MERCY HEALING CENTER Specialized, same-day or ongoing treatment for a range of conditions.

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1 MERCY HEALING CENTER Specialized, same-day or ongoing treatment for a range of conditions. A staff of compassionate, highly trained physicians, nurses and technicians provide timely, personal treatment in a convenient outpatient setting. About the Healing Center: For non-urgent/emergent care Specially-trained nursing staff providing healing center care and physician oversight provided for wound treatments We accept same-day add-ons based on availability of appointments Authorizations Ordering physician s office must obtain any insurance prior authorizations for services or medications administered The Healing Center will obtain authorizations for services we order directly for patients or those managed by a wound care physician Phone: (319) Fax: (319) Hours: Monday through Friday» Infusion related patient care needs 7 a.m. to 5:30 p.m.» Wound Clinic physician visits from 8 a.m. to 4:30 p.m; some openings earlier if physician available Saturday and Sunday 7 a.m. to 7:30 p.m. Holidays 7 a.m. to 3:30 p.m. See reverse for our list of services. HEALING CENTER

MERCY HEALING CENTER OUR SERVICES: Infusion Clinic Hydration infusions Blood transfusions Antibiotic infusions Wound dressings Wound vac dressing changes Specialty infusions related to certain

2 MERCY HEALING CENTER OUR SERVICES: Infusion Clinic Hydration infusions Blood transfusions Antibiotic infusions Wound dressings Wound vac dressing changes Specialty infusions related to certain disease processes Urinary catheterizations Specialty injections related to certain disease processes Port flushes PICC line dressing changes PICC line laboratory draws Total contact casting application/removal Outpatient wound/ostomy nurse evaluations Phlebotomy Wound Clinic Physician initial visits Physician follow up visits Hyperbaric Oxygen therapy work up Hyperbaric Oxygen therapy treatments Compression garment application Lower extremity non- invasive circulation testing Lower extremity/foot assessments Total Contact Casting application Wound vac application and management Must have an open wound Focus is on chronic non-healing wounds not acute wounds Physician referral required for these services.

W ION E N AT C O L Jeremiah Murphy, MD R.

Urology Clinic has moved to the Hall-Perrine

medical and surgical care for male and female

patients, who suffer from problems of the

conditions of the male genital and reproductive

Matthew Smith, MD Urologist Nathaly François, MD

EPIC ambulatory available in your clinic, please

3 W ION E N AT C O L Jeremiah Murphy, MD R. Matthew Smith, MD Nathaly François, MD Mercy Urology Clinic has moved to the Hall-Perrine Cancer Center Mercy s Urology Clinic provides medical and surgical care for male and female patients, and selected services for pediatric patients, who suffer from problems of the urinary tract, as well as diseases and conditions of the male genital and reproductive organs. Meet Our Urologists: R. Matthew Smith, MD Urologist Nathaly François, MD Urologist How To Schedule In EPIC Providers with EPIC ambulatory available in your clinic, please make your referral within EPIC under: Amb Referral to UROLOGY Jeremiah Murphy, MD Urologist Providers without EPIC, please call Mercy Urology Clinic at (319) or fax referral to (319)

4 Conditions We Treat UROLOGIC CANCER TREATMENT ü Prostate cancer ü Bladder cancer ü Kidney cancer ü Testicular and penile cancer ü Adrenal cancer DISORDERS OF URINATION ü Urinary leakage ü Overactive bladder ü Prostatic enlargement ü Recurrent urinary tract infections PROSTATE DISORDERS ü Benign Prostatic Hyperplasia (BPH) ü Prostatitis KIDNEY STONES ü Treatment and prevention URINARY STRICTURE DISEASE ü Ureteropelvic Junction Obstruction (UPJ) ü Ureteral stricture ü Urethral stricture INFERTILITY (MALE) SEXUAL DYSFUNCTION (MALE) ü Erectile Dysfunction (ED) ü Penile Curvature (Peyronie s Disease) VARICOCELE HYDROCELE CIRCUMCISIONS HYPOGONADISM Clinic Procedures ü Cystoscopy ü Diagnostic ü Bladder Biopsy ü Bladder Fulguration ü Botox Injection ü Stent Removal ü Urethral Dilation ü Difficult Catheter Placement ü Urethral Bulking Agents (macroplastique) ü Urodynamics Post Void Residual (PVR) testing Uroflow Cystometrogram (CMG) UROLOGIC ULTRASOUND ü Prostate, kidney, scrotal and penile ultrasound ü Ultrasound guided biopsy of the prostate (TRUS biopsy) CATHETER CHANGES ü Urethral and supra pubic catheters ü Self-catheterization teaching BLADDER INSTILLATIONS ü Bladder cancer ü Intersitial cystitis / Bladder pain syndrome ü Antibiotic instillation HORMONE INJECTIONS FOR PROSTATE CANCER PENILE INJECTIONS NERVE STIMULATION ü Percutaneous Tibial Nerve Stimulation (PTNS) ü Percutaneous Nerve Evaluation (PNE) REMOVAL OF GENITAL LESIONS VASECTOMY - MINIMALLY INVASIVE NO-SCALPEL IN OFFICE. Surgical Procedures Our urologists perform advanced robotic surgery including laparoscopic, endoscopic and lasers, providing patients with a minimally invasive approach and faster recovery time. ENDOSCOPIC PROCEDURES ü Bladder, Prostate and Urethra ü Cystosocopy to diagnose cancers and abnormalities of the lower urinary tract ü Bladder and urethral biopsy ü Removal of bladder tumors (TURBT) ü Destruction of bladder lesions (fulguration) ü Opening of narrow urethra (DVIU) ü Bladder chemotherapy instillation (Mitomycin) ü Removal of enlarged prostate tissue (TURP) Bipolar TURP Laser TURP (Photovaporization) ü Urethral bulking agents ü Botox injection ü Ureteroscopy visualizing the upper urinary tract (kidney and ureter) for stone procedures as well as to diagnose strictures or masses in these areas STONE REMOVAL PROCEDURES ü Removal of stones in bladder (cystolithalopaxy) ü Removal of stones in ureter and kidney Shock Wave treatment (ESWL) Ureteroscopy using a laser to break up and remove stone Percutaneous stone removal using a small hole in your back to remove larger stones SCROTAL / PENILE PROCEDURES ü Circumcision (young boys (older than 6 months) through adulthood) ü Revision circumcision (typically in young boys with an incomplete circumcision at birth) ü Penile exploration for trauma to the penis ü Testicular removal (orchiectomy) for cancer ü Hydrocele removal ü Removal of epididymal cysts or entire epididymis ü Removal of tumors in spermatic cord ü Varicocele repair UROLOGIC IMPLANT SURGERY ü Penile implants for erectile dysfunction ü Artificial sphincter for severe incontinence ü Sling surgery (men and women) for incontinence CANCER SURGERY ü Prostatectomy (prostate cancer) ü Nephrectomy (kidney cancer) Full removal (radical), as well as partial removal (kidney sparing surgery) ü Adrenalectomy (removal of adrenal glands) ü Orchiectomy (removal of testicular tumor) *** The above surgery can be performed robotically in most situations. For more information please contact Stacy Pohlman, RN, Nurse Manager, at (319) , spohlman@mercycare.org, or visit th Street SE Level 2 within Hall-Perrine Cancer Center Cedar Rapids, IA Phone: (319) Fax: (319) /18

5 Cedar Rapids Medical Education Foundation Counting Medical Education Courses April 2018 DATE TOPIC PRESENTOR(S) Tues. 4/ CRMEF Visiting Professor Program Topic: Pediatric and Adolescent Gynecology Speaker: Joshua Kapfhamer, MD University of Iowa ACCREDITATION * The Cedar Rapids Medical Education Foundation is accredited by the Iowa Medical Society (IMS) to provide continuing medical education for physicians. + The Cedar Rapids Medical Education Foundation designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit. Physicians should only claim credit commensurate with their participation in the activity. CONFLICT OF INTEREST As a sponsor accredited by the Iowa Medical Society, the Cedar Rapids Medical Education Program must assure balance, independence, objectivity and scientific rigor in all its individually sponsored or jointly sponsored educational activities. All faculty participating in a sponsored activity are expected to disclose to the activity audience any significant financial interest or other relationship (1) with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity (significant financial interest or other relationship can include such things as grants, or research support, employee, consultant, major stock holder, member of speakers bureau, etc.) The intent of this disclosure is not to prevent a speaker with a significant financial or other relationship from making a presentation, but rather to provide listeners with information on which they can make their own judgments. It remains for the audience to determine whether the speaker s interests or relationship may influence the presentation with regard to exposition or conclusion. Disclosure forms for each presenter are on file in the CME office. Participants interested in viewing copies may write the CME Office, including a self-addressed, stamped envelope. Please write to: Continuing Medical Education Office, Cedar Rapids Medical Education Foundation, nd Avenue, SE, Cedar Rapids, IA DURING PRESENTATIONS THERE ARE OCCASIONALLY DISCUSSIONS OF UNAPPROVED USE OF FDA APPROVED DRUGS, DEVICES OR TREATMENTS. THIS MUST BE DISCLOSED TO THE AUDIENCE DURING THE LECTURE. Page 1 of 1 4/3/2018

#vitalsigns APR. 2018 221 1 in 10 1st New nationwide testing in 2017 uncovered 221 instances of unusual resistance genes in nightmare bacteria.

Launch at the first sign of unusual resistance.

While antibiotic resistance (AR) threats vary nationwide, AR has been found in every state.

6 #vitalsigns APR in 10 1st New nationwide testing in 2017 uncovered 221 instances of unusual resistance genes in nightmare bacteria. 11% of screening tests, in people with no symptoms, found a hard-to-treat germ that spreads easily. The Containment Strategy keeps new threats from spreading. Launch at the first sign of unusual resistance. Containing Unusual Resistance Early, aggressive action can prevent spread More than 23,000 Americans die each year from infections caused by germs resistant to antibiotics. While antibiotic resistance (AR) threats vary nationwide, AR has been found in every state. And unusual resistance germs, which are resistant to all or most antibiotics tested and are uncommon or carry special resistance genes, are constantly developing and spreading. Lab tests uncovered unusual resistance more than 200 times in 2017 in nightmare bacteria alone. With new resources nationwide, early and aggressive action when even a single case is found can keep germs with unusual resistance from spreading in health care facilities and causing hard-to-treat or even untreatable infections. For example, CDC estimates show that this aggressive approach could prevent 1,600 cases of CRE* in one state over three years. Health departments can lead the Containment Strategy and act swiftly with health care facilities and CDC at the first sign of unusual resistance. State and local health departments can: Make sure all health care facilities know what state and local lab support is available and what isolates (pure samples of a germ) to send for testing. Develop a plan to respond rapidly to unusual genes and germs when they first occur. Assess the quality and consistency of infection control in health care facilities across the state. Help improve practices. Coordinate with affected health care facilities, the new AR Lab Network regional labs, and CDC for every case of unusual resistance. Investigations should include onsite infection control assessments and colonization screenings for people who might have been exposed. They could spread it to others. Continue until spread is controlled. Provide timely lab results and recommendations to affected health care facilities and providers. If the patient came from or was transferred to another facility, alert that facility. Want to learn more? Visit: containing-unusual-resistance *CRE is carbapenem-resistant Enterobacteriaceae.

Once antibiotic resistance spreads, it is harder to control like a wildfire. Finding and responding to unusual resistance early, before it becomes common, can help stop its spread and protect people.

7 PROBLEM: Antibiotic-resistant germs can spread like wildfire. Germs constantly develop resistance against new and older antibiotics. Antibiotic-resistant germs can cause difficult-to-treat or untreatable infections. Some types of antibiotic resistance are already widespread. Once antibiotic resistance spreads, it is harder to control like a wildfire. Finding and responding to unusual resistance early, before it becomes common, can help stop its spread and protect people. New or rare types of antibiotic resistance can be easier to contain when found rapidly like a spark or campfire. UNUSUAL ANTIBIOTIC-RESISTANT GERMS Resistant to all or most antibiotics tested, making them hard to treat, and Uncommon in a geographic area or the US, or Have special genes that allow them to spread their resistance to other germs Examples of unusual resistance: Vancomycin-resistant Staphylococcus aureus (VRSA), Candida auris, and certain types of nightmare bacteria such as carbapenem-resistant Enterobacteriaceae (CRE). CDC S AR LAB NETWORK UNCOVERS ANTIBIOTIC RESISTANCE & SILENT SPREAD ANTIBIOTIC RESISTANCE CAN SPREAD AR LAB NETWORK 1 IN 4 GERMS TESTED WAS POSITIVE. 25% of the germs had special genes that allow them to spread their resistance to other germs. In response, many investigations were conducted and screening tests were performed. 1 IN 10 SCREENING TESTS WAS POSITIVE. If left undetected, patients without symptoms could continue spreading rare, hard-to-treat germs in the health care facility. From people with and without symptoms of infection Between facilities Between germs 2 PREVENTING AN UNUSUAL ANTIBIOTIC RESISTANCE WILDFIRE Rapid Response in Tennessee Health department identified an unusual resistance germ in a patient who recently received health care outside the US. Health department and the facility in Tennessee did infection control assessments and colonization screenings within 48 hours. No spread found. Moving forward, CDC s AR Lab Network regional labs expanded services to test patients in the US with recent health care outside the country. Ongoing Vigilance in Iowa Health department identified an unusual resistance germ in a nursing home patient. Health department and the facility did infection control assessments and screened 30 patients for colonization. Investigation revealed the germ may have spread to 5 additional people. Facility used infection control and contact precautions, such as gloves and gowns, to help stop spread. No further spread found during follow-up assessments. SOURCE: CDC Vital Signs, April 2018.

8 Containment Strategy: Be on guard to contain the first spark. THE NATION CAN IDENTIFY AND RESPOND TO UNUSUAL ANTIBIOTIC RESISTANCE 7 AR Lab Network Regional Labs In addition to leading the Containment Strategy, CDC is working with other Federal agencies to combat antibiotic resistance nationwide by preventing infections and improving antibiotic use. CDC s activities are supported by ongoing resources from Congress. 56 AR Lab Network State and Local Labs 500+ Local Staff to Combat AR Advanced Programs to Prevent Spread & Improve Antibiotic Use 49 Projects Exploring Innovative Detection & Prevention Health care facilities, health departments, and CDC are ON ALERT for antibiotic resistance. THE CONTAINMENT STRATEGY RAPID IDENTIFICATION CONTINUED ASSESSMENT & SCREENINGS INFECTION CONTROL ASSESSMENTS COORDINATED RESPONSE BETWEEN FACILITIES SOURCE: AR Investment Map: COLONIZATION SCREENINGS Public health teams nationwide can launch early, aggressive responses to contain spread and protect people at the first sign of antibiotic resistance, every time. Find guidance, lab protocols, and more resources:

9 WHAT CAN BE DONE THE FEDERAL GOVERNMENT IS: Monitoring resistance and sounding the alarm when threats emerge. CDC develops and provides new lab tests so health departments can quickly identify new threats. Improving identification through CDC s new AR Lab Network in all 50 states, 5 large cities, and Puerto Rico, including 7 regional labs and a national tuberculosis lab for specialty testing. Supporting prevention experts and programs in every state, and providing data and recommendations for local prevention and response. Testing innovative infection control and prevention strategies with health care and academic partners. STATE AND LOCAL HEALTH DEPARTMENTS AND LABS CAN: Make sure all health care facilities know what state and local lab support is available and what isolates (pure samples of a germ) to send for testing. Develop a plan to respond rapidly to unusual genes and germs when they first appear. Assess the quality and consistency of infection control in health care facilities across the state, especially in facilities with high-risk patients and long stays. Help improve practices. Coordinate with affected health care facilities, the new AR Lab Network regional lab, and CDC for every case of unusual resistance. Investigations should include onsite infection control assessments to find spread. Consider colonization screenings. Continue until spread is controlled. HEALTH CARE FACILITIES CAN: Plan for unusual resistance arriving in your facility. Find resources: Leadership: Work with the health department to stop spread of unusual resistance. Review and support infection control in the facility. Clinical labs: Know what isolates to send for testing. Establish protocols that immediately notify the health department, healthcare provider, and infection control staff of unusual resistance. Validate new tests to identify the latest threats. If needed, use isolates from Healthcare providers, epidemiologists, and infection control staff: Place patients with unusual resistance on contact precautions, assess and enhance infection control, and work with the health department to screen others. Communicate about status when patients are transferred. Continue infection control assessments and colonization screenings until spread is controlled. Ask about any recent travel or health care to identify at-risk patients. EVERYONE CAN: Inform your healthcare provider if you recently received health care in another country or facility. Talk to your healthcare provider about preventing infections, taking good care of chronic conditions and getting recommended vaccines. Practice good hygiene, such as keeping hands clean with handwashing or alcohol-based hand rubs, and keep cuts clean until healed. Provide timely lab results and recommendations to affected health care facilities and providers. If the patient came from or was transferred to another facility, alert that facility. Find resources: For more information, please contact Telephone: CDC-INFO ( ) TTY: Web: Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Publication date: April 3, 2018 CS286967A

10 MERCY INTERPRETIVE SERVICES Hospitals are required by both law and regulation to ensure effective communication with our patient and visitors. Communication expectations: Patients and their companions will not be excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids or services Patients and/or companions shall be offered auxiliary aids and services, including interpretive services free of charge The use of family members and other companions as interpreters shall be prohibited in non-emergency situations and discouraged in all situations Interpretive services are available 24/7 Interpretive services should be provided by a qualified medical interpreter o Bilingual or multilingual staff or providers should not serve as a medical interpreter without formal training Please document when an interpretive service is used to communicate with your patient. Health history obtained using MARTTI. In-person interpreter used to communicate with patient. What does Mercy Medical Center have available for interpretive services? MARTTI video remote interpretive service In person interpreters Over- the- phone interpretive service Limited number of translated documents What does MercyCare Community Physicians have available for interpretive services? In person interpreters Working on availability of over-the-phone interpretive service What are the top languages requested through one of Mercy s interpretive services? 1. Spanish 2. American Sign Language 3. French 4. Swahili 5. Arabic 6. Mandarin In 2017, there were over 30 languages spoken at Mercy Medical Center and approximately 1900 calls or visits through one of Mercy s interpretive services offerings

Cedar Rapids Medical Education Foundation Continuing Medical Education Courses February 2016

Cedar Rapids Medical Education Foundation Continuing Medical Education Courses February 2016 DATE TOPIC PRESENTOR(S) Mon 2/1 1200 CRMEF PBLA: Obesity - Definition and Epidemiology of Obesity Dr. Jerimiah