Clinical Safety and Effectiveness program graduation Nov. 12

In partnership with the Medical School, Memorial Hermann-Texas Medical Center developed the Physician Quality and Safety Academy in 2008 to build a core group of physician leaders focused on driving improvements in outcomes. Since then, 15 physicians have successfully completed the program’s nine-month Clinical Safety and Effectiveness (CS&E) program and are now members of the Academy.

Fourteen new graduates will be honored as Academy members at a special quality symposium 10 a.m.–1 p.m., Nov. 12 in the Hermann Conference Center. Employees and physicians are invited to attend the event, which will feature presentations on quality-related projects that were conducted by the participants in this year’s CS&E program.

Presentations include:

• Dr. Rondel Albarado, Improving Physician Communication with the Patient in the Trauma Service
• Dr. Colin Barker, Expanding the Use of Trans-Radial Cardiac Catheterization
• Dr. Emily Barker, Improving Patient Satisfaction with the M.D. in the Teaching Medicine Service
• Dr. Sean Blackwell, Eliminating Unnecessary Cesarean Delivery due to Oxytocin-associated Tachsystole
• Dr. Gerald Frankel, Improving Scheduling of Urological Surgery Cases in the OR
• Dr. Polina Gelfer, Improving the Quality of Discharge Teaching in the NICU
• Dr. Ikram Haque, Improving Hand-off Communication between the OR and the PICU
• Dr. Iman Hassan, Increasing Use of Bedside Ultrasound for Placement of Difficult Peripheral IVs in the MICU
• Dr. Eduardo Matta, Reducing Turnaround Time for STAT, CT and Ultrasound Exams
• Dr. Sara Miller, Improving Resource Utilization for Patients Presenting to the EC with Chest Pain
• Dr. Ursula Nawab, Reducing Ventilator Use in the NICU by Increasing the Use of CPAP
• Dr. Nicole Ruddock, Reducing Unnecessary Admission for Pre-ecclampsia Work-up and Treatment
• Dr. Khuram Siddiqi, Standardizing Care for Sickle Cell Patients on the Hospitalist Service

Renowned quality improvement expert Dr. Kenneth Shine, executive vice chancellor for health affairs, will serve as the event’s keynote speaker.

“We are honored to have Dr. Shine join us again as the keynote speaker for this event,” said Dr. Jeffrey Katz, chief medical officer for the Memorial Hermann-Texas Medical Center Campus. “He has established a prestigious career in quality improvement and is highly regarded for his work in the field of medicine. The fact that he will be present at our event for the second year in a row speaks highly of our quality efforts and the work of our Academy members, and I encourage everyone to attend.”

— Memorial Hermann-Texas Medical Center Internal Communications

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Breast milk study furthers understanding of critical ingredients

Ask someone in the know to list the substances in breast milk that make it the ideal food for newborns and you may hear about proteins that guard against infection, fats that aid in the development of the nervous system, and carbohydrates that promote the growth of healthy bacteria. But, you may not hear too much about the nitrite and nitrate and their contributions to developing gastrointestinal, immune, and cardiovascular systems.

In a recent publication in Breastfeeding Medicine, the official journal of the Academy of Breastfeeding Medicine, researchers at The University of Texas Health Science Center at Houston (UTHealth) announced the results of an observational study showing that the levels of nitrite and nitrate in breast milk change during the initial days after birth, which the scientists argue is to accommodate the changing physiologic requirements of developing babies.

“This research shows the essential nature of nitrite in breast milk,” said Dr. Nathan Bryan, the study’s senior author and an assistant professor at the UTHealth Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (IMM). “While the nitrite and nitrate composition of breast milk has been reported, this is the first study to demonstrate the changing levels of nitrite and nitrate early on.”

Dietary nitrite and nitrate are part of a normal diet. When people eat nitrate-rich vegetables, the bacteria in their mouths and stomachs converts the nitrate into nitrite, which in turn aids in the production of nitric oxide. Nitric oxide keeps blood pressure levels normal, fights infection, and supports the nervous system. Animal studies suggest nitric oxide might even guard against heart attack and stroke.

The scientists measured nitrite and nitrate levels in breast milk during the first three days of birth (colostrum), days three to seven (transition milk), and eight or more days (mature milk). Seventy-nine patient samples were analyzed, and they were donated by mothers who were either admitted to Memorial Hermann-Texas Medical Center for childbirth or who were visiting a UT Physicians clinic in the TMC.

Bryan said colostrum has significantly higher concentrations of nitrite and significantly lower concentrations of nitrate than both transition and mature milk, which he believes may be nature’s way of providing nitric oxide to the newborns whose gastrointestinal tract is not yet colonized by bacteria that convert nitrate to nitrite. Nitrite-rich colostrum overcomes this deficit, he said.

To corroborate their findings, researchers analyzed milk samples taken from two women on 14 consecutive days, and the scientists observed the same change in the nitrite and nitrate levels.

Investigators also measured the level of dietary nitrite and nitrate in alternative sources of newborn nutrition: formula, cow milk, and soy milk. Bryan said the study revealed that colostrum contains the highest amount of nitrite of any of the milk products tested.

“This is another difference that has been noted between mother’s milk and formula,” said Dr. Pamela Berens, one of the study’s authors and a professor of obstetrics, gynecology and reproductive science. “Studies like this help us better understand the benefits of breast milk.”

Bryan said the concentration of nitrite and nitrate found in breast milk calls into question the amount recommended by the Joint Food and Agricultural Organization/WHO Acceptable Daily Intake (WHO ADI) standards. Total daily nitrite intake for nursing infants is 20 times that recommended by the WHO ADI, he said.

Too much nitrite/nitrate or too little nitrite/nitrate can be bad for health, Bryan said. Much of the concern about nitrite/nitrate levels stems from a condition associated with too much nitrite in the blood system called methemoglobinemia (blue baby syndrome). Typically, this is caused by infant formulas made from bacteria and nitrate contaminated well water. The levels of nitrite and nitrate that cause blue baby syndrome are much higher than what is present in breast milk, he said.

“These data, considered together with nitrite and nitrate exposure estimates from foods, show that humans are exposed from birth to dietary sources of nitrite and nitrate. The presence of nitrite and nitrate in breast milk argues for a fundamental role in physiology, which is supported by a number of basic science studies and some clinical trials,” Bryan said.

“Contrary to the prevailing scientific opinion about the biological effects of nitrite and nitrate, our data support the view that humans may require these dietary components from birth—from nature’s most perfect food,” said Dr. Norman Hord, the study’s lead author and an associate professor of food science and human nutrition at Michigan State University.

Other contributors include Janine Ghannam, a MSU medical student, and Harsha Garg, a research associate at the IMM.

The study titled “Nitrate and Nitrite Content of Human, Formula, Bovine and Soy Milks: Implications for Dietary Nitrite and Nitrate Recommendations” received support from the American Heart Association and Michigan Agricultural Experiment Station.

The author of several books including “Food Nutrition and the Nitric Oxide Pathway,” “Nitrate and Nitrite in Human Health and Disease,” and “The Nitric Oxide (NO) Solution,” Bryan also is a member of the Graduate School of Biomedical Sciences faculty.

— Robert Cahill, Office of Advancement, Media Relations

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Geriatric division offers CME lectures Nov. 23

The Geriatric and Palliative Medicine Division will host a lunch during Internal Medicine Grand Rounds as well as a free lecture and dinner Tuesday, Nov. 23 for the Reynolds Visiting Professor Program (RsVP).

The first lecture will be presented at noon in MSB B.500. Dr. Stephanie Studenski, professor of geriatrics at the University of Pittsburgh and a staff physician at the Pittsburgh VA Healthcare System, will talk on “Mobility is a Key Measure of Disease and Health in Older Adults: Evidence and Applications to Clinical Practice.”

Lunch will be served on a first-come, first-served basis, and the lecture will offer one hour of CME credit.

Studenski will present on “Novel Interventions to Promote Physical Activity in Older Adults: the Role of Interactive Games” at a dinner CME lecture later that day at 5:30 p.m. in MSB B.500. The lecture also will provide one hour of CME credit.

Visit this website for more information or to register, or contact Rhonda Bailes. Everyone is welcome to both events.

The lectures are funded in part by a grant from the D. W. Reynolds Foundation and by the Phyllis Gough Huffington Lecture Series II.

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President award nominations due Nov. 19

Nominations are now being accepted for two 2011 President's Scholar Awards to honor outstanding faculty achievements in research and teaching for the 2009–2010 academic year.

These faculty honors recognize outstanding scholarly accomplishment and include a $5,000 prize.

Past recipients of the President's Scholar Award for Research include Drs. Jack Schull, Ernst Knobil, James Willerson, John Byrne, Kenneth Wu, Eric Boerwinkle, John Spudich, Barry Davis, William Dowhan, Ferid Murad, Ponnada Narayana, Dianna Milewicz, Frank Arnett, Herbert DuPont, and K. Lance Gould.

Past recipients of the President's Scholar Award for Teaching include Drs. Jeannette Adams, Ron Philo, Marianne Marcus, Stanley Schultz, James Turley, Margaret Uthman, Catherine Flaitz, Frank Arnett, Henry Strobel, Norman Weisbrodt, Cheves Smythe, and L. Kay Bartholomew.

An Awards Committee comprised of select UTHealth faculty members and past President’s Scholar Award recipients will review the nominations and recommend two honorees to President Larry Kaiser.

Complete nomination packets are due no later than Friday, Nov. 19, and must include:

• A detailed statement of the nature and importance of the accomplishments to be recognized;
• A complete curriculum vitae with bibliography;
• A minimum of two recommendations letters from UTHealth-affiliated individuals (e.g., students, former students, colleagues, etc.); and
• Other support as deemed useful.

Please submit all documentation electronically to Terrie Schade-Lugo.

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UT Physicians Bellaire bash