Volume 2 | Winter 2012
A publication of the University of Illinois Hospital & Health Sciences System
HEALTH Changing Medicine. For Good.
NO HARM ON
THE FARM Training medical professionals for the dangers of rural life UI PHYSICIANS COMPRISE A SICKLE CELL DREAM TEAM
THE NEW MILE SQUARE CLINIC HAS MILE-HIGH ASPIRATIONS
GENETICS HELP PHARMACISTS PERSONALIZE MEDICINE
THE SHORTEST DISTANCE BETWEEN TWO DOCTORS IS 855.455.IPAL With the Illinois Provider Access Line (IPAL), you now have a direct line to University of Illinois Hospital & Health Sciences System physicians to get your patients transferred faster or get a quick second opinion. This toll free line, available 24 hours a day, 7 days a week, ensures patient information can be shared directly between attending physicians. IPAL coordinators have access to schedules, mobile, and pager numbers of UI Health physicians to get you in touch with the specialists you need to talk to right away. IPAL has one job. Bringing doctors together. Faster. Itâ€™s just another way the University of Illinois Hospital & Health Sciences System is changing medicine. For good.
Office of the Vice President for Health Affairs Vice President for Health Affairs Joe G.N. “Skip” Garcia, MD Associate Vice President for Hospital Operations Bryan A. Becker, MD Associate Vice President for Enterprise Strategy Michael S. Jonen Associate Vice President for Quality Jodi S. Joyce, BSN, RN, MBA Associate Vice President for Population Health Sciences Jerry A. Krishnan, MD, PhD Associate Vice President for Professional Practice & Chief Medical Officer Jaewon Ryu, MD, JD Associate Vice President for Community-Based Practice Robert A. Winn, MD Assistant Vice President for Finance & Chief Financial Officer (UI Hospital) William L. Devoney, MBA Assistant Vice President for Operations Jeffrey A. Finesilver, MBA
Illinois Health Editorial Staff Publisher Mike Jonen Editor in Chief Camille Baxter, MA Editor Pat Kampert Assistant Editor Cayce Mallen, MHA Creative Direction & Design Hoss Fatemi Copy Editor Kathleen Kopitke Research Editor Cindy Veldhuis, MS Editorial Consultant Michael J. Wesbecher Contributing Writers Kevin McKeough, John Morrissey, Alice Patenaude, and Linda Wilson Photography Al DiFranco, Lloyd DeGrane, Hoss Fatemi, Mike McCafrey and Brian Thomas, All inquiries should be addressed to: ILLINOIS HEALTH Vice President for Health Affairs Marketing email@example.com 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 leverage its unique combination of clinical care, health sciences education and biomedical research in providing high-quality, cost-effective healthcare for the people of the state of Illinois and delivering personalized health in pursuit of the elimination of racial and ethnic health disparities.
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This is an exciting time to be part of the University of Illinois Hospital & Health Sciences System.
HEALTH SYSTEM NEWS
UI Health professionals make a difference, from America to Africa
A HARVEST OF CARE
Rockford campus trains physicians, pharmacists for the nuances of rural health
CURING SICKLE CELL DISEASE
A dream team of UI Health physicians put a deadly disease in the past tense
A DOSE OF GENETICS
Warfarin patients get prescriptions that are a premium in precision
The new Mile Square clinic is part of a grand plan to defeat disparities
FIRST BEST MOST
New accomplishments by our researchers
Sometimes, improving healthcare isn’t as complicated as we think
Fast facts on UI Health’s accomplishments as a national leader
WE LCOM E
This is an exciting time to be part of the University of Illinois Hospital & Health Sciences System. Tremendous advances in our clinical programs, highly accomplished leaders joining our health system and fantastic new healthcare facilities are all coming together in support of our mission to deliver personalized health and eliminate racial and ethnic health disparities. This issue of Illinois Health highlights several of the programs, people and plans within the UI Health System that are delivering on our unique mission and making a difference in the lives of our patients and their communities. For example, sickle cell disease is one of the long-standing threats to the health of young African-Americans. Through the efforts of a distinguished team of UI Health System physician-scientists, that enemy is being vanquished. You don’t often see the term “cure” mentioned in clinical research. We are a cautious community that naturally wants to see substantial evidence to back such claims. Yet in these pages, you will read about how the Joe G.N. “Skip” Garcia, MD UI Health System sickle-cell “dream team” led by Damiano Rondelli, Lewis Hsu and Victor Gordeuk has literally given new lives to sickle-cell patients through the transplant of blood stem cells. Elsewhere in this issue, you will read about the big plans we have for the new Mile Square clinic, set to open in late 2013. This five-story, 60,000-square-foot facility will allow for increased patient capacity, provide for enhanced multidisciplinary care and clinical service offerings, and rapidly incorporate and disseminate evidence-based, personalized medicine aimed at eliminating healthcare disparities. The new facility will meet the health care needs of traditionally underserved and atrisk patient populations while exploring the complex interactions of the social and physical environment, behavioral factors and biologic pathways that determine health and disease. You’ll also learn about another patient care breakthrough for our health system. The University of Illinois has launched the Warfarin Pharmacogenetics Service. This first-in-the-nation clinical service uses genetic testing (genotyping) to determine the optimal warfarin dose for each and every patient in the hospital. Without genotyping, the effect of warfarin dosing among individual patients can vary widely resulting in complications including severe bleeding. By providing this testing for all patients we are providing personalized therapies and gaining important new understanding of the unique genetic polymorphisms amongst racial and ethnic patient populations. We’ll also take you far afield of our urban campus for a look at the rural health care training provided by the UI Rockford campus that finds its culmination in “No Harm on the Farm,” a simulated emergency situation set on a field in northwest Illinois. It’s easy for us to forget that many people in Illinois and the U.S. live miles away from the nearest physician or hospital. Doctors, nurses, pharmacists and other caregivers often need specialized training to deal with issues that their urban counterparts will probably never encounter. That’s just for starters. And that’s fine, because here at the University of Illinois Hospital & Health Sciences System, we feel like we’re just getting started. We have an amazing group of dedicated health care professionals, and we are finding the sum of our efforts has exponential possibilities for eradicating health disparities. I hope you will take a moment to share in these exciting stories of how the University of Illinois Hospital & Health Sciences System is impacting health and changing medicine…for good.
Joe G.N. “Skip” Garcia, MD Vice President for Health Affairs, University of Illinois Earl M. Bane Professor of Medicine, Pharmacology and Bioengineering
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HEALTH SYSTEM NEWS
David Otto, former Chicago Cubs pitcher, demonstrates proper CPR techniques.
UI HEALTH LEADS STATEWIDE EFFORT TO REDUCE SUDDEN CARDIAC ARREST 2
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Photos: Al DiFranco, UIC Photo Services
Too many people die each year from sudden cardiac arrest. A multi-institutional team from Illinois comprised of community leaders, EMS providers, physicians and governmental agencies decided it was time to do something about it. The University of Illinois Hospital & Health Sciences System is helping to lead this statewide effort. Terry Vanden Hoek, MD, professor and chair of emergency medicine for UI Health, is coordinating the collaboration to improve survival rates from sudden cardiac arrest (SCA ). The project, named Illinois Heart Rescue, was launched Aug. 22 at a press conference where Illinois Gov. Pat Quinn delivered a call to action to the people of Illinois to learn CPR and learn to save a life. “As it says in the Talmud, when you save one life it is as if you’ve saved the entire world,” he said. In addition to UI Health, Illinois Heart Rescue partners with leadership from the Chicago Fire Department, the Chicago EMS System, Illinois Department of Public Health and Chicago Cardiac Arrest Resuscitation Education Service. The Heart Rescue Project is a national effort funded by the Medtronic Foundation’s $2.5 million grant to improve cardiac arrest survival in the next five years, and Illinois joins five other states that have received a Heart Rescue Award. “Illinois Heart Rescue is bringing together many different components of the state’s health system,” says Vanden Hoek, who started work on the project in November 2011. “If we are successful, we’ll greatly improve these components and our response to a disease that is the number one cause of death in the country.” In a heart attack, the heart becomes weak when blood flow to the heart is blocked. However, in sudden cardiac arrest, the heart suddenly ceases to beat entirely. As a result, blood stops flowing to the brain and other vital organs. According to the American Heart Association, unless a bystander provides CPR (repeated chest compression to make the heart pump blood), the victim’s chance of survival decreases by up to 10 percent per minute until emergency personnel revive the heart with defibrillation (electric shock). About 375,000 people in the U.S. die of sudden cardiac arrest that takes place outside of a hospital. Only 5 percent of SCA patients survive overall, but there are areas of the country where survival rates are greater than 20 percent, Vanden Hoek says. “In sudden cardiac arrest, a few seconds of time can make a lifetime of difference. The Medtronic Foundation has given us an opportunity to help the people of Illinois make that difference.” This past summer, Illinois Heart Rescue began a three-part effort to more than double the statewide survival rate from SCA. The project will feature promotions at Chicago Cubs games, for example, and use social media to encourage people to seek out CPR training from resources such as the American Heart Association and the American Red Cross. Health care providers volunteering with Illinois Heart Rescue also will provide training in schools and communities at high risk for SCA.
Because firefighters often are called to respond to SCA and frequently arrive before paramedics, the Chicago Fire Department is enhancing its CPR and defibrillation training for all firefighters, EMTs and paramedics. In addition, 911 dispatchers will be trained to calm callers and provide instruction in chest compression-only CPR over the phone. More than 5,000 Chicago fire and emergency medical personnel have been trained. “We will bring the science of cardiac arrest resuscitation to the streets through simulation training,” promises Eric Beck, MD, one of the Heart Rescue leaders who is assistant professor of medicine at the University of Chicago and EMS medical director for the City of Chicago.
Terry Vanden Hoek presenting the project, Illinois Heart Rescue, with Illinois Gov. Pat Quinn
About 30 hospitals throughout Illinois plan to share data confidentially about their SCA patient outcomes in order to identify the most effective methods for caring for such patients. Vanden Hoek hopes University of Illinois alumni can help mobilize their communities and hospitals to participate in the project. In addition to supporting data collection, the funding from Medtronic supports grants to increase CPR training in African-American and Latino communities, including urban and rural communities that are particularly vulnerable to cardiac arrest. To become involved in Illinois Heart Rescue or for more information, contact Vanden Hoek at firstname.lastname@example.org or go to www.illinoisheartrescue.com.
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HEALTH SYSTEM NEWS
CHICAGO, URBANA COLLABORATE TO BRING MOBILE HEALTH TO PATIENTS Technology plays an ever-increasing role in health care, not only in Krishnan himself is working with Bruce Schatz, PhD, head of hospitals and clinics, but in patients’ homes and even in their pockets. the department of medical information science and professor of More and more, mobile technology—especially the use of mobile computer science at UI Urbana-Champaign, on a nascent research phones and tablet computers—is enabling health care providers to project utilizing mobile technology. Schatz has developed a communicate with patients where they live and work, increasing the technology that uses sensors in mobile devices to monitor the accessibility and quality of health care. walking patterns of a device’s owner and detect health abnormalities The University of Illinois Hospital & Health Sciences System is playing indicated by variations from those patterns. an active part in this trend, with innovative projects under way and in Krishnan and Schatz are exploring possibilities for using that development. In addition, this past summer, UI Health researchers in technology to monitor UI Health patients in real time after they leave Chicago were working with the new Health Information Technology a clinic or hospital. “Once they leave our doors, it’s hard to know Center, which includes researchers how they’re doing until they come on the Urbana-Champaign campus, back for a follow-up appointment, to pursue new ways to utilize health but sometimes patients get sick technology. between appointments. Mobile “Our vision is to use mobile health technology may help us technology, when appropriate, to identify health care needs before they collect health information from become serious,” Krishnan observes. our patients without needing them Krishnan believes the collaboration to come to the hospital or clinic. with HITC, which was launched on the Mobile health technology offers Urbana-Champaign campus in the the opportunity to use real-time fall of 2011, will yield much innovation. 1 health-related information to guide The center promotes research 6 decision-making between patients in the application of information 2 and health care providers,” says technology to health care through its 5 5 Jerry Krishnan, MD, PhD, professor website, seminar series and funding of medicine and public health for research projects. 3 and associate vice president for “This cross-campus activity lets population health sciences. us combine the Urbana-Champaign Krishnan points to a research campus’ recognized strengths in study being conducted by Lisa engineering and computer science 4a 4b Sharp, PhD, assistant professor of with the clinical excellence of the medicine, and Ben Gerber, MD, MPH, University of Illinois Hospital & Health 1. Data from personal health monitors sent to Health Cloud. associate professor of medicine, as Sciences System,” says Carl A. Gunter, 2. Health Cloud tracks patient data and sends alerts to patient an example of the ways the UI Health PhD, director of HITC and professor and health professionals, if needed. System can benefit from mobile of computer science at UI Urbana3. Health professional reviews alerts and sends healthcare health technology. Sharp and Gerber Champaign. “It creates a laboratory instructions via Health Cloud. are conducting a two-year study to for understanding how advanced 4a. Home visit by Health professional, if needed. determine whether the addition of technology can improve health care 4b. Patient visits community health center or medical center, if needed. community health workers to clinicfor a diverse population.” 5. Data transmitted wirelessly to Health Cloud. based pharmacist services improves Krishnan is also working with 6. Information & alerts disseminated back to patient. diabetic patients’ adherence to their Barry Pittendrigh, PhD, professor and medication regimen. The study is endowed chair in insect toxicology, and equipping the community health co-founder of Scientific Animations workers with iPads and a multimedia Without Borders. SAWBO is a program created specifically for the University of Illinois-based initiative study to educate patients about launched in 2011 that focuses on their medication. developing animated educational materials in a diversity of languages. “As far as we know, this is the first project in the country that has SAWBO’s original efforts revolved around working with health given community health workers iPad technology to take into the and agricultural issues in the global context. This past spring field,” Sharp says. SAWBO formed a partnership with Krishnan to develop animated In addition, Sharp and Gerber are assisting Melinda Stolley, PhD, patient and provider educational materials that will be available on assistant professor of medicine, with a weight-loss intervention mobile devices (e.g., cell phones and tablets). This cross-campus program for African-American breast cancer survivors. They are effort has potential to reach patients throughout the state of Illinois designing a series of text messages that will be sent to the participants and beyond. throughout the day to encourage them to increase their level of “We’re at a crossroads of health care,” Krishnan adds. “Healthcare physical activity, make better dietary choices and access community systems throughout the country have come to the realization that resources. timely information is needed to provide optimal health care. The technology platforms have evolved to the point to make it possible.” 4
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UI HOSPITAL AGAIN NAMED AMONG THE NATION’S ‘MOST WIRED’
IPAL: A DIRECT LINE TO UI HEALTH PHYSICIANS-AND BETTER CARE
For the sixth year in a row, the University of Illinois Hospital & Health Sciences System has been named among the country’s “Most Wired Hospitals” by Hospitals & Health Networks magazine, the journal of the American Hospital Association. The list recognizes hospitals and health systems for excellence in information technology. The “Most Wired” list is based on a nationwide survey of hospitals and health systems regarding their IT initiatives. To achieve “Most Wired” status, an institution had to meet specific requirements in the areas of infrastructure, business and administrative management, clinical quality and safety, and clinical integration.
When a referring physician encounters a complex case that requires highly specialized care, there are a variety of hospitals in Chicago where they may choose to send their patients. But with the introduction of the Illinois Provider Access Line (IPAL) last June, referring physicians now have access to a direct attending-to-attending physician hotline, simplifying the process for them to transfer patients to the University of Illinois Hospital & Health Sciences System. “We knew from experience at other academic medical centers that having a dedicated line for referring physicians, rather than using multiple phone numbers where access to attending physicians was not always guaranteed, would streamline the transfer process and provide more continuity of patient care,” says Bryan Becker, MD, associate vice president for hospital operations. IPAL is a dedicated toll-free number, 1.855.455.IPAL (4725), available 24 hours a day, seven days a week. Staffed by specialty nurses, the hotline coordinates real-time, physician-to-physician communication and consultation. As the attending physicians discuss the case, the IPAL nurse takes responsibility for coordinating the necessary patient care activities, including inpatient transfer, outpatient scheduling and/or ancillary testing. All calls are recorded for quality assurance purposes and for capturing information related to the patient’s condition and treatment plan. “In addition to making it easier for referring physicians to reach the attending on call, IPAL also provides more opportunities for consultation between attending physicians to ensure that vital information about the patient’s condition is shared,” Becker says. Becker was responsible for creating a team consisting of representatives from information services, patient access, hospital administration and marketing to launch the dedicated phone line within three months. Since its introduction, IPAL has increased the efficiency and number of patient transfers as well as provided a way to monitor performance by tracking call volume and response time. The first two months after the launch of IPAL showed a 15 percent increase in patient transfer requests, along with a corresponding 15 percent increase in the number of visits to the referring physicians section of the UI Health website, while the time it took to respond to calls dropped from 25 seconds to 22 seconds. A marketing campaign is planned for early 2013 to further increase awareness of IPAL’s benefits. “We want to reach out to physicians, not only in Chicago, but also in other communities throughout the state, to make them aware of how IPAL is helping improve the patient care process at UI Health,” says Becker.
“We are honored to be among the prestigious group of ‘Most Wired’ hospitals,” says Joe G.N. “Skip” Garcia, MD, vice president for health affairs at the University of Illinois. “Advancing health care technology is critical to our overall mission to provide innovative research and personalized health care, to address health disparities, and to educate the next generation of researchers and health care providers.” The health system’s electronic medical records securely link the hospital, outpatient centers, satellite facilities, academic offices and laboratories to medical data about more than 2 million patients and is accessible from personal computers located throughout the institution and off-site. This integration provides clinicians in a variety of locations access to the same information simultaneously, which supports best practices in clinical care. Implemented in 1997, the EMR provides an automated process for all aspects of medication reconciliation and maintains a record of the complete continuum of care, including laboratory results, clinical documentation and online imaging.
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HEALTH SYSTEM NEWS
UI HEALTH PROJECTS HELP HAITI ON THE LONG ROAD BACK FROM AN EARTHQUAKE Although Haiti received an outpouring of international assistance immediately after a powerful earthquake struck the Caribbean island nation in January 2010, the impoverished country remains afflicted by a lack of adequate health care worsened by the country’s severely underdeveloped infrastructure.
Since the spring of 2011, teams of UI Health professionals and University of Illinois at Chicago School of Public Health students have been traveling to Haiti to provide both immediate medical care and to identify possible long-term improvements to the country’s health system. The first two teams traveled to Haiti during spring breaks in 2011 and 2012, and a third is planned for spring of 2013. The projects are a collaboration between the Center for Global Health, an interdisciplinary research, education and service initiative at the University of Illinois, and the School of Public Health. The trips have been spearheaded by Janet Lin, MD, MPH, director of health systems development in the Center for Global Health, who holds appointments in both the center and the school. Lin first traveled to Haiti shortly after the earthquake as a team leader of an initial group of volunteer clinicians from Chicago health care institutions that volunteered disaster assistance. “I try to develop programming that simultaneously addresses the clinical side and the public health side,” Lin says.
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“A lot of times, on the public health side, they understand what’s happening to the population, but they don’t see the consequences firsthand. Meanwhile, the clinicians are taking care of the consequences, but there are a lot of systemic issues they don’t see. I try to bring them together to give them exposure to the broader picture.” Accordingly, the dozen people on each trip have included School of Public Health students, nurses, and resident and attending physicians. Working in communities near Portau-Prince, the Haitian capital, the clinicians have provided primary care services, treating infections, chronic diseases and orthopaedic ailments. “Many of the cases we see are related to inadequate access to proper health care and lack of education about health conditions,” Lin says. In response, the public health students have conducted a health needs assessment in a camp for displaced persons in Carrefour and an assessment of another community’s knowledge and needs for disaster preparedness, interviewing more than 330 local residents and stakeholders. “We’re reviewing our findings to see what would be useful for both the Delmas community in Haiti and the international disaster response community. Hopefully, we will be able to use our assessment data to develop an effective community-level intervention,” says Ashley Dyer, MPH, who took part in both trips, the first time as a public health student, the second as a team leader. She now is a research project coordinator at Northwestern University’s Institute for Public Health and Medicine. The UI Health teams have been collaborating with a Haitian physician who worked in the Carrefour camp and later in the community of Delmas. He also came to the University of Illinois Hospital to receive three months of training in emergency medicine in the fall of 2011. A third team traveled to Delmas, Portau-Prince, Haiti, this November to meet with the local government and continue planning, and another one is scheduled to go during spring break of 2013. “I hope to build a long-lasting relationship where we can partner with the people we’re assisting and allow them to learn from us so that, at some stage, they’re in a better situation where they don’t need us,” Lin says.
COLLEGE OF NURSING WORKS WITH BILL CLINTON TO IMPROVE NURSING IN RWANDA Former President Bill Clinton honored the University of Illinois at Chicago College of Nursing by inviting the school to participate in an effort to improve nursing and midwifery, health management and medical education in the east African nation of Rwanda. The college is one of five U.S. nursing schools that were chosen to take part in the Rwanda Human Resources for Health Program by the Clinton Health Access Initiative, a global health organization founded by the former president. The Clinton initiative, in conjunction with the U.S. State Department, has led the coordination of the U.S. academic institutions involved in the project, which also include medical schools and a school of public health. “We were thrilled to be selected for this program, because it is consistent with our long history of improving health internationally,” says Terri Weaver, PhD, RN, dean of the College of Nursing. “Rwanda wanted not only guidance in the development of curricula but mentorship in the application of best practices in the community, and these are areas where we have extensive experience and expertise.” Rwanda, which has a population of 11.7 million people, is facing a severe shortage of highly qualified physicians, nurses, midwives and other health care workers, says Mi Ja Kim, PhD, executive director of the college’s Global Health Leadership office and director of UIC’s participation in the Rwanda program. A contingent of seven nursing faculty members has been in Rwanda since August. During their yearlong stay in the country, four members of the team individually will advise the dean of a nursing college in Kigali, Rwanda’s capital, the country’s national council of nurses and midwives, and the directors of two rural schools of nursing. The other three members will mentor nurses and midwives in hospitals in Kigali. The Rwandan Ministry of Health is coordinating the program, which is believed to be the largest cooperative global health effort ever undertaken between universities in the developed and developing world, according to Kim. Weaver, Kim and the members of the Rwanda-based nursing team met with President Clinton in Chicago prior to the team’s departure. “He’s very supportive of the importance of the roles
that nurses and midwives play in developing countries,” says Kim, who was a member of the Health Professions Review Group on healthcare reform that advised President Clinton and Hillary Clinton. “He was very complimentary about the leadership our college is providing.”
Dean Terri Weaver with former President Bill Clinton
We were thrilled to be selected for this program, because it is consistent with our long history of improving health internationally. Terri Weaver, dean of the College of Nursing
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HEALTH SYSTEM NEWS
NEW PROGRAM AIMS TO PROVIDE HOPE, ANSWERS FOR RECURRENT PREGNANCY LOSS
Women who experience repeated failed pregnancies are left grief-stricken and searching for answers, yet few clinicians have the expertise needed to help them. To address this need and to help such women to give birth to healthy children, the University of Illinois Hospital & Health Sciences System is establishing a new program to treat recurrent pregnancy loss, led by an internationally recognized expert in the field. The term “recurrent pregnancy loss” encompasses both repeated miscarriages during the first 10 weeks of gestation and, less commonly, any loss of pregnancy after 10 weeks. Nearly 5 percent of women trying to conceive have suffered two miscarriages or more. Mary Stephenson, MD, MSc, professor and head of obstetrics and gynecology at UI Health, has been treating RPL for 20 years, beginning at the University of British Columbia in Vancouver, where in 1992 she established what developed into Canada’s largest RPL program. In 2004 she joined the University of Chicago Medical Center, where she initiated and led an RPL program until coming to UI Health this past June. The University of Illinois RPL program will open its doors in 2013 in the ob/gyn offices on the fourth floor of UI Health’s Outpatient Care Center. The location places the program adjacent to the department’s in vitro fertilization and maternal fetal medicine faculty, key collaborators in treating women who are having difficulty bringing a pregnancy to term. In most cases, Stephenson evaluates a patient before the woman and her partner attempt to become pregnant again in order to try to identify the causes of the RPL, develop a treatment plan and determine the likelihood of success with the next pregnancy. “There are different hormonal reasons for RPL, such as thyroid diseases, diabetes and obesity. There are different clotting factors or problems with the lining or shape of the uterus. Also, patients with autoimmune diseases such as lupus have a much higher rate of miscarriage,” Stephenson explains.
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Treatments may include antibiotics for uterine infections, hormone therapy to help build up the endometrium, Mary Stephenson, head of obstetrics medications to and gynecology correct thyroid imbalances, surgery to address problems with the shape of the uterus, and simple administration of low dosages of aspirin and heparin to treat clotting problems. The program also will monitor the patient closely during her first trimester of pregnancy using blood tests and ultrasound and will provide education and emotional support. “Close monitoring and having a health care professional at the end of the phone has been shown to improve outcomes,” Stephenson says. Debbie and Ricardo Sandoval sought out Stephenson in 2008 after Debbie suffered two miscarriages and an ectopic pregnancy while the Norridge couple was trying to have their second child (their first, a son, was born in 1999). Stephenson diagnosed her with hyperthyroidism and blood clotting problems, which she treated with medication including baby aspirin. Stephenson’s care helped Debbie give birth to a daughter in 2009 and a second son, born on the Fourth of July of 2012. “Once we got together with Dr. Stephenson, she gave us renewed hope,” says Debbie, a Chicago Public Schools counselor. “There are no words to thank her. We send her pictures of our kids as they’re growing so she can see the little miracle she helped perform.” The Sandovals had spent four years trying to have their second child before consulting with Stephenson, in part because Debbie’s previous ob/gyn kept assuring her nothing was wrong. “I appreciate Dr. Stephenson being honest with me and not trying to go around it and pretend there’s nothing wrong,” Debbie says. “She’s an asset to anywhere she goes, because she knows what she’s doing.”
YOU HAVE A HISTORY WITH SICKLE CELL DISEASE. SO DO WE. For over 50 years the University of Illinois Hospital & Health Sciences System has been an advocate for people with sickle cell. As the only program in Chicago to treat sickle cell patients from pediatric to adult care, our doctors and staff are here for the long haul. And with our pioneering stem cell treatment that cures sickle cell disease without chemotherapy, our 50 years of battling sickle cell have prepared us to fight hard for you. At the University of Illinois, weâ€™re changing medicine. For good. TO LEARN MORE ABOUT HOW UI HEALTH CAN HELP YOU MANAGE SICKLE CELL, CALL 312.996.6143 OR VISIT AS AT HOSPITAL.UILLINOIS.EDU/SICKLECELL
A HARVEST OF CARE On a cloudy, damp and chilly October afternoon outside of Freeport, Ill., a dozen emergency personnel carefully and quickly extricated a wounded farmer trapped underneath his tractor, while a helicopter and crew stood ready to whisk him to the nearest hospital trauma center in Rockford. Their goal: Move him from farm field to operating room within 60 minutes of the tractor rollover to maximize his chance of survival from myriad potential problems, including internal bleeding, abdominal injuries, broken bones and burns. Fortunately, this particular episode wasn’t real. It was a demonstration with a mannequin staged as part of an educational field trip. Called “No Harm on the Farm,” the event was sponsored by the rural medical-education program, RMED, and its companion pharmacy program, RPHARM, which are based at the National Center for Rural Health Professions at the University of Illinois’ Rockford campus.
3. Life Flight is directed to safe landing zone
1. First responders secure tractor
2. EMTs stabilize accident victim
By Linda Wilson
Photos: Hoss Fatemi & Brian Thomas
UI Health program cultivates a bumper crop of rural physicians, pharmacists RMED celebrates its 20th year in 2013. RPHARM was launched three years ago; its first class will graduate in 2014. In both programs, students complete the regular curriculum in their respective fields in addition to shared, interdisciplinary coursework on health issues in rural areas. On this particular afternoon, 40 students in medicine, pharmacy and the Students on a flatbed watch the disaster drill on a farm near Freeport, Ill. biomedical sciences watched from the sidelines as the tractor-rollover rescue unfolded. The rescue demonstration followed a 90-minute tour of the farm during which co-owner Douglas Scheider discussed potential hazards, ranging from icy steps on the side of a grain silo to noxious gases in manure holding-bins. “I actually know of eight or nine people who have died in farm accidents and many more who have been injured,” Scheider says. Throughout the state, 801 farmers died as a result of work-related accidents between 1986 and 2011, according to the University of Illinois Extension Service. “The problem with these types of accidents is that they happen away from the farmstead where nobody can see them. It might be hours before a family member notices (the farmer) is missing,” explains Mark Baker, coordinator at Stateline Farm Rescue, in Orangeville, Ill., which organizes training programs such as the one staged at Scheidairy Farms. Farmers also are prone to a multitude of job-related chronic conditions, such as lung disease, hearing loss and depression. Residents of rural communities tend to be in worse health than their urban and suburban peers. Rates of high blood pressure, cerebral vascular disease, suicide among men and DUI arrests are higher in rural areas than in metropolitan areas, according to the National Rural Health Association. The students who attended “No Harm on the Farm” learn about these medical issues and many others during their four years in the RMED and RPHARM programs, which are both recruitment and education programs. Like many states, Illinois suffers from long-standing shortages of many types of medical personnel in rural communities. For example, 68 of 83 rural counties in the state do not have enough primary-care doctors, including internal or family medicine and pediatrics. About 500 doctors in rural locations are near retirement age. To create a pipeline of physicians to fill those positions, RMED recruits between 15 and 20 students annually who grew up in rural Illinois and plan to pursue a career in primary-care medicine. The university plans to educate a similar number of RPHARM students annually from rural communities, but the largest class so far is comprised of 10 second-year students. A total of seven third-year students and three first-year students I L L I N O I S H E A LT H also are enrolled in RPHARM.
Throughout the state, 801 farmers died as a result of work-related accidents between 1986 and 2011, according to the University of Illinois Extension Service.
Some 226 students—160 in practice and 66 in residency training—have graduated from the program. Of those in practice, 118 work in 78 different communities in Illinois and 75 percent are in towns of less than 20,000 people. Douglas Scheider speaks to students about the dangers of working on a farm.
Matt and Beth Gullone met while enrolled in RMED.
“When you are a family doctor in a rural area, you are able to use all of the tools and procedures that you learned in residency.’’ - Beth Gullone 12
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Karissa Monney, who grew up in Oreana, Ill., is typical of the type of student RMED attracts. The daughter of a registered nurse and restaurant manager, she plans to practice family medicine in a rural Illinois community after graduation. “I would have a very hard time moving out of Illinois. My entire family is here,” she says. In addition to completing an application for the University of Illinois College of Medicine, prospective students submit a separate application to RMED and meet for an interview with the members of the program’s recruitment and retention committee. Since its inception, RMED has funneled physicians to rural communities. Some 226 students—160 in practice and 66 in residency training—have graduated from the program. Of those in practice, 118 work in 78 different communities in Illinois and 75 percent are in towns of less than 20,000 people. Matt and Beth Gullone are two of those graduates. They met while enrolled in RMED, married after graduation in 2006, and attended a residency program together in South Bend, Ind. They returned to Illinois in August 2009 and joined the staff at Midwest Health Clinic in Galena. Both are happy with their choice. As Beth Gullone explains, “When you are a family doctor in a rural area, you are able to practice the full scope of family medicine and use all of the tools and procedures that you learned in residency. In a city practice, there are so many specialists in the area that oftentimes a patient will go to the specialist.” Matthew Hunsaker, MD, director of the RMED program, notes that primary-care physicians in rural areas “will handle about 80 percent of what walks through their door. About 20 percent of those cases will need referral or subspecialty involvement.” That is why the goal of RMED is to ensure that students graduate with the “skill set to not only make a living in a community but to make a difference,” says Hunsaker, who is a family physician. In addition to classroom lectures and field trips, both RMED and RPHARM include a four-month internship, or preceptorship, in a rural setting. Some 35 rural physician/ educators on staff at 25 hospitals work with the RMED students, while rural pharmacists will host RPHARM students for the first time in the 2013-2014 academic year.
“Four months is more than just a rotation. It is an immersion experience in the context of rural practice. You have a chance to see a patient ill and then return to health,” Hunsaker says. The students not only sharpen their medical skills but also “get a feel for the involvement in the community that rural physicians have and the leadership role that they play in many communities,” he adds.
For example, Matt Gullone volunteers at the local high school. “I am on the sidelines at football games to evaluate injuries— especially the concussions. I occasionally cover other sporting events,” he says. To hone community leadership skills outside of the confines of a medical practice, RMED students complete a communityoriented primary-care project in the same community where they do their four-month clinical rotation. Students develop projects that address “some issue that is of importance in the community … whether it is methamphetamine addiction, teenage pregnancy or obesity,” Hunsaker says. RMED students work with other health professionals, such as nurse practitioners, social workers and pharmacists, throughout their preceptorships. “The program really emphasizes collaboration and teamwork between different health professions, which is where the healthcare system is going now,” Monney says. “Having that extra training is going to be really great when we finish school.”
RMED’s influence reaches beyond the four years of medical school.
Matthew Hunsaker, director of the RMED program, speaks about how medical students can help those in rural communities.
RMED educators worked with officials at KSB Hospital in Dixon to launch a rural medicine residency program in 2004. “It is a great recruitment tool, and it is a great retention tool as well because our physicians love to teach,” said David Schreiner, president and CEO of the hospital. Of the 11 doctors who have completed the residency program, KSB Hospital has hired five of them. The hospital also plans to employ a second-year resident, Emilee Bocker, who also is an RMED graduate, after she completes her training. Bocker, who was raised on a farm in Lanark, always planned to return to her rural roots. “I know there is a definite need in rural areas. That is where my heart is and where I am committed to serve,” she says.
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Above: The Means brothers (Desmond, from left, Clifford and Julius) celebrate a family victory over sickle cell disease. Right: The physicians: Joseph DeSimone, Victor Gordeuk, Damiano Rondelli, Robert Molokie and Lewis Hsu. Photos: Mike McCafrey
The smiles don’t stop as Julius Means describes his new lease on life. “I’m peachy, you know? Never better.” For someone who was fatigued much of the time, bedridden part of the time and chronically ill all his life, the 24-year-old “is perfectly recovered” from an anemia due to sickle cell disease, says his doctor, Damiano Rondelli, MD. “He is very fit, he’s started working out again, he does 30 or 40 pushups at a time-it’s amazing.” A transplant of stem-cell-rich bone marrow from Julius’ brother Clifford last spring did the trick. Another brother with the disease, Desmond, recently received stem cells as well. This actual cure for sickle cell disease, a genetic affliction affecting about 100,000 Americans, is among the advances in treatment and research offered exclusively in the Chicago area by a special force of eminent doctors brought together at the University of Illinois Hospital & Health Sciences System to simultaneously confront the disease’s many different threats to the human body.
The disease’s assaults on organs and extremities (and its pervasive sapping of energy) all spring from either a lack of sufficient numbers of normally sturdy red blood cells—which die more quickly than normal cells at rates faster than the body can replace—or too many of the sickle-shaped, sticky and woodhard cells destined to stack up in blood vessels. Research efforts at the hospital are getting past previous emphases on palliative care and sickle cell crisis management and into more preventive or curative treatments. Among other approaches, the UI Health System team is aiming to discover ways to get more oxygen-carrying hemoglobin into the bloodstream, get cells through blood vessels without incident, and stave off waves of damage to patients’ lungs, heart, kidneys, brain and other organs, says Lewis Hsu, MD, pediatric medical director of the Sickle Cell Center, who was recruited to the team in July 2011 from Children’s National Medical Center in Washington, D.C. Among Hsu’s fellow DC-area collaborators on studies funded by the National Institutes of Health was Victor Gordeuk, MD, who directed a center for sickle cell disease at Howard University. Recruited to the University of Illinois about the same time as Hsu, Gordeuk now heads up the UI Health System’s Comprehensive Sickle Cell Center that encompasses adult and pediatric research as well as coordinated patient care. Hsu credits Gordeuk with “pulling together a sickle cell center that’s not only scientifically strong but compassionate.” That combination is important to both learn about properties of the disease and expeditiously translate that knowledge into better quality of life for those suffering from it, Hsu says.
When Hsu started his medical career at University of Rochester and Cornell University, studying such areas as blood transport and blood viscosity, he noticed that although scientific knowledge was piling up, “there were all these kids sitting around with severe pain, a 10 on a scale of 10.” Treatment consisted of giving palliative medicines and fluids while “waiting for things to get better,” Hsu remembers. “A lot of knowledge but no cure; it really seemed like an area that needed to have more help.” The Chicago area has an estimated 3,000 people with sickle cell disease, and the UI Health System’s center treats about 525 adult and 190 pediatric patients. Gordeuk says a team of doctors working in conjunction with the center-Michel Gowhari, Johara Hassan and Geraldine Luna-care specifically for sickle cell patients in the hospital and outpatient clinic,
VICTOR GORDEUK, MD
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Most patients did not survive childhood years ago, says Gordeuk, but advances in treatment of children with the disease over the years have greatly increased life expectancy-more than half of patients survive past age 50. But that has led to the rise of complications later in life that were under-recognized before, especially pulmonary and cardiac problems, he says. Patients can develop a kind of hypertension in their lungs, suffer strokes when sickle-cell buildup blocks blood flow to the brain, or gradually lose function in organs from insufficient oxygen and diseaserelated assaults again and again. Two pulmonary experts are involved in solving the puzzles of complications in the lungs. The UI Health System’s vice president for health affairs, Joe G.N. “Skip” Garcia, MD, has turned his attention to the molecular and genetic changes
LEWIS HSU, MD
ROBERT MOLOKIE, MD
The Chicago area has an estimated 3,000 people with sickle cell disease, and the UI Health System’s center treats about 525 adult and 190 pediatric patients. along with dedicated clinical and research nurses. Robert Molokie, MD, a veteran hematologist and sickle cell expert, is involved in the clinic as well as in research. Besides Molokie and Hsu, experts researching the way sickle cells behave in the blood include Joseph DeSimone, PhD, the research director of the UI Health System’s center, and Donald Lavelle, PhD, a research associate professor headquartered at nearby Jesse Brown VA Medical Center. Both are working on increasing blood-oxygen levels by producing fetal hemoglobinthe type produced in infancy, when little bodies are growing fast. The only agent able to do that now, called hydroxyurea, was first developed in the 1990s in a multicenter research effort in which the UI Hospital played a main role. Since Gordeuk and Hsu came aboard, the hospital has expanded its research to the use of seven different types of agents.
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that underlie pulmonary complications with an eye toward developing therapies that could overcome the genetic root of the problems, says Gordeuk. In addition to Gordeuk, Garcia recruited Roberto Machado, MD, from the University of Chicago, whom Gordeuk says is a sickle cell expert and making “seminal progress” on addressing pulmonary complications of sickle cell disease. Hsu says part of his interest in coming to the UI Health was Garcia’s investigation into other aspects of the disease, including pulmonary complications. “If we can’t make headway with the blood part, perhaps the better headway might be with treating the lung disease components better.”
The ultimate headway, of course, would be to erase the disease entirely, and the UI Health System is on the leading edge of developing a cure through a special approach to bone-marrow transplantation in adults that their crisis-ridden bodies can withstand. Rondelli, a hematologist and oncologist for 10 years at the UI Hospital, teamed up with Garcia and the UI Sickle Cell Program to bring that approach to Chicago after they independently became aware of a successful procedure at the NIH two years ago that suppressed the immune system before introducing normal donor stem cells rather than employing the usual chemotherapy to completely wipe out abnormal bone marrow-essential in cancer survival but too toxic for damaged organs to tolerate in sickle cell patients. A temporary “freeze” of the immune system allows stem cells to establish themselves “in a sufficient amount to replace the sickle cells with normal cells,” says Rondelli.
JOSEPH DESIMONE, PhD
The stem-cell transplant for Means was the second successful procedure performed at UI Hospital, and two other patients underwent the procedure in late September. Both Means and the first patient to have the procedure, Ieshea Thomas, 33, “have become absolutely normal peopleno disease, no symptoms, no pain,” says Rondelli,” which is extremely rewarding.” Means says he feels not only healthy but useful now, and is anxiously enduring a waiting period before he can seek employment-there are concerns about infection in the work place as his immune system gets back to normal. “Soon as they say I can get a job, I’m on it,” he says. In the meantime he has been working off newfound energy by performing and posting online a number of hip-hop tunes, taking the pseudonym Sinju. He even composed one song about being a stem-cell transplant patient at UI Health. Best of all, “I’m not letting my family down,” Means says. “I don’t have to depend on other people as much. I feel like a lot has been moved out of my path. It’s fantastic.”
The main limiting factor is the close match needed between donor and patient. As it stands now, says Gordeuk, a patient has to have a sibling from the same father and mother, matched completely for the antigens their cells carry that signal to the immune system whether a cell is friend or foe. Without that match, immune cells will attack donor cells after the transplant. The translational research approach at UI Health is developing models to transplant stem cells of people who are “half-matched,” says Gordeuk. “This makes it so many siblings, or mom or dad or any child, has a good likelihood of being a donor for the patient. If this can become a standard therapy, then we can offer curative therapy for the majority of patients with sickle cell disease.” “We’re trying to use our research to come up with a new treatment,” says Rondelli, by using models that can take findings quickly “from bench to bedside.” Researchers have
already shown how a drug can actually modify the genes in a patient, he says. The teamwork of caregivers, specialists, geneticists and research minds makes the odds of success in transplantation and other treatments that much more likely, says Hsu. “Having a number of people who both see patients and do research is extremely helpful.” What’s working in patients’ favor, he says, is “having a simmering pot of people who know what types of questions to tackle because they’re relevant, and knowing what kinds of things are possible because they’ve been in the lab where they’ve been doing clinical research before.” “And so if you put that together with a lot of patients, the large patient population who are willing to participatewilling to get stuck for an extra blood sample, or willing to do questionnaires, or willing to sign up for the new treatments versus a placebo-this is a perfect combination.”
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A DOSE OF GENETICS UI Health System uses science to make personalized health a reality for patients taking warfarin By Alice Patenaude
The right dose for the right patient: That’s the goal of all pharmacists and physicians. And now, the University of Illinois Hospital & Health Sciences System is pioneering the use of genetics to make that personalizedhealth aim a reality. In its work with new patients taking warfarin (a drug used to treat blood clots and prevent strokes), UI Health is the first in the nation to automatically use pharmacogenetics—the science that predicts a response to drugs based upon a person’s genetic makeup—to prescribe the correct dosage. The project is a collaboration between the University of Illinois at Chicago colleges of Pharmacy and Medicine. Each year, more than 2 million people are prescribed warfarin, the most widely prescribed oral anticoagulant drug in North America. But determining the right dose, especially the initial h A critical doses, can be difficult because of variable ss oc factors including a patient’s diet, age and the use of . ia te am other medications. Warfarin is the leading cause of adverse ,a te e nd vi c Ad drug reactions among older people in the United States. er S am s B re ti c Patients who take a dose larger than they can tolerate are at risk ss , ene g R o e se a ac of life-threatening bleeding. Those who receive too low a dose are rc h F e arm llow, are par t of th e Ph at risk of equally dangerous blood clots. The process of personalizing optimal warfarin dosages is based upon data from numerous studies which show that a When patients are first prescribed warfarin under the patient’s variants of the genes CYP2C9 and VKORC1 affect why new service, the computer system automatically triggers a people process the drug differently. laboratory order for warfarin pharmacogenetics and a pharmacy “These two genes explain about 30 percent of the variability in consultation. A small sample of the patient’s blood is drawn and dose that we see in patients,” says Larisa Cavallari, PharmD, and sent to the medical laboratory, where the DNA is isolated and associate professor. “Without using genotype information, it can processed on an FDA-cleared genotyping platform. Results for take weeks or months to figure out the correct warfarin dosage.” the VKORC1 and eight variations of the CYP2C9 genes are usually Cavallari, along with Edith Nutescu, PharmD, the founder of the available within a mere six to eight hours. University of Illinois Hospital & Health System’s Antithrombosis Clinic, The Pharmacogenetics Consult Service provides a are the clinical directors behind the health system’s new Warfarin patient assessment and a genotype-guided warfarin dose Pharmacogenetics Service, which launched in mid-August. recommendation to the medical team via a consult note in the patient’s electronic medical record. Patients are then monitored with blood tests to ensure that the dosage is correct. The arz
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pharmacogenetics service follows up until the patient is discharged from the hospital, and even after for those receiving care at the university’s Antithrombosis Clinic. Rather than starting all patients on the same initial dose, genotyping personalizes the warfarin dosage for each patient, helping to prevent both overdoses and underdoses of warfarin. Studies have shown that patients who used genotype-guided warfarin dosing had significantly fewer serious adverse events (including hemorrhage, thrombosis and death) during the initial three months of therapy compared with control groups. “Not basing a person’s treatment on one standard is better for the patient,” says Vanessa Flores, a UI Health employee and a patient with a blood clotting disorder, who has been treated for deep vein thrombosis and pulmonary embolism at the Antithrombosis Clinic for the last decade. “As a patient, I appreciate having access to the best and newest technology.”
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With the new Warfarin Pharmacogenetics Service, an estimated 500 patients annually will receive their optimal warfarin dose based on their individual genetic testing. This latest addition to the health system’s approach to personalized medicine is a team effort involving many disciplines. For example, medical directorship is provided by physicians Thomas Stamos, MD, William Galanter, MD, PhD, and Victor Gordeuk, MD, with laboratory support by Shrihari Kadkol, MD, PhD, a board-certified pathologist, and Carol Dodge, manager of the UI Health Molecular Pathology Laboratory. Two pharmacy fellows, Adam Bress, PharmD, and James Stevenson, PharmD, handle the daily requests for warfarin genotyping and communication with physicians. Galanter has had three roles in the launch of the new pharmacogenetics service—as a practicing physician, as chair of the Pharmacy and Therapeutics Committee where he is responsible for the quality of the drug TARGETING UNDERREPRESENTED utilization at the hospital, and as the medical director for PATIENT GROUPS clinical information systems. Cavallari also has been instrumental in taking Galanter, with the support of teams from information pharmacogenetics research further, by helping services and the laboratory, brought the computer the UI Health System become one of the few technology behind the new warfarin service to life— centers across the country investigating how implementing the clinical decision support rules that genotyping affects the warfarin dosage level in assist physicians in their warfarin dosage decisions. These African-Americans and Hispanics, who have been clinical support rules allow the computer to automatically underrepresented in earlier research. order the warfarin genotyping lab tests and pharmacy In a 2010 study of more than 200 patients consult. The system also provides physicians with dosing from the university’s Antithrombosis Clinic, information based on available literature, even prompting Cavallari used buccal cells from mouthwash them if the dosage they prescribe is very different than samples of patients who agreed to be part the recommended dose. of the study. DNA from the buccal “The pharmacogenetics service makes cells was isolated, and genotype it more convenient for the doctor was determined first using to do the right thing for the biochemical technology patient,” he says. “It automates called the polymerase chain the process so there is less reaction and then different chance for error. The new forms of sequencing genotyping service is to map the chemical completely transparent building blocks within to the patient, but the DNA, using it allows for a more technology in her accurate dosage rate laboratory and and should reduce the UI Research complications for Resources Center. the patient. It’s a Using these data, win-win from both Cavallari was the the patient’s and first to describe an physician’s points of association between view.” a variant of the Galanter notes CYP2C9 gene, which that the University of occurs very commonly in Illinois Hospital & Health African-Americans, and the Sciences System has a long ro lP fe a need for lower warfarin dose tradition of using technology ss ic or li n requirements. “We are working C to improve the utilization of of , Ph scu arm e toward adding this CYP2C9 variant t medication. “If a physician orders Nu acy P r a c t i c e , a n d Ed i t h to the hospital’s warfarin genotyping a medication which shouldn’t be given service within the next year,” she says. to a particular patient for a variety of reasons Cavallari also is researching another gene that could —allergy, kidney function, or a change in lab results — have implications for lower warfarin dosing requirements the computer will prompt the doctor,” he says. “We use for Hispanics. computer technology to help reduce medication errors.” of
Photos: Lloyd DeGrane
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THE FUTURE OF ILLINOIS PHARMACOGENETICS The warfarin genotyping service is the first time that the particular genetic predisposition of the patient comes into play in individualized care at UI Health, but it won’t be the last. “We wanted to build the system in such a way that it is scalable to other genetic markers and other medications,” says Galanter. In fact, genetic testing for clopidogrel (Plavix), a drug for patients who have heart disease or stents, also was recently introduced as part of the health system’s genotyping service. “We’re continuing to expand our genotyping services as well as our research, focusing on how gene variants might affect optimal prescription dosages, particularly in underrepresented populations,” says Cavallari. “Our goal is to improve the safety and effectiveness of drug therapy based on a patient’s individual characteristics. At the University of Illinois Hospital & Health Sciences System, we’re working to improve disease management through a better understanding of genetics.”
KORITZ: GENOTYPING THE LATEST BREAKTHROUGH IN THE UI HEALTH SYSTEM’S STRONG TRANSLATIONAL HISTORY – ALICE PATENAUDE
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After completing his residency in anesthesiology at the University of Iowa, Koritz wanted to return to his Illinois roots. He settled in Rockford where he has been a staff anesthesiologist at Rockford Memorial Hospital since 1994. He also served as a clinical assistant professor for UI’s College of Medicine for 15 years until he was named to the Board of Trustees by Governor Pat Quinn in 2009. “I have taken care of patients who suffered from a warfarin overdose,” Koritz says. “Genotyping provides physicians with a better idea of how patients metabolize the drug so they s can more effectively tailor their therapy. Using pharmacogenetics offers fewer deleterious results and a quicker achievement of the therapeutic levels of the drug.”
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Taking science from the research lab and translating it to practical applications used in patient care is what sets the University of Illinois Hospital & Health Sciences System apart. “From bench to beside, providing greater patient safety and better patient outcomes is what the University of Illinois is all about,” says Timothy Koritz, MD, PhD, an anesthesiologist and member of the university’s Board of Trustees. “The new Warfarin Pharmacogenetics Consult Service is a great example of how high-tech science can improve patient care.” As the only physician on the 13-member board and chair of its Healthcare System Committee, Koritz reviews initiatives related to the medical enterprise of the university. That’s a tall order considering the health sciences colleges, medical school and medical center constitute almost 25 percent of the university’s more than $5 billion budget. A Rochelle, Ill., native, Koritz’s commitment to the university is a family tradition that began with his grandfather and now spans four generations. He received his bachelor’s degree in biology from the University of Illinois in 1978, and now three of his four daughters carry on the Illinois tradition, with one waiting to wear orange and blue. After winning a distinguished Marshall Scholarship, Koritz attended Cambridge University for his PhD in immunology before completing his medical degree at Harvard University in 1987 on an Air Force scholarship. He then served almost four years in the Air Force, in charge of the Space Shuttle Emergency Medical Response Team at its alternate landing site in Holloman, N.M.
OUR RESEARCH ISN’T JUST GROUNDBREAKING.
IT’S LIFE CHANGING. At the University of Illinois Hospital & Health Sciences System we’re doing ground breaking research to find life changing results. Combining some of the best doctors in the state with the latest research and technology, we’re blazing a new path to better care for the people of Illinois. With a Neurosurgery program that has treated the most brain aneurysms in the state and a transplant program with some of the best outcomes in Chicago, UI Health is striving to revolutionize patient care with a simple notion: greater research for the greater good. It’s another way we’re changing medicine. For good.
FIND OUT MORE AT HOSPITAL.UILLINOIS.EDU
ASPIRATIONS A MILE HIGH FOR MILE SQUARE TO REDUCE HEALTH DISPARITIES By Kevin McKeough Mile Square Health Center has been part of the University of Illinois Hospital & Health Sciences System for more than two decades, and it never has been more important to UI Health’s mission than it is now. Mile Square is playing a critical role in the health system’s increased commitment to addressing health care disparities and providing care for the underserved. The center also is a central part of UI Health’s ability to adapt to the increased importance of community-based primary care sites brought about by health care reform. These are major responsibilities, and Mile Square is going through a period of rapid growth and expansion to meet them. In 2013, Mile Square will move its main clinic from its longtime location about a mile northwest of the University of
Illinois’ Chicago campus into a newly constructed facility at the southwest intersection of Wood Street and Roosevelt Road. The new facility will thus serve as a gateway to the University’s health science campus while providing enhanced access to specialty patient care services that will be just two blocks away. Mile Square also recently took over operations of a clinic in the South Side Englewood neighborhood from the City of Chicago. In addition, the center’s school-based program has added a new clinic in each of the past two years and has aspirations to continue adding one a year. Finally, a Mile Square program that provides care for the chronically mentally ill expanded this past year as well.
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No wonder that Henry Taylor, MPA, the center’s executive director, says “Mile Square today has an immense impact in providing access to care for the citizens of Chicago.” The opening of the Mile Square’s new clinic will mark a milestone for the University of Illinois: It will be the first major new clinical facility opened by the university since UI Health’s Outpatient Care Center opened in 1999. The center will occupy the first two floors of a five-story building that it will share with other University programs. The $22 million budget for Mile Square’s portion of the $44 million project will come from $12 million in federal funding, a $7 million commitment from the office of Joe G.N. “Skip” Garcia, MD, UI Health’s vice president for health affairs, and a loan for the balance from U of I. The first floor will include an urgent care center that will help address the tendency of people with public or no insurance to seek out emergency rooms when they need care. The new facility also will enhance and expand Mile Square’s patient care services; providing enhanced imaging capabilities, including mammography, state-of-the-art pharmacy services, and an onsite medical laboratory that will speed the time it takes to provide the results of patients’ medical tests. The location also will facilitate collaboration with community-based research programs that are expected to be housed in the building. In addition, the closer proximity to UI Health’s primary location will enhance Mile Square’s integration with the university, making it easier to utilize the resources of the UI Health System. “It’s a new frontier for us. There’s such expertise on campus that can help us address health issues,” Taylor says. The new clinic and the expansion of Mile Square’s community-based programs will further the center’s already broad reach. During its current fiscal year, Mile Square will provide care for an estimated 75,000 patients, many of them with incomes below the federal poverty level. The majority of the center’s patients are on public insurance or are uninsured, but the center provides care on a sliding fee basis, including free care in many cases. “The communities we serve tend to be some of the most economically challenged in the city of Chicago, have medical health issues that are challenging as well, and have some of the worst health outcomes in the city,” Taylor says. “We have a commitment to be part of a solution to providing patients with access,” Taylor continues. “We feel that having our clinic in these communities can help beat some of those ills.” “You can walk into that building and get help and not get turned away because of your lack of finances, your lack of insurance,” says Gloria Riley, one of the patients who make up more than half of Mile Square’s board of directors. “No one should be turned away, and we don’t turn people away.” A resident of the Austin neighborhood on Chicago’s Far South Side, Riley, 51, first sought out Mile Square for health care services almost 20 years ago, when she was unemployed and
didn’t have insurance. She received prenatal and postnatal care surrounding the birth of the youngest of her four children, now 17, and while she now has insurance through her job as an accountant, Riley continues to receive her primary care at the center. She’s among the growing number of patients from throughout Chicago who seek out Mile Square for care. “One of the reasons we’re expanding to all these satellite offices is because so many people were coming to Mile Square from other areas,” Riley observes. In addition to primary care services such as checkups and immunizations, Mile Square efforts also include disease prevention and health promotion. The center’s staff even helps patients find and contact social service providers for assistance with housing and other needs. The center does all that on an annual budget of $24 million and a staff of about 150, which includes physicians in family medicine, obstetrics and gynecology, pediatrics, midwives, psychiatrists and advanced practice nurses. Mile Square is furthering its effort to address issues away from campus as well. In July, the center took over the operation of the Englewood clinic, providing services to a socio-economically devastated community with some of the worst health outcomes in the city. “Because we recognize the importance of being in the community, we chose to expand Mile Square into Englewood,” Garcia says. “I have a lot of patients that feel the University of Illinois has a very good reputation, and they are very happy to be getting services and being connected to that system,” says Carla Burdock, APN, a certified nurse midwife in the department of obstetrics and gynecology, who works at the Englewood clinic.
This addition brings the number of Mile Square clinics (accessible to the general public) to five, including the Washington Street headquarters, clinics in the Back of the Yards and South Shore neighborhoods on the South Side, and one in the Near West suburb of Cicero, which recently became fully staffed. Further extending Mile Square’s reach, the center operates four clinics located in schools in high-need communities, including one that opened this past year in the Brighton Park neighborhood on the Southwest Side. Two more clinics are planned to open in the next two years.
Staffed by advanced practice nurses who are abetted by a social worker or psychologist at each facility, the program provides care both for the schools’ students and adult members of the surrounding communities, receiving about 5,700 visits annually. “They provide a way to reach the hardest-to-reach kids that often were of disparate health but not connected to a care provider,” says Cynthia Barnes-Boyd , PhD, director of the
UI Health’s Neighborhoods Initiative that oversees the program. “The ones with chronic disease might be out of school often if we didn’t provide care. There also are many families that don’t go anywhere for health care, but they do come to get their kids. It’s a way for us to reach them as well.” Mile Square employs a similar strategy to reach another highneeds population, providing care for people with chronic mental illness by situating two primary care clinics in facilities run by Thresholds, Illinois’ largest provider of mental health services. In April Mile Square also opened a psychiatric care clinic in a South Side Thresholds site at 47th and Halsted streets that also houses one of the primary care clinics. “We know that the life span for people with serious chronic mental illness is anywhere from 20-25 years shorter than the general public, due to complications from some of their medications that can lead to diabetes and cardiovascular health problems,” says Emily Brigell, MS, RN, director of Integrated Health Care in the College of Nursing, who oversees the clinics. “The causes of death are very preventable, but this population has problems accessing care due to the many complex challenges they face, including lack of financial resources, transportation and just support in their life.” From the Brighton Park School to the Thresholds site to the Englewood clinic, Mile Square’s recent, rapid expansion parallels UI Health’s renewed commitment to providing health care to Chicago’s underserved communities. “Dr. Garcia has made it very plain that caring for the underserved is the business of the University of Illinois Hospital & Health Sciences System. Mile Square has an enormous role to play in that regard,” Taylor says. “The opportunity is for the university to lead the way and be a model in the country for other institutions.”
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RESEARCH ACROSS THE HEALTH SYSTEM UNDERSTANDING AFRICANAMERICAN MENâ€™S INCREASED RISK FOR PROSTATE CANCER Rick Kittles, PhD, associate professor of medicine and epidemiology and biostatistics, examined genetic predictors of prostate cancer. Prostate cancer affects men of color disproportionately
and by level of education. The life expectancy of men and women with fewer than 12 years of education was similar to the life expectancy of adults in the 1950s, and this lowered life expectancy was particularly pronounced when race and education were combined. Although the life expectancy of Hispanics and African-Americans has risen, African-Americans still do not live as long as whites and Hispanics. White women with no high school diploma had the steepest decline in life expectancy. These findings highlight a troubling relationship between education and health and the significant role that social issues play in the persistence of health disparities.
FAMILY FACTORS AND CIRCUMCISION IN KENYA A recent article by researchers from obstetrics & gynecology (Sherry Nordstrom, MD, & Tracy Irwin, MD, MPH) and the School of Public Health (Marisa Young, BA, & Robert Bailey, PhD, MPH), in collaboration with colleagues from Kisumu, Kenya, was highlighted in the New York Times in June 2012. The researchers examined parental attitudes and decision-making related to infant male circumcision among parents in Kisumu. IMC has been shown to reduce male to female HIV transmission in Africa, highlighting the value of understanding the factors that influence the decisionmaking process. The decision to circumcise a male infant was largely influenced by whether the father was himself circumcised and if both parents agreed to the procedure. If parents disagreed about whether to do the procedure, the procedure was
OVARIAN CANCER LINKED TO OVULATION
in terms of both incidence and mortality. Previous research has suggested genetic risk factors for European-Americans; the finding of the risk factor has not been replicated among African-Americans. Using fine-mapping and larger samples of African-American men than previous research, Kittles and his colleagues found that prostate cancer among African-American men is associated with polymorphisms of the IL16 gene. Although more research is needed, this study demonstrates that IL16 polymorphisms play a role in AfricanAmerican menâ€™s susceptibility to prostate cancer.
LOWER LEVELS OF EDUCATION RELATED TO DECREASED LIFESPAN Research by S. Jay Olshansky, PhD, professor of public health, was recently featured in the New York Times in September 2012. Olshansky found significant disparities in life expectancy among racial groups
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Joanna Burdette, PhD, from the University of Illinois College of Pharmacy and a member of the University of Illinois Cancer Center, is analyzing whether ovarian cancer is potentially linked to ovulation. Burdette is investigating whether ovulation increases a signaling pathway that transforms the cells of the ovary surface or the lining of the fallopian tubes, and turns the cells into cancer. Burdette is focusing on Akt (protein kinase B)
typically not undertaken, irrespective of whether it was the mother or father who disagreed. Understanding how decisions are made can help with targeted interventions and education aimed at decreasing HIV transmission through IMC in sub-Saharan Africa.
TAILORING ANTIBIOTIC DOSAGES FOR PREGNANT WOMEN because it is the most frequently activated pathway in ovarian cancer. Akt is also involved in ovulation; the gene that produces Akt responds to oxidative stress or the hormones that trigger ovulation. Burdette has received an American Cancer Society of Illinois grant to fund her investigation.
The New York Times highlighted a new study by James Fischer, PharmD, professor of pharmacy practice and executive IRB chair at the University of Illinois. Fischer found that the correct dose of antibiotics in pregnancy may differ for AfricanAmerican women as compared to other women. After a five-day course of antibiotics, Fischer and his
colleagues examined blood levels of azithromycin among 53 pregnant and 25 nonpregnant women. Regardless of whether the African-American women in the study were pregnant or not, their blood levels of azithromycin were the same. Caucasian, Asian, Hispanic and Pacific Islander pregnant women eliminated the antibiotic more slowly than did nonpregnant women. Because azithromycin is one of the safest antibiotics, it is commonly used during pregnancy and is typically administered at the same dosages for pregnant women as other adults. This study suggests, however, AfricanAmerican women may need different dosages in order to fight infections during pregnancy.
CAUSES OF TOOTH BREAKAGE
Image Copyright Istvan Csak and Oleg Zabielin, 2012. Used under license from Shutterstock.com
Robert Druzinsky, PhD, of the University of Illinois College of Dentistry, has been examining the etiology of tooth breakage. Although much research on tooth breakage has focused on the enamel, Druzinsky is taking a novel approach by focusing on the underlying dentin. To study this, Druzinsky has been going to the Weizmann Institute of Science in
Israel to study mice who were bred to develop enamel on the tongue side of the tooth. Understanding what leads to tooth breakage can help ascertain ways to restore teeth and to prevent them from breaking in the first place.
ENZYME RELATED TO CANCER CELL SURVIVAL Nissim Hay, PhD, College of Medicine professor and member of the University of Illinois Cancer Center, and his colleagues recently published an article in Nature investigating how AMP-activated protein kinase inhibits cancer cell growth. Although previous research has shown that AMPK inhibits cancer cell growth in culture, Hay and his colleagues found that when AMPK is under metabolic stress, it is activated to promote cell survival and prevent cell death. Thus, AMPK is integral to the survival of cancer
cells. Although these findings seem to contradict previous research, it is clear that AMPK is still a promising target for chemotherapy. However, the protective effects of AMPK would need to be blocked in order for chemotherapy to be successful.
COMMUNITY OUTREACH AND RESEARCH TO REDUCE HIV TRANSMISSION AND INTRAVENOUS DRUG USE The University of Illinoisâ€™ School of Public Healthâ€™s Community Outreach Intervention Projects is a unique program that combines community outreach and cutting-edge research in reducing the transmission of HIV/ AIDS. The program, headed by Geri Donenberg, PhD, professor in the UI Department of Psychiatry, trains people from the community to do outreach in communities like Englewood, Humboldt Park and Austin. In a recent study by the group, the mental health of young injection drug users recruited from the Chicagoland community was the focus; most research on drug use and comorbid psychiatric disorders is conducted among inpatients. COIP researchers found that young IDUs had higher rates of depression, alcohol dependence, antisocial personality disorder and borderline personality disorder than the general public. These findings help understand both the treatment needs of young injection drug users, and also helps to shape outreach and intervention efforts.
FINDING TREATMENTS FOR GULF WAR SYNDROME Steve Lasley, PhD, assistant head of the department of cancer biology & pharmacology at the University of Illinois College of Medicine in Peoria, is studying the effects of Gulf War syndrome. He estimates that onequarter of all veterans from the Gulf War returned from combat with the
disorder. The etiology of Gulf War syndrome is currently thought to be related to the combined effects of anti-nerve gas, insect repellent and the stress of war. Lasley will use a mouse model to investigate the effects of anti-nerve gas combined with pesticides with the overarching goal to support the development of medications to treat the disorder.
PATIENT NAVIGATORS TO REDUCE CANCER DISPARITIES AMONG UNDERSERVED WOMEN Researchers at the Institute for Health Policy & Research Julie Darnell, PhD, and Elizabeth Calhoun, PhD (who are also both faculty in the School of Public Health), evaluated the effectiveness of a patient navigation program for
underserved, urban women in Chicago who have abnormal findings on breast or cervical cancer screenings. Women in the study who had a patient navigator (a trained staff member who supports and assists patients with navigating appointments and treatments) were more likely to have a shorter time to diagnostic resolution than women with no navigator. This decreased time to diagnostic resolution was particularly pronounced among women in the breast cancer navigator group. These findings suggest that using patient navigators for underserved women may help decrease barriers to care in order to reduce health disparities in the morbidity and mortality of breast and cervical cancer.
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SOCIETY’S MOST VULNERABLE PATIENTS STILL DESERVE THE BEST CARE WE CAN OFFER By Patricia W. Finn, MD Dr. Patricia W. Finn is professor and chair of the department of medicine in the College of Medicine at the University of Illinois Hospital & Health Sciences System.
Since I became chair of the department of medicine in February 2012, the question I have been asked most often is: Why did you move from sunny San Diego, where I was a professor of medicine at the University of California, to Chicago, a city known to have incredibly harsh winters? My answer: the absolutely unique mission of the University of Illinois Hospital & Health Sciences System. We have a commitment to serve everyone—regardless of gender, race, ethnicity, or economic status—with the highest level of medical care. Some share that commitment to community service, but here at the University of Illinois we go one step further by declaring the elimination of racial and ethnic health disparities as central to our mission. Academic medical institutions always have a three-part mission: patient care, education and scholarly activities. But at the University of Illinois, we have a fourth part: our commitment to serving the most vulnerable members of our society. In this tight economic climate, many academic institutions are stepping away from that responsibility. We are not. We are here to serve our people—a population that is one-third white, one-third Latino and one-third AfricanAmerican. I grew up in New York City as the daughter of Irish immigrants. When my siblings or I needed medical care, we relied on the public health care system. That is part of the reason why I wanted to become a doctor and why our mission here is very compelling to me. At the end of the day, I think it even trumps 365 days a year of sunshine. In the department of medicine on the Chicago campus, it is our job to foster opportunities for the next generation of doctors. Quite honestly, we must always be looking for our
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replacements. The 204 members of our faculty are responsible for educating the medical students and training the residents as well as the fellows, who are pursuing advanced training in 12 subspecialties of medicine, such as cardiology, digestive diseases and nutrition, and infectious diseases. All of our subspecialties, or sections, have robust research programs led by experienced investigators, including both physicians and scientists. For example, I am an immunologist and pulmonologist. I run my own laboratory. I want to help uncover the role that our immune system plays in the development of lung diseases, such as asthma and chronic obstructive pulmonary disease. I discovered this type of work quite unexpectedly during my residency training in internal medicine. One of my patients had idiopathic pulmonary fibrosis—a very debilitating lung
We are here to serve our community disease. I felt compelled to find out more about this disease, which led to courses in immunology and training in a basic science lab. Clearly, our students have many avenues in medicine to explore. I want them to recognize that pursuing a career in this field may not always follow a straight path. Sometimes you veer off course to find your passion. In my role as a professor, I give a lecture on academic medicine and why it is a great career choice: you take care of patients, train the next generation and discover solutions to some of medicine’s most pressing problems. All of these roles are geared toward improving health care for everyone, particularly the most vulnerable.
This is a job with great personal satisfaction. This is what I love. This is my passion.
FIRST BEST MOST
FIRST University of Illinois Hospital & Health Sciences System surgeons became the first to simultaneously perform a robotic kidney transplant and sleeve gastrectomy.
BEST The College of Applied Health Sciences has the No. 1 ranked (by US News & World Report) occupational therapy program at any public university in the nation.
MOST The College of Dentistry serves as the largest dental Medicaid provider in the state of Illinois, providing approximately 40,000 appointments to patients enrolled in the state dental Medicaid program.
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