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.

Demographic and clinical characteristics of emotionally disturbed children being raised by grandparents.

Among 233 youths treated at a community mental health center, 51 were living with their grandparents. Youths who lived with grandparents were more likely to be male, African American, and younger. Frequent psychiatric diagnoses included oppositional defiant disorder, depressive disorders, and anxiety disorders.

Cervical secretory immunoglobulin A in adolescent girls.

Purpose: To determine whether there are differences in levels of cervical secretory immunoglobulin A (sIgA) between adolescent girls in the secretory and proliferative phases of their menstrual cycle.

Methods: Sexually active adolescent girls (n = 117) at health maintenance organization (HMO) based adolescent medical clinic were recruited into the study. In addition to demographic and clinical data, cervical specimens were collected for sIgA measurement and gonorrhea culture, urine for chlamydia ligase chain reaction, and blood for progesterone levels.

Sexually transmitted diseases in a health maintenance organization teen clinic: associations of race, partner's age, and marijuana use.

Objective: To determine the role of sociodemographic risk markers and behavioral risk factors associated with sexually transmitted diseases (STDs) in sexually experienced youth seeking care at an urban, general health maintenance organization teen clinic.

Design: Cross-sectional.

Participants: A consecutive, racially and ethnically diverse sample of 285 sexually experienced youth who were preponderantly female (58.

Progress in adolescent mental health.

This chapter reviews the status of emotional and behavioral problems in adolescents and current issues in their assessment and treatment. The authors emphasize the need for the development of mental health programs for adolescents in natural settings such as schools, and present a conceptual framework for intervention based on provider knowledge of risk and protective factors.

Is the routine pelvic examination needed with the advent of urine-based screening for sexually transmitted diseases?

Objective: To determine the most cost-effective method of screening for chlamydia and gonorrhea to prevent pelvic inflammatory disease (PID) in asymptomatic sexually active adolescent females.

Design: Cost-effectiveness decision analysis comparing pelvic examination with cervical screening (the current national standard) with a model of urine screening with ligase chain reaction testing for Chlamydia trachomatis and Neisseria gonorrhoeae.

Methods: Four strategies using decision analysis were compared for a potential cohort of 100000 asymptomatic sexually active young women: (1) pelvic examination screening in 100%; (2) urine screening in 100%; (3) actual predicted pelvic examination screening in 70%; and (4) actual predicted urine screening in 90%.

Asymptomatic sexually transmitted disease prevalence in four military populations: application of DNA amplification assays for Chlamydia and gonorrhea screening.

The prevalence of asymptomatic chlamydial and gonococcal infections in male and female military populations was determined using urine-based ligase chain reaction DNA amplification assays (DAAs). Cross-sectional surveys in four military settings revealed an overall prevalence of asymptomatic chlamydial infection of 4.2% (56/1338).

Evaluation of a knowledge- and cognitive-behavioral skills-building intervention to prevent STDs and HIV infection in high school students.

The purpose of this study was to evaluate the efficacy of a school-based knowledge- and cognitive-behavioral skills-building STD/HIV prevention intervention. Subjects were 513 ethnically and racially diverse students attending four urban public high schools. The sample was 59% female and had a mean age of 14.

Adolescents' perceived risk for STDs and HIV infection.

Purpose: (1) To determine whether adolescents systematically underestimate their relative risk for STDs and HIV; and (2) to determine to what extent anxiety about STDs and HIV, past condom use, number of lifetime partners and STD/HIV-related beliefs predict perceived relative risk.

Methods: Two hundred and thirty-one sexually experienced, racially diverse, urban high school teenagers (mean age = 15.5 years; 53% male) were surveyed regarding their STD/HIV-related attitudes, beliefs, and behaviors.

Detection of Chlamydia trachomatis in first catch urine samples from symptomatic and asymptomatic males.

Background And Objectives: Non-invasive tests are needed to detect Chlamydia trachomatis in the genital tract. For men, urine appears to be a useful specimen for chlamydial antigen or nucleic acid detection.

Goal Of This Study: To evaluate enzyme immunoassays (EIA) for chlamydial antigens in first catch urine (FCU) from symptomatic and asymptomatic men.

Evaluation of urine-based screening strategies to detect Chlamydia trachomatis among sexually active asymptomatic young males.

Objective: To evaluate the performances of diagnostic screening tests alone or in combination to detect asymptomatic chlamydial urethral infection in young males.

Design: Comparisons of the performance profiles of the following chlamydia screening strategies were done: urethral culture; identification of polymorphonucleocytes (PMNs) on spun first-void urine (FVU); urinary leukocyte esterase test (LET) on unspun FVU; chlamydial enzyme immunoassay (EIA) applied to FVU sediment; combining LET on unspun FVU followed by EIA with or without direct fluorescent antibody (DFA) confirmation on FVU sediment; and combining PMNs on spun FVU followed by EIA with or without DFA confirmation.

Setting: General clinics at a youth detention center, university-based teen clinic, college health service, and a military screening clinic.

Relationship between drug use and sexual behaviors and the occurrence of sexually transmitted diseases among high-risk male youth.

Background And Objectives: Sexually active adolescents, especially those in detention, are at high risk for acquisition of sexually transmitted diseases (STDs), including HIV infection. Yet little information is available that describes their risk behaviors associated with STDs. The overall objective was to define the relationship between risk behaviors and STD acquisition among adolescents.

Use of hyperbaric oxygen as adjunct therapy to surgical debridement of complicated wounds.

The use of hyperbaric oxygen therapy is expanding as research continues to validate its use in a variety of chronic and acute illnesses. High-dose oxygen, delivered under pressures greater than sea level, enables the body to increase diffusion of oxygen into tissues and stimulates angiogenesis and the immune response. These effects improve overall wound healing for those suffering from radionecrosis, peripheral vascular disease, and a variety of complicated infections.

Implementing a school-based STD/HIV prevention intervention: collaboration between a university medical center and an urban school district.

To effectively implement a school-based STD/HIV prevention intervention program developed by a community-based agency, several issues must be addressed to build a collaborative partnership between the agency and the school district. Steps taken by the Division of Adolescent Medicine, University of California, San Francisco, in achieving partnership with a local urban school district are outlined. The process of recruiting school district administrators, health education liaisons, teachers, parents, and students is emphasized.

[Chlamydia trachomatis: risk factors in women in the Parisian region. Importance of smoking and cervical ectropion].

A study of chlamydial infection and its clinical correlates was undertaken collaboratively among french women attending sexually transmitted disease (STD, prenatal, and teen clinics (n = 148). A complete sexual and gynecologic history and pelvic exam was performed on all women. Endocervical and urethral cultures were obtained for C.

[The possible effect of membrane-pathological processes on the atherogenicity of hypertension].

A total of 110 young males suffering from hypertensive disease (HD) were studied. Out of them 21 patients had concurrent HD. As HD progresses, there is an accumulation of free cholesterol in the lipid bilayer of erythrocytic membranes, which promotes the limitation of higher membrane permeability for calcium ions.

Evaluation of Syva's enzyme immunoassay for the detection of Chlamydia trachomatis in urogenital specimens.

A newly developed microwell enzyme immunosorbent assay (EIA) system by Syva Company (Palo Alto, CA) can detect Chlamydia trachomatis in < 3 hr. It uses a polyclonal antibody to chlamydial lipopolysaccharide and end points are determined with a spectrophotometer. Three clinical trial sites (University of California Medical Center, San Francisco, CA; University of Washington, Seattle, WA; and Louisiana State University Medical Center, New Orleans, LA), compared this EIA with tissue culture (TC) for identifying Chlamydia in urogenital specimens.

Preparing for Medicare hospice benefit certification.

When the Visiting Nurse Association of Central Illinois staff began to investigate Medicare Hospice Benefit Certification, they had to start from scratch. In this first-person account, they share their experience and valuable informational shortcuts to help others streamline their process and assure adequate preparation for the certification survey and subsequent operation.