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eric-burge-transplant-gamesEric Burge of Davenport is no stranger to the world of organ transplantation. In fact, Eric’s brother, John, received a kidney transplant just a few years prior to Eric discovering he needed a transplant as well. Eric and John have an inherited disorder called polycystic kidney disease. It is the most common hereditary disease in the U.S., affecting more than 700,000 people each year. Many cases require an organ transplant due to the formation of cyst clusters in the kidneys that destroy healthy tissue.

Alan Reed, M.D., director of the Organ Transplant Center at University of Iowa Hospitals and Clinics, says many individuals with polycystic kidney disease need a transplant need a transplant but tend to have a very favorable prognosis. Luckily, when Eric started having health issues, his lifelong friend, Mary Beth Murray, had a special connection with organ donation and was willing to help. Mary Beth, who also lives in Davenport, decided to become an organ donor because of her father’s kidney issues when she was younger. Although she desperately wanted to help, Mary Beth was not a compatible match and unable to donate to her father.

When Mary Beth’s older sister faced the same kidney issues years later, Mary Beth once again was not a compatible match and unable to donate to her sister. Unwilling to give up, Mary Beth was determined to help Eric when she discovered he needed a kidney transplant. This time around, Mary Beth was a perfect match for her friend in need.

On January 3, 2013, the day of the surgery, Mary Beth remembers feeling excited and unsure what to expect, but determined to have a successful procedure. Reed performed Eric’s kidney transplant surgery with great success.

Since his transplant, Eric’s care has been managed by UI Post Kidney and Pancreas Transplant Coordinator Lou Ann Reynolds, RN. Eric describes Lou Ann’s support and calming influence as “immeasurable.”

Reynolds stresses the importance of becoming an organ donor. “Whether it’s for a friend, a workmate, or a total stranger, I would tell people they have the ability to change another person’s life,” Reynold says.

To Eric, a kidney transplant meant a second chance at life; “As a recipient, there’s no way to thank [my donor] to that magnitude.”

Both Eric and Mary Beth will participate in the 2016 Transplant Games, set for June 10-15 in Cleveland. They look at the games as a celebration of life and an opportunity to be together with family and friends. They will be competing together in the donor/recipient bowling event. Eric will also participate in the track and field events and swimming relay.

“I’m incredibly proud of these athletes and so pleased that they have taken this opportunity to do such great things,” Dr. Reed says.

To learn more about organ and tissue donation and the Iowa Donor Registry, click here.

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(From time to time, the blog features recipients of the IHA Iowa Hospital Heroes Award. These outstanding hospital employees come from across the state and work at hospitals of every size. They exemplify the courage, caring and community focus that are the hallmarks of the hospital mission in Iowa.)

Laine Custer smallAs a Greene County Medical Center public health nurse for 23 years, Laine Custer has worn many hats in her time – but it’s the coat of many colors she wears as she trains, teaches, heals and mentors that makes Laine a real hero for so many.

As a public health nurse, she has cared for thousands of Greene County residents in time of physical need. Blood pressure clinics, immunizations, foot clinics – Laine has literally washed the feet of those she serves.

As an instructor for Greene County High School’s health care occupations classes, she has mentored hundreds of students over several years. Many of these students go on to careers in nursing and some of them become part-time or full-time employees at Greene County Medical Center. Her impact on young people is incredible and is visible in the hallways of the medical center on a daily basis.

She is also a wonderful mentor for coworkers, as was made evident in her receiving the nationally recognized DAISY Award after a nomination by a coworker who noted Laine’s encouragement and compassion when working with others.

Laine and super heroes smallAs a recently designated master trainer in the “A Matter of Balance” fall prevention program, Laine has been improving the health and well-being of the elderly in our community one person at a time. She also helps organize and lead the “Psychological First Aid Training” course for medical center employees, volunteers and community partners who might be called upon in a community disaster.

Over her 23 years at the medical center, Laine has been instrumental in countless committees that have improved the patient environment. She has also been instrumental in planning employee events that boost morale and encourage team work.

Laine represents the best in kindness and genuine love for what she does. She simply does everything well. She is a hero for many at Greene County Medical Center.

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Do you or someone you know suffer from a mental illness? During National Public Health Week recently, we were reminded that most Americans do. Architects are rethinking how their building designs influence the health and well-being of people and are developing designs for mental health as well as for safety and physical wellness. By applying therapeutic design concepts to the built environment, it is possible to improve mental health of occupants. We can create communities that contribute to the prevention and control of an illness labeled as the leading cause of disability worldwide, according to National Institute of Mental Health.

As an advocate for healthy design, the American Institute of Architects has outlined five specific areas of opportunity to enhance physical and mental health. These five areas include: safety and social equity, sensory environments, access to nature, physical activity and environmental integrity. Of these, safety has been valued and even mandated by entities like the International Code Council and the American National Standards Institute. Safe egress and fire rating controls, for example, have minimum requirements that ensure we build safely.

The industry has made significant strides in encouraging physical activity by designing facilities that promote fitness and healthy living in our everyday routines. For example, active design guidelines include appealing staircases and walking routes that make it easy to move during short breaks. However, we must now expand our focus on healthy design by developing a more holistic approach. We must increase applications of architectural design that encourage mental wellness, a concept far from mainstream in today’s society.

The greatest opportunity for architecture to encourage the prevention and control of mental illnesses is in residential and workplace environments, where most of our time is spent.  According to a recent Mental Health America’s report, approximately 1 in 5 American adults suffer from a mental illness. In Iowa, a state that ranks better than average, an estimated 418,000 adults suffer from mental illness. Architecture design is one of the many solutions that have been proven to improve mental health and well-being.

To date, the focus of architectural design as related to wellness has been in health care, giving us a highly-studied and practical experience that can be applied to residential and commercial spaces. In recent projects, building designs that increase natural daylighting, use color and texture, encourage movement and incorporate nature have led to improved patient satisfaction and staff productivity.

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Patient room at Mercy Children’s Hospital and Clinics, Des Moines (Photography by Integrated Studio)

In fact, after drastically enlarging the patient room windows in Mercy Children’s Hospital and Clinics in Des Moines from 20 sq.ft. to 90 sq.ft., the director of pediatrics and pediatric intensive care noted a 15 percent improvement in patients’ ability to manage pain. Patients also responded to care more quickly by a rate of 25 percent. Increasing natural daylighting could have similar effects at home and work by reducing stress and fatigue, promoting more positive lifestyles.

Patient-centric modeling design is another trend in health care that can be applied to residential and commercial environments. How people move through spaces in a way that encourages interaction, a comfortable patient experience and an enhanced healing atmosphere is often overlooked. By rethinking movement at home and at work, we can achieve some of the same benefits. Another design trend in health care is the blurring of interior and exterior environments to bring the known benefits of nature and landscape sceneries inside. This concept can create similar results in home and work environments by using nature as a healing tool to reduce mental health conditions such as anxiety and depression.

By applying architectural designs that improve mental health, we can positively impact this issue. Architects and the design community can expand the industry’s focus on initiatives that contribute to mental health prevention and control. Business leaders can incorporate design concepts that influence mental health into their project goals when planning new facilities or renovations. As community residents, we can all increase our awareness of our everyday surroundings and how they impact our mental well-being. Together, we can contribute to the prevention and control of this disease that claims lives and affects many people on a daily basis.

Tonia Householder is a member of the American Institute of Architects and an architect at INVISION Architecture in Des Moines. This article was created in partnership with the American Institute of Architects, Iowa Chapter’s Public Outreach Program. It was originally published by the Des Moines Register on April 22, 2016.

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Montgomery County Courthouse, Red Oak, Iowa

It’s about 100 miles from Red Oak, Iowa to St. Joseph, Missouri, but if you’re poor, that distance might take years off your life. According to a study published this month in the Journal of the American Medical Association, life expectancy for 40-year-olds with household incomes less than $28,000 is about 80.2 years in Red Oak, compared to 77.9 years in St. Joseph.

The study found, to no one’s surprise, that people with high incomes live significantly longer than those with low incomes. The top 1 percent in income among American men live 15 years longer than the poorest 1 percent; for women, the gap is 10 years. This is true from coast to coast.

A much tougher question the researchers tried to address is what causes differences in life expectancy between populations that have essentially the same (low) income. In other words, why does being poor in Oklahoma City appear to be much more detrimental than being poor in Boston (or in St. Joseph versus Red Oak)?

The study suggested that fixing broad, multi-decade problems like insurance, transportation, pollution, unemployment and income inequality may not extend the lives of the poor. Rather, localized programs and policies that help the poor adopt healthier habits – especially with regard to smoking and obesity – appear to be the key. A public health official in Birmingham, Alabama, where the life span for adults in the bottom quarter of income rose 3.8 years for men and 2.2 years for women from 2001 to 2014, said it takes a “culture of health.”

That culture is not going to be built or sustained by huge state and federal programs like Medicare and Medicaid (nor the huge private companies that manage them), that much is self-evident. Make no mistake, these programs are crucial to the foundation of our health care system, but, despite their glossy marketing, they lack the ability to personally and effectively engage people in their health. That remains, as it should, in providers’ hands.

And as health care providers well know, real engagement requires understanding and overcoming the hurdles and barriers that are part of each person’s life story, from how they were cared for in the womb and as an infant to how they did early on in school to how they coped with adolescence and beyond.

With leadership from hospitals and other providers, such high-touch, high-value, community-based care is predominant in Iowa, and the life expectancy study shows it. But there is still room for improvement and for health care providers to collaborate more and learn from each other. Most importantly, Iowa’s health care culture must be protected from top-down, broad-brushed intrusions that undermine local control and patient-provider relationships.

Because within those relationships lives the best hope for extending and improving the lives of our most vulnerable neighbors.

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telemedicine-childrenTelemedicine – connecting health care providers and patients via computer or smart phone for diagnosis and treatment – has been making it easier, and more cost-effective, to “see” the doctor. Using a camera-enabled computer or smart phone, patients with common health concerns can get some diagnoses without leaving their homes. Emergency room doctors and nurses are able to communicate with their peers in larger trauma centers via computer, as well.

Now a new University of Iowa study, published recently in the journal Pediatrics, shows that parents with children on the autism spectrum are able to have a specialist address challenging behavior in these children by interacting over the computer, too – and at less than half of the cost of receiving similar care in person.

“A lot of kids who are on the autism spectrum have significant problems with behavior,” says Scott Lindgren, Ph.D., professor of pediatrics in the Stead Family Department of Pediatrics at University of Iowa Carver College of Medicine and lead author of the study. “These kids may have trouble following directions, or have problems when there are changes in their schedule or routine. They also don’t always have good enough communication skills to be able to explain to someone why they’re getting upset or having a meltdown.”

Parents are often frustrated, Lindgren says, because they don’t know how to communicate with their child to find a way to prevent or stop a meltdown. What adds to frustrations, he says, is that many Iowa families live in areas where services for children on the autism spectrum may be hard to come by.

“There are a limited number of professionals with the training and expertise needed to work with these children, which means a lot of families can’t get access to the services they need,” Lindgren says. “That’s the situation we have in Iowa.”

With the availability of telemedicine, he says, families with limited access – particularly those in rural settings – will be able to connect with their provider without causing a big disruption to their child or their family.

Additionally, the study showed that total costs for treating a child for challenging behaviors was cut from nearly $6,000 per child to just over $2,100 through the use of telemedicine – or telehealth, as it is often called. Cost savings were seen in various areas, including travel expenses and staff hours that were saved when no travel was involved.

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Scott Lindgren, Ph.D.

In the study, Lindgren, who is co-director of the UI Children’s Hospital Autism Center, and David Wacker, Ph.D., professor of pediatrics in the Stead Family Department of Pediatrics at UI Carver College of Medicine, along with other UI colleagues, examined whether these families could be served by using telehealth to train parents to use applied behavior analysis (ABA), a common intervention for children with autism spectrum disorder (ASD).

The group studied 107 children ages 21 months to 6 years old with ASD or other developmental disabilities and who were treated between 1996 and 2014. The children were divided into three groups: 52 kids treated between 1996 and 2009 who had a behavior consultant come to their home; 23 children treated between 2009 and 2012 whose parents went to a clinic near their home to be coached via telehealth; and 32 children who were treated between 2012 and 2014 as part of a trial in which their parents were trained in functional communication training (FCT), a type of ABA treatment, via telehealth coaching at home.

Researchers found that not only are specialists able to successfully train parents to use ABA procedures using telehealth, and at a fraction of the cost, but they are also able to provide the training to families in outlying rural areas who might otherwise not have access to care.

“When we were starting to do this with telehealth a few years ago, a lot of people said there’s no way to work with children with autism without seeing them in person,” Lindgren says. “Usually the way they had been managed was that the family would come to the hospital and see Dr. Wacker and he’d evaluate the children.” Behavior analysts were then sent out to the home to work with the family, Lindgren says.

As telehealth services evolved, he says, families would go to one of 14 regional clinics around the state and be coached by a behavior consultant via an internet connection between the hospital and the local clinic. It saved families from having to drive to the hospital, but it still involved leaving the home and disrupting the child’s routine.

With the most recent approach of using in-home telehealth, parents and consultants could connect via a computer at home, which often gave consultants a glimpse into where the child was most comfortable and where most challenging behavior occurred. The parents would then receive coaching in functional communication training at home.

“This coaching is more than having a casual talk with families,” Lindgren says. “It’s setting up a variety of situations in which problem behavior may occur, and helping parents find ways to address problems constructively, and to better understand why that behavior is occurring. For 90 percent of the kids we evaluate, we can find a social reason for what that child is doing.”

Lindgren said he’s been pleased with the results of the consultations via telehealth – and so have been families.

“It’s been impressive to me to see how well this works in different settings,” he says. “Almost all of the parents do well enough in this training to be able to help their kids a lot. And that reduces stress on the family and helps kids succeed in school and in life.”

Other UI researchers involved in this study include Kelly Pelzel, Ph.D., Todd Kopelman, Ph.D., and John Lee, BA.

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