways to help patients address their emotional concerns and lifestyle behaviors that can act as barriers to good health and well-being.

]]>
0
Madison Matous <![CDATA[Collaborative curriculum: Students develop palliative care scenarios]]> http://news.tamhsc.edu/?post_type=post&p=23756 2015-07-02T13:47:41Z 2015-06-25T17:51:43Z In the wake of a family crisis with her grandmother, Georgina De la Garza's family turned to her to assess the difficult decisions. Despite a few lectures on palliative care in her first year of medical school, De la Garza was unsure of how to handle such situations. The realization that there was much more for her to learn, for her sake and for the sake of her patients, guided her desire to assist in the development of new experiential training. ]]>

Texas A&amp;M medical student practicing comforting an elderly patient after giving news that there is no more they can do, but keep her comfortable.Georgina De la Garza had only been a student at the Texas A&M Health Science Center (TAMHSC) College of Medicine for a year when she went home in summer 2012 to visit her family in Mexico, but the real world doesn’t always stagger challenges as predictably as licensing exams. She arrived home at a moment of familial crisis: Her grandmother was dying, and the medical director at her hospital was a firm believer in aggressive medical treatment, insisting on lifesaving measures even when they could significantly impair a patient’s quality of life.

“My grandma was suffering, and she told us she wanted to stop all of it, and go home and rest,” De la Garza said. “So we took her home.”

Mexico does not have widespread access to hospice care, and in the weeks that followed, the family turned to De la Garza as the expert who could help them navigate the complex and confusing decisions involved in palliative, or “end-of-life,” care, when goals shift from fighting off the disease to maximizing the patient’s comfort in the last phase of life.

“I was the only one in my family with any medical background,” De la Garza said, but her family turned to her to assess each difficult decision. Should they give her IV fluids? A feeding tube? What about a blood transfusion, if her peptic ulcer started bleeding?

“I wanted my grandma to have a dignified death. I wanted her to be comfortable, and I didn’t want to prolong her suffering,” she said. “But I didn’t know what to do. Was withdrawing fluids and food the humane thing to do? Was a narcotic induced coma to relieve the pain ethical? It was all very hard.”

Despite a few lectures on palliative care in her first year of medical school, she admitted, “I really didn’t know anything about what to do in these cases. My grandma’s disease made me realize I needed to learn more…for my own sake and for the sake of my future patients.”

The next fall, De la Garza asked Dr. Craig Borchardt, an assistant professor in the medical school’s Department of Humanities in Medicine and the head of Hospice Brazos Valley, to mentor her as part of a second-year mentorship opportunity. Dr. Borchardt suggested she work with another student, Charis Santini, who had participated in a summer fellowship program on end-of-life care, to develop palliative care scenarios for students to experience in the TAMHSC’s Clinical Learning Resource Center in Bryan, a simulation lab where students were already using sophisticated equipment to simulate medical emergencies and doctor-patient interactions using mechanical and computer simulations and local actors.

Under Dr. Borchardt’s guidance, De la Garza and Santini spent time between anatomy labs, lectures and study sessions writing scenarios for a pair of exercises. First- and second-year students would have exercises appropriate for their level of training, and each exercise would require dozens of case studies—each a “character” with his or her own case presentation, complicating factors, and personal and family details to script.

The workload was, as Santini put it, “a bit of a challenge,” but also helped reinforce what she was learning in the rest of her classes. “It was a great experience to be able to incorporate everything we had learned in other blocks to develop the cases,” she said.

The first- and second-year students, or “M1s” and “M2s,” each face two distinct challenges in the new curriculum. For first-year students, one scenario involves visiting with and examining a patient and determining whether the patient is actively dying; in the other, they must have a difficult conversation with a patient to help them develop an advance directive.

Second-year students must assess patients’ appropriateness for hospice care, an important distinction for Medicare eligibility and coverage for hospice services. They also face perhaps the most unnerving challenge: Delivering the news to a patient that he or she is dying, or delivering news to a loved one that a patient has died.

Each group also has small-group discussions on separate occasions. For M1s, the focus is on practical topics like pain management, hydration and nutrition, and sedation. M2s discuss ethical issues in palliative and hospice care.

After months of research, writing, reviews by members of the Hospice Brazos Valley team of physicians and nurses, and copious revisions, the students were ready for the next phase of their curricular experiment: Piloting the scenarios with the Bryan-College Station campus’ first- and second-year classes.

“Georgina and Charis will leave a significant legacy in advancing our college’s mission to train students,” Dr. Borchardt said.

All that was left was see if it worked.

Story by Jeremiah McNichols

Read Part 2 of this two-part story.

]]>
0
Rae Lynn Mitchell <![CDATA[Texas A&M researchers confirm value of statewide health and wellness program]]> http://news.tamhsc.edu/?post_type=post&p=23786 2015-06-25T18:20:22Z 2015-06-24T17:01:05Z A team of researchers led by Regents and Distinguished Professor Marcia G. Ory, Ph.D., examines the effectiveness of Texercise Select on physical functioning and quality-of-life outcomes. Researchers collected information on 220 participants 65 years of age and older from eight Texas counties]]>
Older people exercising

The results of the study showed positive improvements in both physical activity and nutrition outcomes.

A statewide program evaluated by researchers at the Texas A&M Health Science Center School of Public Health can help older adults meet their exercise and nutrition goals.

Texercise Select is a free 12-week program for seniors delivered throughout Texas in various locations from senior centers to faith-based organizations. Trained facilitators lead the program that includes education and discussion on physical activity and nutrition as well as 30-45 minutes of guided exercise.

A team of researchers led by Regents and Distinguished Professor Marcia G. Ory, Ph.D., examined the effectiveness of Texercise Select on physical functioning and quality-of-life outcomes. Researchers collected information on 220 participants 65 years of age and older from eight Texas counties.

Participants were surveyed at the beginning of the program and at completion, using a variety of survey methods to collect data on sociodemographics, health indicators, general health status, physical activity, confidence and social support. Additionally, participants completed a Timed Up-and-Go (TUG) test that measures the time required for participants to rise from a standard arm chair, walk at their typical pace three meters, turn, and walk back to their chair and sit down. The TUG test examines functional mobility and predicts fall risk.

The results of the study showed positive improvements in both physical activity and nutrition outcomes as well as objective functional assessments. Participants increased their likelihood of engaging in strength training and flexibility activities more than four-fold. Further, more than two-thirds of participants had improved TUG test scores, indicating decreased risks for falling and other mobility problems. Additionally, participants engaged in healthier eating practices. After being in the program, participants consumed more fruits and vegetables and increased their water consumption weekly. Participants also increased their self-confidence in making good nutrition choices. Those who completed more sessions had the greatest benefits.

Marcia Ory, Ph.D.

Marcia Ory, Ph.D.

As part of this effort, Alan Stevens, Ph.D., of Baylor Scott and White Healthcare, interviewed program facilitators and providers to better understand factors leading to the success of embedding Texercise Select into existing community and clinical settings.

“Programs such as Texercise Select which are rooted in best practices show great promise for positively impacting large numbers of participants and becoming sustained in communities,” Ory said. “Additional attention should be focused on examining the organizational and programmatic factors that facilitate the wide-spread dissemination and sustainability of effective health promotion programs.”

“Although Texercise has a long history of serving seniors in Texas, more efforts like these are needed to see the impacts of lifestyle improvement programs on the lives of older adults,” said Matthew Lee Smith, Ph.D., assistant professor at the University of Georgia College of Public Health, who was part of the research team.

Research findings were recently published in Frontiers in Public Health Education and Promotion, Journal of Aging and Physical Activity, and Translational Behavioral Medicine: Practice, Policy and Research.

Additional researchers from the Texas A&M School of Public Health include Luohua Jiang, Ph.D., Doris Howell, M.P.H., Shuai Chen, M.S., Jarius Pulczinski and Suzanne Swierc, M.P.H.

For more information on Texercise, see http://www.texercise.com

]]>
0