University Of Iowa Hospitals And Clinics Research Articles

Facial and ocular injuries associated with methamphetamine production accidents

To evaluate the relative contribution of methamphetamine production-related accidents to facial and ocular injuries admitted to a regional burn unit. Retrospective observational case series. Chart review of all patients admitted to the Burn Unit at the University of Iowa Hospitals and Clinics (UIHC) over a 16-month interval. Methamphetamine related accidents were responsible for thirteen (9.8%) of 132 patients admitted with facial burns to UIHC during the study period. All victims were male. In addition to facial burns, eight patients (14 eyes) suffered chemical or thermal burns of the ocular surface of Hughes grade I or worse. One patient required full-thickness skins grafts for cicatricial ectropion of all four eyelids. In endemic areas such as Iowa, methamphetamine production accidents contribute to as many as 10% of admissions to burn care units for facial and ocular injuries.

Education of the ventricular assist device patient's community services.

Two implantable, electric left ventricular assist systems have received approval from the Food and Drug Administration (FDA) for use outside a hospital environment. As patients supported with these systems are discharged from the hospital, it is important that various community services and agencies be involved in the care of this unique patient population. Between January 1999 and May 2001, The University of Iowa Hospitals and Clinics (UIHC) implanted 14 HeartMate VE LVAS (Thoratec Corporation, Pleasanton, CA) in patients as a bridge to cardiac transplantation. Of these 14 patients, 13 were discharged home from the hospital. On the basis of our 3 year experience, a discharge program has been developed to educate the ventricular assist device (VAD) patient's community services. Ten community services most critical to a safe home discharge program are identified. Timing of service contact, mechanism of contact, community education method, education content, education materials, and outpatient community service usage are described.

Belt lipectomy: procedure and outcomes.

Belt lipectomy includes the traditional abdominoplasty or panniculectomy with excision extended laterally around the entire trunk. This technique yields a lateral thigh and buttock lift, and when combined with liposuction is used to improve contour of the thighs. The focus of this paper is to describe current surgery for body contouring of the entire trunk and our experience at University of Iowa Hospitals and Clinics (UIHC) with 32 belt lipectomies.

Laryngeal Cancer Cost Analysis: Association of Case‐Mix and Treatment Characteristics With Medical Charges

To examine the relationship of various pretreatment case-mix characteristics and treatment modalities with medical charges incurred during diagnosis, treatment, and 2-year follow-up for patients with laryngeal cancer. Retrospective chart review and billing record analysis. The charts and billing records of patients diagnosed with laryngeal cancer at the University of Iowa Hospitals and Clinics (UIHC) between January 1, 1991 and December 31, 1994 were reviewed. The independent variables included various pretreatment patient-mix and tumor characteristics (age, AJCC TNM clinical stage, smoking history, ASA class, and comorbidity as defined by Kaplan-Feinstein grade) as well as type of treatment. The dependent variables included total physician, office, and university hospital-based charges incurred during the pretreatment evaluation and 0- to 3-, 3- to 12, and 12- to 24-month billing periods after the initiation of cancer-directed therapy. Total 1-year and 2-year charges were also evaluated. Univariate and multivariate analyses were used to investigate the relationships between dependent and independent variables and to develop models predictive of management charges during the individual and total billing periods. Pretreatment charges showed no significant associations (P < .05) with any of the independent variables. Multiple regression analyses indicated that comorbidity, stage, and initial treatment modality were significant variables in one or more of the models predicting charges incurred during the 0- to 3-month, 3- to 12-month, total 1-year, and total 2-year billing periods. The models yielded R2 values for the total 1- and 2-year billing periods of 0.5246 and 0.5055, respectively. This work supports continued study of measures that may result in earlier detection of laryngeal cancer as a potential means of reducing management charges. These results also indicate that a more accurate method of stratifying the disease severity of laryngeal cancer patients for reimbursement purposes would include measurements of the severity of the index disease as well as comorbid diseases.

Persistence of Legionella pneumophila in a hospital's water system: a 13-year survey.

To describe the molecular epidemiology of Legionella pneumophila infections in the University of Iowa Hospitals and Clinics (UIHC). Molecular epidemiological study using pulsed-field gel electrophoresis (PFGE). A large university teaching hospital. ISOLATES: All surviving isolates obtained from culture-proven nosocomial L. pneumophila infections and all surviving isolates obtained from the University of Iowa Hospital and Clinics' water supply between 1981 and 1993. Thirty-three isolates from culture-proven nosocomial cases of L. pneumophila pneumonia were available for typing. PFGE of genomic DNA from the clinical isolates identified six different strains. However, only strain C (16 cases) and strain D (13 cases) caused more than 1 case. Strain C caused clusters of nosocomial infection in 1981, 1986, and 1993 and also caused 4 sporadic cases. Strain D caused a cluster in 1987 and 1988 plus 4 sporadic cases. Of the six strains causing clinical infections, only strains C and D were identified in water samples. PFGE identified three strains in the water supply, of which strains C and D caused clinical disease and also persisted in the water supply during most of the study period. Specific strains of L. pneumophila can colonize hospital water supplies and cause nosocomial infections over long periods of time.

Telemedicine to Iowa's correctional facilities: initial clinical experience and assessment of program costs.

To evaluate the costs and benefits of a prison telemedicine program for the institutions involved and to assess early provider satisfaction. A survey of primary care and consulting providers from four prisons and an academic tertiary care facility in Iowa was conducted during the first year of telemedicine service linked with the state's correctional facilities, from March, 1997 to February, 1998. Data were evaluated from 247 completed telemedicine encounters. Cost estimates were made for (1) 1997 cost data for the 4,396 Iowa prisoners who were transported to The University of Iowa Hospitals and Clinics (UIHC) for their health care, and (2) the equipment, circuitry, and personnel costs necessary on both ends of the network to provide comparable telemedicine service to remote patients and providers. A formula for estimating the cost of implementing a telemedicine service is presented. It includes a projection for determining at what point the cost of the telemedicine visit approaches the average cost of an on-site visit (breakeven point). There was also a brief survey administered to presenting and consulting physicians to determine their overall satisfaction with the telemedicine system for diagnosis, treatment planning, and follow-up. The average cost to the prisons for an on-site inmate visit to the University of Iowa Hospitals and Clinics (UIHC) was $115 during our study period, from March 1997 to February 1998. Using a formula that specifies a number of fixed and variable costs for implementing telemedicine, we were able to determine that the breakeven point for Iowa's correctional facilities would require 275 teleconsultations per year, per site (total of 1,575 consultations a year). Given the higher equipment investment at the UIHC hub, the breakeven point would be around 2,000 teleconsultations annually. Cost studies did not include medical care, which is assumed to be relatively comparable for both on-site and telemedicine interactions. Overall, referring physicians expressed a higher rate of satisfaction with telemedicine than specialists (4.19 to 3.45, respectively, on a scale of 1 to 5 - 5 representing the highest ranking). Both consulting and referring physicians ranked the quality of transmission the highest among all questions regarding satisfaction with the telemedicine system. No one should anticipate instantaneous cost-effectiveness with telemedicine. However, with careful planning, implementing a telemedicine program can be "cost-acceptable" initially. Telemedicine ultimately becomes cost-effective as the volume of teleconsults increases.

University of Iowa Hospital and Clinics: outcomes management.

Delivery of quality patient care and management of patient outcomes is critical to the success of academic medical centers in the ever-changing health care market. The University of Iowa Hospitals and Clinics (UIHC) promotes quality care through the provision of organizational structures and processes that are described in this article. In addition, quality of care and outcomes management are described by members in various roles within the UIHC health care system. It is the authors' belief that understanding quality from these various perspectives helps UIHC work across departments to achieve excellence in patient care.

Vertical gastroplasty: evolution of vertical banded gastroplasty.

The objective of this paper is to summarize the goals, technical requirements, advantages, and potential risks of gastroplasty for treatment of severe obesity. Gastroplasty is preferred to more complex operations, as it preserves normal digestion and absorption and avoids complications that are peculiar to exclusion operations. The medical literature and a 30-year experience at the University of Iowa Hospitals and Clinics (UIHC) provides an overview of vertical banded gastroplasty (VBG) evolution. Preliminary 10-year results with the VBG technique currently used at UIHC are included. At UIHC the VBG is preferred to other gastroplasties because it provides weight control that extends for at least 10 years and the required objective, intraoperative quality control required for a low rate of reoperation. It is recommended that modifications of the operative technique not be attempted until a surgeon has had experience with the standardized operation--and then only under a carefully designed protocol. Realistic goals for surgery and criteria of success influence the choice of operation and the optimum, lifelong risk/benefit ratio. In conclusion, VBG is a safe, long-term effective operation for severe obesity with advantages over complex operations and more restrictive simple operations.

Education of staff and students in health care settings: integrating practice and research.

A cooperative program between the University of Iowa Hospitals and Clinics (UIHC) Department of Social Service (DSS) and the University of Iowa School of Social Work (UISSW) integrates faculty and students with clinicians for both practice and/or research internships. This program has endeavored to enhance practice and research social work through the development of (1) multiple student training programs offering both practice and research placement opportunities, (2) a jointly appointed faculty position between the UISSW and the UIHC DSS designed to improve researchers' access to and involvement with practice and practitioners' involvement in practice research, and (3) specialized student training programs including research projects in practice specialties. This project has helped clinicians conduct research, provided students with practical research experience within a clinical setting, and has increased the likelihood that both staff and students will participate in research.

Abnormalities in control of ventilation in newborn infants with myelomeningocele

Objective: The objective of this study was to assess respiratory responses of newborn infants with myelomeningocele through pneumograms and carbon dioxide challenge, and to evaluate the possibility of predicting which patients with myelomeningocele acquired respiratory symptoms related to the Arnold-Chiari deformity and brain-stem dysfunction. Methods: All surviving infants with spina bifida who were born at the University of Iowa Hospitals and Clinics (UIHC) or were transferred there on the first day of life between January 1987 and January 1991 were assessed with a pneumogram and CO2 challenge once they were medically stable, and were followed for a mean of 30 months (10 to 53 months). Results: Thirty patients met the inclusion criteria for this study; four died before being studied. Of the 26 remaining patients, 12 were born at the UIHC and 14 were transferred to the UIHC on the first day of life. Of the 26 infants studied, 12 (46%) had abnormalities on the pneumogram, including 2 with significant periodic breathing and 10 with episodes of desaturation below 87%. Of the 26 infants studied, 4 had no detectable response to an increasing fraction of CO2 in inspired air on the CO2 challenge and 12 had an increase in exhaled minute ventilation per increase in the alveolar fraction of CO2 in exhaled air more than 2 SD below the mean. Only 10 patients (38.5%) had normal ventilatory responses to the increasing fraction of CO2 in inspired air. On follow-up, only one study patient had symptoms related to Arnold-Chiari deformity and brain-stem dysfunction (bilateral vocal cord paralysis). His neonatal CO2 challenge results and his pneumogram were normal. Conclusion: We conclude that these two tests are not useful in predicting which patients will have symptoms related to Arnold-Chiari deformity. Specificity for the pneumogram and the CO2 challenge was 0.52 and 0.36, respectively. Sensitivity was zero for both tests, although this result is limited by the low incidence of symptomatic Arnold-Chiari deformity in this sample. As previous investigators have found, a significant number of patients with meningomyelocele had abnormal ventilatory patterns. These ventilatory abnormalities indicate that even in the absence of severe symptoms, the control of the ventilatory response is somewhat impaired in many patients with meningomyelocele. This alteration in ventilatory control is probably related to abnormalities in the development of the brain stem. (J PEDIATR 1995;126:1011-5)

Development of a method to monitor dietitian productivity

The University of Iowa Hospitals and Clinics (UIHC) Dietary Department recognized the need for a better method of assessing clinical dietitian productivity. To determine methods already in use, surveys were mailed to 52 teaching hospitals around the United States. Responses were received from 27 (51%) of the hospitals. UIHC clinical dietitians were also surveyed.

Certifying competencies of personnel.

Marjorie Moore Cantor, R.N., Ph.D., is Associate Director, Nursing Staff and Program Development, University of Iowa Hospitalsand Clinics. A graduate in Nursing from University of Nebraska, Dr. Cantor received her Master's degree in Child Welfare at the University of Iowa where she later earned her Ph.D. in Educational Psychology. She has been affiliated with the University of Iowa since 1950 when she was associate in preventive psychiatry. Since that time she served as instructor in nursing, assistant professor of nursing, acting chairman of medical and surgical nursing and assistant professor of nursing in the graduate program.