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Illinois Health Magazine
Volume 1 | Spring 2012 A publication of the University of Illinois Hospital & Health Sciences System ILLINOIS HEALTH Changing Medicine. For Good. I NAUGU R AL ISSU E A new State of Healing Chicago leading the way to a healthier Illinois Islet cell project a diabetes breakthrough Bernie Mac Foundation: A partnership of hope Smiles all around as our dental school gets a makeover tHe best wAy to treAt A communIty Is by treAtIng tHe people wHo mAKe It up. Introducing the university of Illinois Hospital & Health sciences system. what you knew as the university of Illinois medical center is now part of a larger organization that also includes the university health sciences colleges. by bringing these resources together, weâ€™ll be able to make the best care accessible to those who need it most. because we all deserve the best healthcare. the university of Illinois Hospital & Health sciences system. changing medicine. for good. Find out more at HoSPitaL.uiLLinoiS.edu Welcome I’m pleased to introduce the first issue of Illinois Health, a brand-new publication of the University of Illinois Hospital & Health Sciences System. I hope you will spend a few minutes reading about the exciting changes taking place throughout the University of Illinois’ health sciences schools, colleges and patient care entities. Over the last year, we have streamlined the internal structure of our health system and introduced a new name for our combined clinical research, health professional training and patient care enterprise. As the University of Illinois Hospital & Health Sciences System, we are poised like never before to make a difference in healthcare, beginning with the people served by our flagship health campus in Chicago and extending to the people of Illinois and our nation. Every day I spend with my colleagues on our campuses Joe G.N. “Skip” Garcia, MD and elsewhere, I am constantly impressed with their knowledge, dedication and optimism. From what I hear and see, there is a feeling that this is a place where you can truly make a difference. Our exceptional health professionals are working to gain knowledge and develop treatments that will improve outcomes and long-term health. These game-changers are not just for our own patients, but for patients at the hospital up the street or across town and for people in communities across the state. What exactly does it mean to “make a difference?” There are as many answers to that as there are people working here. And they are all important. But as a whole, as a health science system with our public charter from the people of Illinois, we can do more than just about anyone in the region to make a difference in people’s health. In this first issue you will learn more about how we are fulfilling our renewed mission to provide health care for the people of Illinois, find innovative ways to deliver personalized health to those who need it most and grow clinical programs of distinction out of our outstanding translational research programs. For example, the relatively new field of human genomic science promises to make a difference in how we diagnose and treat diseases that impact genetically similar populations. Comedian Bernie Mac suffered from sarcoidosis, an immune system disorder that African-Americans are three times more likely to have than whites. Together with his family and the Bernie Mac Foundation, we are determined to make inroads in the fight against a disease that we are just beginning to understand. In a country with ostensibly the best healthcare on earth, there are millions of people who aren’t benefiting from it. The problem of health disparities among African-American and Latino populations is complex. Access, genetically different responses to disease and treatment, and health literacy all play a role. But in our health system, we have the science and the community populations to prove that this can be changed, that disparities can be reduced or even eliminated. As a boy, I picked strawberries with migrant workers in California. I saw up close the disadvantages the workers faced when a number of them became ill with lung disease. I decided then and there to pursue a career in healthcare and try to make a difference. That is why it is so refreshing to find kindred spirits all over the University of Illinois campuses who are driven to do the same. I hope you enjoy some of their encouraging stories in these pages. As we launch this first issue of Illinois Health, I would like to dedicate it to all the people in our health system who are working every day to make a difference in other people’s lives. I hope you will join me in supporting them and the exciting work they are doing. Joe G.N. “Skip” Garcia, MD Vice President for Health Affairs, University of Illinois Earl M. Bane Professor of Medicine, Pharmacology and Bioengineering Illinois Health | 1 illinois health Office of the Vice President for Health Affairs Vice President for Health Affairs Joe G.N. “Skip” Garcia, MD Interim Associate Vice President for Professional Practice & Chief Medical Officer, UI Hospital Bryan A. Becker, MD Associate Vice President for Population Health Sciences Jerry A. Krishnan, MD, PhD Associate Vice President, UI Hospital John DeNardo, MS, MPH, FACHE Associate Vice President for Enterprise Strategy Mike Jonen Assistant Vice President for Finance & Chief Financial Officer, UI Hospital William Devoney Illinois Health Editorial Staff Publisher Mike Jonen Editor in Chief Camille Baxter, MA Editor Pat Kampert Assistant Editor Cayce Mallen, MHA Editorial Consultants Michael J. Wesbecher, Carl Vogel Contributing Writers Kevin McKeough, John Morrissey, Alice Patenaude, Cindy Veldhuis, MS, and Linda Wilson Design Anne Boyle, Boyle Design Associates Photography Donald Barge, Lloyd DeGrane, Barry Donald, Bart Harris, Mike McCafrey and David Zalazniki/ Star Journal Illinois Health is a publication of the University of Illinois Hospital & Health Sciences System ©2012 All rights reserved. All inquiries should be addressed to: Illinois Health Vice President for Health Affairs Marketing firstname.lastname@example.org HIPAA Compliance Statement The Health Insurance Portability and Accountability Act of 1996 (HIPAA) outlines the minimum standards that need to be met to ensure the confidentiality, privacy and security of health care information. The University of Illinois Hospital & Health Sciences System ensures that all parties involved in the use and/or disclosure of protected health care information comply with current HIPAA regulations. Any identifiable and/or disclosed patient information within this publication has been consented by the patient or appropriate family member for the purpose of advancing the mission and visibility of the UI Hospital & Health Sciences System. Mission The mission of the University of Illinois Hospital & Health Sciences System is to provide high-quality, cost effective health care for the people of the state of Illinois, to leverage leadership in education and innovation to deliver “personalized medicine” to vulnerable populations and to grow clinical programs that are tightly linked to translational research and are academically distinct both regionally and nationally. cover design: Laughlin Constable In this Issue 1 4 Vice President’s Message The sum of the health system’s parts is potent indeed Health SYSTEM News Latest happenings at the hospital and in health sciences 9 14 A New State of healing 18 Turning laughs into life savers Chicago leading the way to a healthier Illinois Insulin independence Islet cell project a breakthrough for difficult diabetes cases Health system teaming up with the Bernie Mac Foundation to search for a cure for sarcoidosis 22 Smiles all around 26 28 Key Findings 29 First Best Most $22 million renovation will have College of Dentistry ready for the future New accomplishments by our researchers My Passion Sometimes, improving healthcare isn’t as complicated as we think Fast facts on the health system’s accomplishments as a national leader Health System news College of Medicine in Peoria opens cancer research facility I 4 | Illinois Health above : The College of Medicine at Peoria’s new cancer research facility (above) covers 24,000 square feet and cost $10 million to build. r i g ht: Dean Sara Rusch is shown welcoming U.S. Transportation Secretary Ray LaHood prior to his remarks at the opening ceremony. The official ribbon cutting for the Cancer Research Center represented the fulfillment of a dream 10 years in the making. below : Photos: David Zalazniki/Journal Star n December, the College of Medicine in Peoria opened its $10 million, 24,000-square-foot cancer research facility, which will enhance the leading-edge research conducted by cancer biology and pharmacology faculty into the molecular, cellular and genetic characteristics of cancer. “We have spent nearly 10 years dreaming about this building and the vital research that will occur within it,” says Sarah Rusch, MD, regional dean in Peoria. “Each of us has a friend or relative who has been impacted by cancer. It is critically important that we find a cure. Peoria has the people, the plan and the potential—and now the place.” Researchers led by Jasti Rao, PhD, senior associate dean for research and head of cancer biology and pharmacology in Peoria, will work collaboratively with their peers at other facilities, including the Illinois Cancer Center, an oncology practice based in Peoria, and Children’s Hospital of Illinois at OSF-Saint Francis Medical Center in Peoria, which is the Midwest affiliate of St. Jude Children’s Research Hospital in Memphis, Tenn. Since its founding in 2001, the cancer research program in Peoria has received more than $27.7 million in grants and published 150 papers. Rao has discovered and patented a promising new anti-cancer treatment that’s now being safety-tested before it progresses to human trials. The University of Illinois collaborated on the project with Caterpillar Inc., OSF-Saint Francis Medical Center, Methodist Medical Center, the Heartland Partnership and other public agencies and private donors. Health system leads partnership to establish Nepal’s first blood and marrow transplant program T he University of Illinois Hospital & Health Sciences System is part of a partnership to develop the first blood and marrow stem cell transplant center in Nepal. Stem cell transplant is a standard procedure for the treatment of many blood cancers, including leukemia, lymphoma and myeloma. The planned BMT center in Bharatpur, in central south Nepal, will aim to serve thousands of blood cancer patients from among the 30 million people of Nepal and the nearly 1.2 billion people in neighboring India. The Health System is collaborating on the project with B.P. Koirala Memorial Cancer Hospital in Bharatpur and the Binaytara Foundation, an Illinois nonprofit organization that promotes health and education, which was founded and is led by an oncologist who trained at UI Hospital. The UI Blood and Marrow Transplant program and the Center for Global Health will train staff in Nepal via videoconferencing and host physicians from Nepal. “After visiting the cancer hospital in Bharatpur last May, I immediately felt the challenge to help patients with blood cancer in Nepal,” says Damiano Rondelli, MD, professor of medicine and director of UI Hospital’s BMT program, who is heading the project. “Many of these patients are in need of stem cell transplant but currently don’t have this option,” Rondelli continues. “We are well aware of the many challenges that this project will face but we are fully committed to assist Nepal in achieving this goal.” Nepal is a landlocked developing country in South Asia bordered by China and India. Recent World Health Organization reports suggest that deaths from cancer are increasing to epidemic proportions in developing countries. At B.P. Koirala Memorial Cancer Hospital, 600 patients with leukemia, 110 patients with lymphoma and 40 patients with multiple myeloma were diagnosed in 2010 alone. UI Hospital receives bariatric surgery center reaccreditation T he University of Illinois Hospital’s bariatric surgery center has received reaccreditation as an American College of Surgeons Level 1 Accredited Bariatric Center, maintaining its standing as the only center in Chicago with this status. The center received its initial accreditation in 2008. Accredited bariatric surgery centers provide not only the hospital resources necessary for optimal care of morbidly obese patients, but also the support necessary to address the entire spectrum of care and needs of bariatric patients, from the prehospital phase through the postoperative care and treatment process. More than 11 million people in the U.S. suffer from severe obesity, which plays a critical role in type 2 diabetes, hypertension, cardiovascular disease and many other medical complications. “For some patients, the only effective, lasting treatment for severe obesity is weight loss surgery,” says Subhashini Ayloo, MD, assistant professor of surgery and director of bariatric surgery at UI Hospital. Physicians at the hospital perform robotic-assisted laparoscopic procedures, including gastric bypass (reducing the size of the stomach and routing food past part of the small intestine), sleeve gastrectomy (surgical removal of part of the stomach) and adjustable gastric band surgery (placing an adjustable band around part of the stomach to reduce food intake). In the past two years, more than 500 bariatric procedures have been performed. The hospital offers patients a multidisciplinary approach to bariatric surgery with a state-of-the-art facility, the latest technology to minimize complications and successful weight loss maintenance through the Nutrition and Wellness Center. Illinois Health | 5 A F R Senegal Public health professor takes aim at cervical cancer in Senegal A t l a n t i c H ealth SYSTEM faculty, students and medical residents are working with health care providers in Senegal to increase detection and treatment of cervical cancer in the Northwest Coast African nation. In late January, Andrew Dykens, MD, MPH, assistant clinical professor of family medicine, led a team that traveled to the Saraya district in southeastern Senegal. Working in collaboration with Peace Corps volunteers in the district, they spent nearly a month training staff at the district’s health center to in turn train health providers to perform cervical exams. Dykens first traveled to Senegal in 2010 to perform an assessment of the district’s health needs and has returned with a team each year. On the latest trip, the team expanded its efforts to encompass the entire surrounding Kedougou region, which has a population of about 130,000, including an estimated 35,000 women in the target age range for the exams. “There will be at least one person at each health post throughout the region by the end of this year, meaning 35,000 women will O c e a n have access to a service that they did not have previously,” Dykens says. In the developed world, the precancerous cells that develop into cervical cancer are detected easily with routine Pap smear screenings. However, these screenings require equipment to collect the samples and a pathologist to read them, neither of which are widely available in Senegal. Dykens’ team is training the health workers in the use of a common technique for cervical exams that entails washing the cervix in a diluted form of acetic acid, the main component in vinegar, which causes precancerous cells to appear as white patches. “The technique we’re using is highly appropriate for a low-resource setting,” Dykens says. Treatable if caught in the precancerous or early stages but usually fatal once it becomes advanced, cervical cancer is the number one cancer killer of women in Senegal. Current estimates are that 1,197 Senegalese women are diagnosed with cervical cancer each year, and that 795 of them die from the disease. Because it takes two to five years for precancerous cells to develop into malignancies, there is time to treat them if detected. Dykens’ team has begun teaching health workers the use of cryotherapy, a technique that freezes the abnormal cells, causing them to slough off the cervix. “By the end of 2013, trainers will be in place for both the exams and cryotherapy, and with the assistance of Peace Corps workers, the development of health service delivery can continue with very little help from us,” Dykens says. “We hope to work ourselves out of a job.” Fourth-year medical student Amish Desai (from left), Peace Corps volunteer Leah Moriarty and Andrew Dykens confer in Senegal. 6 | I l l i n o i s H e a lt h Medit erranean Sea Bailey’s work in Kenya helping to curb HIV I C A T Kenya I n d i a n O c e a n Circumcision program hopes to avert 200,000 HIV infections throughout the Nyanza province. he HIV infection rate in Kenya is 7 percent of the country’s population, but it’s 20 percent in the country’s Nyanza province. To help reduce infection rates, Robert C. Bailey, PhD, MPH, professor of epidemiology at the School of Public Health, has helped lead a campaign to circumcise young adult men in Nyanza. Bailey’s past research has found that circumcision helps reduce incidence of HIV infection, but unlike the rest of Kenya, the practice is not common in Nyanza. Following the early 2007 publication of Bailey’s findings, the World Health Organization recommended that in areas with a high prevalence of HIV, male circumcision should be offered as part of a multipronged approach to HIV prevention. Bailey and collaborators from the University of Manitoba and the University of Nairobi designed the policies for the circumcision promotion program and worked with the Kenyan government to implement it. The program is supported by funding from the U.S. President’s Emergency Plan for AIDS Relief and the Bill and Melinda Gates Foundation. “We train people in major health facilities to perform circumcisions, we have teams that go out to smaller health facilities in the villages, and there’s been a major effort to promote circumcision,” says Bailey, who spends five months out of the year in Kenya, on the East Coast of central Africa, where he has been working since 1997. “I assist with strengthening the infrastructure and making sure there are urologists and medical doctors who are training health service providers and helping direct the program.” Since the program began, 400,000 males between 15 and 30 years old—the age range with the highest incidence of HIV infection— have been circumcised. The program’s goal is to perform 950,000 circumcisions by the end of 2014, which Bailey estimates would avert nearly 200,000 HIV infections. Working with five School of Public Health PhD students, Bailey has been the primary investigator on a series of studies assessing the impact of the program, including changes in the prevalence of HIV infection, sexual behavior, beliefs and attitudes about circumcision, and women’s feelings of vulnerability to HIV infection. Bailey also conducted a 2008 study to pilot infant male circumcision as a means of overcoming some of the implementation barriers among adult males. He collaborated on the study with obstetrics and gynecology assistant professor Tracy Irwin, MD, MPH, associate professor Sherry Nordstrom, MD, and Marisa Young, an MD/PhD student in the College of Medicine. “It’s very gratifying to see that we’re achieving large numbers of circumcisions that I’m very confident are going to avert hundreds of thousands of HIV infections,” Bailey says. “When you reduce the HIV prevalence in men, you reduce it in their partners and eventually in their babies. We hope this effort is going to have a substantial benefit.” location Photography by Tracy Irwin and sherry Nordstrom I l l i n o i s H e a lt h | 7 ‘Interrupters’ documentary wins Spirit film award A 8 | Illinois Health C hicago Bears wide receiver Earl Bennett partnered with the hospital’s pharmacy practice last fall in a campaign to promote flu vaccination and flu awareness. In March, the department received a national award for immunization community outreach by the American Pharmacists Association. Bennett participated in a community flu vaccination event, held at the Student Recreation Facility in September. His image also was used in promotional materials for the campaign, which ultimately resulted in more than 400 people receiving flu shots. “Much of maintaining your health is just taking necessary preventative steps. The same goes for preventing the flu. A simple vaccination can keep you healthy and productive. That’s why I get my flu shot every year,” Bennett says. In addition to receiving their flu shot, participants in the event had the opportunity to meet Bennett, have their photo taken with him and receive a miniature football with his autograph. Student pharmacists, along with a pharmacy faculty preceptor, also staffed tables to educate participants on topics such as the proper hand washing technique and the differences between a cold and the flu. The event Chicago Bear Earl Bennett (center, first row) joins a winning team provided practicum with the hospital’s pharmacy practice. experience for fourthyear pharmacy students, who provided the vaccinations under faculty supervision. “I was able to put into practice the skills that I have learned via my immunization training,” says Merrideth Gilly, a fourth-year pharmacy student. Between 5 and 20 percent of the U.S. population become infected with influenza each year, according to the Centers for Disease Control, and approximately 200,000 people annually are hospitalized for flu, according to Janet Engle, PharmD, professor and head of pharmacy practice and executive associate dean of the College of Pharmacy, who coordinated the event. “Reaching out to the community and providing the surrounding neighborhood with high-level pharmacy services is a priority for our department,” Engle says. “Partnering with Earl Bennett gave us an excellent opportunity to provide community outreach.” The number of people who were vaccinated against the flu decreased dramatically in the 2010-2011 flu season compared with the previous year, when flu awareness was heightened by the H1N1 (“swine flu”) epidemic. To address this issue, pharmacy practice developed a marketing campaign incorporating Bennett’s likeness, which stressed the importance of flu shots. The event kicked off the 2011 flu vaccine campaign by the university pharmacies. As a part of this push, flu vaccines were distributed on campus in early October. This initiative led to more than 4,000 students and employees being vaccinated against the flu. photo: Barry donald documentary film about three people working for CeaseFire— a violence prevention program founded by Gary Slutkin, MD, professor of epidemiology at the School of Public Health—received the 2012 Spirit Award for best documentary. The annual Spirit Awards honor excellence in independent filmmaking. This year’s ceremony was held Feb. 25 in Santa Monica, Calif. Filmed over a year beginning in 2009, the film, titled The Interrupters, follows violence interrupters Ameena Matthews, Cobe Williams and Eddie Bocanegra as they attempt to intervene in impending shootings. Directed by Steve James (whose previous credits include the acclaimed documentary Hoop Dreams), and produced by James and best-selling author Alex Kotlowitz (There Are No Children Here), the film has been shown in theaters across the country, including weeks of sold-out screenings at the Gene Siskel Film Center in Chicago. The Interrupters also was broadcast nationally on Feb. 14 as an episode of the PBS television program “Frontline” and was released on DVD and Blu-ray disc. CeaseFire employs dozens of interrupters to work in some of Chicago’s most violent neighborhoods, where they head off events that otherwise might result in a shooting. “Violence interrupters were invented by the CeaseFire program,” says Slutkin, CeaseFire’s executive director. Violence interrupters in Chicago stopped nearly 500 events in 2011 and more than 2,000 events in the last five years, according to Slutkin. “They know what’s going on in the neighborhoods. They get information from hospitals, from friends, from moms, and because of their training and their support, they are able to effectively persuade people into not doing a shooting,” Slutkin says. In use in 15 U.S. cities and five countries, the CeaseFire method treats violence as an infectious disease, preventing its spread to keep neighborhoods safer. Pharmacy and Chicago Bear form an award-winning team to urge flu vaccinations A new State of Healing Chicago leading the way to a healthier Illinois T he competitive landscape for health care in the Chicago area is a crowded one, where new buildings and advertising campaigns seem to attract as much attention as quality medicine. While the University of Illinois, with its flagship academic medical campus in Chicago, has long been known as the largest and most diverse medical school in the country, the schoolâ€™s depth and scope of colleges have been a lesser-known source of strength, one that dwarfs the offerings at institutions like Northwestern University, University of Chicago and Loyola University. I l l i n o i s H e a lt h | 9 10 | I l l i n o i s H e a lt h “This is an opportunity for us to create some excitement and be clear about what we’re about,” Garcia explains. “It’s also an opportunity to connect more closely with the people we take care of and leverage the research prowess and the intellectual firepower that the university has.” In the academic medical world, UI’s reputation is well-established among its peers locally and nationally. College of Medicine researchers in Chicago, for example, attract an enormous amount of funding from the prestigious National Institutes of Health. Perhaps not coincidentally, research has been a passion for Garcia throughout his career, which took him to major leadership positions at Johns Hopkins University and the University of Chicago before he arrived at the University of Illinois. As an elected member of the National Academies Institute of Medicine, a community of the nation’s elite thought leaders, he is determined to give research a spotlight in the new system. “Our research portfolio is incredibly strong, and we blend that into our clinical mission in a distinctive way. Not too many ‘‘ We are the foremost training site for health professionals for the entire state. ‘‘ To better marshal the University of Illinois’ powerful healthcare forces into a national presence, university leaders have integrated the school’s health institutions into the University of Illinois Hospital & Health Sciences System, a newly created umbrella that encompasses the university’s health care facilities and the colleges of Medicine, Applied Health Sciences, Dentistry, Pharmacy, Nursing, the School of Public Health as well as the Jane Addams College of Social Work. “This is not a new path for us, just a better-articulated one,” says Joe G.N. “Skip” Garcia, MD, university vice president for health affairs. “No other institution in the Midwest has anything close to the strength of these seven units, which are now working together in a way they never have before.” The university’s individual colleges have reputations for excellence, Garcia says, but have not always functioned in a cohesive manner. But as the researchers, faculty and clinicians in various health entities get to know each other, the possibilities for collaboration, breakthroughs and success increase exponentially, he adds. Joe G.N. “Skip” Garcia, MD The new University of Illinois Hospital & Health Sciences System has four key emphases as it moves forward: institutions can lay claim to a powerful combination like that.” The heart of the new health system is Chicago, and Garcia believes that the medical campus’ home on the near West Side can be a key advantage, one that can benefit patients throughout Illinois and the rest of the country. Garcia says the university plans to bring more personalized medicine to the 2 million people in its service area, of whom 35 percent are Hispanic and 35 percent are African-American. “The practices and research within the health system, and the way it serves the Chicagoland area, make it an incubator for programs across the country,” Garcia notes. “Our goal is to be recognized for our programs both within our communities and throughout the state and country.” The solutions that will result from such efforts should help hospitals and health systems around the country better care for underserved and genetically diverse populations, he says. “These types of research opportunities aren’t as readily available in other parts of the country,” Garcia says. “But we need to do a better job of letting the community know about our services and extend our reach into these areas.” Battling health disparities is an overarching theme of the university’s mission, according to Garcia, who believes that the new health system can be a leader in that regard. “We want to bring high-quality, costeffective health care to the state, especially to medically underserved Latinos and AfricanAmericans,” he says. “We truly want to make a difference in Chicago — and beyond.” Illinois Health recently interviewed Garcia about the new direction: Q: Why is the effort to defeat disparities so important? A: This is an issue that truly affects everyone. It affects our healthcare costs. And it affects our culture because we have these growing populations that are unable to receive the basics of stable health. It impacts the ability of people in our community to be productive, to be with their kids, to live and interact on a daily basis with people who have advantages. It’s a divisive factor in urban life. Q: Despite that, the issue of disparities is one that few urban healthcare institutions have tried to address. What is prompting the university to make this a key component in its future? Innovative Research Research is a cornerstone of the University of Illinois Hospital & Health Sciences System. By combining resources, the health system has the opportunity to extend studies with community research. “The healthcare landscape is changing,” says Garcia. “The challenge is adapting to these changes.” UI Health System personnel frequently join researchers at the University of Illinois’ Champaign-Urbana campus in studying population health and biochemical illnesses. The University of Illinois Hospital & Health Sciences System is recognized in research of alternative medicine, cancer biology, drug development, genomics and infectious diseases, among other areas, and the university is a magnet for graduate study. Among the greatest beneficiaries of this innovative research are members of our community. Personalized Health Because no two patients are the same, the researchers and specialists at the health system work together to give everyone the individualized care they deserve. Personalized care is determined by the patient’s genetic makeup and lifestyle. In the long run, studies in personalized treatment—for Alzheimer’s disease, diabetes, obesity and more—can help to lower drug costs and increase research funding. Addressing Disparities “We saw the opportunity to bring resources together to successfully address healthcare disparities,” says Garcia. “Health disparities are a problem that has been recognized for decades—without any significant progress. Being in this community, being a research institution and having a public charter, we are in a position to actually make a difference in reducing health disparities in our patients and community.” Health Sciences Education In addition to its innovative care and research, the health system provides access to health education for young people from diverse backgrounds so they can become leaders, researchers and care providers—another way the health system is addressing health disparities. The health system is comprised of seven colleges: Medicine, Applied Health Sciences, Dentistry, Pharmacy, Nursing, the School of Public Health, as well as the Jane Addams College of Social Work. With the largest college of medicine in the nation, the University of Illinois Hospital & Health Sciences System is changing the future of medicine for students and the patients they serve. I l l i n o i s H e a lt h | 11 A: As the state’s flagship health center, we have an obligation to improve the health and the well-being of all citizens, regardless of their socio-economic status. The current healthcare system has marginalized folks who do not always have the means to access quality care. In addition, all too often racial and ethnic minorities are also disproportionately affected by the current care delivery system. We are here for all of these people and believe we can make a difference in improving the quality and reducing the cost of healthcare for all Illinoisans. Q: Have other medical schools/academic medical centers attempted to translate their research into clinical treatment of diverse communities to the extent that you envision? Do you see this as a way to enhance the health system’s reputation nationally? A: Plenty of academic medical centers are talking about reducing health disparities in their communities. The simple fact, however, is that disease frequency and death rates among minorities and the poor are getting worse, not better. So, no, I do not see others making the type of mission statement and commitment of resources that we are undertaking here at the University of Illinois. And yes, our success in this endeavor will put us on the national stage because if we can even slightly reverse the disease and death rates among the population we serve right here in Chicago, that will force others across the country to take notice as to what can be possible. Q: At other medical schools around the country, the reputation of the health system is wellestablished. But in the general community, what are some key strengths of the University of Illinois that may not be widely known? A: We are the foremost training site for health professionals (across all disciplines—physicians, nurses, dentists, pharmacists, therapists, etc.) for the entire state. Our transplant programs consistently rate highest in both case complexity and outcome (survival) statistics. Our oral health providers take care of more children than almost all other dentists statewide. We have the only dedicated center for adults with sickle cell disease in the Midwest. Q: In uniting all these colleges and departments under one umbrella, is one of your goals to eliminate the “silo” effect? History of the University of Illinois Hospital 12 | 1881 1907 1913 1924 1940 College of Physicians and Surgeons (P & S) incorporated as the seventh medical school in Chicago, located across from entrance of Cook County Hospital. P & S faculty open 110-bed hospital at Ogden, Lincoln (Wolcott) and Congress. P &S becomes University of Illinois College of Medicine. First building opens of the 50-bed University of Illinois Research & Education Hospital on Polk, Wolcott and Wood. Illinois General Assembly creates Illinois Medical District. Rush and Presbyterian share facilities with college. Illinois Health 1965 1970 Eye and Ear Infirmary building opens on Taylor St. State mandates rural-health initiative; College of Medicine at Peoria site opens. A: Absolutely! The deans of the University of Illinois health sciences colleges are unanimous in their support for the “power of one.” Collectively, we realize that our ability to improve community health, make a difference in the lives of each individual patient and deliver innovation throughout the entire healthcare system will be accomplished only by working together. Q: What message are you trying to send to the alumni of all these health sciences colleges as the health sciences combine their efforts? A: The University of Illinois Hospital & Health Sciences System combines the hospital, clinics and federally qualified healthcare centers with the University of Illinois’ seven health sciences colleges: Medicine, Nursing, Pharmacy, Dentistry, Applied Health Sciences, School of Public Health and the Jane Addams College of Social Work. No other health care provider in Chicago or the state brings together leading educators and researchers across the health sciences to combine innovative research with the delivery of advanced patient care. ‘‘ Q: You’ve mentioned a desire for the various campuses throughout the state to work more closely together. What are some ways you hope to achieve that? ‘‘ No other institution in the Midwest has anything close to the strength of these seven units, which are now working together in a way they never have before. Joe G.N. “Skip” Garcia, MD 1989 1971 College of Medicine campuses in Urbana– Champaign and Rockford open. 1980 1982 UIC Hospital opens at 1740 W. Taylor St. College of Medicine and University of Illinois Chicago Circle Campus merge to form UIC. UIC Hospital and Michael Reese Hospital agreement unfolds. A: This is happening already. For example, in mid-November, the Center for Medicare and Medicaid Services issued a three-year, $1 billion funding announcement for demonstration projects that improve patient care and reduce the cost associated with the federal Medicare, Medicaid and Children’s Health Insurance programs. The “CMS Innovation Challenge” provided an opportunity for an extraordinary level of crosscollege collaboration to develop four proposals that we believe will improve the outcomes and efficiency of our healthcare enterprise. 1999 Outpatient Care Center opens on Taylor St. June 2011 September 2011 4th and 5th floors of hospital are designated by NACHRI as Children’s Hospital University of Illinois. The University of Illinois Medical Center and seven health sciences colleges are integrated to create the University of Illinois Hospital & Health Sciences System. Illinois Health | 13 B y Kev i n M c Ke o u g h insulin Independence D aily insulin injections didn’t prevent JudithRae Ross from frequently having medical crises brought on by her diabetes. A retired history professor who taught at one time at the University of Illinois’ Chicago campus, Ross experienced severe drops in her blood sugar levels that sometimes caused her to experience hallucinations or lose consciousness. “I was a frequent flyer in the emergency room,” says Ross, 67, who in recent years had come to expect that her diabetes soon would lead to her death. On Feb. 26, 2009, Ross underwent an experimental treatment for diabetes at the University of Illinois Hospital. A team led by José Oberholzer, MD, chief of transplant surgery and director of cell and pancreas transplantation at the UI Hospital, transplanted insulin-producing islet cells into Ross’ bloodstream. She quickly began tapering off her insulin injections, stopping them altogether by mid-April of 2009. She hasn’t needed them since. What’s more, her eyesight and learning abilities have improved. “It’s allowing me to really enjoy and appreciate life for the first time,” she says. “I don’t have the words to thank Dr. Oberholzer and his team. They have given me my life back.” The Chicago Diabetes Project, an international research effort led by Oberholzer and based at the University of Illinois Hospital & 14 | Illinois Health Health Sciences System, has been advancing the use of islet cell transplant in the hope of making it available to more patients like Ross. Launched in 2005, the project enlists experts in research institutions around the globe, including physicians, molecular biologists, engineers and chemists. Diabetes is a chronic disease caused by a lack of insulin, a hormone produced in the pancreas that regulates blood glucose (sugar) levels in the body. The World Diabetes Foundation estimates that 285 million people were living with diabetes in 2010, and that the number would grow to 438 million by 2030. The Chicago Diabetes Project currently is focusing its efforts on patients with type 1 diabetes, such as Ross, whose insulin-producing cells have been destroyed by a malfunctioning immune system. To survive, they must take insulin injections several times a day. “They are the most urgent cases, the easiest to cure and the most justifiable to take the risk involved in treatment, because they have the higher rate of diabetes-related complications,” Oberholzer says. Eventually, though, he hopes to make islet cell transplants available to treat type 2 diabetes, which occurs when the pancreas doesn’t produce enough insulin or the body doesn’t use it effectively. Treatable with diet modifications, exercise and glucose-lowering pills, it’s more manageable than type 1 diabetes. It’s also the far more common form of diabetes, comprising 90 to 95 percent of all diabetes cases. How it works The transplant process begins with scientists in Oberholzer’s laboratory extracting islet Islet cell project breakthrough for difficult diabetes cases Photo: Lloyd degrane 15 | Illinois Health cells from the pancreas of a deceased organ donor. First the donor pancreas is emulsified through the combined use of chemicals and heat, then it’s run through a centrifuge, which separates the islet cells from the rest of the organ. Between 300,000 and 600,000 cells typically are extracted, compared with the estimated half a million to 1.5 million cells that a healthy pancreas harbors. During the transplant procedure, the cells are flowed into the recipient’s body through a tube passed through a small incision and threaded into a vein in the liver (chosen because it has a better blood supply than the pancreas). In most cases, the cells begin doing what the donor recipient’s body could not on its own—generate insulin that maintains blood glucose at healthy levels. The project began performing islet cell transplants—all of which take place at the UI Hospital—in 2005. By the end of that year, the project completed a combined Phase I and II clinical trial demonstrating both the safety and efficacy of the procedure based on the results of the first 10 transplant recipients. Since then a total of 25 patients have receive transplants, and the vast majority have remained insulin-free. The small number of patients receiving the transplants reflects another key obstacle the project is trying to overcome: the project’s very limited finances and the very small number of available donor pancreata (plural of pancreas), which averages around a mere 6,000 each year. “Even if we could use every single organ that can be used in the United States, we would be limited to 1,500 transplants a year,” Oberholzer says. Therefore, researchers with the Chicago Diabetes Project are trying to find ways to grow islet cells. Collaborators at the Cleveland Clinic and at Johns Hopkins are investigating genes in mice that regulate how stem cells 16 | Illinois Health develop into insulin-producing cells. Reflecting the project’s collaborative nature, Oberholzer arranged for the Chicago Diabetes Project to fund a postdoctoral fellow to work in the lab of a Johns Hopkins University expert on pancreatic cancer whose research in pancreas stem cells had relevance to the project’s efforts. The fellow found that certain stem cells will cluster together and under the right conditions produce insulin. An international effort Like organ transplant patients, islet cell recipients must take immunosuppressive medication to prevent their immune systems from attacking the transplanted islet cells, which it recognizes as foreign to the recipients’ body. Since these medications have side effects and leave patients at risk for illness, the Chicago Diabetes Project is pursuing a means of encapsulating islet cells, that is, coating them with protective molecules that can withstand the immune system’s attacks, rendering immunosuppressants unnecessary. Such vastly complex pursuits require highly specialized knowledge and abilities, which is why the project enlists experts at six sites outside Chicago. Researchers at the Norwegian University of Science and Technology in Trondheim, Norway, for example, have worked for five decades studying alginate, the molecule the project is using to protect islet cells, and the Slovak Academy of Sciences in Bratislava, Slovakia, has one and a half buildings dedicated to studying encapsulation technology. In all, about 50 scientists are participating in the project, plus support staff and volunteers. In Chicago, Oberholzer has a team of 20, including five assistant professors working in his laboratory, plus postdoctoral fellows, PhD students and technicians. The project holds immense promise, but its potential is being held back by funding L e f t to r i g ht: Grateful patients Bruno Pasquinelli and Janette Leal with José Oberholzer and UI Surgery Head Enrico Benedetti Chicago Leads Global Team The Chicago Diabetes Project enlists clinical and basic science researchers at the following sites around the world: Cleveland Clinic, Cleveland, Ohio Johns Hopkins University, Baltimore, Md. Norwegian University of Science and Technology, Trondheim, Norway Slovak Academy of Sciences, Bratislava, Slovakia University of Geneva, Switzerland University of Illinois at Chicago University of Lille, France constraints, reflecting what Oberholzer says is a widespread difficulty that researchers are having in obtaining funding. In its entirety, the Chicago Diabetes Project operates on an annual budget of less than $2 million, compared with the $13 million annually that Oberholzer estimates the project would need to fully realize its potential. “There are many experiments that we know we have to do, and we know how to do them, we just can’t do them with the limited support from family and friends. All the money they raise goes to the project. In its first three years, the effort has enlisted more than 600 runners and raised more than $500,000. Oberholzer, an avid runner, takes part in both the Chicago and New York races and this year also is running the Boston Marathon, placing him among the elite group who have qualified for the highly competitive event. Other Chicago Diabetes Project researchers Photos: Bart Harris means we have,” he says. The project receives about a third of its funding from grants from the National Institutes of Health and additional funding from the U of I, but relies mostly on support from charitable foundations. It was begun with a grant from Chicago-based Washington Square Health Foundation, whose executive director, Howard Nochumson, encouraged Oberholzer to begin the project. Since then, the project has received major support from the Christopher Family Foundation in Hinsdale. “We’re incredibly encouraged by the quality of life improvement being experienced by so many type 1-afflicted individuals due to the work of the Chicago Project,” says Kelley Christopher Schueler, executive director of the foundation. The project also has received support from the Juvenile Diabetes Research Foundation, the American Diabetes Foundation, the Dr. Scholl Foundation, Tellabs Foundation, the Efroymson Family Fund and a number of smaller foundations. Marathon fundraising The work also has developed an unconventional source of funding in the form of Cellmates on the Run, a group of volunteers that runs the Chicago Marathon and/or New York Marathon each year and enlists pledges of and members of Oberholzer’s lab team also have donned the team jersey to participate in the races. The project’s annual meeting takes place the week after the Chicago Marathon, so members of the global research team are in town to cheer on the runners and join in the post-race party at the race site. Further complicating the funding picture is the status of islet cell transplant as an experimental procedure not covered by insurance, which means the Chicago Diabetes Project itself must cover the approximately $100,000 required for each trial participant ($30,000 for the procedure and the rest in follow-up costs). The project is in the process of submitting an application to the U.S. Food and Drug Administration to have islet cell transplant recognized as a standard of care, which will allow it to be covered by insurance. Oberholzer hopes to submit by the end of 2012 and receive approval within a year—during which time the CDP will have to ramp up from a research program to a full-fledged clinical care service. “The UI Hospital likely would become the first center in the U.S. to offer this treatment as a standard of care,” Oberholzer says. “We have been a leader in moving this treatment toward being put into widespread use, and I look forward to the day when we can offer islet cell transplant widely to the large number of diabetic patients whose lives would be improved and, in many cases, saved by this treatment.” The process of extracting islet cells is a complicated one. First, the donor pancreas is emulsified and then run through a centrifuge, which separates the islet cells from the rest of the organ. Between 300,000 and 600,000 islets are typically extracted during the process. Illinois Health | 17 Health system teams up Turning laughs with the Bernie Mac Foundation to search for a cure for sarcoidosis 18 | Illinois Health B y J o h n M o r r i s sey B ernie Mac was a beloved entertainer and a Chicago native whose knack for generating laughter stood in poignant contrast to his concurrent suffering from a mystifying chronic disease. More than three years after his death from complications of sarcoidosis, a foundation named for him is partnering with the University of Illinois Hospital & Health Sciences System to demystify that disease and lend some star quality to the system’s efforts to discover a cure. Details of the public partnership were announced in April, which was Sarcoidosis Awareness Month, says Nadera Sweiss, MD, lead researcher in the sarcoidosis program at the University of Illinois. It’s the culmination of nearly two years of talks with top executives of the Bernie Mac Foundation, who were drawn to the campus collaboration by both expertise and inspiration. Sweiss, a specialist in rheumatology, had developed a practice in Chicago centered on treating people with sarcoidosis, a disease of unknown etiology that attacks multiple organs but most often the lungs and lymph nodes. It disproportionately affects African-Americans, who constitute more than 90 percent of her patients. So there was a lot for those patients to identify with as Bernie Mac fought the disease from onset in 1983 until his death at age 50 in 2008. “His death was devastating to a lot of my patients,” says Sweiss. “They would come to me and say, ‘Am I going to die the same way Bernie Mac died? Why did Bernie Mac die?’” In 2010 Sweiss called the Bernie Mac Foundation’s executive director, Mary Ann Grossett, the older sister of the comedian’s wife of 30 years, Rhonda McCullough. They discussed how they were engaged in the same push for both awareness of the disease and a clear plan to unlock its mystery and thus point the way to productive treatment. Sweiss unveiled the imagery of a “star center” at the University of Illinois, which would incorporate Bernie Mac’s star quality as well as an acronymic identity: Sarcoidosis Translational Advanced Research. For Grossett, it wasn’t just what Sweiss said but the way she said it. A like-minded relationship “started immediately when I picked up the phone,” she says. “What stuck out in my mind about Dr. Sweiss was her pure honesty and her being connected personally to what she does. I immediately saw and felt from her a sincerity that was beyond her being a doctor—I saw a real compassion and truthfulness in her,” Grossett remembers. “We began to communicate like we had known each other all of our lives.” That warm inspiration spread quickly to McCullough. “When the opportunity came up that we would be able to work with the University of Illinois, for me it was like a dream come true,” she says. “I always wanted to partner with a world-renowned facility—they had the means, they had the pulmonologists in place, it was just wonderful. And, to me, their focus just kind of mirrored mine.” Star power for the STAR program Establishing the research program also was a dream come true for Sweiss, who follows 400 sarcoidosis patients in her practice along with 200 living with scleroderma, another disease of unknown origin that attacks healthy tissue. Before coming to the University of Illinois from the University of Chicago, she had initiated three interrelated studies into sarcoidosis, including the use of drugs to inhibit tumor necrosis, which plays a role in the disease. She developed a reputation as an expert in these disorders that drew patients regionally and nationally. Photo: donald barge into life savers Rhonda McCullough (from left), who was married to Bernie Mac for 30 years before his death, at the premiere of the documentary with Nadera Sweiss and Skip Garcia, VP for Health Affairs Working with the University of Illinois is “like a dream come true.” — Rhonda McCullough Illinois Health | 19 The image above shows the inflammation commonly found in the lungs and other organs of sarcoidosis patients. In sarcoidosis, immune cells cluster to form a granuloma — inflamed cells that have replaced normal tissue. 20 | Illinois Health In the Bernie Mac Foundation, the STAR program gains a powerful source of funding and visibility that first became apparent amid the tragic news of the entertainer’s declining health in 2008. Bernie Mac had established the foundation himself a year earlier, intending to make it a priority alongside his acting career. Donations started pouring in as news of his ultimately unsuccessful battle with pneumonia played out, says McCullough. More money came in after his death, “but I really wasn’t ready to do anything with it just yet, because it took me awhile to grieve,” she says. Nearly two years went by. “At first I thought about not continuing the foundation, and then I realized that this was the last thing he was working on and this is a great way to continue his legacy. So that’s when I took over the reins.” Attaching the foundation’s goals to a celebrity’s name “allows us to reach a wider audience,” says Grossett, “and people are just more naturally curious because it’s the Bernie Mac Foundation.” Family involvement Growing up as Bernard Jeffrey McCullough, the man who would become Bernie Mac met Rhonda at Chicago Vocational High School on the city’s South Side. “We met him when he was 16 years old,” says Grossett. “And so when you know someone that long, he becomes your brother.” The legacy issue is not just a cliché. All of Mac’s family is involved in the foundation, and Chicago is their home. The foundation “was truly where his head was; he wanted to leave the world with something that he felt would make a difference. I know he felt like he had made a difference in the entertainment world, and he had done all that he could do in that arena,” Grossett says. “But for sarcoidosis he wanted to leave his mark there, something that could be carried on, even in his passing.” As the foundation found out more about the approach and aims of the STAR program, it latched onto the underlying theme of personalized care. The personalization includes both the clinical and humanistic needs of each patient and the family that gathers around. For patients stricken with a chronic disease, says Grossett, there’s a toll on the person physically, financially and mentally, as the McCullough family lived through for years. “The medical team is interested in treating the patient holistically.” It’s also a medical and research theme, says Sweiss. “As a disease, sarcoidosis affects almost every single system in the body; it most commonly affects the lungs, so it’s most commonly taken care of by lung specialists, but the patient may end up in the eye clinic, or in the gastrointestinal clinic, because of the nature of the disease.” Sweiss, still rare in the field as a specialist in inflammatory diseases, is taking a multidisciplinary approach to evaluating the disease in a systemic way. Each patient, with individualized aspects of sarcoidosis, will provide a piece of the puzzle and a bit of the solution as bedside clinicians work with lab researchers and geneticists to combine expertise and move more quickly to treatment options. A day at the university Foundation members spent a day at the hospital and its research facilities to get a tour and learn about the history of the disease and the STAR team assembled to target it—including Vice President for Health Affairs Joe G.N. “Skip” Garcia, MD, with his eminent background in translational research, and Rick Kittles, PhD, with a track record of discovering the role of genetics in disease, especially in racial minorities. Among Garcia’s contributions to sarcoidosis research is a collaborative effort to establish a biobank to enable studies of genomic associations between DNA and diseases. Sweiss, a clinician and teacher as well as a researcher, has leveraged her experience to create guidelines to plug the gap in available clinical trial data, including algorithms to manage bone issues and rheumatic manifestations of sarcoidosis. Impressed with the science as well as alignment with the foundation’s own mission statement, “I think it’s safe to say that after that first meeting, we were signed, sealed and delivered,” says Grossett. “There was a sense of comfort, a sense of trust on both parts. We were in the right place, at the right time, talking to the right people.” “They’re going to help us to keep up awareness of the disease sarcoidosis with the public,” says McCullough, “and it will also help to allow treatment for patients and their families, because families need an understanding of the disease, too, for their loved ones.” Driven by the continuing need for medical discovery—the Food and Drug Administration still has no approved treatments—the University of Illinois is grateful for the foundation partnership, says Sweiss. “Sarcoidosis patients really need a star in their lives; we live in the darkness with this disease, as physicians, because we don’t know what is the best way to treat this disease.” Gaining the star quality of Bernie Mac will help accelerate the process. Even before the official inking of the partnership, the foundation held a fundraising gala in January to coincide with the red-carpet premiere screening of a tribute to the entertainer’s life, titled, “I Ain’t Scared of You,” that later aired on Comedy Central. Garcia and Sweiss made short speeches about the program as part of ceremonies at the Showplace Icon Theater in Chicago’s South Loop neighborhood prior to the screening. Associating the Bernie Mac name with a program destined to have a worldwide reach is the ultimate tribute to the man, says his wife. “Bernie was an international star, and the health system will welcome patients from around the world. So to me that makes them an international star. “I actually believe this was Bernie’s dream, and I do believe it exceeds what he thought could be accomplished.” Nadera Sweiss (above): “As a disease, sarcoidosis affects almost every single system in the body.” Illinois Health | 21 By Linda Wilson I magine spending less time in the dental chair while also getting higher-quality care— thanks to dental students, faculty and graduates using the latest-generation equipment and technology. That is the expected outcome after the University of Illinois Hospital & Health Sciences System’s College of Dentistry completes a $22-million renovation of its clinical facilities. Scheduled for completion in early 2015, the project will modernize all of the school’s clinics, comprised of 300 patient-treatment rooms, or operatories. The school has clinics for predoctoral degree students, which is a four-year process, and postdoctoral students, who receive additional training in dental specialties. The dental school’s patients will benefit, too. Using the new equipment and technology, students and faculty will be able to diagnose and treat patients more efficiently. “More efficient means, in theory, less time in a dental chair—we all like that as a patient,” says David M. Clark, DDS, the dental school’s associate dean for clinical affairs. One example: root canals. Through a combination of high-speed handpieces, surgical microscopes and digital imaging, dental students and faculty will sometimes be able to complete the procedure in one appointment, as opposed to multiple appointments, as overall efficiency is improved by the new technology. The new equipment will be more reliable, which also will increase efficiency. In the old clinics, Smiles all around $22 million renovation will have College of Dentistry ready for the future Pi c tu r ed above : Dr. Robert Brunetti (left) and Dr. Bruce Graham, dean (right), offer each other congratulations after signing the agreement for the $8.2 million donation by the Brunetti Foundation to the College of Dentistry. In the back are Executive Associate Dean for Academic Affairs Dr. Bill Knight (left) and Vicente Reynal of KaVo. o p p osite pag e : A young patient receives treatment in the updated Pediatric Dental Clinic. 22 | Illinois Health The new clinics will include various dental equipment such as leading-edge high-speed handpieces, suctioning equipment, operating microscopes, surgical lighting, state-of-the-science hygiene and cleaning instruments, and advanced water-treatment systems. Digital radiography will replace film-based X-rays, and the digital images will become part of each patient’s permanent electronic dental record. Chairs and cabinetry also will be replaced. “Green” technology will provide more light with less heat and superior quality water. To allow room for more students to observe, some surgical suites will be larger and the layout of equipment will be rearranged. The new clinics will be located on the first three floors of the dental school, encompassing what will be known as the Integrated Clinical Technology Center. “This is critical to ensuring that our students are getting a state-of-the-science education in patient care. When they graduate, they are going to be fully prepared to make sure their patients receive the benefits of that technology,” Bruce S. Graham, DDS, dean of the dental school, says, noting that the current facilities are nearly 40 years old. The college will standardize on equipment and technology primarily from the KaVo Group in Charlotte, N.C. It also will be involved in testing new KaVo products, giving students access to the latestgeneration dental technology for years to come. “there are constant breakdowns and repairs that have to be taken care of,” Clark says. Improved efficiency also will help the college increase access to dental care among low-income patients. “We are the largest dental safety-net clinic in Northern Illinois and maybe in the whole state. If we can see patients more time-efficiently, that means we can take care of more people who desperately need our care,” Graham says. The college provides $2.3 million in uncompensated patient care annually. It also is a major provider of dental services to Medicaid beneficiaries. Nearly half, or 46 percent, of the dental school’s patients are Medicaid recipients. The renovation of the college’s clinical space was supported through the Brilliant Futures: Educating the New Dentist for America capital campaign, which has raised more than $37 million. Among those gifts was the largest-ever single donation to the college: an $8.2 million gift from the Guy D. and Rebecca E. Brunetti Foundation, a private grant-making philanthropy in Arlington Heights, Ill. The foundation’s gift is in the form of equipment and technology, Graham said. “Helping to provide the resources to renew the clinical facilities was the right thing to do. The value of a professional education cannot be underestimated and, consequently, its value to society cannot be overestimated,” says Robert G. Brunetti, DDS, a dentist who is president of the foundation named after his parents. “We truly share the vision Photo: Lloyd degrane 23 | Illinois Health and mission of the college in its goal to educate and create ‘Brilliant Futures’ for the dentist of tomorrow and have supported this mission for over a decade.” Brunetti also is the chief executive officer of ProCare Dental Group PC, which operates 14 dental offices in the Chicago metropolitan area. “We used to rely upon graduates from all three schools in Northern Illinois to associate with us and practice in our offices and serve our growing patient base,” Brunetti says. “But once both Loyola and Northwestern universities closed their dental schools, we relied solely upon the College of Dentistry at the University of Illinois to fulfill our growing need for associates.” The dental school has clinics in other dental specialties as well: endodontics, periodontics, pediatric dentistry, prosthodontics/ restorative dentistry and oral and maxillofacial surgery. 24 | Illinois Health Dentures make way for implants ProCare Dental also donated $1 million to pay for construction of the ProCare Dental Group Implant and Innovation Center, while the Brunetti Foundation donated another $1 million to endow two full professorships at the center. “Hopefully our gift and the many generous gifts of others will spur more people to support the future of our profession and our society,” Brunetti adds. One feature of the future of dentistry may be the disappearance of dentures, and the renovation at the school takes that into consideration, too. Dental implants are artificial but have permanent roots to hold replacement teeth. Implants are “probably the biggest shift in dentistry,” and could eventually replace dentures, Graham says. “The only barrier right now is cost. It is certainly preferable to denture treatment,” he added. To create the implant center, “we took an unused space on the third floor of the building and repurposed it,” Graham says. The facility includes 12 operatories and classroom space. The administrative offices of the department of restorative dentistry are located nearby. Patients already are receiving care in the implant center, which is nearly complete. In addition to the Dental Implant and Innovation Center, the doctoral-degree pediatric dentistry clinic and the postdoctoral orthodontic clinics also have been renovated. The 2,500-square-foot Delta Dental of Illinois Predoctoral Pediatric Dentistry Clinic has 14 operatories, including specialized areas for special-needs patients and a quiet room for infant oral care. Piped-in nitrous oxide, for sedation, and digital imaging are available in each unit. A diversity of strengths The new orthodontic clinic has 27 dental chairs, up from 17 in the old clinic. The move allows each postgraduate student in orthodontics to have a dedicated chair. The orthodontic renovation also includes a computer and imaging laboratory with 34 computers and Web conferencing capabilities, re-equipping of classrooms and office renovation. The dental school has clinics in other dental specialties as well: endodontics (tooth pulp and nerves), periodontics (gums and soft tissues), pediatric dentistry, prosthodontics/restorative dentistry and oral and maxillofacial surgery. The school also operates three multispecialty group practices, comprised of 150 operatories. The group practices are staffed mainly with third- and fourth-year dental students, although second-year students provide some care as well. First-year students primarily observe. Faculty—both general dentists and specialists—oversee each student’s clinical work. “The student is responsible to oversee and manage all of the care for the patient. Now, they don’t provide all of the care because sometimes these patients have to be referred to a specialty clinic, but they are involved in managing those consultations,” Clark says. The multispecialty group practices replaced separate doctoral-degree specialty clinics in 2002. The group practices, which mimic private practices, were created as part of an evolution in the approach to education, emphasizing more hands-on clinical training and fewer classroom lectures. The move also has allowed the college to treat more underserved patients. Currently, the college provides 90,000 patient visits per year. The addition of new technology will further enhance what the dental school can do for both students and patients. “We are already getting feedback from students: they can’t wait to use this new equipment,” Clark says. How do we better serve tHe people of IllInoIs? by combInIng tHe resources of IllInoIs. Introducing the university of Illinois Hospital & Health sciences system, a revolution in healthcare that combines all the university of Illinois health science resources to provide an even higher level of research, care and innovation to the people of Illinois. At the university of Illinois, weâ€™re changing medicine. for good. Find out more at HoSPitaL.uiLLinoiS.edu Key findings Low-fat diet a key to cardiovascular health? Weight loss alone may not reduce the risk for adverse cardiovascular events. Shane Phillips, PT, PhD, at the College of Applied Health Sciences, and his colleagues investigated dietary factors that might be associated with improved brachial artery flow-mediated dilation. Improved FMD reduces the risk of adverse cardiovascular events, however, prior research has been conflicting in isolating the dietary factors that impact FMD. Phillips randomly assigned participants who were obese to one of two six-week diets: high fat or low fat. Both groups experienced weight loss, but only the low-fat group also experienced a decrease in fat mass and waist circumference. And, only the low-fat group also experienced FMD improvements. Taken together, these results suggest that weight loss alone may not improve cardiovascular health and that a low-fat diet is key to reducing one’s risk. Personalized dosages can improve coagulation outcomes African-Americans are at higher risk than Caucasians for poor outcomes as a result of subtherapeutic anticoagulation, which is associated with greater stroke-related disability 26 | Illinois Health and higher mortality rates from stroke and pulmonary embolism. Thus, achieving optimal anticoagulation efficiently is particularly important for African-Americans. Larisa Cavallari, PharmD, a faculty member in the College of Pharmacy, and her colleagues investigated GGCX (glutamyl carboxylase, an enzyme associated with how Vitamin K is metabolized). Specifically, they sought to discover whether GGCX mutations were associated with changes in dosage requirements. In this study, African-Americans were more likely to exhibit the specific mutations of GGCX, and among participants in the study who were AfricanAmerican, the mutations of GGCX were overrepresented among those who required higher doses of Warfarin, which is a blood thinner. This suggests that patients who have mutations of GGCX may require higher dosages of Warfarin and gives some guidance in terms of determining the optimal dosage of Warfarin in order to improve patient outcomes. Glycemic variability impacts mood, quality of life Diabetes is a chronic condition that significantly impacts quality of life. Poor glycemic control is associated with more diabetes complications, depression and worse quality of life. Carol Ferrans, MS, PhD, RN, FAAN, a professor in the College of Nursing, and her colleagues examined whether glycemic variability had an effect on mood and quality of life among women with diabetes. Ferrans found that among women with diabetes, greater glycemic variability was associated with lower quality of life and negative moods. Does oxytocin reduce symptoms in schizophrenia? Personalized approach aids older adults with osteoarthritis Susan Hughes, DSW, DO, of the School of Public Health, and her colleagues recruited 600 people to participate in an eight-week “Fit and Strong!” exercise intervention to study osteoarthritis. Osteoarthritis is the most common condition affecting older people today. It is the leading cause of disability among older people and its impact is projected to increase substantially with the aging of the U.S. population. Although there have been multiple randomized trials investigating the efficacy of different exercise interventions among older adults, few have looked at longer term adherence and outcomes, and extant research has shown mixed results. After the intervention by Hughes’ team, participants were randomized into one of two maintenance conditions (individualized maintenance and program-based maintenance). Participants who were in the individualized maintenance program had greater adherence, self-efficacy and improved functional status compared with those in program-based maintenance. This suggests that adherence to an exercise regime for older adults with osteoarthritis is more successful when the program is tailored to the individual. Leah Rubin, PhD, faculty in psychiatry, and colleagues have examined hormonal contributors to cognitive performance and symptom severity in schizophrenia. In a study of women and men with schizophrenia, they found that higher levels of oxytocin in women were associated with a decrease in positive symptoms (such as delusions, hallucinations, disorganized behaviors) severity and an increase in prosocial behaviors. This study provides support for new clinical intervention studies of oxytocin and the potential oxytocin has for improving symptoms and affective states in schizophrenia. Framework offers personalized health care for midlife women Lab tests can’t yet tell women if they are menopausal. Therefore Pauline Maki, PhD, faculty member in Psychiatry, and a panel of experts from five countries met in 2011 to review reproductive staging research and to change how menopausal stage is determined (e.g., whether someone is perimenopausal). The panel created recommendations for the identification of menopausal stages in order to help clinicians predict when a woman will enter menopause and to guide the selection of treat- ment options for menopausal symptoms and other related conditions. The framework, named STRAW +10, created by the panel, will help physicians and researchers systematically and consistently identify the different reproductive stages women go through from adolescence to menopause and beyond. Further, it will improve comparability between research on midlife women and is expected to facilitate clinical decision-making. Investigators in the Brodie Laboratory for Craniofacial Genetics, directed by Tom Diekwisch, DMD, PhD, a professor and head of oral biology in the College of Dentistry, have been doing research in the area of regenerative dentistry, which has the potential to enable people to maintain their own teeth for longer and to reduce the need for dentures. Diekwisch and his colleagues have grown stem cells from the periodontal ligament of rats’ molars. They then seeded the cells on barren rat molars, and reinserted the teeth into the animals’ tooth sockets. In two to four months, the stem cells aligned and formed new fibrous attachments between tooth and bone as compared with molars replanted without stem cells that were either lost or loosely attached. Cell migration provides insight into tumor metastasis Understanding how and why cancers metastasize is crucial to halting the spread of tumors. Krishna Kumar Veeravalli, PhD, and colleagues at the College of Medicine at Peoria studied the migration of cells as Photo: Lloyd degrane Promising future for tooth regeneration Shane Phillips works alongside a dietitian who prepares meals for a study on cardiovascular health. a way of better understanding tumor metastasis. To migrate, cells must perform a complex set of maneuvers as they travel. To do so, they respond to a variety of factors such as extracellular matrix molecules and growth factors, which engage cell surface receptors (such as the integrins) to initiate and maintain migration. The researchers conducted a simultaneous knockdown of MMP-9 and uPAR/cathepsin B, and in doing so, they identified a novel mechanism of integrin-dependent glioma cell migration (α 9 β 1 integrinSSAT-Kir4.2 potassium channel pathway); α 9 β 1 integrinmediated cell migration uses SSAT and the Kir4.2 potas- sium channel pathway. These results provide insight into how tumor cells migrate, and thus metastasize. BPA exposure alters prostate Gail Prins, PhD, a researcher in urology, has found that early exposure to extremely small amounts of Bisphenol A, an ingredient in many common plastics with a similar chemistry to estrogen, leads to genetic changes in the prostate as it develops. Although these changes are not yet conclusively tied to prostate cancer late in life, Prins continues to investigate. Prins is the principal investigator on three National Institutes of Healthfunded studies examining the effects of early life exposure to BPA. Her work has led her, rather unexpectedly, to social and political activism. Her presentation to the Chicago City Council in 2009 helped influence the council to ban sales of BPA-containing cups and baby bottles in Chicago. An anthropological look at maternal mortality Julienne Rutherford, PhD, a faculty member in the UIC College of Dentistry, and Elizabeth Abrams, PhD, a faculty member in anthropology, used a novel approach to understand the underlying causes of postpartum hemorrhage, which is the leading cause of maternal death worldwide and accounts for nearly 35 percent of maternal deaths. Postpartum hemorrhage is common among humans but rare among other mammals. Abrams and Rutherford argue that the human placenta has evolved to become more invasive into the uterine wall in order to increase the flow of nutrients to the fetus. Although this is beneficial to fetal development, the invasiveness of the placenta into the uterus increases the risk of blood loss during labor. Abrams and Rutherford hope that their research can lead to the identification of biomarkers of increased risk for postpartum hemorrhage so that medical care can be tailored to the woman’s risk level. Illinois Health | 27 My Passion b y J e r r y K r ishnan , M D , Ph D Improving healthcare, one person at a time A s a physician-scientist at the University of Illinois Hospital & Health Sciences System, no two days are alike nor would I like them to be! I have a passion for We need a strategy to ensure that patients like Kendra have access to innovations in healthcare and that we translate advances in care into clinical routines every time. We need to increase our emphasis on preventing illness, promoting wellness and empowering patients to make informed decisions about their health care. This will require teamwork—individuals, communities, clinicians, health systems, insurers and policy makers working together. This will also require that we think differently about how, where and when health care is delivered. For example, we need to embrace technology to expand the science, for helping those in need and for reach of the health system into homes and communities. Innovative problem solving. I am grateful to have a daily applications of mobile health technology platforms would allow our dose of all three and the opportunity to work with others to make health system to more consistently intervene earlier in the course a difference in the health of the populations we serve. of illness or to efficiently deploy Over the past few decades, resources to prevent illness enormous strides have been made altogether in the populations in the understanding of disease and we serve. the development of new treatment The health system is options. Unfortunately, not all popuuniquely suited to improving lations are benefiting from these population health and eliminating advances, and health disparities health disparities. We have outremain a key challenge. Some have standing clinicians, a broad base difficulty getting access to highof academic programs across quality care. Some have difficulty the health sciences, and partners understanding healthcare instrucacross the University of Illinois, tions. Others cannot afford to pay including leaders in the fields of for treatments they need. education, technology and health Let me give you an example. policy. We also have a strong col Kendra (not her real name) is Not all populations are benefiting from advances in healthcare. laborative relationship with offia 68-year-old Chicago woman who cials in the county, city, state, and was having difficulty breathing due federal governments, as well as with colleagues at other institutions to asthma. She never smoked and had no environmental triggers in Illinois and across the nation. at home, such as dust or cigarette smoke, she said. I asked her to I suspect that there are more people like Kendra in our clinics. bring her medications to the next clinic visit so that we could be In such cases, taking the time to better understand how patients sure she was getting the treatment that was prescribed. manage their illness may be all that it takes to find a solution. No At her follow-up appointment, we realized why she had need for special tests or more medicines. Yes, others may need a difbeen having trouble breathing. She had the right medicines, but ferent approach altogether. But we need a strategy for health care was unable to read. She admitted that she was often unsure which that focuses on improving the health of people one person at a time. medicines to take and when. She had been taking medicines That’s how we’ll improve population health. That’s how we’ll incorrectly—overusing some and underusing others. She was too eliminate health disparities. embarrassed to tell her doctors, nurses or pharmacist that she needed help. This had been going on for years. We reassured her and helped her remember which medicines to use when. Perhaps not surprisingly, her breathing then improved. Four weeks later, there was a huge snowstorm. She was able to shovel snow at her house with no difficulty at all. She even helped her neighbor shovel snow. 28 | Illinois Health Jerry Krishnan, MD, PhD, is associate vice president for population health sciences and professor of medicine and public health for the University of Illinois Hospital & Health Sciences System. First Best M ost FIRST We were the first academic medical center in Chicago to offer femtosecond laser for cataract surgery. For 150 years, the Illinois Eye and Ear Infirmary has been the leader in treating the most difficult and complex ophthalmology cases. BEST The University of Illinois Hospital has the best kidney and liver transplant survival rates in the city of Chicago. A multidisciplinary approach to transplant care offers patients and their families a supportive and highly successful program. MOST We treat the most brain aneurysms in the state of Illinois. Health system neurosurgeons have treated more than 1,000 brain aneurysms in the last four years. Illinois Health | 29 Nonprofit Org. U.S. Postage PAID Chicago, IL Permit No. 4860 Vice President for Health Affairs Administration 914 South Wood Street (M/C 973) Chicago, Illinois 60612 The mission of the University of Illinois Hospital & Health Sciences System is to provide high-quality, costeffective health care for the people of the state of Illinois, to leverage leadership in education and innovation to deliver â€œpersonalized medicineâ€? to vulnerable populations and to grow clinical programs that are tightly linked to translational research and are academically distinct both regionally and nationally. You can reach us online at hospital.uillinois.edu/about or via email at email@example.com.