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GRAND ROUNDS:

Encouraging a Culture of Learning and the Integration of Evidence into Practice

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Fall 2019 Semester

Presentations are held on Wednesdays from 11:00 a.m. to 12:30 p.m. Central Time in Austin (1100 W. 49th Street, see map) or via webinar.

September 11: Public Health and Medical Response in Texas
September 18: The Supportive Palliative Care Paradigm: An Evolving Approach to Serious Illness Care
September 25: Internet Safety for Children and Families
October 2: Four Ways to Help You Feel Good About Your Opioid Prescription
October 9: How Maternal Early Warning Systems Can Decrease Maternal Morbidity and Mortality in Texas
October 16: It’s Hard to Make A’s with a Toothache: Oral Health Status of Texas Elementary Students

*"live" = not recorded 


Jeffrey Hoogheem
Jeffrey Hoogheem


Public Health and Medical Response in Texas

Public Health and Medical Response in Texas

Presenter:
Jeffrey Hoogheem 
Director of Health Emergency Preparedness and Response Texas Department of State Health Services

Description
Texas is a large state with a diverse set of threats, hazards and risks. Consequently, Texas’ emergency managers must plan for response to all incident types. Almost every incident has a significant public health and/or medical component necessitating comprehensive and ongoing planning, training and exercising. This session will describe the system, including the processes and resources, that has been developed to respond to public health and medical threats in Texas.

Learning Objectives:

  • Identify three of the unique hazards and risks that exist in Texas.
  • Describe the public health and medical resources that are maintained for disaster response in Texas.
  • Examine the components of the Public Health and Medical response system in Texas.
  • Discuss the implications of Emergency Support Function 8 (ESF8).

1.5 Continuing Education Credits/Contact Hours Available for the Following (live* event only):

  • AMA PRA Category 1 CreditsTM
  • Continuing Nursing Education
  • Certified Health Education Specialists  
  • Master-Certified Health Education Specialists
  • Certified in Public Health
  • Licensed Marriage and Family Therapists
  • Licensed Chemical Dependency Counselors 
  • Licensed Professional Counselors
  • Licensed Psychologists 
  • Registered Sanitarians
  • Social Workers

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources:

Cross K, Horney JA. Use of the Community Assessment for Public Health Response (CASPER) method by public health agencies in Texas, 2001-2015. Disaster Med Public Health Prep. 2018 Dec;12(6):680-684. doi: 10.1017/dmp.2017.143. Epub 2018 Jan 24.

Culver A, Rochat R, Cookson ST. Public health implications of complex emergencies and natural disasters. Confl Health. 2017 Nov 29;11:32. doi: 10.1186/s13031-017-0135-8.

Murthy BP, Molinari NM, LeBlanc TT, Vagi SJ, Avchen RN. Progress in public health emergency preparedness-United States, 2001-2016. Am J Public Health. 2017 Sep;107(S2):S180-S185. doi: 10.2105/AJPH.2017.304038.

Rose DA, Murthy S, Brooks J, Bryant J. The evolution of public health emergency management as a field of practice. Am J Public Health. 2017 Sep;107(S2):S126-S133. doi: 10.2105/AJPH.2017.303947.

Upton L, Kirsch TD, Harvey M, Hanfling D. Health care coalitions as response organizations: Houston after Hurricane Harvey. Disaster Med Public Health Prep. 2017 Dec;11(6):637-639. doi: 10.1017/dmp.2017.141.

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Robert L. Fine
Robert L. Fine, MD, FACP, FAAHPM


The Supportive Palliative Care Paradigm: An Evolving Approach to Serious Illness Care

The Supportive Palliative Care Paradigm: An Evolving Approach to Serious Illness Care

Presenter:
Robert L. Fine, MD, FACP, FAAHPM

Clinical Director, Office of Clinical Ethics and Palliative Care, Baylor Scott and White Health

Description
Health care professionals and lay persons have confused Palliative Care and Hospice for too long. This lecture will help end that confusion by delivering a broad overview of Supportive Palliative Care (newly defined in Texas law and serving the sickest 5-15% of us) as a service quite distinct from Hospice care (long defined in Texas law and serving the less than 1% of us who die yearly). The evolution of Supportive Palliative Care (SPC) to meet the many deficits in serious illness care in our hospitals will be explored. Evidence of the myriad peer reviewed benefits of SPC to patients, families, professionals, and health care organizations will be shared.

Learning Objectives:

  • Define two different components of palliative care – Hospice and Supportive Palliative Care (SPC).
  • Outline the evolution of SPC and explain to others the benefits of SPC services to patients, families, health care providers and payers (including the state)
  • Articulate the Tasks of Supportive Palliative Care and explain at least one factor in meeting each of the tasks.
  • Report to your respective health care organizations current challenges in the availability of SPC services in Texas and how one large health care system is trying to meet those challenges within its service areas.  

1.5 Continuing Education Credits/Contact Hours Available for the Following (live* event only):

  • AMA PRA Category 1 CreditsTM
  • Continuing Nursing Education
  • Certified Health Education Specialists
  • Master-Certified Health Education Specialists
  • Certified in Public Health
  • Licensed Marriage and Family Therapists
  • Licensed Professional Counselors
  • Licensed Psychologists
  • Registered Sanitarians
  • Social Workers

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources:

Berry LL, Connor SR, Stuart B. Practical ideas for improving the quality of hospice care. J Palliat Med. 2017;20(5):449-452.

Buss MK, Rock LK, McCarthy EP. Understanding palliative care and hospice: a review for primary care providers. Mayo Clin Proc. 2017;92(2):280-286.

De Lima L, Pastrana T. Opportunities for palliative care in public health. Annu Rev Public Health. 2016;37:357-374.

May P, Normand C, Cassel JB, et al. Economics of palliative care for hospitalized adults with serious illness: a meta-analysis. JAMA Intern Med. 2018;178(6):820-829.

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Mollyanne Vasquez
Mollyanne Vasquez

Internet Safety for Children and Families

Internet Safety for Children and Families

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Presenter:
Mollyanne Vasquez
Education Services Manager, Center for Child Protection

Description
The technology available today provides many useful avenues for children’s educational and social development. However, the rapid evolution of technology has also left gaps in the protection of children, as many are not aware of the potential risks for children online. Learning where, when, and what children access while on the Internet, and potential dangers they may encounter online is imperative for creating a safe environment for our children to learn, play, and grow. In this workshop parents and caregivers will be empowered to set up safe boundaries for children on the Internet, have open communication with their children about the Internet, and react responsibly to any suspicious behaviors online.

Learning Objectives:

  • Describe aspects of the Internet in which children may be involved
  • Discuss the different types of threats encountered on the internet, including real cases that exemplify the dangers 
  • Analyze safety precautions & conversation techniques that can be used as prevention tools

1.5 Continuing Education Credits/Contact Hours Available for the Following (live* event only):

  • AMA PRA Category 1 CreditsTM
  • Continuing Nursing Education
  • Certified Health Education Specialists
  • Master-Certified Health Education Specialists
  • Certified in Public Health
  • Licensed Chemical Dependency Counselors
  • Licensed Marriage and Family Therapists
  • Licensed Professional Counselors
  • Licensed Psychologists
  • Registered Sanitarians
  • Social Workers

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources
:

Edwards S, Nolan A, Henderson M, Mantilla A, Plowman L, Skouteris H. Young children’s everyday concepts of the internet: a platform for cyber‐safety education in the early years. British Journal of Educational Technology. 2018;49(1):45-55.

Hamm MP, Newton AS, Chisholm A, et al. Prevalence and effect of cyberbullying on children and young people: a scoping review of social media studies. JAMA Pediatr. 2015 Aug;169(8):770-7. 

Montgomery KC, Chester J, Milosevic T. Children's privacy in the big data era: research opportunities. Pediatrics. 2017 Nov;140(Suppl 2):S117-S121.

Reid Chassiakos YL, Radesky J, Christakis D, Moreno MA, Cross C. Children and adolescents and digital media. Pediatrics. 2016 Nov;138(5).

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Marc Fleming
Marc Fleming, PhD, MPH, RPh

J. Douglas Thornton
J. Douglas Thornton, Ph.D., Pharm.D., BCPS

Michael Mackert
Michael Mackert, PhD

Kasey Strey
Kasey Strey

 Four Ways to Help You Feel Good About Your Opioid Prescription

Four Ways to Help You Feel Good About Your Opioid Prescription

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Presenters:
Marc Fleming, PhD, MPH, RPh

University of Texas Health Science Center
J. Douglas Thornton, Ph.D., Pharm.D., BCPS
University of Houston
Michael Mackert, PhD
Dell Medical School, University of Texas-Austin
Linda Yazdanshenas
Enforcement Officer, Texas State Board of Pharmacy
Kasey Strey
NASADAD Prevention Coordinator for Texas, TTOR Opioid Prevention Lead, and SPF-Rx Project Director, HHSC 

Description
The Texas Prescription Monitoring Program (PMP) helps health professionals make decisions about prescribing and dispensing and can be used to improve patient health. Four experts will share their knowledge about the Texas PMP, enhancements to the system, and new tools available to help you feel confident about sending someone home with opioids.

Learning Objectives:

  • Describe the Texas PMP and what it can do. 
  • Discuss how to register for and use the Texas PMP. 
  • Examine free tools to aid patient conversations about opioid use, misuse, and safe disposal.

1.5 Continuing Education Credits/Contact Hours Available for the Following (live* event only):

  • AMA PRA Category 1 CreditsTM
  • Continuing Nursing Education
  • Certified Health Education Specialists
  • Master-Certified Health Education Specialists
  • Certified in Public Health
  • Licensed Chemical Dependency Counselors
  • Licensed Marriage and Family Therapists
  • Licensed Professional Counselors
  • Licensed Psychologists
  • Registered Sanitarians
  • Social Workers
  • Dental Continuing Education Credits 

PACE accreditation statement

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources

Ferries EA, Gilson AM, Aparasu RR, Chen H, Johnson ML, Fleming ML. Prevalence and factors associated with multiple provider episodes in Texas: an epidemiological analysis of prescription drug monitoring program data. Pain Med. 2017 Oct 1;18(10):1941-1951.

Pitt AL, Humphreys K, Brandeau ML. Modeling health benefits and harms of public policy responses to the US opioid epidemic. Am J Public Health. 2018 Oct;108(10):1394-1400.

Rutkow L, Chang HY, Daubresse M, Webster DW, Stuart EA, Alexander GC. Effect of Florida's prescription drug monitoring program and pill mill laws on opioid prescribing and use. JAMA Intern Med. 2015 Oct;175(10):1642-9.

Wen H, Hockenberry JM, Jeng PJ, Bao Y. Prescription drug monitoring program mandates: impact on opioid prescribing and related hospital use. Health Aff (Millwood). 2019 Sep;38(9):1550-1556.

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Catherine Squire Eppes
Catherine Squire Eppes, MD MPH

Christina M. Davidson, MD
Christina M. Davidson, MD

How Maternal Early Warning Systems Can Decrease Maternal Morbidity and Mortality in Texas

How Maternal Early Warning Systems Can Decrease Maternal Morbidity and Mortality in Texas

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Presenters:
Catherine Squire Eppes, MD MPH 

Baylor College of Medicine
Chief of Obstetrics Ben Taub Hospital
Maternal Medical Director Ben Taub Hospital
TexasAIM Faculty Chair
Christina M. Davidson, MD
Baylor College of Medicine 
Texas Children’s Fetal Center™
Maternal Fetal Medicine
Texas Children’s Hospital

Description
Delayed recognition and response to abnormal vital signs is a known etiology of maternal morbidity and mortality in many states, including Texas.  Maternal early warning systems are systems for specific response with vital signs that are known to be associated with maternal adverse outcomes.  These systems work to expedite the response to conditions such as preeclampsia, sepsis, cardiovascular complications, and hypovolemia.  

Please join recognized experts, Dr. Catherine Eppes and Dr. Christina Davidson, for a thought-provoking discussion of maternal early warning systems.

Learning Objectives:

  • Review causes of maternal morbidity and mortality in Texas.
  • Outline the evidence behind systems of early warning recognition.
  • Illustrate parallels in the AIM pph and HTN bundles and maternal early warning systems.

1.5 Continuing Education Credits/Contact Hours Available for the Following (live* event only):

  • AMA PRA Category 1 CreditsTM
  • Continuing Nursing Education
  • Certified Health Education Specialists
  • Master-Certified Health Education Specialists
  • Certified in Public Health
  • Registered Sanitarians
  • Social Workers

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources

Friedman AM. Maternal early warning systems. Obstet Gynecol Clin North Am. 2015 Jun; 42(2):289-98.

Hirshberg A, Srinivas SK. Epidemiology of maternal morbidity and mortality. Semin Perinatol. 2017 Oct; 41(6):332-337.

Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL. Use of Maternal Early Warning Trigger tool reduces maternal morbidity. Am J Obstet Gynecol. 2016 Apr; 214(4):527.e1-527.e6.

Zuckerwise LC, Lipkind HS. Maternal early warning systems-towards reducing preventable maternal mortality and severe maternal morbidity through improved clinical surveillance and responsiveness. Semin Perinatol. 2017 Apr; 41(3):161-165.

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Rhonda Stokley
Rhonda Stokley, DDS

It’s Hard to Make A’s with a Toothache: Oral Health Status of Texas Elementary Students

It’s Hard to Make A’s with a Toothache: Oral Health Status of Texas Elementary Students

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Presenter:
Rhonda Stokley, DDS
State Public Health Dental Director, DSHS 

Description
The Texas Department of State Health Services Oral Health Improvement Program conducted statewide oral health surveillance of public schoolchildren in Kindergarten and third grade from 2017-2019.  This presentation shares key findings and compares and contrasts the two age groups. Dr. Stokley will also compare Texas to national Healthy People 2020 targets and discuss what should be done next to help reduce the prevalence of tooth decay in Texas children.

Learning Objectives:

  • Describe the impact of tooth decay on a child’s ability to learn.
  • Compare the oral health status of younger and older Texas elementary school students.
  • Describe how the oral health status of Texas children compares to Healthy People 2020 targets.

1.5 Continuing Education Credits/Contact Hours Available for the Following (live* event only):

  • AMA PRA Category 1 CreditsTM 
  • Continuing Nursing Education
  • Certified Health Education Specialists
  • Master-Certified Health Education Specialists
  • Certified in Public Health
  • Licensed Chemical Dependency Counselors
  • Licensed Marriage and Family Therapists
  • Licensed Professional Counselors
  • Licensed Psychologists
  • Registered Dietitians
  • Registered Sanitarians
  • Social Workers 
  • Dental Continuing Education Credits 


    PACE accreditation statement

A certificate of attendance is available for those not seeking the credits/contact hours listed above.

Suggested Resources

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Last updated September 22, 2019