Behavior modification in prisons.
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Behavior↗
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Results for “Iowa State Medical Facility”
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Mortality in patients with schizophrenia, mania, depression and surgical conditions. A comparison with general population mortality.
Mortality data are presented from a four-decade follow-up study of 200 schizophrenic, 100 manic, 225 depressive patients, and 160 surgical controls (80 appendicectomy; 80 herniorrhaphy). Data for this analysis were available on 648 (95 per cent) members of the study population. Using sex-age standardized mortality ratios (SMR), the mortality experience of the study population was compared with that of the state of Iowa, the geographical area served by the admitting medical facility for the study group. Results are presented for a four-decade period beginning 1935-44, and ending 1965-74. All three psychiatric groups had a significant increase in mortality risk. This was most pronounced in the first decade following admission, although schizophrenic patients, especially females, continued to show a significant excess of deaths throughout the entire four decades of the follow-up period. During no decade of the follow-up period did the mortality of the surgical controls differ significantly from that of the Iowa population.
Adult↗
Robert McCool, MD opening doors to the uninsured.
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Ambulatory Care Facilities↗
District court finds proposed Iowa women's health facility does not need state approval.
On October 18, the US District Court for the Southern District of Iowa ordered the Iowa Department of Health to withdraw its demand that Planned Parenthood of Greater Iowa obtain a "certificate of need" in order to open a new facility in Davenport. Judge Charles R. Wolle found that state officials had deliberately misused the certificate of need requirement--a policy originally created to allow communities to influence health care standards at local facilities and prevent duplication of medical services--to block the clinic, which far from providing duplicative services would become the only provider of abortions in the Quad Cities. For at least 10 years, no family planning facility in Iowa has been required to obtain a certificate of need, in large part because the review standards are generally regarded as obsolete. The application process would have required Planned Parenthood to publicly disclose its sources of funding, identify the intended site of the facility, and pay a substantial fee; it would also have involved a public hearing at which members of the community could object to the clinic. The court concluded that state officials could not justify applying the requirements to a facility providing abortions when it had routinely failed to apply them to other clinics that offer the same services but do not provide abortions. Judge Wolle further ruled that the state's order for a certificate of need imposes a substantial obstacle to access to abortion that is unjustified by any government interest--and therefore unconstitutional under the standards established by the US Supreme Court in Planned Parenthood vs. Casey. Planned Parenthood Federation of America is representing the plaintiffs in Planned Parenthood of Greater Iowa vs. Atchison.
Abortion, Induced↗
Catholic tradition preserved, high-technology promoted by hospital's new branding effort.
Mercy Medical Center, Cedar Rapids, Iowa, brings together high-touch and high-tech to market its historic institution. It achieves its goals in a centennial celebration which emphasizes both today's state-of-the-art facilities and the humanitarian legacy of its founders, the Sisters of Mercy.
Catholicism↗
A preceptor focus group approach to evaluation of a dietetic internship.
Geographical dispersion of preceptors within dietetic internship programs creates educational challenges. Iowa State University's dietetic internship utilizes preceptors from more than 90 facilities statewide. Three preceptor focus groups were conducted to identify strengths and areas needing improvement in the internship, including preceptor and intern needs and expectations. Of the more than 90 preceptors representing medical nutrition therapy, foodservice management, and community nutrition, 36 were contacted and 18 preceptors participated, resulting in 5 to 7 participants per focus group. Emerging themes included effective feedback; preceptor networking; and communication between internship program/faculty, interns, and preceptors. Geographic isolation and minimal use of Internet-based resources may contribute to these themes. Whereas the majority of preceptors had access to the Internet, only 7 (38%) had accessed the Internet-based resources provided by the program. Preceptor suggestions can provide new perspectives for enhancing the learning environment. Regional workshops and e-mail list-serves can help facilitate communication and networking among preceptors.
Communication↗
Carbon monoxide poisoning associated with use of LPG-powered (propane) forklifts in industrial settings--Iowa, 1998.
In 1998, the Iowa Department of Public Health (IDPH) and Iowa State University (ISU) Extension Department, with the assistance of local health departments, investigated a series of carbon monoxide (CO) poisonings associated with the use of liquified petroleum gas (LPG)-powered forklifts in light industry. In each episode, forklifts emitting high CO concentration levels were operated in inadequately ventilated warehouse and production facilities, which resulted in high CO accumulations. Employees at each site developed symptoms of CO poisoning, and some employees received inadequate or inappropriate medical care. This report summarizes the investigations and provides recommendations to prevent such incidents.
Air Pollutants, Occupational↗
Evolution of a veterinary medical library.
Planning a new library and developing a book and journal collection for the College of Veterinary Medicine at Iowa State University are described. The Veterinary Medical Library is a self-contained unit (6,800 square feet) for print material within the Veterinary Medical Building. Seating for 140 patrons is available. The collection is designed to provide basic materials for teaching and research in veterinary and comparative medicine. Indexing and abstracting tools permit access to local, state, and national resources as well. At present the collection totals over 17,000 volumes and over 500 serial titles. A working collection of 25,000 volumes will be maintained in the Veterinary Medical Library, and the University Library will continue to function as the principal backup source.
Book Collecting↗
Cut to the quick. Hospitals face bleak choices as Congress debates Medicare's future.
Deep slashes in Medicare funding would have a devastating effect not only on hospitals, but on their communities as well--from possible closure of some facilities, elimination of some services at others, and a re-examination of support for graduate medical education at some urban teaching hospitals. A look at the difficult choices ahead.
Budgets↗
The changing pattern of neonatal mortality in a regionalized system of perinatal care: A current update.
OBJECTIVE: Our earlier studies about the changing pattern of neonatal mortality were based on data from 1978-1979 and 1982-1983. In this report, we provide a modern update of the causes of neonatal deaths to help focus prevention measures. STUDY DESIGN: We reviewed neonatal deaths for the years 1995 and 1996 and assigned a clinical cause of death. Deaths were reviewed and analyzed by place of birth and death, according to level of care. We provided an estimate of the change in causes of death between 1982-1983 and 1995-1996 and calculated an idealized neonatal mortality rate for each level of care and for the entire state. RESULTS: The major changes in causes of death occurred in the respiratory distress syndrome (RDS) and extremely low birth weight (ELBW) categories. RDS showed a substantial decline, but ELBW deaths increased by nearly the same amount that RDS declined. The idealized neonatal mortality rate calculations suggest that fewer potentially medically preventable deaths occur now than in 1982-1983. Currently, more neonatal deaths of level I births occur in level III facilities than in 1982-1983. However, at that time, Iowa had only one tertiary facility, and the level II regional hospitals were the site of more deaths. CONCLUSION: We believe that assigning deaths to a clinical category rather than to a catastrophic final event helps focus on sources of preventable death in the medical care system. To reduce neonatal mortality, the incidence of lethal congenital malformations and ELBW infants must be impacted.
Cause of Death↗
Mastering the APG grouping process.
This case history details one company's success in using coding software to handle the requirements of the new ambulatory patient group (APG) system following the implementation of this complex new payment mechanism for outpatient care. Providers and payers are looking to coding software for help in billing and paying for outpatient services. Since the APG system "consolidates," "packages," and "discounts" a facility's payment for outpatient services, the new coding software helps ensure adequate reimbursement.
Ambulatory Care↗
Network 12 hepatitis B vaccination quality improvement program: an educational program directed at physicians, staff, and patients.
Hepatitis B is easily spread via contact with infected blood. Hemodialysis patients and staff are particularly at risk for acquiring hepatitis B. Consequently, vaccination of hemodialysis patients and staff is strongly recommended. However, the vaccination rate among dialysis patients in this country remains below 50%. End-Stage Renal Disease (ESRD) Network 12 developed a quality improvement project directed at increasing patient vaccination by regular surveys, reports, and education of physicians, staff, and patients. Seventy-seven percent of facilities in the 4-state Network participated. Overall vaccination rate increased from 66.9% to 73.2% over 18 months (P <.05). The greatest improvement was seen among units with less than 60% of patients vaccinated initially, with mean facility vaccination rate increasing from 31.2 +/- 20.5% to 57.5 +/- 30.1% in the last available data period (P <.001). Only 3 of these 29 units failed to improve. The 90 units that had 60% to 97% vaccination rates initially improved significantly from 79.8 +/- 9.6% to 82.4 +/- 15% (P =.015). Three quarters of these units showed improvement. Only units with 100% vaccination deteriorated, but still maintained vaccination rates of 74.5 +/- 25.6%. An education-based quality improvement project can improve the hepatitis B vaccination rate of hemodialysis patients.
Centers for Medicare and Medicaid Services, U.S.↗
Barriers to obesity management: a pilot study of primary care clinicians.
BACKGROUND: Obesity is an increasing epidemic in both the US and veteran populations, yet it remains largely understudied in the Veteran's Health Administration (VHA) setting. The purpose of our study was to identify barriers to the effective management of obesity in VHA primary care settings. METHODS: Three focus groups of clinicians from a Veteran's Affairs Medical Center (VAMC) and an affiliated Community Based Outpatient Center (CBOC) were conducted to identify potential barriers to obesity management. The focus groups and previously published studies then informed the creation of a 47-item survey that was then disseminated and completed by 55 primary care clinicians. RESULTS: The focus groups identified provider, system, and patient barriers to obesity care. Lack of obesity training during medical school and residency was associated with lower rates of discussing diet and exercise with obese patients (p < 0.05). Clinicians who watched their own diets vigorously were more likely to calculate BMI for obese patients than other clinicians (42% vs. 13%, p < 0.05). Many barriers identified in previous studies (e.g., attitudes toward obese patients, lack of insurance payments for obesity care) were not prevalent barriers in the current study. CONCLUSION: Many VHA clinicians do not routinely provide weight management services for obese patients. The most prevalent barriers to obesity care were poor education during medical school and residency and the lack of information provided by the VHA to both clinicians and patients about available weight management services.
Adult↗
Painful medicine: managed care and the fate of America's major teaching hospitals.
Healthcare spending in the United States has risen steadily throughout the post-World War II period as the American healthcare system has been transformed from cottage industry to big business. The increasing rate of social investment in healthcare also transformed America's major teaching hospitals. As a case in point, the University of Iowa Hospitals and Clinics saw annual operating revenues rise from $1 million in 1945 to more than $350 million in 1995, which was accompanied by an extraordinary expansion in its physical facilities and in its multifaceted operations. In the 1970s and even more so in the 1980s, however, the unceasing climb in healthcare spending fueled concern among policy experts, politicians, employers, and insurers alike. In turn, the search for effective cost controls led to the current managed care revolution. While the end of that revolution is not yet in sight, managed care has, it appears, effected significant cost savings, but at no small cost to America's major teaching hospitals and their social missions of teaching, research, and patient care. Whether those missions can survive--and, if so, in what form--in a healthcare system dominated by the managed care ethos is an increasingly important concern.
Centers for Medicare and Medicaid Services, U.S.↗
Mastering the Ambulatory Patient Groups system.
Providers and payers will need to implement the Ambulatory Patient Groups (APG) system, a complex new payment mechanism for outpatient care. Because the APG system consolidates, packages, and discounts a facility's payment for outpatient services, providers might receive decreased reimbursement for services, as compared to the reimbursement received under their present outpatient payment arrangements. APGs, like DRGs, will force providers to examine their coding practices carefully to ensure that they will receive reimbursement adequate to cover their costs.
Ambulatory Care↗
The effect of ten years of regionalized perinatal health care in Iowa, U.S.A.
In 1973, Iowa, a rural, midwestern state in the U.S.A., established a Statewide Perinatal Care Program. A major objective was to develop and maintain a regionalized system of care. Such a system has been developed but differed from traditional systems by using regional level II centers. Iowa's low population density necessitated this modification. The development and maintenance of Iowa's system is described. Evaluation is provided by analysis of commonly available birth and mortality data. Improved birth-weight-specific neonatal and fetal mortality rates suggest an overall improvement in care. A more favorable birth weight distribution and evidence of screening and selective referral of high-risk patients provide evidence of improvements in prenatal care. Data are presented to show that a stratified system of care is evidence in the state. Level I hospitals currently manage low-risk patients and report very low mortality rates. Level II facilities receive high-risk referrals, but selective referral occurs since the tertiary center accounts for a disproportionate number of fetal and neonatal deaths, and births weighting less than 1500 g. Other regions may benefit from similar approaches to development of regionalized systems of care and evaluation of the same.
Birth Rate↗
Evolution of robotics in surgery and implementing a perioperative robotics nurse specialist role.
Use of robotics is expanding rapidly in the medical arena. Not only are a growing number of facilities purchasing robotic systems, but the number of surgeons using them also is increasing, which creates many challenges (eg, cost, training, safety). The evolution of robotics in surgery is presented within the context of virtual reality, telepresence, telemanipulation, and passive (ie, master-slave) robotic surgical systems. A new perioperative nursing role, the robotics nurse specialist, was developed and implemented at one facility. The need for a robotics nurse specialist and how this role can help the entire surgical team promote positive patient and facility outcomes also is discussed.
Education, Nursing, Continuing↗
The status and future of small maternity services in Iowa.
Small Iowa community hospitals (fewer than 500 deliveries annually) are currently the site of approximately 37% of hospital births in the state. Many of these facilities face severe financial constraints aggravated by reduced Medicare payments and diagnosis-related group payment mechanisms. The quality and quantity of services provided by small hospitals are illustrated by birth and mortality data for the period that spans the development of Iowa's regionalized perinatal care system. Small hospitals appear to compare very favorably when matched with their larger level I counterparts with regard to neonatal mortality rates, incidence of births of very-low-birth-weight neonates, survival of very-low-birth-weight neonates, occurrence of neonatal deaths relative to the total birth population, and incidence of neonatal morbidities. Because these hospitals provide valuable services in Iowa's perinatal care system, their closure may seriously compromise perinatal health care for rural Iowans.
Birth Rate↗