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UI Consult Summer 2009Download PDF
Spinal osteotomies for children … Stuart Weinstein, MD, professor of orthopaedics and a world-renown orthopaedic surgeon treating children with scoliosis, performs spinal osteotomies in children with complex deformities of the vertebral column at University of Iowa Children's Hospital. Complex deformities that need this type of correction include scoliosis associated with different types of spine arthritis that can result in hyperkyphosis. Major spinal osteotomies are surgical approaches that go over and above the basic treatment for spinal deformities, in which standard correcting maneuvers cannot achieve the desired outcome. Weinstein sees about 500 new pediatric patients with complex deformities a year and operates two to four cases a week.
Weinstein's counterpart in using major spinal osteotomies to treat adult patients with complex deformities is Sergio Mendoza, MD. Mendoza operates on patients who are typically older than 60 and have developed a degenerative scoliosis and/or kyphosis. These adults present with imbalance and a rigid position of the spine, which is off their line of gravity, sciatic nerve syndrome, neurogenic claudication, and leg pain. The surgical correction significantly improves their quality of life. To refer pediatric patients to Weinstein, call 310-356-1872. To refer adult patients to Mendoza, call 319-384-6025. Testing a promising prostate cancer vaccine Physicians can inform qualifying patients of a phase II clinical trial of a therapeutic vaccine for prostate cancer. This trial follows a Phase I trial of the vaccine where no significant adverse events were observed. The vaccine is a replication defective adenovirus transformed with the gene for human prostate specific antigen (PSA). Data from pre-clinical animal studies demonstrated the production of vigorous antibody and cell-mediated immune responses to PSA as well as the destruction of PSA-producing mouse prostate tumors. In the Phase I trial, 54 percent of 32 immunized patients produced anti-PSA antibodies; more importantly, 68 percent of the patients produced anti-PSA T cell responses. The current Phase II trial has two protocols, one applied to men with prostate cancer recurrence following recent definitive primary therapy (radiation or prostate removal), and another to men who failed hormone therapy. In both protocols, men will receive three injections of the vaccine, 30 days apart. They will return for clinical and immunologic evaluations at regular intervals following vaccination until a clinical response is confirmed. Interested patients or their physicians can contact the following for eligibility evaluation: Pamela Zehr, RN, at 319-353-8914; David Lubaroff, PhD, at 319-335-8423; or Richard Williams, MD, at 319-356-0760. Holden noted for prostate cancer excellence: The April 2009 issue of Urology Times named Holden Comprehensive Cancer Center at The University of Iowa as one of its 15 Clinical Centers of Excellence for prostate cancer. Because these centers “rise above the pack,” the editors say, the institutions bring something extra to the specialty through research, patient care, and community outreach. The listing provides physicians with information about where to refer challenging cases. Richard Williams, MD, head of the UI Department of Urology, noted that collaboration between members of his department and others, including Daniel Vaena, MD, medical oncology, and Mark Smith, MD, radiation oncology, plays a pivotal role in providing excellent care to patients. Advanced surgery for vision correction
To refer a patient for evaluation and selection of the most suitable refractive or cornea replacement surgery, call Lisa Milder at 319-353-7625 or e-mail lisa-milder@uiowa.edu. An organization that rigorously evaluates health care providers who specialize in costly, complex, and catastrophic conditions has renewed the Neonatal Intensive Care Unit at University of Iowa Children's Hospital as a designated Neonatal Center of Excellence. The United Resource Network's “centers of excellence” concept supports safe, successful, and cost-effective patient care. The NICU has been a neonatal center of excellence since 2007. Its excellence status is due to:
For referrals and emergencies, physicians should call UI Consult at 800-322-8442 and ask for neonatology. University of Iowa Children's Hospital's specialized neonatal/pediatric transport team. About one third of the 850 newborns seen at the NICU, as well as sick children under the age of nine, are transferred from across the state via the ground or air transportation services of UI Hospitals and Clinics. Depending on distance, acuity, and availability, the team uses either the AirCare helicopters or two ambulances turned into mobile emergency pediatric care units. As the major referral center in Iowa for pediatric specialized care, UI Children's Hospital treats babies and children with all life-threatening conditions. Each year, the team transports more than 300 critically ill infants and children, over half of them via helicopter and the rest by ground transportation. When you need to transport a sick infant or child to UI Children's Hospital, call UI Consult at 800-322-8442 and ask for the neonatologist (for patients less than one month of age) or the pediatric intensivist on call. 37th consecutive refresher course for family physicians For 36 years in a row, the Department of Family Medicine at University of Iowa Health Care has sponsored and conducted the Annual Refresher Course for the Family Physician. Course attendees earn American Academy of Family Physicians CME credits. The 37th edition of the course occurs April 6 to 9, 2010, at the Coralville Marriott Hotel and Conference Center. Co-directed by Jason Wilbur, MD, and John Ely, MD, the course spans three and a half days. Each year, about 40 UI Carver College of Medicine faculty from a wide range of specialties lecture at the course on current topics of interest to family physicians. So far, participants give the course high marks: in 2008, for example, 100 percent of those who completed the course evaluation reported that their personal objectives had been met fully. For more information about the course or to enroll for year 2010, call Jo Bowers at 319-384-8994, or e-mail to josephine-bowers@uiowa.edu. Electrical neuro-stimulation for overactive bladders Urogynecologists with UI Women's Health offer two neurostimulation procedures to women with high urinary frequency and urge urinary incontinence (overactive bladder). The procedures are performed by Catherine Bradley, MD, director of the Division of Urogynecology in the UI Department of Obstetrics and Gynecolgy, and colleague Ali Luck, MD. Sacral nerve stimulation os performed by implanting a neuromodulator under the skin in the sacral area in an outpatient surgical procedure; it allows patients to control their bladder activity. An alternative procedure is posterior tibial nerve stimulation, an office procedure involving electrical stimulation of a peripheral nerve on the ankle applied once weekly for 12 weeks. For more information or to refer a patient, call 319-356-2294. Referring providers will benefit from future enhancements in care and communications planned for a new electronic medical record (EMR) and order-entry system at UI Hospitals and Clinics. The May 2, 2009 conversion to the Epic EMR for all patient care and ancillary services means not only a paperless medical record system, but also significant advances in patient safety and confidentiality, provider access, order entry, and other aspects of patient care. As faculty physicians and staff become more familiar with Epic, UI CareLink will be slowly introduced. It will first be tested with a small, pilot group of providers for release of information requests. Broader access to clinical information, with patient approval, is the eventual goal. If you have questions about UI CareLink, contact UI Physician Relations at 319-384-6103, or e-mail referring-physicians@uiowa.edu. Watch for more information in future issues of UI Consult and on the web at www.uihealthcare.com/uiconsult.
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