With holiday events and meals to prepare, eating healthy is a challenge. It’s important to know the science behind healthy food choices when you’re grocery shopping and how to use the ingredients. We’ve included a few dishes below to try this holiday season.

Turkey Cranberry Meatballs

Ingredients:
1 pound ground turkey

1 large egg

1/3 cup dry breadcrumbs

1/4 teaspoon salt

1/2 teaspoon pepper

1/2 teaspoon garlic powder

1/2 teaspoon onion powder

1 cup 100% cranberry-apple juice

2 tablespoons low sodium soy sauce

2 tablespoons honey

1 1/2 teaspoons cornstarch

2-4 tablespoons sweetened dried cranberries (optional)

Preparation:

1. Combine turkey, egg, breadcrumbs, salt, pepper, garlic powder and onion powder in a large bowl. Shape mixture into about 15 (1-inch) balls.
2. Combine the juice, soy sauce and honey in a small bowl. Sprinkle cornstarch on top and whisk together well.
3. Bake meatballs on a cookie sheet (spray first with cooking spray) for 30 minutes at 350 degrees.
4. Place meatballs into a 3.5-quart slow cooker. Pour the juice mixture on top and sprinkle with dried cranberries (optional).
5. Cook on low, covered, for 1.5 hours, or until the meatballs are thoroughly cooked. Remove the lid and finish cooking uncovered for 30 minutes until the sauce has thickened.

Cooking tip: To make ahead, place cooked meatballs in a zip-top plastic freezer bag, and freeze up to 1 month. Thaw in refrigerator, and cook, stirring occasionally, until thoroughly cooked. You may also use pre-made frozen meatballs, but they will likely be higher in sodium.

Nutrition information (2 meatballs): 177 calories, 6g fat, 17g carbohydrates, 1g fiber, 14g protein, 376mg sodium

Yield: 1 ½ dozen

Nutritional highlight:
Turkey: Lower in saturated fat which can increase your risk for heart disease.

Oven Roasted Sweet Potatoes

Ingredients:
4 medium sweet potatoes, peeled and cut into 2-inch pieces

2 medium sweet onions, cut into 1-inch pieces

2 tablespoons extra-virgin olive oil

1/2 teaspoon black pepper

1/2 teaspoon garlic powder

Preparation:

1. Preheat oven to 425 degrees.
2. Combine all ingredients in a 13 x 9 inch baking dish. Toss to coat.
3. Bake for 35 minutes or until tender.

Cooking tip: To avoid crying while cutting your onions try cutting near an open window, under a thin sheet of water (be careful maneuvering the knife) or freeze the onion for 10-15 minutes prior to cutting.

Nutritional information (1 cup serving): 151 calories, 5g fat, 26g carbohydrates, 4g fiber, 2g protein, 57mg sodium

Serves: 6 (1 cup)

Nutritional highlight:
Sweet Potatoes: A nutrient dense food packed with fiber, potassium, phosphorous, calcium, magnesium, Vitamin C, Vitamin A and folate. Sweet potatoes also contain beta-carotene, which can help lower the risk of colorectal, esophageal, lung and head and neck cancers.

Onions: Provide a source of calcium, potassium and Vitamin C. Onions are also a source of quercetin which may help lower blood pressure and decrease total cholesterol.

Cranberry Vinaigrette

Ingredients:
1 cup frozen cranberries

3/4 cup cranberry juice

1 tablespoon sugar

2 garlic cloves, minced

3 tablespoons apple cider vinegar

1 teaspoon salt

1 teaspoon pepper

2 tablespoons olive oil

Preparation:

1. Cook frozen cranberries, cranberry juice, sugar and garlic over medium heat.
2. Bring to a boil, simmer 2 minutes, then remove from heat and whisk in remaining ingredients. Chill.

Nutritional information (1 ounce): 40 cal, 2g fat, 4 g carb, 0g protein, 235 mg Sodium

What happens when an athlete has a concussion? Watch our recent Medicine of the Games segment to learn more from David Brody, MD, PhD, a Washington University neurologist at Barnes-Jewish Hospital.

Put simply, there are little tears in the wiring of the axons, which connect one part of the brain to another. There are also changes in blood flow and some changes in the electrical function of the brain.

Every sport has a risk of concussion, even some unusual sports like trampolining and diving. There has been a lot of interest in concussive injuries in soccer and what the rules about return to play are. According to Dr. Brody, “The sports that worry me the most as a physician are the martial arts. Boxing is the biggest one.” However, Olympic boxing is quite different from professional boxing in the sense that the athletes wear head gear and there are a lot of rules in place to prevent concussive knockouts. Unfortunately, every knockout is a concussion.

Interestingly, the biggest risk of concussion to an athlete is in equestrian sports, which has the highest risk of concussion per hour played. It’s a sport we may not watch every day, but it’s a big part of the summer games.

A common question around concussions is “What is the cost to an athlete who suffers a concussion?” Dr. Brody says, “Most athletes who suffer a concussion make a very, very good recovery and there are no serious consequences with regard to their long-term Olympic careers. The problem is when people have multiple concussions. When they have three, four, five or even 10 concussions during their careers.”

Hank Mihelcic spends a lot of time working in his yard. That doesn’t sound out of the ordinary until you learn that Mihelcic is 84. Even more amazing is the fact that 30 years ago, he received a new heart.

Mihelcic was the 29th adult patient to undergo a heart transplant at Barnes-Jewish Hospital, previously named Barnes Hospital. As he marks the 30th anniversary of his operation, the Washington University and Barnes-Jewish Transplant Center is celebrating more than 30 years of successful heart transplants. Since it began, the heart-transplant program has given almost 800 patients a new chance at life.

Mihelcic, a 25-year Air Force veteran, was 54 when he suffered a massive heart attack on April 18, 1986, which happened to be his 26th wedding anniversary. He was initially admitted to Scott Air Force Base Medical Center and later transferred to Barnes Hospital. On May 9, he was placed on the heart-transplant wait list.

“At the time, people didn’t know much about heart transplants,” Mihelcic says. “I thought it was the end for me.”

Just four days later, on May 13, he received his new heart. The operation was performed by R. Morton “Chip” Bolman III, MD.

A four-day wait time is almost unheard-of today, but in the early days of the heart-transplant program, it was normal. The hospital’s first heart-transplant recipient waited just one day to receive his new heart.

“In those days there were very few potential recipients and many more heart donors, but that’s completely different now,” Gregory Ewald, MD, a Washington University cardiologist at Barnes-Jewish Hospital and the medical director of the hospital’s heart-transplant program says. “The number of organ donors has not changed much over time, but many more patients are waiting for a heart transplant. We are doing about 2,300 heart transplants each year in the United States. Promoting donor awareness and having people who are willing to donate their organs can make a big impact.”

Mihelcic describes his post-transplant recovery as “slow but sure” and says he has been in good health ever since. He returns to Barnes-Jewish Hospital for annual exams, and every day for 30 years he has faithfully taken his immunosuppressant medication to help prevent his body from rejecting his donor heart.

“When Mr. Mihelcic had his operation in 1986, there was no long-term experience with heart transplantation,” Ewald says. “In the early days of transplantation, patients were often told they might live five years.”

Though the surgical techniques used in heart transplantation haven’t changed much in the last 30 years, knowledge about immunosuppression—or keeping the body from rejecting the new heart—has grown.

“Today we have better medications and new ways to suppress the immune system,” Ewald says. “I think that’s why people are doing better and living longer.”

“Hank has done really well,” says Cindy Pasque, MSN, RN, Mihelcic’s current transplant nurse coordinator. “He’s done everything he’s supposed to do to take care of himself for the last 30 years, and he’s watched his children become successful and his grandchildren grow.”

Mihelcic’s connection with his doctors and nurses goes beyond his medical care. Along with Pasque, he spent several years playing on a Barnes-Jewish Hospital softball team made up of heart-transplant recipients and doctors and nurses from the heart-transplant program.

“At the time, it was thought that heart-transplant recipients couldn’t be very active,” Mihelcic says. “But there we were—playing on a softball team.”

They even competed against a team from Paducah, Kentucky, that was also composed of Barnes-Jewish heart-transplant patients.

Ewald says part of the reason for the heart-transplant program’s success over the past three decades is the fact that many of the physicians and staff have been here long term.

“We have been striving for the best outcomes for our patients ever since our heart-transplant program started more than 30 years ago,” he says. “It truly is a group effort, and our team, including physicians, surgeons and transplant nurse coordinators, is committed to excellence. There aren’t many programs that have a 30-year heart transplant survivor.”

It’s not news that things are changing on the Washington University Medical Center campus, where Washington University School of Medicine, Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, St. Louis Children’s Hospital and other patient-care facilities are situated. If you drive along Kingshighway Boulevard, just east of Forest Park in St. Louis, the changes are obvious: cranes, steel girders and a transformed skyline offer more than a hint that renovation is underway.

What’s not so obvious is the nature of the planning process that helped bring a vision to fruition, well before an old brick came down or new beam was hoisted. Honoring the mission of the medical campus—to take exceptional care of people—the architects, designers and engineers worked with several BJC HealthCare advisory groups to arrive at a plan for the 780,000-square-foot-expansion.

Rendering of a labor and delivery room.

“We pioneered a new, innovative design process,” says Nancy Coleman, BJC HealthCare’s director of planning and design. BJC HealthCare is the parent health system for Barnes-Jewish and St. Louis Children’s hospitals. In addition to the patient-satisfaction data that BJC HealthCare collects through the national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, it also gathers its own data based on feedback from its employees, and patients and their families.

“Traditionally, hospital-design decisions are made without reference to HCAHPS performance scores, safety information, or employee-satisfaction data,” Coleman says. But in designing the new buildings, she notes, “we used all these things to help determine design solutions that ultimately will improve patient outcomes and satisfaction. Former patients and their family members served on three different advisory councils, along with more than 350 physicians, clinicians and non-clinical staff.

The goal is to build buildings designed to help doctors, nurses and technicians meet the mission. “We feel confident that the new buildings will help us deliver the highest level of patient-centered care,” Coleman says.

Little changes, big impact

Peter Grandine, vice president and senior medical planner of the health care division of HOK, the architecture and engineering firm for the project, offers an illustration of the mission-influenced design: “In a traditional hospital room, the patient has to cross the room to get to the bathroom. In the new patient rooms, these facilities are located on the headwall, where the head of the bed is positioned. That means there’s a shorter, safer walk for the patient and a reduced risk of falling.”

The proximity of bathroom to bed is just one element of a new, standardized room layout. As staff members enter one of the new rooms from the hallway, the bed is always on the left, in one of three distinct areas called zones by the planning and design teams. In each room, there’s a zone in the center of the room for the patient and bed; a zone near the window and bed for visitors to gather; and a zone nearest the hallway for caregivers, oriented so that caregivers face patients and family when they enter.

The benefit of standardizing the room design—hundreds of rooms, all the same—is that it helps staff react quickly when necessary; no one has to pause to study the room and locate emergency equipment—it’s always in the same place. This kind of consistency also means that staff can be more efficient, with more time to spend with their patients.

Stephanie Kroener, BSN, RN, project manager for St. Louis Children’s Hospital, offers this example of patient-centered design: “Traditionally, computers are placed on the sidewalls of patient rooms. In one of our advisory council meetings, a teenager mentioned that staff always had their backs to patients when they turned to enter information in the computerized medical chart. So we moved the computer from the sidewall to the headwall. Now staff members face patients and families while they are charting.”

Color and light

A rendering of the garden intended for women and their families postpartum.

The new buildings are designed to take advantage of as much outdoor light as possible. Because natural light promotes healing, every patient room has one wall that is almost entirely window; nearly 85 percent of these rooms look out onto Forest Park. Many of the other rooms offer views of one or more of five outdoor gardens. Windows placed at the end of each corridor are there to help visitors orient themselves within the building, helpful when trying to navigate a complex campus.

Color, too, is important and plentiful, employed for three primary purposes: to help visitors find their way through the buildings, to distinguish staff work areas from patient-care areas and, most important, to promote healing.

In the new buildings, colors were chosen for their abilities to generate emotional and physical responses. Kroener says, “Research tells us that different colors elicit different responses. So we’ve asked, ‘Are we trying to motivate patients? To help them stay calm?’” By way of example, Kroener notes, the orthopedic unit has incorporated brightly colored stripes into the flooring that serve as distance markers. “It’s more fun for children if you can say, ‘You made it to the green stripe yesterday. Let’s go for blue today.’” Similar striping in the labor and delivery unit helps women and their partners mark their progress as they walk the corridors, preparing for delivery.

Shhhhh

Noise is a major stressor. According to Jon Bettale, BSN, MBA, project manager for the Barnes-Jewish Hospital expansion, “Stress can lead to elevated blood pressure in our patients and raise their heart rates, ultimately affecting the body’s ability to heal. And research tells us that staff members working in calm, quiet environments are better able to focus.”

Accordingly, one of the top design priorities was banishment of as much noise as possible. This has been accomplished in a number of ways, including: use of sound-absorbing flooring and ceiling materials, and placing the doors leading to busy supply and utility rooms in ways that reduce noise levels in public corridors.

And, Bettale says, “walls in patient rooms are thicker, reducing the transmission of noise and vibrations.” Additionally, the new room configuration places the headwall of one patient room directly opposite the footwall of the room on the other side of the wall. When beds are placed headwall to headwall, Bettale says, bedside activity is transmitted through the shared wall, disturbing neighboring patients and distracting medical caregivers.

Offering respite

Honoring the requests of former patients, families, physicians and nurses, every floor in both buildings has separate respite areas for families and for staff, and every floor in St. Louis Children’s Hospital has what’s called a child life room, where therapists and children can “play” through the challenges of hospitalization. “We’ll have respite areas at the end of each corridor, where patients and their families can be together. For patients with extended hospitalization, these areas are a welcome change from the hospital room,” Bettale says.

Other accommodations designed for families include kitchen and dining areas, showers, laundry facilities, private computer stations and lounges with comfortable, living-room style furniture.

Bettale describes the staff respite areas this way: “It’s more of a lounge, small and quiet, with soft seating and dimmer switches on the wall for lighting.” Grandine adds, “The requests for this space actually came from patients and families who understand the intense emotions associated with caring for patients. They wanted physicians and nurses to have a place where they can take a few quiet moments for themselves.”

Offering comfort and healing for patients and their families, and efficiency and calm for staff, the new patient-care spaces make healing more pleasant for everyone.

In an emergency department that receives more than 82,000 visits per year, patients can often experience full waiting rooms and extended wait times. Even with these challenges, the Barnes-Jewish Hospital emergency services team is on a mission of continuing to provide exceptional patient care while also improving patient satisfaction.

In the summer of 2014, we completed a renovation of the emergency department waiting area. The project took six weeks to complete and was designed to provide an improved environment for patients and a more efficient triage process. The project enhanced patient flow, improved navigation and provided a more comfortable space for our patients.

When people enter the emergency department, they’re registered, asked about their health condition and sent to one of four triage rooms. One of the rooms is designated for lower acuity patients, like those who have a tooth ache or sprained ankle.

“We’ve been able to cut our wait times in half by designating a triage room for our lower acuity patients,” says Brenda Rocha, DNP, RN, emergency services director at Barnes-Jewish. “Those requiring immediate treatment are seen first, but we also really wanted to reduce the wait time of our lower acuity patients as well.”

Meeting the needs of patients and family members in the emergency department’s waiting area includes checking vital signs and providing blankets while they wait to be treated. Shorter wait times, excellent customer service and proactively addressing patient needs in the waiting area all began to create a positive effect in patient satisfaction ratings.

“We want our patients and their family members to be as comfortable as possible in our waiting area,” says Cindy Lefton, PhD, RN, patient experience manager and researcher at Barnes-Jewish. “We can have up to 50 people waiting at a time so we want them to know that we care and we’re doing everything we can to meet their needs while they wait to be treated.”

The emergency department has also turned its attention to continue providing excellent customer service after the clinical care has been provided.

“We’re focused on a more consistent and efficient process for checking on patients and our discharge phone calls,” says Dawn Marchetto, MBA, RN, BSN, emergency services and patient access director at Barnes-Jewish.

A team of nurses now calls every patient that is discharged from the emergency department, which can be more than 3,300 calls a month. They answer questions patients may have regarding their health condition, medication, test results and ask if they’ve made their follow-up appointment.

The calls are also an opportunity for patients to ask questions about their health they may have forgotten to ask during their initial treatment and for the clinical team to reinforce the medical advice the patient was given during their visit.

Follow-up calls are not only a benefit to the patient, they’ve had a positive impact on how patients rate their overall emergency department experience.

“Understanding each patient’s experience is one of our top priorities,” says Marchetto. “Our goal is to continually improve our processes in the emergency department so we are always providing excellent care to our patients and families.”

A change in how nurses are assigned patients not only saved thousands of steps each shift but also led to a significant improvement in patient satisfaction on 17300 GYN oncology. When Martha Rahm came to the floor as clinical nurse manager in 2014, patient satisfaction scores were not where they should have been. “We were at 14.7 percent excellent for overall quality,” said Rahm, MBA, BSN, RN.

At the time, patient assignments were based on acuity, without consideration to location. A nurse could have patients at opposite ends of the floor. Two nurses could be assigned to separate patients in the same room. “When patients see a nurse, they sometimes make requests or have questions. If it is not your patient, you have to find their nurse,” said Rahm. “It was a lot of extra work for the nurses and it was confusing for the patients.”

In 2015, Rahm instituted two big changes – team nursing and geographical assignments. Two nurses and a patient care tech share responsibilities for eight patients. Assignments of those eight patients are based on location.

Nurses were skeptical. “We were afraid making an assignment based on the location of the patient on the floor would not give enough weight to how sick they were,” said Sarah Drake, BSN, RN.

To help her team see the difference, Rahm asked several nurses to count their steps using wearable activity trackers. Before team nursing and geographical assignments, they reported walking about 17,000 steps-per-shift. After the changes, the number of steps dropped to around 10,000 and patient satisfaction rose, as did teamwork scores.

In 2015, our overall quality scores reached 48.8 percent excellent.

Rahm reminds nurses their job is not a fitness program. “Our goal is to provide excellent patient care, do it efficiently and proactively and then we take care of ourselves,” Rahm said. “And it’s working.”

Click here to view the video on YouTube.

On the one year anniversary of his stroke, Blair Russell spent the evening with friends at Busch Stadium cheering his favorite team, the St. Louis Cardinals, on to a win.

On May 4, 2015, 37-year-old Blair Russell was teaching his fifth-graders math, just as he did every day after lunch. Suddenly, something felt off. “I was walking around the classroom. I never sit while I teach, so I was walking around when three fingers on my left hand went numb,” said Russell.

Russell reached for his water and tried to take a drink but it dribbled down his chin. He tried to sit down but fell to the floor. When three boys couldn’t help him into his chair, they got the school nurse. Russell wasn’t sure what was happening. But when the nurse got to his side, she said something he did not expect. She told him he was having a stroke. He asked someone to call his wife, all while his fifth-graders watched.

When EMTs arrived, Russell again heard the word “stroke.” Once at an area hospital, he recalls a robot type computer equipped with a camera. Through the technology of telemedicine, a neurologist asked Russell to raise his arm. “In my mind, I was. It felt like I was but when I looked down, my arm hadn’t moved.” He also remembers a doctor telling the medical staff to get him to Barnes-Jewish Hospital as soon as possible.

Before he was transported, Russell received the clot-busting drug known as tPA. Tissue plasminogen activator is the only FDA-approved drug for treating strokes caused by the blockage of an artery in the brain. But tPA was only the beginning of his treatment. Based on the clinical exam, Russell’s stroke was assessed to be moderate in severity, suggesting the blockage was in an artery that might be accessible by endovascular catheters, further reason to get him to Barnes-Jewish.

Within minutes of his arrival, the stroke team activated the rapid response protocol and conducted a computed tomographic angiography, or a CTA. Jin-Moo Lee, MD, PhD, a Washington University neurologist at Barnes-Jewish Hospital, was the attending neurologist. “We could see that there was a clot blocking a major artery that fed the right side of his brain—explaining the symptoms that he was experiencing,” said Dr. Lee.

Russell was sent immediately to DeWitte Cross, MD, a Washington University interventional neuroradiologist at Barnes-Jewish Hospital. Dr. Cross performed an endovascular clot removal procedure. “We made two separate passes with that catheter. We were able to retrieve some of the clot but not all of it. Then we used the stent retriever. After several passes, we were able to retrieve the clot,” said Dr. Cross. “Interventional treatments have come a long way in the past five years.” After many years of stagnation, there have been significant breakthroughs in stroke treatments recently.

When it comes to stroke, every minute matters and time saved is brain saved. For Russell, the onset of symptoms started around 1:40 p.m. Three hours later, Dr. Cross was removing the clot. Eight days later, Russell returned to work and his students. “They saved my life just as much as the nurses and doctors. I wanted to tell them myself I was ok. I wanted to send them off the right way for the summer,” Russell said.

As Missouri’s first certified Comprehensive Stroke Center, the Washington University and Barnes-Jewish Stroke and Cerebrovascular Center is able to treat patients with stroke faster than other emergency departments in the area, with more successful recoveries.

Our stroke team has made a commitment to making sure patients have the best acute stroke care possible by collaborating with other hospitals to create a Stroke Network. Area hospitals work closely with Barnes-Jewish to streamline and improve stroke care, regardless of where a patient is located.

“With increasing treatment options available at only certain hospitals like Barnes-Jewish, we are becoming a unique resource in the larger St. Louis region. Therefore, acute stroke care is becoming regionalized, and we must make our resources available to the larger community,” said Dr. Lee.

Russell still has some weakness caused by the stroke but overall, he says he has recovered well. “I’m lucky to be here,” Russell said. “And that’s how I look at life now. If my team doesn’t win, it’s okay. If I didn’t do a great job teaching one day, I’ll do better tomorrow. It’s going to be okay.”

Tamara Ramage Bruce’s life is full of blessings. In the past six years, she’s gotten married and had two children.

“I’m so grateful and amazed that I can be here,” she says with a laugh after being treated for a rare brain tumor in 2010.

Bruce was a healthy young woman in her mid-20s when she started waking up with hot and cold sweats and had a constant feeling of nausea. Taken to the emergency room by her father, Bruce was startled to be diagnosed with low grade leptomeningeal chondrosarcoma, a brain tumor so rare only a handful of people in the world have been diagnosed with it.

“I had always been healthy until about a year before when I had several bouts of severe headaches,” Bruce recalls. “I remember I joked then that I hoped it wasn’t a brain tumor, but then, when it came true, I thought for a split second that my life was over. I couldn’t believe what was happening.”

At Barnes-Jewish Hospital, Bruce was seen by a skilled neurology team. The team recommended surgery to remove the tumor. In addition, the team took advantage of intraoperative magnetic resonance imaging (iMRI), advanced technology at the time that allowed for real-time image scans of Bruce’s brain tumor so surgeons could precisely remove it without harming surrounding healthy tissue.

“I was happy to be at one of the best hospitals in the world,” Bruce says. “The neurosurgeons were so loving and caring and also calm. I knew I could beat this.”

Two years after her brain tumor was successfully removed, Bruce married her husband, Steve. “We met through family friends,” Bruce says. “My dad used to play hockey and some of his friends had kids so I met him that way.”

She also became a certified Montessori educator. A year and a half after her wedding, Tamara and Steve welcomed their daughter, Scarlett, into the family. Their son, Parker, was born in 2015.

“They keep me on my toes, for sure,” says Bruce. “My life is now always active!”

Now more than five years after her diagnosis and treatment for her brain tumor, Bruce says she doesn’t often think about her experience anymore. “It’s kind of like an out-of-body experience,” she explains. “It’s surreal, but it’s something that just happened. I have a lot of respect for the neurosurgeons who were skilled enough to take out my tumor and let me live my life. I have gotten married, I have a family—I’m really living the life that everyone hopes for.”

Tamara does offer one piece of advice. “I would say if you have headaches or nausea, get it checked out.”

Don’t ignore the early warning signs of a stroke. For internationally acclaimed textile artist and educator Lindsay Obermeyer, her first sign was double vision while having dinner with her daughter.

“Suddenly there were two of her,” Obermeyer recalls.

She went to the internet to search for a reason for her symptoms. “I read that it could be stress, which was possible because I was in the middle of my biggest art commission project, or that I needed new glasses. Or—it could be a stroke.”

The next morning, Obermeyer went to pick up a coffee cup and the mug fell from her hand. “All of a sudden, the whole left side of my body drooped and I couldn’t pick up my arm,” she says. “I was drooling.”

Her daughter called 9-1-1. Obermeyer was taken to Barnes-Jewish Hospital for an immediate stroke evaluation and treatment. Obermeyer had an ischemic stroke, the most common type. Doctors gave her the clot-busting drug tPA.

What Obermeyer didn’t know was her early double vision was a symptom of a transient ischemic attack, or TIA, which is sometimes called a mini-stroke. Symptoms, which can include sudden vision problems, dizziness, headaches, confusion or trouble speaking. They sometimes last a few hours or a day before disappearing. A TIA can be a critical warning sign that a true stroke may occur. 40-percent of people who have a TIA will develop an actual stroke and many will have a stroke within days after a TIA. For Obermeyer, it was a matter of hours.

As she progressed in her recovery, Obermeyer became involved in her neurologist’s research project. The Social Networks and Stroke Recovery Project at Washington University School of Medicine examines the impact a stroke patient’s social network has on their recovery. Based on the research, Obermeyer created beautiful crocheted mandalas that artistically depict the social networks of stroke survivors.

“I adopted the visual metaphor of tree ring diagrams to show the changes of networks over time within one image, something the social network research software was unable to do. It’s a way of diagramming visually those social connections of stroke survivors that are important for recovery,” she says.

More than just artistic expression, though, her work helped restore her own visual balance. “The stroke affects my left side, so I was visually imbalanced,” Obermeyer explains. “Crocheting these mandalas helped me recover from that.” Mandalas have long been used as a symbol of healing.

Since her stroke, Obermeyer has created hundreds of mandalas and others have joined the project. “Many mandalas were contributed by other patients who learned of me working in the Arts and Healthcare room. Mandalas have been received from around the metro region and as far away as Greece.”

She also started crocheting them in local coffee shops, thereby increasing her own social network. “I think this art project played a huge role in my recovery and it serves as a way for me to build stroke awareness,” she says.

In the Center for Advanced Medicine at Barnes-Jewish Hospital, a large wall now is filled with Obermeyer ’s artwork. “It’s exciting when you’re given that much space to work with,” she says. “I wanted to educate anybody who came in there about strokes and the symptoms of stroke.”

She adds, “The artwork is important to me because the more you know how to recognize the symptoms, the sooner you can get to the hospital. It could save your own life or the life of a family member or friend. Art is my passion and it also can serve a great purpose.”

Obermeyer’s work is in the national collection of Sweden and has been displayed in galleries and museums around the world, including the Museum of Fine Arts in Boston and the Museum of Fine Art and Design in New York.

Nurse researchers at Barnes-Jewish Hospital are pioneering the application of new technologies to reduce the incidence of inpatient hospital falls. Nationally, between 700,000 and 1 million patients fall in U.S. hospitals each year.*

A Barnes-Jewish pilot program conducted on a nursing division has resulted in a 58 percent reduction in the fall rate, and a 42 percent reduction in falls with injury during the trial’s initial phase.

To conduct the pilot study, researchers installed 52 depth-sensing cameras (originally, these were xBox Kinect® cameras) in two general medicine divisions. The cameras collect video of a room’s occupants prior to and during a fall without revealing their identity. The study is providing valuable information to the researchers about the nature of falls and nurse responses.

The cameras record only silhouette forms of those in a patient room, so their privacy is protected. Patients also are advised about the presence of the camera upon admission and given the option of having the system switched off.

To obtain additional data about patient movement, bed sensor mats were installed on one of the two units. By observing a patient’s gait (walking movement), the depth sensor, working with the bed sensor system, is able to compute a patient’s fall risk.

“We’re very excited by our early results,” says Pat Potter, PhD, RN, FAAN, Barnes-Jewish Hospital director of research for patient care services, who is leading the team evaluating the fall prevention technology. “There’s plenty of data on why patients fall, but this study is providing our clinical teams with real-time input and yielding some new insights on why falls happen.”

This is how the system works. As a patient moves around his or her room, the bed sensor and camera gather information that the system uses to automatically compute a patient’s fall probability as high, moderate or low. If a patient is rated as a high fall probability, the next time they get out of bed, an alert is sent to the cell phone of nurses on that unit. In that way, nurses can react before a potential fall occurs. An alert also is sent if a patient of any risk level falls.

Following a fall, information from the system allows members of the project team and unit staff to analyze what patient behaviors or conditions in the room might have contributed to a fall.

“Among other interesting findings, we’ve determined that patients move about in their beds an average of four minutes before getting up,” says Potter. “That’s a window of time that we might be able to utilize in developing an ‘early warning system.’ ”

The project team also has observed patients getting up and falling after a caregiver takes their vital signs in the middle of the night. The project team theorizes that patients, like most every adult, realize they need to use the bathroom before they can go back to sleep. Instead of asking for assistance, they get themselves out of bed and fall. In fact, no patient who fell during the study utilized their call button for assistance with getting out of bed.

In addition to yielding useful, real-time data, Potter believes the study has raised awareness and created an “enhanced culture” around falls in the units participating in the study.

The project team also is comparing the system’s assessment of fall risk to scores obtained from the Johns Hopkins Falls Assessment Tool, which Barnes-Jewish and many other hospitals have used for years to assess a patient’s fall risk.

During the trial phase, 52 sensors were in operation, but the ongoing study has been scaled back to 26 patient rooms.

“We believe we’re the first hospital to implement this technology on this scale,” says Potter.

In addition to this new technology, Barnes-Jewish Hospital utilizes an array of methods to reduce patient falls and to reduce the likelihood of injury from falls, such as:

• Conducting fall assessments on every patient upon admission and throughout their stay and assigning a fall risk status
• Discussing with every patient their related fall risk and the importance of asking for assistance if they are identified as at risk to fall
• Attaching a bright yellow armband to high-risk patients
• Utilizing a signage system that reminds patients and their visitors about their fall risk status
• Utilizing bed alarms to notify staff when a high-risk patient is getting out of bed
• The use of lowered beds and fall mats to reduce injuries from falls

Barnes-Jewish has achieved a 20 percent reduction in falls and a 29 percent reduction in falls with injury hospital-wide since 2009.

* The Agency for Healthcare Research and Quality: Preventing Falls in Hospitals
A Toolkit for Improving Quality of Care