Innovative thinking and the future of health care!

In a world where it sometimes feels better to “stay the course,” it’s both exciting and refreshing to watch a new process unfold.

Led by Winjie Miao, President of Texas Health Harris Methodist Hospital Azle, and supported by a strong cast from the Center for Learning at Texas Health Resources, a small group of intrepid explorers are about to embark on a virtual journey to the future.

This dozen or so employees, representing a wide spectrum of experiences and skills are charged with “future thinking” their way to a new vision of health care delivery by Texas Health. To what model will health care morph, five, ten, twenty years from now? What should it look like? These employees hope to create a vision that will help us get to that reality.

Make no mistake. The future of health care will look much different that it does today, regardless of what is accomplished in the US Congress. As the demographics evolve, we will need to look ahead and be ready for an aging population. Bricks and mortar alone will not get the job done. New structures in health care delivery will need to be created to meet the growing needs of our communities. New ways to enhance disease prevention and disease management will be mandated – failure to do so will result in health care drowning in a sea of acute care needs with no lifeboat in sight.

Starting at the end of this month, this group will begin working on what the next generation of health care delivery will look like. Congratulations to all the members of the team for their willingness to think outside the box. Congratulations to Texas Health for its willingness to support and nurture such innovation.

Now, we would like to hear from you. What do you think the next generation of health care delivery looks like? Leave us a comment!

- Dr. Joe Prosser, chief quality officer
Texas Health Fort Worth
Texas Health Azle

What more can we do to ease our patient's anxiety??

As health care workers, we see many patients that become anxious in the hospital. Whether it be related to a new diagnosis, a disease process, or prior to any procedure, patients may not be able to cope. Essential oils can be very effective in promoting relaxation in patients with anxiety. These highly concentrated oils have chemical properties that can help sooth and relax the body. In the ICU's, we have used single oils or a blend of oils including Sandalwood, Mandarin, Frankincense, Bergamot, and True Lavender. Oils higher in esters, such as Frankincense and True Lavender are known to have calming properties. Studies on True Lavendar have shown to produce sedating effects similar to diazepam, whereas Sandalwood had shown to have an action similar to chlorpromazine.

Patients are given two to three different oils to choose from. Not everyone may enjoy a floral smell like True Lavender. We try to involve the patient in picking out the most suitable oil for them. Essential oils for anxiety have been administered through direct/indirect inhalation and the M® technique. The use of touch by using the M® technique adds an extra calming effect to the oil during application. Again, (as mentioned in previous posts) this can be taught to family to aid in care of their loved ones. What is more calming then light touch by a family member?

Our patients who used aromatherapy in the ICU responded with a decrease in anxiety on a numeric rating scale, expressed a feeling of relaxation, and overall enjoyed the experience. Medications like Ativan and Xanax are commonly used for anxiety, but may have unwanted side effects. Essential oils are a safer way to reduce patient anxiety and also reduce the amount of medication needed to calm a patient. Also, the use of essential oils can be a complimentary option to consider adding to your routine treatment/procedure.

- Erin Munoz, RN, Med-Surg ICU nurse

Red Wine: To Drink or Not to Drink

February is National Heart Health Month…Can red wine help your heart?

The Thought

Many years of research has touted the pros and cons of consuming alcohol, especially regarding heart health. New research has given insight into what the link between red wine and a healthy heart might be, but the real question is, “To drink or not to drink.”

The Research

Antioxidants, such as flavonoids, are generally thought to be one of the main components in red wine that promote heart health. Resveratrol has gotten the most fame for its suspected role, but studies have yet to confirm a heart-protective effect. Resveratrol is thought to help decrease inflammation and prevent blood platelets from sticking together, thus reducing blood clot formation. This, in theory, would decrease the risk for stroke. Resveratrol, among many other antioxidants, is also found in whole plant foods and juices, like cranberries and red grape juice. The jury is still out, however, regarding whether these foods or juices may be equally as helpful in protecting the heart as red wine or other alcohol.

Studies have also shown that alcohol consumption, in moderate amounts, may help slightly raise HDL (“good”) cholesterol, prevent artery damage from high LDL (“bad”) cholesterol and reduce blood clot formation. Studies have not concluded, however, that red wine is the only form of alcohol that can provide such benefits.

The Recommendation

The bottom line with alcohol consumption is moderation. Just because red wine is potentially helpful to heart health, more is not better! In fact, too much alcohol can cause triglyceride levels and weight to increase. Increased risk for high blood pressure, heart failure, stroke and breast cancer are just a few other problems related to excessive alcohol consumption. Moderate alcohol consumption is no more than one drink per day for women and two drinks per day for men. Remember, one drink is not equal to whatever will fit in your glass! One drink is: 12 ounces beer, 4 ounces wine, 1.5 ounces 80-proof spirits or 1 ounce 100-proof spirits.

It is also important to note that the American Heart Association does not recommend that you start drinking alcohol for heart-protective reasons if you do not generally consume alcohol. Remember, nothing is a cure-all or substitute for healthy lifestyle choices such as eating a balanced diet, exercising regularly, not smoking and maintaining a healthy weight! Certain health conditions and medications may contraindicate alcohol consumption. Check with your doctor about whether it is safe for you to drink alcohol.

If you have a question for the dietitian, visit www.texashealth.org/askamy

References

American Heart Association. Alcohol, wine and cardiovascular disease. Available at:
http://www.americanheart.org/presenter.jhtml?identifier=4422. Accessed December 9, 2009.
Ferreira M & Weems M. Alcohol Consumption by Aging Adults in the United States:
Health Benefits and Detriments. Jour Amer Diet Assoc. October 2008; 108: 1668-1676.
Mayo Clinic Staff. Red wine and reseveratrol: Good for your heart? Available at:
http://www.mayoclinic.com/health/red-wine/HB00089/NSECTIONGROUP=2. Accessed,
December 9, 2009.
Peregrin T. Wine- A Drink to Your Health?. Jour Amer Diet Assoc. July 2005; 105: 1053-1054.

Amy Goodson, MS, RD, CSSD, LD
Registered Dietitian
Ben Hogan Sports Therapy Institute
Executive Health Program

Is Obesity a National Security Threat?

According to the Pentagon, 75% of young Americans are unable to serve in the U.S. military due to being physically unfit, not having a high school diploma or having a criminal record. 27% of prospective applicants cannot join because they are overweight; making weight factors the single biggest factor in limiting potential recruits.

Child obesity rates have tripled in the last 30 years. 1 in 3 American children ages 10-17 are overweight or obese. The White House has taken notice and so have many retired admirals and generals who have formed Mission: Readiness. (www.missionreadiness.org)

To add to this impending crisis, our current troops are gaining weight at an alarming rate. The number of troops diagnosed with being overweight or obese has more than doubled since the start of the war in Iraq.

According to a Defense Department study, from 1998 to 2002, 1 to 2 out of every 100 servicemen was diagnosed as overweight or obese. By 2003, nearly 1 in every 20 servicemen was diagnosed as overweight or obese. Stress and readiness for deployment are the most frequent cited reasons for gaining weight.

Obesity issues that affect the general public, such as fast-food restaurants and popular sedentary activities such as video games, are also affecting military personnel.

"Overweight/obesity is a significant military medical concern because it is associated with decreased military operational effectiveness," according to the January edition of the Defense Department's Medical Surveillance Monthly Report.
If the chronic illnesses increase in health care dollars, decreased life expectancy and the other myriad of maladies that affect us with each increasing percentage of obesity don’t get our attention, decreased military effectiveness and increased national security risks should.

What are you going to do to fight this epidemic in our country?

- Tiffany Norris, MSN, RN, BC, PMHNP
Bariatric Nurse Coordinator

Sources: Washington Post, Mission: Readiness.

An experience through the med-surg residency program.

Being a part of the Med-Surg Residency was a really interesting experience for me. I got to see all of the med-surg floors at Texas Health Fort Worth and as I rotated through the floors I got to bring my experiences from the previous units with me.

Through the residency program, I was exposed to a lot of different opportunities that I might not necessarily have received if I had just hired on to one specific unit. I was able to see an actual kidney transplant from before the surgery, through the surgery and even the monitoring that occurs after the surgery on the unit. I was able to take care of patients receiving chemotherapy, patients with chest tubes, ones that had recently had strokes and patients before and after all different types of surgeries.

As much as I enjoyed working in all of the different units by the end of the year of rotating I was more than ready to have a home on a specific unit. Even though there were a lot of really great units none of them really felt like home for me and I was a having a difficult time trying to decide which unit to apply for.

Palliative Care was suggested to me as a unit that I should apply for. I was skeptical at first because I wasn’t too sure what palliative care was and the 7-70 schedule was something that was completely new to me. However, I thought that it was an interesting concept and thought that I would apply for the unit. Once the unit opened I realized that I had truly found my home. I love the Palliative Care Unit and know couldn’t imagine working anywhere else. We really strive for excellent patient care and with the overlap we have more opportunities then most units to concentrate not only on our patients physical needs, but also on our patients’ and their families emotional and spiritual needs, as well.

All the staff really work together to try to give our patients the best possible experience at a really difficult time in their life. Another great bonus is the fact that we work really closely with Dr. Mathe and the Nurse Practitioners and are able to easily communicate with them when we need something.

- Ashley Hodges, RN
Palliative Care Nurse

End-of-Life Care - a Learning Opportunity

“I must have missed that course in school.”

Whether we are referencing seminary, social work school, nursing school, or medical school, there are some career experiences that leave us feeling like we must have missed something. Staring into the faces of a family that is struggling with decisions about end-of-life care is one of those situations. As human beings who are nurtured by families and communities, we have developed some basic skills that help us respond when a neighbor or a stranger is grieving. We know we should be kind to them, express sympathy, and offer to help. Our extensive advances in medical technology, however, have left some patients and their families trapped in difficult “in between” territory. A human being who in days past would have died in the natural course of a disease process can now be kept alive by machines, medicine, and around-the-clock nursing interventions. That person can be kept alive far beyond his or her ability to appreciate or enjoy life.

You and I are often the people these patents’ family members look to for guidance amid these emotional and moral quagmires. Responding to their searching stares with inspiring clichés or just more technical information proves unhelpful. This is true because the ethical and religious mazes of these dilemmas are mixed in with longstanding family dynamics and the messy landscape of anticipatory grief with all its sadness, guilt, and anger.

“Was I sick the day we had this lecture?”

If that’s how you sometimes feel when you care for people in these predicaments, this year’s Faith Community Leadership Summit is one you cannot afford to skip. You will hear from clinicians who courageously lead patients and families through the humbling and holy encounter with dying. They will teach from both their personal experiences and state-of-the art research. If you feel like you missed out on a piece of training when confronted with these situations, this is make-up day. Don’t miss it.

Register today here! . For more information, please call 817-703-8432.

- Timothy Madison, PhD, BCC
Chaplain Manager
timothymadison@texashealth.org

Red, Red, Red!

What are you doing to beat heart disease? Check out this fun video about beating heart disease and "Going Red." Hope it inspires you!

http://www.youtube.com/watch?v=UjHz-ErKqlg

Please share this video with others!

Happy Heart Month and don't forget to wear red on Friday (National Wear Red Day).

Saving lives in the church congregation!

I would like to share with you an amazing story from a faith community nurse that really emphasizes the difference a faith community nurse can make in a congregation.

Here is her account:

“Several Sundays ago I was sitting in my official parish nurse pew, when a congregant came rushing into the service, up the aisle and grabbed me by the shoulder. She whispered in my ear.. 'Quick, I need help in the parking lot!' As we left the sanctuary I realized I had nothing with me... No watch, no phone, no blood pressure equipment and I was not sure what I was walking into. Because I had worked with this woman and her husband I knew he had a cardiac history. So, as we rushed passed a minister I said 'please call 911 and have an ambulance sent. I want no sirens.' I figured I could always call and cancel the ambulance but I had a gut feeling that we were walking into a bad situation. I made it to the car in the lot to find a disoriented man babbling on about double vision. I could counted a rapid thready pulse and observed that he was more pale than usual. I assessed for signs and symptoms of a stroke. He was not outwardly demonstrating any signs other than double vision and flat affect. Our other nurse and a paramedic met me in the parking lot. They brought all the necessary equipment AED, blood pressure cuff and phone. The firemen arrived and assessed the man and we agreed he needed to get to a hospital. Final diagnosis.. brain stem stroke! He was in church this Sunday to tell the story! He does remember me talking to him and having trouble with his vision but nothing else. He has a slight hitch in his gait but NO other residual. The doctor says this was amazing and credited his recovery to rapid medical response. Because the other nurse and myself see him in our blood pressure clinic each month, we had the knowledge to project forward and anticipate what could possibly be his problem, even without overt symptoms. The faith community nurse program is a valuable asset to the community.”

Not every faith community nurse will have an experience like this but every one is making a difference in the lives of the people in their congregations and the community. They do this by taking blood pressures, visiting with home bound members, those recently discharged from the hospital, holding the hands of those who are grieving over the loss of a loved one or a member who has just received a diagnosis of a terminal illness. Faith Community nurses are there for all the stages of life.

Faith Community nurses are knowledgeable, caring and able to advice and direct individuals to appropriate health care facilities. They also offer spiritual, emotional, and physical support, if they don’t have the answer, they will pursue the question until they get answers.

If every faith community had a faith community nurse we would indeed see health care reform , because we would be tending body, mind and spirit.

For more information on faith community nursing, please click here

- Paulette Golden, RN, community health manager and faith community nurse coordinator

Emotional Eating and How to Gain Control Over It

First of all, what is it emotional eating?
Emotional eating can be defined as eating in response to feelings rather than to true hunger.

Emotional eating is common in our society. We eat to celebrate, we eat to mourn, we eat when we are tired, happy, sad, anxious and often, when we are bored.

So, what is the solution?

The first step is to determine what causes the triggers of your emotional eating.

Stress is a frequent trigger for out of control eating. If you know you tend to overeat when you are stressed then you can plan for it. Learn from your past experiences. Plan to have healthy snacks available during these stressful times.

Maintaining a balanced diet and healthy life style is a great defense against emotional eating. If you always eat breakfast then you will have the energy and reserves to tackle your job demands. Munching on your favorite comfort food can make you feel better physically and relieve the stress that you are feeling temporarily. If you skip breakfast, then become too hungry during the day, your body will go into survival mode and your food choices may not be as wise as when you have planned ahead.

Another great defense against emotional eating is physical activity. Taking a walk (outside if the weather allows) will help to relieve some stress and get you out of the environment of eating. Exercise can also improve your mood and give you more energy. (This is what emotional eating may be trying to do).

Maybe a specific food or situation is the trigger for your eating. If you identify a certain food that gives you problems, then don’t have that food around. If possible, avoid places where that food is available. Unfortunately you can’t always do this.

One of my favorite solutions (to many different types of nutrition related questions, not just emotional eating) is to keep a food diary. (Yes, I can hear you moaning). Food journals may seem tedious but with just a little work and planning they can provide insight and solutions that, normally, are not obvious. Food journals are great tools. They can be very simple. Keep a record of what you eat, when you eat it, and how you are feeling at that time.

After a few days, your answer may be obvious.

- Jaime Bass, RD, dietitian for the Bariatric Program at Texas Health Fort Worth

What do the airline industry and health care have in common?

There’s a short video making the rounds that compares health care to the airline industry, looking at data and information sharing. Click here to watch this short video:

It’s humorous, and worth watching. Sadly, it’s also very true. In this time of extreme high-tech capabilities, the ability of health care workers to access or share information about a patient continues to be sorely lacking. Does it matter? Yes it does and it is something our hospitals are working on fixing for you the patient. A few short examples below are scenarios that can be resolved through a meaningful use of the electronic health record and hospitals who are focused on improving coordination of care:

1. A female patient enters your emergency department with abdominal pain. She notes that the symptoms are similar to a spell she had six weeks ago, while she was visiting her mom out of town. At that time, she went to the urgi-center and underwent numerous xrays and blood tests, and was told that she could go home. You, the doctor, cannot access those records, since the urgi-center only uses paper charts. As a result, you will need to perform studies that are potentially unnecessary.

2. A man enters your emergency room after a motor vehicle accident that had occurred the prior day. He had gone to another hospital and underwent numerous CT scans. Now, due to persistent discomfort, he has come to your hospital for a “second opinion.” Your electronic record does not “talk” to the electronic record at the other hospital, so you cannot access the results of the CT scans. Your next step, after your physical exam of the patient, is to duplicate the studies.

3. An elderly patient is admitted with pneumonia. You order a pneumococcal vaccination. Since you cannot access the patient’s office records, you don’t realize that he received the vaccination only four weeks ago.

Cost, excess radiation exposure, pain and suffering, wasted time, delayed diagnoses…yep, it matters. That is one reason our hospital is working to make health care more human again and reducing the pain, waiting and improving coordination of care for our patients.

Hopefully, the national focus on the meaningful use of electronic medical records will reduce the likelihood that the scenarios suggested above will perpetuate into the distant future. It’s about time we got serious over this issue. I hope we have the willpower and the backbone, as a society, to seize the electronic data sharing opportunity and use it to improve the lives in the communities we serve.

- Dr. Joe Prosser, chief quality officer

Welcome to Harrisville!

Some people call Texas Health Fort Worth Harris Hospital a small town since its grown so much. Along with this hospital growth, so do the opportunities for you to explore while you’re here. Click HERE for a map to “Harrisville,” population 4,023 (number of employees) who are here to serve you. Listed below are some places to consider the next time you’re “passing through” our town.

As a town, our picturesque park would be the Morris Meditation Garden. It’s a beautiful place to get away without having to. The park entrance is by the Heart Center entrance. Open every day during daytime hours.

As a town, our family diner is the brand new Cramer Café which offers something for everyone and it’s no “greasy spoon.” Fresh sandwiches, salad bar, Italian, hamburgers, taco bar, soups, and more. The café is located by the Bloxom Tower with the main serving hours between 7:00 AM – 8:00 PM.

Our local place of worship is highlighted by the Castleberry Memorial Chapel. From the Richardson Tower elevator go to the Plaza Level and behind the elevator is the chapel’s entrance.

Our newly renovated library is here to help with medical research and offers internet access. Go up the escalator from the ground floor of the Harris Tower. Keep veering right past the elevator. Open daily Monday – Friday, 817-250-3191.

No town is complete without a general store. The 5th Avenue Gift Shop offers flowers, magazines, gifts, and snacks and is located on the Ground Level of the Richardson Tower. Open daily with a smile, 817-250-3024.

Our “town square” is in the Klabzuba tower, the separate building just a few steps south of our Emergency Department which offers numerous opportunities to improve your health on the ground floor:
• The Cancer Resource Library & Consumer Health Information Center has a large selection of books to consider along with internet access.
• The Healing Arts Center offers 4 types of massages, clinical aromatherapy, and reflexology. 817-820-4839
• Cancer Boutique and Resource Center helps cancer survivors with many specific needs. 817-820-4861

Parking can be an issue for any town so if you’re planning on staying a few days, Standard Parking Company located on the ground floor of the Harris Professional Center offers discounted parking tickets for the visitor’s garages, 5 tickets for $10.00, 817-250-7885.

Our “bank” (which means ATM machines) are located in the Jones Tower lobby by the west entrance doors and also in the Emergency Department lobby.

These are just a few things to see in our “town.” Like any town, what makes it special are the people who are here to welcome you during your stay.

- Craig Pomykal, patient advocate

Meet Mr. Nichols

Mr. Michael Nichols, senior vice president of Freese and Nichols, was making one of many bi-monthly trips to the company’s corporate office in Fort Worth, Texas. Since he’d been trying to get back in shape, he thought it would be a good idea to visit the Executive Health Program at Texas Harris Methodist Hospital Fort Worth while in town.

He knew he needed to make some changes in his diet, so he decided to end his habit of drinking Mountain Dew two months before his appointment. Boy, did that decision change his life!! After going through the first screening, Mr. Nichols returned for a second appointment and doctors discovered he had a very low heart rate. The caffeine he had been drinking made it appear that he had a normal heart rate.

After learning of his naturally low heart rate, Mr. Nichols was immediately referred to a cardiologist and within 30 minutes had made the decision to have a pacemaker implanted. He had this done only three days later!!! Thanks to Texas Health Fort Worth’s Executive Health Program, he has returned to his home in Austin, Texas and has returned to his normal life (now a healthier life) with his family and friends!

- Nikki Hall-Branch and the staff at the Executive Health Program

Out with the Old…Rejuvenate with the New!

Cleaning Out the Kitchen

It’s a New Year…time for a new, fresh and healthy you! This year as you clean out the closet, pack up the holiday decorations and clean your house, don’t forget to clean out your kitchen and replace old foods with new, fresh, whole foods that are nutrient-rich. Nutrient rich foods are those that have more vitamins, minerals and nutrients per bite.

So where do you start? Let’s start with the pantry. Throw away canned foods, vegetables and fruits that are out of date or are loaded with sodium and sugar. Replace with fresh or frozen vegetables that are less processed and thus higher in fiber. Next, throw out all the open bags of chips and snack foods. Replace these snacks with 100% whole wheat crackers and pretzels, nuts and dried fruit. Finally take a look at your cereal selection. Do you have boxes of rainbow-colored or frosted cereals? If so, throw those away and replace with whole grain cereals like Kashi®, All Bran®, Total® and Wheaties®. Also, make sure to add some hot cereal like oatmeal to your morning ritual. Oatmeal is full of fiber and B vitamins which is a nutrient-rich breakfast choice!

Next take a look at the refrigerator. Start by removing all foods that are out of date. Take a look at your dairy selection. Do you have choices like low-fat milk, 2% cheese and yogurt? Dairy foods are rich in calcium, potassium and a great source of protein. Throw out your sugary yogurts and try low-fat Greek yogurt; it is much higher in protein and has no added sugar. Next look at your snack choices. If your refrigerator and freezer are full of pudding, ice cream and frozen desserts, replace them with fresh fruit, 100% fruit bars and yogurt smoothies. The replacement choices are full of vitamins and minerals. Finally make sure your refrigerator has a rainbow of vegetable colors. Vegetables are great snacks with hummus or avocado which can quickly be mixed in salads or casseroles or added to sandwiches and wraps.

It is important that you don’t waste food. If you have unopened, non-perishable goods, consider donating them to a local food pantry. Make a New Year’s resolution to rejuvenate your kitchen with fresh, nutrient-rich foods!

If you have a question for the dietitian, visit www.texashealth.org/askamy

Amy Goodson, MS, RD, CSSD, LD
Registered Dietitian
Ben Hogan Sports Therapy Institute
Executive Health Program

RSV-three very scary letters for parents of premature infants.

What is RSV?
RSV stands for respiratory syncitial virus. It is a very common virus in the community from November through March of every year. In most people, infection with RSV results in annoying, but not life-threatening cold. In infants and small children, especially those who were born prematurely, infection with RSV can be much more serious.
Is RSV different in premies?
When RSV infects a premature infant, the virus has a tendency to settle in the small air passages in the lungs called bronchioles. The result is bronchiolitis, characterized by lots of swelling and mucous production in the air passages. This inflammatory process can cause severe coughing, wheezing, and trouble breathing. In infants in the first few months of life, RSV can also cause apnea or cessation of breathing. This is an extremely serious complication that can result in death if not detected.
What can you do to protect yourself and your family?
As with most viruses that cause colds and coughs, RSV is found in nasal secretions. It is easily spread from person to person. When an infected person coughs or sneezes, they send virus containing droplets into the air. These droplets can infect others if they are inhaled or come in contact with the mouth, nose, or eyes. Transmission can also result from direct contact with nasal secretions, kissing the face of a child with RSV for example; or indirect contact with the virus on an environmental surface like a doorknob. If an uninfected person touches the doorknob, then rubs his eyes or nose, he can easily become infected.
How can RSV be prevented?
There is no effective vaccine to prevent RSV, but there are some simple, cheap, and effective ways that people with cold symptoms can keep from spreading RSV.
1. Cover your mouth and nose when you cough
2. Wash your hands frequently with soap and water for 15-20 seconds.
3. Avoid sharing cups and eating utensils with others
4. Refrain from kissing others when you have cold-like symptoms
Frequent cleaning of contaminated surfaces like doorknobs, computer keyboards and telephone handsets can also reduce transmission.
There is a drug call palivizumab (Synagis) that can help prevent severe RSV infection in those at highest risk for complication including very premature babies, babies with serious heart disease, children with weakened immune systems. Palivizumab consists of antibodies against the RSV virus. It is given as a shot once a month during RSV season. Your health care provider can tell you if your child would benefit from this drug.

- Dr. Fran Lynch, MD, Neonatologist

MRI help...

Hi Yvonne,

Saw your comment and thought I would give you my personal email and I would help navigate your journey.

Please email me at: whitneyjodry@texashealth.org

I would be happy to help you and get your questions answered.

Sorry for your troubles.

- Whitney Jodry