Des Moines University’s Kendall Reed Rare Book Room recently acquired a rare, first English edition copy of The Workes of That Famous Chirurgion Ambrose Parey [sic], printed in 1634. French surgeon Ambroise Paré (1510-1590) made innumerable contributions to the field of medicine and is considered a father of modern surgery. On the battlefield, Paré resurrected an old but rarely used concoction of egg yolk, oil of roses and turpentine to treat wounds in lieu of boiling elderberry oil. He also successfully disproved the theory that Bezoar Stones contained magical healing properties. In addition, Paré introduced groundbreaking work in obstetrics and developed the Bec de Corbin, an early version of contemporary hemostats.

The Workes of That Famous Chirurgion Ambrose Parey features more than 300 beautiful and weird woodcut illustrations that supplement his writings on the plague, popular myths (such as the use of unicorn horns to treat illness), materia medica, 16th century medical instruments and much more. The tome is available for viewing in the Rare Book Room along with other books and journals on the history of osteopathy, podiatry, surgical anatomy, military medicine and medical education. Dating from the 17th century to present, DMU’s rare book collection is an important resource for medical students, practitioners and historians.

The Paré book and other items in the collection “allow students to feel, smell and imagine the past and what physicians of that time endured to assure the progress that we benefit from today,” says Kendall Reed, D.O., dean of the College of Osteopathic Medicine.

“Books of this era are rapidly disappearing from the market and form the cornerstone of any rare book collection,” he adds. “We must diligently and purposely continue to acquire rarities such as this for our next generation of physicians. It’s a part of our rich culture at DMU that we need to not just preserve but expand upon. Time is of the essence.”

Information courtesy of DMU Archivist Lindsey MacAllister, M.A.; the DMU Archives and the Kendall Reed Rare Book Room.

Swim, bike, run. Triathlons are easy
to understand.

But magnify the concept to 10,225 miles
and stretch the route across 13 countries
in 11 months and it becomes The World
Triathlon, a nearly unfathomable concept
that’s just under way.

Charlie Wittmack, a Des Moines attorney, the
first Iowan to climb Mount Everest and a life-
long adventurer, embarked on this epic
journey July 1 when he jumped into the
River Thames to swim to the North Sea and
across the English Channel. He’ll
follow that with a 9,000-mile bike
ride across mountains and deserts
in Europe, Asia and Nepal. Next he’ll hop
off the bike to run a 950-mile trail from sea
level at the Bay of Bengal through
the Himalayas to the summit of Mount Everest.

The whole trek is roughly 100 times the length of an Ironman triathlon.

Wittmack is not making this crazy-ambitious journey on a whim or to show off superhuman endurance. He’s doing it to bring light to issues he considers very serious. Health. The environment. Education. That’s where Des Moines University fits in.

Yogesh Shah, M.D., associate dean of global health at DMU, created a partnership among The World Tri team, DMU, the World Health Organization and the White Ribbon Alliance (WRA) to promote a message of public health and education to combat maternal mortality. The WRA is an international coalition working to make childbirth safe for all women.

“Nepal’s maternal mortality rate is the 16th worst in the world,” Shah says. “Improving mortality rates around the world is an important focus at DMU and the World Health Organization. By joining with the WRA, we gain even more strength in bringing awareness to this topic.”

That fits Wittmack’s world view. “I stopped thinking about the parts of the trips as adventures and instead as opportunities to form connections,” he said in a May 17 talk with DMU students.

So while he recovers from biking and prepares to hike Everest, a DMU group will work with him and his wife, Cate Wittmack, on the maternal mortality challenge. The team includes DMU faculty, graduates, staff and students as well as physicians and health care students from around the United States.

Beginning in December, the team will train health care workers in the Kathmandu hospital on safe, clean delivery procedures, using birthing models from DMU’s Iowa Simulation Center for Patient Safety and Clinical Skills.

From January through June 2011, the team will visit rural villages along Wittmack’s hiking route to speak in schools and at community gatherings. They will share information on safe sex, pregnancy complications and maternal health issues, using materials prepared by UNICEF.

“Right now many in rural areas consult an untrained birth attendant for deliveries. They do not get even a local birth attendant involved until there are complications, at which point it’s often no longer an option to get the mother to a larger town with a medical facility,” Shah explains. “Part of the message we will share is why it’s important to get prenatal care and call the attendant at the start of labor.”

Members of the team will rotate through in month-long stints, but the message will remain constant: No woman should die while giving birth.

As the 2009 recession continues to depress household incomes, stymie job growth and spike government debt, Forbes.com offered a suggestion: Move to Middle America. Specifically, to Des Moines.

In April, Forbes declared Iowa’s capital the number-one “best place for business and careers” based upon its “reasonable business costs, strong economic outlook and solid quality of life.” The city was seventh on the list last year.

Forbes is not the only one praising Des Moines these days. In May, Kiplinger’s Personal Finance magazine pegged the city number seven on its “best cities for the next decade” list for attracting “global talent”; its other draws are low-cost housing and the city’s “long-touted reputation for family-friendliness and a ’19-minute commute.’”

Des Moines also has attracted the attention of The Wall Street Journal and the New York Times, which in February featured an article about “recent commercial, residential and retail development in Des Moines, where public and private cooperation has produced a robust urban landscape matched by few cities its size.”

So what’s up with all this applause for a city in the heart of fly-over land?

“I’ve seen transformations in the city,” says DMU Trustee Dale Andres, D.O.’73, senior vice president of medical affairs at Mercy Medical Center-Des Moines. “It’s multidimensional, from sports to recreation to schools to shopping.”

Developments in the metro area in the past five years include:

• Installation of the John and Mary Pappajohn Sculpture Park, named after the couple who donated to the city 25 works by international artists, valued at more than $40 million. Midwest Living magazine recently included the park among its top 45 “best new Midwest spots to play, eat and stay.”

17th

STRONGEST U.S. METRO ECONOMY
Farmers Insurance Group of Companies

• A new central branch of the Des Moines Public Library spanning two blocks in the heart of Des Moines’ Western Gateway Park. Designed by London-based architect David Chipperfield, the library features Okatech windows that create an external copper façade but, from inside the building, are transparent.

#1

BEST PLACE TO RAISE A FAMILY
Farmers Insurance Group of Companies

• The new Science Center of Iowa, which includes a 216-seat IMAX Dome Theater and a 50- foot domed Star Theater.
• Renewal of Gray’s Lake Park, with creation of the two-mile Kruidenier Trail that encircles it and connects to other trails in the area.
• Construction of Wells Fargo Arena, Hy-Vee Hall and the Iowa Hall of Pride adjacent to Veterans Memorial Auditorium, which is scheduled to be remodeled as a convention center. Home of the Iowa Barnstormers arena football team, Wells Fargo Arena has hosted performers including Elton John, the Black Eyed Peas, Justin Bieber and Taylor Swift.
• Historic East Village east of the Des Moines River stretching six blocks to East 14th Street, previously a dilapidated area now home to hip eateries, eclectic boutiques and swanky loft-style housing.
• In West Des Moines, Jordan Creek Town Center, the state’s largest shopping complex with upscale retailers, restaurants and a 3.5-acre lake with walking trails.

These and other new developments join the area’s tried-and-true favorites, such as the famed goldleaf-domed State Capitol Building, historic Valley Junction (West Des Moines), Living History Farms, Blank Park Zoo and the renowed Des Moines Art Center.

Annual events also add to
Des Moines’ cool factor, including the following:

• the annual Iowa State Fair, which draws nearly one million visitors and was included in the New York Times best-selling travel book 1,000 Places to See Before You Die and subsequent travel book 1,000 Places to See in the U.S.A. and Canada Before You Die.
• the Des Moines Arts Festival, which annually draws more than 200,000 people; it was named the nation’s fifth top art fair by AmericanStyle Magazine in 2008.
• the Hy-Vee World Cup Triathlon, which attracts thousands of elite and amateur athletes with its rich purses; the event also has raised more than $750,000 for Variety–the Children’s Charity
• the Principal Charity Classic, the only Champions Tour event in Iowa; named “best event” in 2009 by the Tour, the golf tournament has raised $1.7 million for local children’s charities.
• the 80/35 Music Festival, launched in 2008 in downtown’s Western Gateway Park and named after the area’s crossing interstates; performers have included the Flaming Lips, Public Enemy, Ben Harper and Modest Mouse.

15th

HEALTHIEST STATE IN THE NATION
United Health Foundation

• new and classic Broadway shows, Des Moines Symphony concerts, comedy performances and more at the Civic Center of Greater Des Moines, which ranked 17th in ticket sales in the Jan. 11, 2010, edition of Pollstar magazine’s annual list of the top 100 worldwide theater venues.
• the annual prestigious World Food Prize, created by Nobel Peace Prize winner Norman Borlaug in 1986 to recognize international leaders in improving the quality, quantity and availability of food in the world.
• the Downtown Farmers Market, which lures thousands of people every Saturday from May 1 through Oct. 30 with its more than 200 vendors; the Farm Boys’ breakfast burrito alone makes the trip well worth it.

Variety marks Des Moines’ dining scene, too. With more than 850 restaurants in the metropolitan area, diners can choose from upscale French cuisine to fusion, Cajun, sushi, vegetarian, Vietnamese, Italian and all ethnic versions in between.

“Everything went from meat and potatoes and spaghetti to chef-driven restaurants, where the chef has a vision of what he or she wants to create,” says W.E. Moranville, restaurant reviewer for The Des Moines Register since 1997. “The whole mantra today is fresh and local and making a restaurant truly one of a kind. It’s such a nice change.”

Progress in Des Moines has not occurred overnight. Art Wittmack, retired president, CEO and chairman of Neumann Brothers, a Des Moines-based construction company, says the evolution has been driven by an ongoing strategic planning process; productive partnerships among public and private sectors; and, relative to many other cities, fewer economic ups and downs thanks to agricultural, banking, insurance and health care industries in the area.

Wittmack should know: His company, founded in 1912, has literally changed the face of Des Moines with dozens of construction and renovation projects, including the Ruan Center (once Iowa’s tallest building), Science Center of Iowa, the award-winning Employers Mutual Casualty Co. building, the Meredith Co. building and several DMU projects.

Wittmack, a member of the DMU Board of Trustees and the Greater Des Moines Partnership Board, says the city’s secret sauce is its user-friendly environment.

“I’ve had the opportunity to travel a lot and live on both coasts and in Chicago, but what brought me back was that Des Moines is a great place to live, work and bring up children,” he says. “It has that balance that other cities were missing. Bike trails, Broadway plays, the Des Moines Symphony, the Art Center, music, athletics – you can do all those things in Des Moines.”

Want sports? Des Moines offers plenty, all at family-friendly prices:

• Des Moines Buccaneers USHL hockey team
• Des Moines Menace PDL soccer team
• Iowa Barnstormers arena football team
• Iowa Crush women’s professional football club
• Iowa Cubs Triple-A baseball team
• Iowa Energy NBA D-League basketball team

For more information about Des Moines visit the Greater Des Moines Convention and Visitors Bureau.

Kenneth Hisley, Ph.D., used OsiriX software to transform sequential CT images of the thorax to in-depth three-dimensional views. Above, he dissected the view to expose an aortic aneurysm.

Kenneth Hisley, Ph.D., a
faculty member in DMU
anatomy department, is
manipulating a human torso to
reveal the thoracic cavity of a
human subject – slicing it
horizontally, observing the lungs
and thorax obliquely to show the
spatial relationshipsof the heart
chambers, right and left ventricles,
in relation to a lesion.

Hisley, whose academic interests include clinical imaging
and anatomical visualization, is exploring the thorax not
with physical scalpel and cadaver, but with their digital
equivalents: a sophisticated medical image processing
computer program called OsiriX and an x-ray-computed
tomography (CT) image series of a patient’s thorax and abdomen.

The OsiriX program allows anatomical observation from many viewpoints, zooming in and out of regions, redefining three-dimensional (3D) structural perceptions using tissue colors and transparencies, and the display or removal of arbitrary regions. Hisley sees this new software tool as simply an extension of the physical methods medical students come to know so well, with added advantages for visualizing spatial relationships.

In DMU’s anatomy laboratory, students dissect and explore cadavers at 43 dissection stations, each equipped with a 32-inch flat screen monitor offering dissection directions and descriptive atlas images. Hisley believes this system will be updated to exploit the power of current 3D visualization technology, allowing direct, guided student interaction.

“There are additional manipulations that are difficult or impossible to accomplish with the physical cadaver that might add entirely novel insights into the study of clinical anatomy,” he says.

For example, if a student wishes to understand visceral relationships using an unusual surgical approach, he or she can do so through layers of superficial-to-deep transparencies and without having to turn the physical body. Thus, manipulating CT and magnetic resonance imaging (MRI) image set reconstructions can enhance students’ anatomical knowledge in preparation for their clinical rotations and residencies.

“Physical and digital techniques, by their nature, augment each other,” Hisley says. “Physical dissection provides systematic detailed, spatial and haptic knowledge of anatomy, while digital exploration provides the opportunity for exploration using novel viewpoints increasing recall and a sense of clinical application.”

Previously, Hisley hypothesized that student generation and manipulation of 3D models in parallel with routine physical dissection would significantly improve students’ ability to recognize known anatomy observed from novel viewpoints. He assigned groups of students to explore a randomly assigned region of the body, one group using physical dissection; the other, digital dissection. Results showed that the digital dissectors did better in spatial logic assessment tasks while the physical dissectors were superior in the naming of specific structures. These preliminary outcomes indicate that both techniques should be used in combination.

“Physical dissection is still the gold standard, and I believe it always will be. True anatomical skill is the understanding of complex structures combined with the tactile understanding of the human condition so intrinsic to osteopathic education,” he says. “On the other hand, there is strong evidence that digital anatomical methods are part of the future of clinical practice. Students will need to understand it for this reason as well as for the additional insights it affords into the human body.”

Physicians, scientists, students and others will increasingly access 2D and 3D images on a variety of mobile devices.

His laboratory student research assistants are working with DMU’s osteopathic manual medicine (OMM) department, chaired by Brad Klock, D.O.’81, to create a 3D visualization model of the thigh’s fascial architecture and dynamics. A better understanding of fascial structural relationships using this digital demonstration model could enrich student understanding of fascial mechanics and OMM procedures.

Hisley’s ultimate goal is to create a DMU-wide online clinical anatomy resource by digitizing and reference-linking a wide range of information resource components (print, image, digital model, sound, etc.) into an indexed library database of training exercises. These accessible learning resources will be intended to execute on all Windows and Macintosh computing tools supporting the curriculum, including desktops, laptops, iPhone/ iTouches and iPads.

On the topic of technology, Vincent Grasso says embrace the machine – it benefits patients, takes health care to underserved areas and complements osteopathic medicine’s holistic approach.

S. Vincent Grasso, D.O.’91, has taken telemedicine to the most remote place on earth. As a postdoctoral associate in the Yale University School of Medicine’s surgery department and project manager in the NASA Yale Commercial Space Center for Medical Informatics and Technology Applications, he led a team of Yale researchers, MIT engineers and U.S. Defense Department personnel in using new technologies to monitor the endurance, physiologic status and the effects of extreme exertion, low oxygen and the cold on four Mount Everest climbers.

Vincent Grasso, at right, shows a cardiac device used to monitor a Mount Everest climber in 1998.

As a Yale publication described, “vest-like biopacks transmitted viral data from the slopes of the 29,028-foot mountain to the base camp at 17,000 feet, relaying the information to Yale by satellite phone and the Internet.” Grasso and his base camp colleagues also set up a video connection so they could talk face to face with a physician team back at Yale-New Haven Hospital and Walter Reed Medical Center.

“The Everest expedition team proved that one could remotely monitor the clinical and environmental state of each climber and remain in contact to diagnose, advise and assist within a 24/7 window,” he says.

The only problem with the cutting-edge technology: It was too cutting-edge at the time, May 1998. While the expedition helped NASA and its sponsors advance medical-monitoring systems for astronauts, it failed to spur rapid adoption of commercial applications of telemedicine among earth-bound humans.

“If the technology is too early, it’s more frustrating than if you have nothing,” Grasso says.

The world has changed. The federal government is pushing doctors, clinics and hospitals to have electronic health records for all patients before 2015. Some are embracing technology similar to the monitoring and transmitting devices Grasso used more than a decade ago on Mount Everest.

Among these adopters and innovators, Grasso is hyper-high tech, a Renaissance combination of surgeon, medical informatics expert, software architect, business analyst, entrepreneur, certified project management professional and adjunct professor at Stevens Institute of Technology in Hoboken, NJ. In July, he was appointed founding trustee for New Jersey’s regional health information exchange, NJ-HIGHT ECH, part of a national framework funded by the stimulus legislation to educate and assist care providers in sharing information securely.

Grasso’s ability to straddle clinical care, management and technology equips him to show how new technologies can result in financial and clinical benefits.

“I’m working on ways to bring value to the health care delivery community and prove that a new technology-rich model for enhancing return on investment exists – to meet the existing cost structure or beat it, and in tandem deliver better clinical outcomes,” he says. “That’s the holy grail.”

Grasso offers a laparoscopic training symposium in Bolivia.

Grasso has implemented technology in a number of health care efforts. Through the company he founded in 1999, Technology Integrations for Medical Applications (TIMA), he and his colleagues have trained physicians in war-ravaged Serbia and are enabling doctors and visiting nurses to make “virtual” house calls in New York and New Jersey. Last year, his team landed a five-year, $2.8 million grant from the U.S. Department of Health and Human Services to monitor and connect women of color with HIV/AIDS with clinics and hospitals around the country.

“The grant’s technology platform consists of a grid-based centralized and exceedingly secure solution operating within top-tier data centers, facilitating ease of use and access,” Grasso explains. “By giving participating clinics and doctors secure access to the solution, we empower a community of distributed care-givers with one record source.

“Doctors don’t have to make a capital investment in redundant systems to access the information. They can make decisions quickly with their work environments for timely intervention,” he adds. “That decreases decision-time related costs and improves clinical outcomes.”

Grasso is driven to utilize technology to serve the underserved. In 1991, as a medical student and Jesuit missionary volunteer in Peru’s cholera epidemic that year, he founded the nonprofit organization AYUDAMOS – Spanish for “we help” – to alleviate suffering in poor countries by coordinating donations of medical supplies, application of telecommunication technology and the expertise of physicians, engineers, scientists and other professionals. AYUDAMOS has trained surgeons in Bolivia and treated landmine victims in Cambodia, among other activities.

Closer to home, the organization’s Adopt-a-Clinic program is working with technology vendors and local non-governmental organizations to raise funds to add more clinics to the HIV/AIDS grant project.

“Our consortium approach allows for an efficient, effective means of offering services to the disadvantaged at a fraction of the traditional cost,” he says.

Vincent Grasso educates students at a Ugandan medical school.

Grasso is now working with Panasonic and Cywee via one of his start-up companies, Medical Motion Monitoring and Metrics (M4), to create technology-enhanced braces and bands that, when worn by patients, will enable their health care providers to monitor their home-based physical therapy. He’s planning more medical missions. And he’s working with a team to return to Mount Everest next year to test a new generation of monitoring and medical information systems on climbers.

These technologies, he says, create opportunities for D.O.s to show the value of osteopathic medicine and improve their patients’ lives.

“With all that’s going on in health care, some think it’s not a good time to get into medicine,” Grasso says. “But my pitch to students is they are very lucky to be healers. And if you work really hard and hustle, look at all the cool things you can do.”

Andrew Burchett, D.O.’03, admits with a laugh that when he agreed to become his health system’s medical information officer, he didn’t know what he was getting himself into. He took on the role in 2007, when the Avera health system – which provides services in South Dakota and surrounding states – launched an update of its Meditech software system; the previous system had been implemented 14 years earlier, eons in technology years.

“There are 50,000 patient charts in my clinic alone,” says Burchett, who has a full-time family medical practice at Avera McGreevy Clinic and also serves as chair of family medicine at Avera McKennan Hospital, both in Sioux Falls, SD. “Our goal is for all our systems to talk to each other, but we’re not there yet.”

Avera

Avera is not alone in that regard. According to a recent report in Business Week, just 10 percent of U.S. health care facilities used electronic health records in 2009. The federal government wants more than half of all facilities to use them by 2014, and it provided $36 billion in last year’s stimulus legislation to help them do so. Like many physicians, Burchett is convinced EHR s won’t fulfill one of their purported promises: cutting health care costs.

“The cost of implementation means savings can’t be part of the equation for a long time,” he says, noting that Avera McKennan and its clinics had to spend significantly more than the $40 million initially budgeted for the project – and that was just for an upgraded system. “Improved patient safety, quality and efficiency are what drive us.”

That’s where technology makes a difference. In recent years, Avera has developed several innovative technology applications, Avera eCare ™, that connect specialty care physicians and pharmacists to health care workers and patients in rural areas. Through two-way video and other equipment, 24 hours a day, seven days a week, Avera staff can view a patient in a rural facility miles away, guide its care providers, view the patient’s records and radiographic images, arrange for transportation to a bigger facility if needed, and review and approve prescriptions. eCare also provides patients with monitors set with individualized health instruction and follow-up care in their homes.

In addition to supporting rural practitioners, these services allow many patients to get care in their own communities. More important, they save lives. Since 2005, Avera’s electronic intensive care unit services alone have enabled nearly 400 individuals, who initially were not predicted to survive, to leave hospital care alive.

“That’s how technology can save lives and reduce costs,” Burchett says.

Look beyond the potentially torturous transition to electronic health records, requisite brain-cramping lessons on updated computer systems and their
hair-raising costs: New technologies are equipping physicians and others to give better patient care by enhancing diagnosis and treatment, increasing access
and more effectively educating future health care professionals.