Spring 2008

• New Emergency Treatment Center opens
• Unique comprehensive approach to motility problems of the GI tract
• Multidisciplinary team transplants lungs to end-stage pulmonary patients
• Allomap®: a routine test for heart transplant patients
• Experts provide team approach to women's breast health
• Research: Pediatric research training grant extended five years
• One call puts you in touch
• Upcoming CME Activities
• New Faculty

New Emergency Treatment Center opens

The newly renovated Emergency Treatment Center at UI Hospitals and Clinics, which opened April 2, 2008, more than doubles the size of previous ETC facilities and incorporates the latest concepts of personalized, patient-centered care. The $30 million upgrade features 28 private patient rooms, three major critical care rooms, three specialized trauma areas, and rooms for psychiatric, ophthalmologic, dental, forensic, and pediatric urgent care. Designed with a Lean-based process of patient flow in mind, the new facility has a capacity of up to 60,000 patients per year. In addition to expanded clinical areas, the ETC includes new teaching areas with an auditorium, designated space for laboratory and radiology services, and—to address Iowa's shortage of emergency physicians—a new home for Iowa's only emergency medicine residency program. For security purposes, the facility includes tracking devices, entrance and exit controls, and sophisticated security cameras. The ETC is the primary entry point for the sickest patients who are flown to UI Hospitals and Clinics from around the state, and serves that role for about half of the hospital's patient admissions.

Unique comprehensive approach to motility problems of the GI tract

Designated as one of ten centers of excellence by the American Society of Neurogastroenerology and Gastrointestinal Motility, the UI Neurogastroenterology and GI Motility Center is directed by Satish Rao, MD, PhD, FRCP, professor of internal medicine. The center provides a range of diagnostic and treatment procedures and comprehensive care for patients with the following conditions: a) esophagus: dysphagia, non-cardiac chest pain, and GERD; b) stomach: gastroparesis and functional (non-ulcer) dyspepsia; c) colon: constipation, fecal incontinence, IBS, and ano-rectal disorders, such as fissures, hemorrhoids, and pain. All of these are surprisingly frequent, with a prevalence rate of 30 to 40 percent in population. The center performed about 2,000 diagnostic procedures in 2007 and provided treatments that are non-invasive and tailor-made for individual patients. These include conventional medical therapies and neuromuscular training. The latter is the basis of the biofeedback program that treats about 400 patients annually. The biofeedback approach uses advanced knowledge of the ways by which the autonomous nervous system regulates the activity of the GI tract smooth muscle and is designed to help patients learn how to manage their debilitating bowel and gut symptoms.

Multidisciplinary team transplants lungs to end-stage pulmonary patients

UI Hospitals and Clinics is home to Iowa's only specialized Lung Transplant Program. Since the program's inception in May 2007, seven patients have received lung transplants, all with optimal outcomes. Candidates for lung transplantation are patients in the final stages of cystic fibrosis, emphysema, chronic obstructive pulmonary disorder, pulmonary fibrosis, bronchiectasis, and pulmonary hypertension. Julia Klesney-Tait, MD, assistant professor with the Division of Pulmonary, Critical Care, and Occupational Medicine and medical director of the Lung Transplant Program, identifies the patients likely to benefit from transplantation, optimizes their medical management as they await transplantation, and manages their immunosuppression post transplantation. The thoracic surgeon who performs the transplants is Kalpaj Parekh, MD, assistant professor with the Department of Cardiothoracic Surgery. The management team that takes care of lung transplant patients also includes a transplant social worker, transplant pharmacist, and transplant nutritionist. For more information or to refer a patient for evaluation, call program coordinator Jana Beaver at 319-394-8357.

Allomap®: a routine test for heart transplant patients

Traditional endomyocardial biopsy for heart transplant rejection monitoring, which is invasive, expensive, and variable, is being replaced at UI Hospitals and Clinics by a noninvasive screening method, commercially available as AlloMap. AlloMap, which was approved for clinical use in the U.S. in April, 2005, measures the expression of 20 genes in blood mononuclear cells by real-time PCR. It provides a score ranging from 0 to 40, with lower scores indicating a very low likelihood of rejection. The advantages in accuracy of Allomap compared with biopsy were demonstrated in a multi-center clinical trial which proved that gene expression testing could detect absence of rejection better than biopsy. The test is applied two months after the transplantation and to patients older than 15. Currently, it has greatly reduced the number of cardiac biopsies; the goal is to eliminate the latter altogether. AlloMap improves patient satisfaction and reduces the cost of managing heart transplant patient care. For more information on AlloMap, visit www.allomap.com/html/tc_whatis_allomap_testing.html. To refer a patient for monitoring, call the UI Heart Transplant Program at 319-356-1028.

Experts provide team approach to women's breast health

The recently established UI Breast Health Clinic offers women comprehensive care for breast problems, both benign and malignant. The clinic is a logical extension of the highly effective breast care that UI Health Care has provided to Iowa women for decades, drawing expert consultants from several departments into a multidisciplinary team to offer both diagnostic testing and treatment options. For women with newly diagnosed breast cancer, Jean Arndt RN, the breast nurse coordinator, will arrange a single visit with multiple consultations as appropriate. These could include a surgeon, a medical oncologist, a radiation oncologist, a plastic surgeon, and even a dietician or social worker for additional support. The breast specialists, together with the patient, decide a management plan. Sonia L. Sugg, MD, a breast/endocrine surgeon, directs the clinic. For more information or to refer a patient, call the Breast Health Clinic at 319-384-9717.

Research

Pediatric research training grant extended five years

The Children's Health Research Center (CHRC) within the UI Carver College of Medicine has received a renewed NIH developmental award of $2.1 million for another five years. The program is led by Michael Artman, MD, professor and head of the Department of Pediatrics and physician-in-chief of UI Children's Hospital. With this new award, the total funding for the CHRC since its inception in 1990 has reached $7.4 million.

The CHRC is a research training program that provides time, resources, and mentorship to help new pediatric faculty build their individual research programs. Funded by NIH training grants, it creates a highly competitive yet supportive environment to individuals who have excelled in their medical education—one-third of them have graduated from MD-PhD programs—and have shown a sustained interest in clinical and basic research related to children's health. Twenty-six researchers have been supported thus far by this program; 19 have remained with UI Health Care and continued their successful research endeavors. Four of those are not only successful researchers but have become clinical leaders in the Department of Pediatrics: Val Sheffield, MD, PhD, director of the Division of Medical Genetics; Warren Bishop, MD, director of the Division of Pediatric Gastroenterology; Katherine Mathews, MD, director of the Division of Pediatric Neurology; and Fred Lamb, MD, PhD, director of the Pediatric Intensive Care Unit.

The CHRC scholars are sponsored for three years until they can get their research funded through individual grants. Although they see patients in their clinics, the program ensures 75 percent of their time is allocated for research activities. "Currently, there are three main foci of research within the CHRC," says program director Brian Schutte, PhD: "the genetic basis of birth defects, the fetal origins of adult disease, and innate host defense." These three are interconnected as they use genetics and molecular biology to understand such diverse topics as the pathophysiological mechanisms of cystic fibrosis or to develop vaccines against pathogenic bacteria. The cardiovascular biology focus connects knowledge of genetic and environmental factors with increased risk for cardiovascular disease during adulthood and the potential preventive programs derived from this association.

One call puts you in touch
UI Consult is a centralized resource linking health care providers with members of UI Physicians and services at UI Hospitals and Clinics. Whether you are seeking a consultation, are providing a referral, need patient information, or want news about clinical trials or CME courses, a single call is all it takes to put you in touch with the right person. UI Consult is available 24 hours a day, 7 days a week. Simply call 800-322-8442. When referring a patient, you may also fill out an online referral form at www.uihealthcare.com/consult.

Information needed to refer a patient:

• Patient's name
• Address
• Phone number
• Date of birth
• UI Hospitals and Clinics registration number (if born or previously seen here)
• Type of insurance (i.e., HMO, workers' compensation, medical assistance)
• Nature of the medical problem
• Services you would like us to provide

Upcoming CME Activities

For the full list of upcoming UI Carver College of Medicine continuing medical education events, visit: www.medicine.uiowa.edu/cme/ or call the CME office, 319-335-8599.

New Faculty
University of Iowa Health Care is pleased to introduce the following faculty:

Family Medicine

Sandra Rosenfeld, MD
Clinical focus: Family medicine and obstetrics at UI Family Care Center — Family Medicine Clinic

Lisa Soldat, MD
Clinical focus: Family medicine at UI Family Care Center — Family Medicine Clinic

Ophthalmology

Arlene Drack, MD
Clinical focus: Pediatric ophthalmology

Otolaryngology-Head and Neck Surgery

Nitin Pagedar, MD
Clinical focus: Head and neck oncology

Erin O'Brien, MD
Clinical focus: Rhinology

Pathology

Yasuko Erickson, MD
Clinical focus: Transfusion medicine

Pediatrics

Sunny Arikat, MD
Clinical focus: Neonatology

Charuta Joshi, MD
Clinical focus: Management of intractable epilepsy, including pre-surgical evaluation and non-medication management with the ketogenic diet and vagus nerve stimulator; pediatric neurotransmitter disorders; relationship of sleep to epileptic encephalopathies

Sameer Kamath, MD
Clinical focus: Pediatric intensive care for acute lung injury, congenital heart disease, procedural sedation, and trauma

Julie Lindower, MD
Clinical focus: Developmental and family-centered care; infant feeding; lung-protective strategies; newborn resuscitation

Marguerite Oetting, MD
(UI Family Care Center—Pediatric Clinic)
Clinical focus: Iowa City Community School District's school-based health clinics

Psychiatry

Anthony Miller, MD
Clinical focus: Adult inpatient and outpatient psychiatry

Surgery

Melhem Sharafuddin, MD
Clinical focus: Vascular surgery

Aimen Shaaban, MD
Clinical focus: Pediatric surgery

Physicians who would like to communicate directly with our consultants, members of the faculty group practice UI Physicians, should go to www.healthcare.com/uiphysicians and follow the links to find the consultant profile of each faculty along with their contact information.