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William Beaumont Army Medical Center’s Central Simulation Committee Medical Simulation Center recently gained provisional accreditation from the Society for Simulation in Healthcare, an international organization promoting improvements in simulation technology, educational methods, and patient safety.

The Simulation Center at WBAMC supports Continuing Medical Education and Graduate Medical Education (CME/GME) to increase patient safety and practitioner competence. The center provides healthcare professionals with lifelike scenarios aimed at developing and shaping teamwork, communications and critical thinking skills to enhance outcomes.

“(Full accreditation means) we’ll have an opportunity to bring different funding and programs into the organization and have broader opportunities,” said Lt. Col. Olga Betancourt, deputy chief, Education Division, WBAMC. “In turn, these increased opportunities will affect patient care because residents will be able to practice more and conduct different research improving Army Medicine.”

Although the simulation program at WBAMC is vastly focused on supporting the GME mission at WBAMC, CME is also profiting from the Sim Center’s various programs designed to educate and refine nursing skills and training requirements, as well as honing the skills of Soldiers preparing for deployment. After documenting outcomes for two continuous years, the center will be eligible to reapply for full accreditation from the organization.

In preparing for the accreditation, staff members developed curriculum to evaluate detailed processes for each scenario presented to GME residents.

“Everything we do here is to assist in (GME residents’) training development and to provide medical simulation for their respective programs,” said Thomas Soto, Simulationist, WBAMC. “So when residents actually conduct a procedure for the first time, it isn’t on a patient. It’s training hands on with high-fidelity Manikins.”

According to Betancourt, a native of Philadelphia, one of the first steps toward accreditation was formulating a multidisciplinary strategic plan to welcome creativity and collaboration thus developing the center’s programs to benefit training.

“It’s not just about doing the training but providing the curriculum that backs that training up such as what are the objectives, who’s the target audience, and developing scenarios for different training events,” said Soto, the simulation center’s only dedicated simulationist. “Simulation isn’t just providing a simulation the technician wants to show. This is targeted to residents and providers that are going to (or already) working on real patients and going out in to the community and performing these skills. It’s very specific and really detailed.”

Simulation programs at the center range from endoscopic surgery to neonatal care, benefiting all new healthcare professionals training at WBAMC from general surgery residents to the Army’s junior enlisted medics.

“There’s a lot of programs that are currently using the simulation program,” said Betancourt, who also supervises operations in the simulation center. “One of the rooms we created within the sim center is a patient room, a lot of the students will actually come into the room and actually work with a (simulated) patient in the room.”

Future plans include expanding the center’s capabilities to include laparoscopic surgery, spinal fusions, and robot-assisted surgery simulations.

In addition to current capabilities, the center is also an approved Fundamentals of Endoscopic Surgery site, meaning residents may be evaluated on their fundamental knowledge, clinical judgement and technical skills at the center required in endoscopy, a requirement for most surgery residents in WBAMC’s GME programs.

“We have the equipment and the site for designation which they need before graduating,” said Soto, a native of Aransas Pass, Texas. “We’re saving the Army money, getting residents trained and what they need to be credentialed.”

Future developments with full accreditation will also provide the necessary training physicians may require, eliminating the need to travel to other medical centers or hospitals to conduct training.

Simulation center staff credits WBAMC’s chief of education, Col. Susana Argueta, with initiating the accrediting process and collaborating with WBAMC leaders to develop program curriculums. Full accreditation across all Army Medicine simulation centers is also a goal to improve overall Army readiness.

Author: Marcy Sanchez – WBAMC /US Army

Earlier this year, William Beaumont Army Medical Center doctors performed the first Transcatheter Aortic-Valve Replacement (TAVR) in El Paso at WBAMC.

The procedure is a minimally-invasive alternative to open-heart surgery for patients with severe Aortic Stenosis (AS), a condition involving the narrowing of the heart’s aortic valve which minimizes or blocks blood delivered to the aorta resulting in limited blood flow throughout the body.

The TAVR procedure is revolutionary not only as an alternative to traditional means of treating AS but also as a solution for patients who may not have had an option two years ago.

“It (is) a feasible way to save patients who are not good candidates for surgery,” said Maj. Ryan McDonough, interventional cardiologist and chief of cardiology, WBAMC. “There are patients who are not good surgical candidates but are excellent candidates for a percutaneous approach due to comorbidities, illnesses and previous surgeries.”

Because blood flow is limited in patients with AS, it makes the heart work harder to pump blood through the body, resulting in symptoms such as chest pain, fatigue and difficulty breathing.

Similar to a stent placed in an artery, patients are implanted with self-expanding valves via a catheter usually entering the body through the femoral artery in the groin. The minimally-invasive procedure results in reduced operating and recovery time when compared to traditional open-heart surgery procedures which usually demand for a sternotomy (opening of the sternum) to treat AS.

According to McDonough, as new as the procedure is to medicine, there are two Food and Drug Administration-approved devices available to patients for the procedure: self-expanding and balloon-expanded valves. While both have similar functions, the WBAMC patients were implanted with the self-expanding to minimize risks.

“The valve is stented on a self-expanding metal that reacts to heat. When exposed to heat it expands to a predesigned form and the catheter slowly comes off the valve and expands,” said McDonough, a native of Port Jefferson, New York. “You don’t have to balloon expand or pace (regulate the heartbeat by means of an artificial pacemaker), (the valve) is recapturable and repositionable. The valve deploys to 80 percent first, allowing us to assess whether it’s position and functionality is correct before fully deploying.”

The self-expanding valve also conforms and seals to non-circular aortic valve annulus (passages) and may be safer to use than other TAVR devices due to decreased potential to rupture tissue, decreasing mortality risk.

For 75-year-old Daniel Mooneyhan, the second patient to be implanted with the valve in El Paso, the valve provided relief after suffering with AS for two years.

“I was walking one day and I had to stop and hold on to a tree at a park. I was having a lot of heaviness, a little chest pain here and there,” said Mooneyhan, a 75-year-old retired Army first sergeant.

After a series of tests and exams, Mooneyhan was informed that his aortic valve was failing. Due to previous ailments along with reluctance to open-heart surgery, Mooneyhan didn’t prove to be a good surgical candidate for a bioprosthetic valve, which must be sewn into place during open-heart surgery, occasionally taking hours to complete.

“I didn’t want to be cut open. If I had to be cut open just forget it,” said Mooneyhan.

While this was a first at WBAMC, it wasn’t new to Mooneyhan, who had been researching treatment options for his condition.

“I watched hundreds of videos (regarding the procedure) and talked to the specialists,” said Mooneyhan. “They (perform the procedure) in Tucson, Albuquerque, Lubbock, Dallas, Indianapolis, San Antonio, so why can’t we do this here in El Paso?”

After McDonough spent three years supporting and training for the use of the TAVR device, the device was approved for treatment at WBAMC.

“It’s awesome,” said McDonough, who along with an interdisciplinary team of surgical professionals performed both treatments. “I felt very comfortable with our team doing this procedure and it’s very much a collaborated team approach. It’s not the technical part of deploying the valve, it’s the process.”

On Nov. 15, Mooneyhan received a call to be admitted for treatment at WBAMC the following day. Less than a week later, Mooneyhan was back home, feeling relieved.

“I’m sleeping better, I’m getting a full breath, I’m feeling good and have no scars or anything,” said Mooneyhan, just 10 days past the TAVR procedure. “There’s people here in this city, in this county who probably need this procedure, I think this is the future.”

“Once the valve is in and it’s functional, their heart is fixed,” said McDonough. “The only reason we keep the patient is to make sure they don’t develop conduction abnormalities (electrical impulses which cause the heart to beat), a potential need for a pacemaker and to monitor the access site.”

While WBAMC has already scheduled another pair of TAVR procedures, the success and benefit of the treatment made an emotional impact on Mooneyhan.

“There’s people out there who need this, who are dying,” said Mooneyhan. “To those guys that are retired and any veteran who needs this, they need to come (to WBAMC). These doctors are awesome, they’re good doctors.”

Author –  Marcy Sanchez – WBAMC / U.S. Army

From adolescence to beyond menopause, midwives offer a broad scope of practice tailored to women’s preference of care. To celebrate their holistic approach and contributions to the medical community, midwives are being recognized October 1 – 7 as part of National Midwifery Week.

At William Beaumont Army Medical Center, a team of Certified Nurse-Midwives (CNMs) provide around-the-clock care, the only medical center in El Paso to do so, ranging from well-woman exams to postpartum care.

“I love being a nurse and being a midwife,” said Maj. Noelle Dove, nurse midwife, Department of Women’s Health Services, WBAMC. “(Being a midwife) is about being able to offer more to the patient and increasing the opportunities that (CNMs) can be involved in.”

According to the American College of Nurse-Midwives (ACNM), in 2014, 8.3 percent of all U.S. births were delivered by CNMs. Furthermore, statistics show a steady rise in CNM-attended births in the U.S. since 1989.

The growth in opting for CNM-attended births may be attributed to CNMs’ commitment to evidence-based practices which continuously introduces options for women not just during labor but also within their primary care practice.

“Women’s bodies are pretty amazing,” said Capt. Merry Fontenot, nurse midwife, WBAMC. “As midwives, which means ‘with women,’ we also provide our patients the tools to make decisions. We don’t make the decision for them on a regular basis; we empower them to make the best decision for themselves.”

While some patients may not be familiar with the profession, CNMs and Obstetrician-Gynecologists do have a shared goal of promoting safe women’s health through evidence-based models. Such evidence-based models are a staple at WBAMC’s Labor & Delivery Unit where CNMs have introduced a variety of modalities to broaden women’s options during labor such as hydrotherapy, wireless monitoring and are currently looking into other alternative pain management techniques such as Nitrous Oxide, better known as laughing gas.

“Labor can be a long process and sometimes women need all sorts of options to get them through it,” said Dove, a native of Woodbridge, Virginia. “We’re going to let women go on and have their babies in the way that their bodies and babies are dictating and sometimes that could take a couple of days. So offering (nitrous oxide) can get them through the pain of labor in the early and late stages and starts working in a few minutes and can stop working in a few minutes.”

In addition to providing clinical diagnosis during low-risk interventions, midwives also emphasize prenatal education and pain-mitigating techniques for moms during pregnancy, labor and birth.

“The actual practice of midwifery extends back to the beginning of time,” said Valerie Miller, nurse midwife, WBAMC. “It’s a practice that has an amazing culture of promoting women having their babies in a safe way and a way they want to do it.”

Nurse midwives’ roles also expand beyond the exam rooms to WBAMC’s group prenatal care sessions where they provide expecting and

new moms a group setting to discuss concerns, pain management, expectations, birthing plans and a health check-up during two-hour-long sessions.

“We do a lot of education and provide good quality care to our patients while letting them own their own experience,” said Fontenot. “It’s really their choice how they want their care. If they do or don’t want a medicated labor, we’re there with them. We’ll be there while they’re breathing and laboring through the pain if that’s the experience they want. It’s their choice and we’re there to support them and allow them to make the best decision for themselves, it’s their time.”

WBAMC’s group prenatal care sessions are where first-time mom, Susan Molina, was introduced to the profession.

“This is my first experience with a midwife and I didn’t expect it to be so awesome,” said Molina, a military spouse whose daughter, Veronica, was delivered at WBAMC on Sept. 19. “The experience was definitely more personal and felt like a closer connection.”

According to Molina, a 28-year-old native of Westchester, New York, the midwife care she experienced made her pregnancy and labor easier. So much so, during labor Molina was nervous and anxious but felt relieved once Miller, the midwife on duty, came into the room before delivering her baby.

While WBAMC midwives focus on OB care, they are capable of providing well-women exams, gynecologic, family planning and menopausal care.

“Patients have a choice,” said Fontenot. “Our end goal is healthy mom, healthy baby.”

Author: Marcy Sanchez – WBAMC

Growing up in war-torn Nicaragua in the early 80s, 1st Lt. Lizamara Bedolla vaguely recalls the sounds of heavily-armored vehicles driving past her front door.

It was after the violent ousting of Nicaraguan dictator, Anastasio Somoza DeBayle, followed by the deaths of tens of thousands of Nicaraguans caused by rebel fighting that Bedolla’s parents decided to flee the country for the safety of their family.

After fleeing the country at the age of four, Bedolla, now an Army nurse who was recently promoted to first lieutenant, was raised in Houston after her family applied and was granted family-sponsored visas. While Bedolla has led a rewarding 16-year Army career, the road to commission hasn’t been easy.

“It was very dangerous,” said Bedolla, of the war in Nicaragua. “Sometimes we would have propane and electricity, sometimes we wouldn’t and it wasn’t safe.”

As refugees traveling to the U.S., Bedolla and her family were stalled in Mexico, spending several months waiting for their visas to arrive. Refusing to wait any longer, Bedolla’s father decided it would be safer crossing the border on their own.

“My dad tried to have us cross the border by travelling underground through (cross-border) tunnels in the nighttime,” recalls Bedolla. “We could hear (U.S. Customs and Border Protection officers) up above yelling ‘We know you’re down there’.”

As the group of immigrants travelled through the tunnels, Bedolla recalls singing in the manmade passages.

“I was singing throughout the whole journey, it was an adventure,” said Bedolla. “(Other refugees in the group) would tell my mom to tell me to stop singing… We ended up getting detained.”

As Bedolla and her family waited at a border detention facility, their visas arrived and they were granted legal entrance into the U.S.

After entering the U.S., the family rented a two-bedroom Houston apartment which later welcomed the addition of Bedolla’s two younger sisters. Away from the dangers of her native country, Bedolla began school. As a young child, Bedolla recalls watching a U.S. Army commercial on the family’s 13-inch black and white television and expressing to her mom, “That’s what I wanted to do when I grow up.”

A model student, Bedolla was seeking a break from school and felt that if she didn’t take an opportunity to explore the world, she wouldn’t get that chance again. As she neared high school graduation, Bedolla enlisted in the Army and shipped off to basic training soon after graduating.

As a young enlisted Soldier, Bedolla received training as an Operating Room technician and soon after deployed with the 10th Combat Support Hospital in support of combat operations during the initial invasion of Iraq in 2003.

“It was a high-stress environment,” said Bedolla. “There was nothing there, everything was literally tents and pallet floors.”

Following the deployment Bedolla served for a total of 12 years as an enlisted Soldier, gaining U.S. citizenship in 2005 and reaching the rank of sergeant before applying for the Army’s Enlisted Commissioning Program.

“One of my biggest drives was that I always told my mom I would finish my degree,” said Bedolla. “My initial plan wasn’t to become a nurse. When I started taking courses I wanted to get a general degree.”

According to Bedolla, the longer she served as an enlisted Soldier in the medical field the more she realized nursing was what she was looking for in a career.

“I loved the medical field, it’s dynamic, there’s always something to learn and you grow every day,” said Bedolla, now a wife and mother of two. “I had such great nurses (as an enlisted OR technician) that it pulled me to want to know more of that side of the medical field.”

After 16 years in the Army, Bedolla is now a staff nurse at William Beaumont Army Medical Center’s Surgical Ward, with temporary assignment as the officer in charge of the hospital’s Neurology Clinic.

“From her (noncommissioned officer) roots she understands Soldiers and what it means to take care of Soldiers,” said Maj. Tanisha Currie, officer in charge, Surgical Ward, WBAMC. “Her team player efforts and work ethics are part of the reason she was selected to fulfill the role at the Neurology Clinic.”

Although Bedolla has only served as a nurse for just over two years, Currie describes her as a rock-solid, very mature and poised Soldier.

“My experience as a nurse has been more than I could hope for,” said Bedolla. “(Nursing) has helped me gain much more empathy and sympathy than I thought was possible. Whatever my idea of empathy was 16 years ago, has completely grown while serving in the Army.

“There’s such a myriad of people that I’ve encountered and that’s one of the biggest things I’ve learned,” said Bedolla. “The Army has taught me a lot about tolerance, self-awareness, patience and has opened my eyes to the different people that are all over this country and abroad.”

From a small Nicaraguan city torn by conflict to living a childhood dream, Bedolla’s journey from refugee to Army officer is telling of the unique opportunities the Army provides. Bedolla’s plans for the future include serving in the Army as long as she can and continuing to set an example for her younger sisters, and children.

“I’m grateful for the opportunities I’ve had and proud of what I do,” said Bedolla.

Author: Marcy Sanchez –  William Beaumont Army Medical Center

William Beaumont Health System and the Dental Clinics are slated to become tobacco-free beginning May 8.

The ban prohibits all active-duty Soldiers, staff, patients and visitors from using any tobacco product (including cigarettes, cigars, pipes, smokeless tobacco and electronic cigarettes) while on William Beaumont Army Medical Center (WBAMC) grounds or any outlying medical or dental clinic throughout Fort Bliss.

“Providing a tobacco-free campus demonstrates our dedication and commitment to the health and wellness of our Soldiers, staff, patients and families,” said Col. John A. Smyrski III, commander, WBAMC.

The policy will not force tobacco users to quit using tobacco, but will encourage healthier choices.

WBAMC’s goal is to set the example by promoting healthy lifestyles and behaviors that contribute to overall better health in the Fort Bliss and El Paso communities.

The Army Medicine 2020 Campaign Plan sparked the ban, changing from a healthcare system to a system for health.

“We are promoting a safe environment of care to fortify the system for health in our community,” said Smyrski.

In accordance with Army Regulation 600-63, use of tobacco will no longer be authorized in any MEDCOM-operated building, including medical, dental and veterinary clinics; administrative buildings; roadways, sidewalks, parking lots and grounds external and adjacent to WBAMC property.

The Tobacco Free Campus policy will not apply to Bargaining Unit Employees pending the completion of negotiations in accordance with the collective bargaining agreement and 5 USC 7116(a)(5).

Author:  Marcy Sanchez – William Beaumont Army Medical Center Public Affairs Office

William Beaumont Army Medical Center performed its first ever Skin-to-Skin Contact after cesarean delivery, March 21, 2016.

The completion of the first Skin-to-Skin Contact (SSC) after cesarean delivery (C-section) opens the doors to future SSC after C-section as part of WBAMC course to seeking national accreditation as a Baby-Friendly hospital.

“This is new,” said Lt. Col. Cattleya Born, chief, Maternal Child Nursing Section. “(WBAMC) used to not let the baby go skin-to-skin, we would wrap the baby up and then let mom hold the baby for a few seconds

Although not yet common practice, the implementation of the first and successful attempt at SSC after C-section provides expecting parents an option that may benefit both mom and baby.

“It was very rewarding and actually made me feel much calmer in the Operating Room,” said Kristy Goldberg, 36 and native of Delanco, New Jersey whose delivery with son, Kaleb, was WBAMC’s first SSC after C-section. “He was comforting me and I was comforting him at the same time.”

Although Kristy Goldberg was nauseous after the C-section, she says having the immediate skin-to-skin contact and bonding helped and prevented further nausea.  Goldberg, now a mother of three, said she didn’t have the opportunity to experience SSC after C-section with her oldest daughter, Maya.

In a 2010 study, the National Center for Biotechnology Information found no evidence of newborns being at risk when experiencing SSC after C-section. In addition, the study found that newborns that experienced SSC after C-section were more likely to attach and breast-feed earlier than those who didn’t. The study also stated SSC mothers expressed high levels of satisfaction with the SSC.

“I think this is a great thing we are doing,” said Born, a native of Cold Water, Michigan. “When you compare military to non-military hospitals, WBAMC’s doing the same procedures as non-military hospitals in birthing.”

Also known as Kangaroo care, SSC has been proven to have health benefits for newborns as well.

“It really does help to calm a baby down,” said Born. “Newborns hear the mother’s heartbeat and it brings them back to when they are in utero. It helps with the stabilizing vital signs.”

“It was nice for all of us to be together and the two of them being together right away, there wasn’t a delay or rush,” said Maj. Michael Goldberg, Kaleb’s father and husband to Kristy Goldberg. “They both just seemed calmer; he looked like he was doing very well from the get-go.”

Michael Goldberg, 39, gastroenterologist, WBAMC, attested to Kaleb’s progress as he latched on to breastfeeding much quicker than his siblings after their birth.

Prior to performing the actual C-section, hospital staff had performed mock C-sections to ensure medical equipment and staff would be positioned to make skin-to-skin contact possible. While the SSC after C-section isn’t common WBAMC practice, the staff is working to implement it in birthing at WBAMC.

“We have certain criteria when we can do (SSC after C-section). It can only be for scheduled routine C-sections not for urgent C-sections,” said Born. “Our surgeons will screen patients and give candidates the opportunity to choose SSC after C-section.”

“I think it be great for every mom to have the opportunity to have skin-to-skin after any birth,” said Kristy Goldberg. “It was a positive experience and important to me because I heard of the benefits from SSC for the baby.”

“I’m thrilled that they got the opportunity,” said Helen Goldberg, Kaleb’s grandmother and native of Wynnewood, Pennsylvania. “Thirty-nine years ago they just took the baby away (referring to Michael Goldberg’s birth).”

Currently WBAMC is in the dissemination phase or phase three on the pathway to a Baby-Friendly Hospital accreditation.

The designation Baby-Friendly Initiative was launched by the World Health Organization in 1991 to encourage and recognize hospitals that offer optimal level of care for infant feeding and mother to baby bonding. Once a medical facility completes the 4-D pathway to designation, which consists of four phases, the medical facility is designated as Baby-Friendly. Currently, WBAMC is in phase three of the pathway.

As of March 14, there are two medical facilities in West Texas that are accredited as Baby-Friendly, both non-military hospitals.

Author: Marcy Sanchez – William Beaumont Army Medical Center Public Affairs Office