Texas Medical Center Research Articles

Laryngeal mask placement in a teaching institution: analysis of difficult placements.

Laryngeal mask airway (LMA) placement is now considered a common airway management practice. Although there are many studies which focus on various airway techniques, research regarding difficult LMA placement is limited, particularly for anesthesiologist trainees. In our retrospective analysis we tried to identify predictive factors of difficult LMA placement in an academic training program. This retrospective analysis was derived from a research airway database, where data were collected prospectively at the Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA, from 2008 to 2010. All non-obstetric adult patients presenting for elective surgery requiring general anesthesia, were enrolled in this study: anesthesiology residents primarily managed the airways. The level of difficulty, number of attempts, and type of the extraglottic device placement were retrieved. Sixty-nine unique Laryngeal Mask Airways (uLMAs) were utilized as a primary airway device. Two independent predictors for difficult LMA placement were identified: gender and neck circumference. The sensitivity for one factor is 87.5% with a specificity of 50%. However with two risk factors, the specificity increases to the level of 93% and the sensitivity is 63%. In a large academic training program, besides uLMA not been used routinely, two risk factors for LMA difficulty were identified, female gender and large neck circumference. Neck circumference is increasingly being recognized as a significant predictor across the spectrum of airway management difficulties while female gender has not been previously reported as a risk factor for difficult LMA placement.

John P. McGovern: A Lifetime in Stories by Bryant Boutwell (review)

Reviewed by: John P. McGovern: A Lifetime in Stories by Bryant Boutwell Megan Seaholm John P. McGovern: A Lifetime in Stories. By Bryant Boutwell. (College Station: Texas A&M University Press. 2014. Pp. 262. Photographs, notes, bibliography, index.) At first glance, this book by Bryant Boutwell seems to be a hagiography of a remarkable man—physician/scientist, consummate professional, philanthropist, and one who made the Texas Medical Center into a magnificent and unparalleled collection of therapeutic, educational, and scientific institutions. Indeed, seventeen pages of appendices are required to list John P. McGovern’s awards, editorial appointments, and professorships, as well as facilities and endowed programs named for him. But Boutwell has done much more. [End Page 336] Boutwell, a doctor of public health, teaches medical communications, history, ethics, and humanities at the University of Texas (UT) Medical School at Houston and has held leadership positions at the UT School of Public Health and at M.D. Anderson Cancer Center. Before writing this biography of McGovern, he wrote Conversation with a Medical School: The University of Texas-Houston Medical School, 1970–2000. Boutwell writes of McGovern’s early and prodigious accomplishments—stellar medical student at Duke University, impressive resident at Yale University as well as in London and Paris, military service in a veteran’s hospital (1946–1948) and physician/scientist in the relatively new field of pediatric allergy. McGovern was just twenty-eight when he joined the faculty at George Washington University. He was teaching at Tulane’s School of Medicine when “[Lee] Clark’s pink palace of healing . . . captured the attention and imagination of Jack McGovern” (127). McGovern moved to Houston in 1956, assumed a thriving practice in pediatric allergy, created Baylor’s first allergy and immunology residency and fellowship program, taught in the UT Houston Postgraduate School of Medicine, began investing some of his money, and became a major philanthropic force for Houston and the Texas Medical Center. McGovern was, Boutwell explains, “the triple hitter in medicine . . . physician, teacher, and researcher” (104). Boutwell provides a veritable genealogy of famous physicians, milestones in the development of medical education, and a short history of the Texas Medical Center. For example, he tells the story of Johns Hopkins Medical School, opened in 1893 and representing “a new era in American medical schools . . . along the lines of the great German model that [William] Osler and other leaders in American medicine admired” (45). This is pertinent to McGovern because Wilburt Davison, early mentor and life-long friend, studied medicine at Hopkins when Osler and other luminaries in American medicine taught there. Boutwell provides similar informative digressions regarding Duke, Columbia, and Tulane Universities; M.D. Anderson Cancer Center; the Hôpital des Enfants-Malades in Paris; and McGovern’s associates. Senior scholars in the history of medicine will not find any new arguments about medical education, the development of the specialty of allergy and immunologic disease, or what makes a great physician, but general readers will gain a splendid introduction into the history of medical education in the United States, the significance of “Oslerian Medicine,” the development of the Texas Medical Center, and the life and career of McGovern. Megan Seaholm The University of Texas at Austin Copyright © 2014 The Texas State Historical Association

Acute Intravenous Tissue Plasminogen Activator Therapy does not Impact Community Discharge after Inpatient Rehabilitation

Discharge status and acute re-hospitalization are used as indicators of stroke severity and recovery. Intravenous t-PA (tissue plasminogen activator) is one of two treatments shown to have a positive impact. Stroke rehabilitation patients are an important population who will end up integrated back into the community, institutionalized or hospitalized due to late stroke complications. We sought to determine factors contributing to post rehabilitation discharge and acute re-hospitalization, in particular, the impact of t-PA therapy. Retrospective analysis of census data from ischemic stroke patients on the UTHealth Stroke/Neurorehabilitation Services at Memorial Hermann Hospital - Texas Medical Center between Jan 2011 and Nov 2013, discharged to the Community, SNF (Skilled Nursing Facility) or AC (Acute Care). Demographics and NIHSS (National Institutes of Health Stroke Scale) were collected. Discharge FIM (Functional Independence Measure) was the reference standard. Genitourinary infections were a negative mediator in the multivariate regression. Of 346 patients, 274 returned to the community, 47 to SNF, and 25 to AC. Median NIHSS values were 8 in the community group, 11 in SNF and 9.5 in AC. 31.8% of patients received IV t-PA in the community group, 23.4% in SNF and 24% in AC. There were no statistically differences in community discharge rates. One day increase in rehabilitation hospitalization correlated with 19% decreased odds of AC readmission (OR 0.81; P=0.001). One unit discharge FIM increase correlated with 13% decreased odds of AC readmission (OR 0.87; P=0.003). One year age increase correlated with 4% increased odds of SNF admission (OR 1.04; P=0.02). Intense rehabilitation evidenced by FIM improvement and length of stay, impacts community discharge in mild to moderate stroke patients. t-PA had no effect. This study is limited by sample size, retrospective design and undetermined psychosocial factors.

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1University of Texas Health Science Center At Houston, Houston, TX 2Memorial Hermann Healthcare System - Texas Medical Center, Houston, TX 3Medical Student, University of Texas Medical School, Houston, TX 4The University of Texas Health Science Center At Houston, Houston, TX

In memoriam: John C. Norman (1930-2014).

In memoriam: John C. Norman (1930-2014).

John Albert Majors Jr., 1920–2013, and William Harcourt Majors, 1925–2013.

John Albert Majors Jr., 1920–2013, and William Harcourt Majors, 1925–2013.

An overview of neurovascular disease management.

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Guest Editor Gavin Britz Oversees Special Issue on Neurovascular Disease for the <i>Methodist DeBakey Cardiovascular Journal</i>

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Host factors and clinical outcomes of Candida colonization in critically ill patients.

This study aimed to describe factors and outcomes associated with Candida colonization of critically ill patients. This was a cross-sectional study conducted over 2 weeks in the intensive care unit (ICU) of a tertiary care hospital at the Texas Medical Center, Houston, TX. All Candida samples were prospectively collected with demographic and clinical data collected retrospectively. We examined 48 patients, 32 (67%) were colonized with Candida spp; 25 (52.1%) patients were isolated with Candida albicans and 18 (37.5%) were isolated with a non-albicans species, mostly commonly Candida glabrata. A multivariate analysis identified proton pump inhibitor administration at admission to ICU [odds ratio 5.66; 95% confidence interval 1.12-28.5] as associated with colonization. Patients colonized with Candida had a significantly longer length of ICU and hospital stays (7.6 ± 6.6 vs. 4.2 ± 2.6 days, P = 0.01 and 14.9 ± 12.9 vs. 7.5 ± 6.7 days, P = 0.02, respectively). Clonality testing between C. albicans and C. glabrata strains identified indistinguishable strains among the patient cohort. These data provide additional information on Candida colonization in critically ill patients.

Important advances in technology and unique applications related to cardiac magnetic resonance imaging.

Cardiac magnetic resonance has become a well-established imaging modality and is considered the gold standard for myocardial tissue viability assessment and ventricular volumes quantification. Recent technological hardware and software advancements in magnetic resonance imaging technology have allowed the development of new methods that can improve clinical cardiovascular diagnosis and prognosis. The advent of a new generation of higher magnetic field scanners can be beneficial to various clinical applications. Also, the development of faster acquisition techniques have allowed mapping of the magnetic relaxation properties T1, T2, and T2* in the myocardium that can be used to quantify myocardial diffuse fibrosis, determine the presence of edema or inflammation, and measure iron within the myocardium, respectively. Another recent major advancement in CMR has been the introduction of three-dimension (3D) phase contrast imaging, also known as 4D flow. The following review discusses key advances in cardiac magnetic resonance technology and their potential to improve clinical cardiovascular diagnosis and outcomes.

Wading the River

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Overview of Quality in Cardiovascular Imaging and Procedures for Clinicians: Focus on Appropriate-Use-Criteria Guidelines

Cardiovascular imaging and procedures have experienced exponential growth over the past 20 years in terms of new modalities, procedure volume, technological sophistication, and cost. As a result, related quality improvement tools have become multifaceted works in progress. This article briefly summarizes the evolution of the time-honored American College of Cardiology Foundation/American Heart Association clinical practice guidelines versus the newer American College of Cardiology Foundation appropriate-use-criteria guidelines and how these may interact with emerging performance measures, clinical data registries, and cardiovascular laboratory accreditation initiatives.

The development and implementation of a nurse practitioner sepsis screening team: Impact on transfer mortality

Background: Sepsis is a potentially deadly but treatable condition that occurs as a result of the systemic manifestations of infection. Despite large healthcare expenditures, patient outcomes can be poor, and survivors may still suffer from permanent organ damage, cognitive impairment, and physical disability. Failure to recognize and implement early goal-directed therapy leads to increased mortality. A review of hospital mortality identified that sepsis among inbound transfer patients to acute care units significantly contributed to the overall hospital mortality. As part of a multipronged, multidisciplinary approach, a nurse practitioner sepsis screening team was implemented to improve early diagnosis and treatment of sepsis and decrease mortality in this high-risk population. Methods: A large academic medical facility located in the Texas Medical Center in Houston accepts a significant number of transfer patients requiring a higher level of care from other institutions. A nurse practitioner sepsis screening team was created to focus on this highly vulnerable group. A validated, electronic screening tool was utilized to screen patients and facilitate early identification and treatment of sepsis. The nurse practitioner team screened and evaluated 3,268 inbound transfer patients from 10/01/2009 to 06/30/2012. When a high suspicion for sepsis was appreciated, or another acute condition was identified, the nurse practitioner collaborated with the attending physician and initiated appropriate treatment. The data analyzed were part of an Institutional Review Board (IRB) approved prospectively collected data set. The data were collected over a 57 month period spanning from 09/30/2007 through 06/30/2012 on all inbound transfer patients to the facility, which include pre-screening baseline statistics. Basic demographics including the patient’s age, gender, and race were collected. The outcome variable was status at discharge from the facility (alive or dead). After verifying assumptions of the chi-square test were met, a Pearson’s chi-square was run against the data set. All data were analyzed using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results: There was a significant association between inbound transfer patients who were evaluated upon arrival at this institution by the nurse practitioner sepsis screening team and mortality in this population regardless of their diagnoses (χ 2 (1) 115.04, p < .001). A patient not screened by the team was more likely to die during the hospitalization than a transfer patient that was screened. Conclusion: In this institution, the development and implementation of a nurse practitioner sepsis screening team has contributed to reducing mortality among the inbound acute care patient transfer population regardless of diagnoses. Further investigation is needed to understand the exact mechanisms that have contributed to this outcome.

Cardiac Amyloidosis

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

The 1,000 th VAD, the great rivalry, and the grand experiment of the Texas Medical Center.

In the closing days of 2013, Dr. O.H. “Bud” Frazier and the Texas Heart Institute (THI) team performed their 1,000th ventricular assist device (VAD) implantation. This landmark achievement occurred barely more than half a century after Dr. Denton A. Cooley founded THI in 1962 as an institution dedicated to reducing the “devastating toll of cardiovascular disease through innovative programs in treatment, education, and research.”1 The 1,000th VAD implantation occurred almost exactly 50 years after the original 1964 National Heart Institute (NHI) grant was awarded to Dr. Michael E. DeBakey and the Baylor College of Medicine for the development of an artificial heart. The juxtaposition in time of these 2 auspicious events would begin a unique and remarkable story—one that would ultimately lead to the realization of VAD implantation as a standard of care after more than 5 decades of ceaseless effort and unrelenting innovation.

Intracardiac Echocardiographic Atrial Septal Defect Closure

The Methodist DeBakey Cardiovascular Journal provides timely updates on important topics in cardiovascular medicine with quarterly, thematic review-article issues. Each issue is curated by subject-matter-expert guest editors and includes invited reviews along with case reports, interesting multimodality images, and humanities submissions. Additional case reports, images, CME quizzes, and editorials are published on a continuous basis online. MDCVJ is geared towards cardiologists, cardiovascular surgeons, general practitioners, and CV residents and fellows and is indexed in PubMed and MEDLINE.MDCVJ is published by Houston Methodist DeBakey Heart & Vascular Center as part of DeBakey CV Education, an epicenter for cardiovascular academic and clinical education programs located in the heart of the Texas Medical Center. Along with the Journal, DeBakey CV Education offers online and hands-on training for cardiovascular healthcare professionals at all stages in their careers. DeBakey CV Education’s vast YouTube library features hundreds of training videos and live webcasts, including Journal features. Subscribe to the YouTube channel today and sign up for newsletter updates about training opportunities.

Case Study of Flood Mitigation and Hazard Management at the Texas Medical Center in the Wake of Tropical Storm Allison in 2001

Between June 5 and 9, 2001, Tropical Storm Allison dropped upwards of 50 cm (20 in.) of rain on the Texas Medical Center (TMC) in Houston, causing the worst urban flood in U.S. history. The unprecedented rainfall event flooded hospitals, labs, underground tunnels and garages, and power stations, and resulted in excess of $1.5 billion in damages and the loss of decades of medical research. Tropical Storm Allison served as a severe wake-up call to management at the TMC. In response, they developed a hazard mitigation plan (HMP) to minimize the impact of natural and artificial hazards on the TMC campus and its member institutions in the future. Today, the TMC is the premier example of a world-class institution that has a working hazard mitigation plan. This paper discusses the impacts of Tropical Storm Allison (2001) to the TMC and the measures officials have taken to protect and upgrade the flood infrastructure as an example of hazard management for other large, vulnerable institutions.

WITHDRAWN: The 1000th VAD, the Great Rivalry, and the Grand Experiment at the Texas Medical Center

WITHDRAWN: The 1000th VAD, the Great Rivalry, and the Grand Experiment at the Texas Medical Center

Assessment of the Knowledge and Utilization of the Partograph among Non-physician Obstetric Care Givers in the University of Calabar Teaching Hospital, Calabar, Nigeria

Thomas U. Agan, Ubong Akpan, Ita B. Okokon, Afiong O. Oku, Udeme E. Asibong, Margaret M. Opiah, Ekere J. Essien and Emmanuel Monjok Department of Obstetrics and Gynaecology, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria. Department of Family Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria. Department of Community Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria. Department of Maternal and Child Health Nursing, Faculty of Nursing, College of Health Sciences, Niger Delta University, Bayelsa State, Nigeria. University of Houston, Institute of Community Health, Texas Medical Center, Houston Texas, USA.

The 1000th VAD, the Great Rivalry, and the Grand Experiment of the Texas Medical Center

In the closing days of 2013, Dr O.H. “Bud” Frazier and the Texas Heart Institute (THI) team performed their 1000th ventricular assist device (VAD) implantation. This landmark achievement occurred barely more than half a century after Dr Denton A. Cooley founded THI in 1962 as an institution dedicated to reducing the “devastating toll of cardiovascular disease through innovative programs in treatment, education, and research.” The 1000th VAD implantation occurred almost exactly 50 years after the original 1964 National Heart Institute grant was awarded to Dr Michael E. DeBakey and the Baylor College of Medicine for the development of an artificial heart. The juxtaposition in time of these 2 auspicious events would begin a unique and remarkable story—one that would ultimately lead to the realization of VAD implantation as a standard of care after more than 5 decades of ceaseless effort and unrelenting innovation. The saga of the 1000th VAD is a testament to the perseverance of Dr Frazier and his colleagues at THI, under the leadership of Dr Cooley, in designing and perfecting circulatory assist devices. However, as noted by Dr Frazier, the saga is also firmly rooted in foundations first laid at Baylor, including the pioneering work of DeBakey proteges such as Dr George P. Noon. After 1969, these key players found themselves working at rival institutions located a stoneʼs throw from each other on the Texas Medical Center (TMC) campus. The 1000th VAD implantation therefore highlights an intriguing story of medical progress and scientific collaboration borne of conflict and competition.