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McCullough P.A.,Heart Health | Brown W.W.,Jesse Brown Veterans Administration Medical Center | Gannon M.R.,National Kidney Foundation | Vassalotti J.A.,National Kidney Foundation | And 6 more authors.
American Journal of Kidney Diseases | Year: 2011

KEEP clearly shows that targeted screening for kidney disease has a high yield for identifying people in the community at increased risk and detecting individuals with decreased kidney function. More importantly, KEEP is a screening and awareness program for the common soil of major chronic conditions, including obesity, diabetes, hypertension, CKD, and cardiovascular disease. The importance of early intervention in these chronic disease states has gained widespread recognition, helping KEEP grow in the past decade into an international program. Additionally, the versatility of the KEEP database enables researchers to work with the KEEP Steering Committee to conduct population-based epidemiologic analyses. From this information, the NKF and the global public health community can identify the need for future educational programs and match content to specific target audiences. The goal of KEEP is not just to identify and measure illness parameters, but also to increase awareness of kidney disease risk and complications in physicians and patients to optimally influence care measures and clinical outcomes. The model for KEEP has emphasized volunteerism, community involvement, simplicity, multidisciplinary oversight, attention to safety, assiduous results reporting, repeated follow-up, and continuous improvement. These tenets, coupled with a focus on primary prevention, have produced the nation's only sustainable chronic disease screening program, which serves as a model for other national and global attempts aimed at controlling chronic illness. © 2011 by the National Kidney Foundation, Inc.

Kuzmis A.,University of Illinois at Chicago | Lim S.B.,University of Illinois at Chicago | Desai E.,University of Illinois at Chicago | Jeon E.,University of Illinois at Chicago | And 4 more authors.
Nanomedicine: Nanotechnology, Biology, and Medicine | Year: 2011

Human neuropeptide Y (NPY) is an important biologics that regulates a multitude of physiological functions and could be amenable to therapeutic manipulations in certain disease states. However, rapid (within minutes) enzymatic degradation and inactivation of NPY precludes its development as a drug. Accordingly, we determined whether self-association of NPY with biocompatible and biodegradable sterically stabilized phospholipid micelles (SSM) improves its stability and bioactivity. We found that in saline NPY spontaneously aggregates; however, in the presence of SSM it self-associates with the micelles as monomers. Three NPY molecules self-associate with 1 SSM at saturation. This process stabilizes the peptide in α-helix conformation, abrogates its degradation by dipeptidyl peptidase-4 and potentiates NPY-induced inhibition of cAMP elaboration in SK-N-MC cells. Collectively, these data indicate that self-association of NPY with SSM stabilizes and protects the peptide in active monomeric conformation, thereby amplifying its bioactivity in vitro. We propose further development of NPY in SSM as a novel, long-acting nanomedicine. © 2011 Elsevier Inc.

Menon U.,Arizona State University | Belue R.,Pennsylvania State University | Wahab S.,Portland State University | Rugen K.,Jesse Brown Veterans Administration Medical Center | And 4 more authors.
Annals of Behavioral Medicine | Year: 2011

Background Early-stage diagnosis of colorectal cancer is associated with high survival rates; screening prevalence, however, remains suboptimal. Purpose This study seeks to test the hypothesis that participants receiving telephone-based tailored education or motivational interviewing had higher colorectal cancer screening completion rates compared to usual care. Methods Primary care patients not adherent with colorectal cancer screening and with no personal or family history of cancer (n=515) were assigned by block randomization to control (n=169), tailored education (n=168), or motivational interview (n=178). The response rate was 70%; attrition was 24%. Results Highest screening occurred in the tailored education group (23.8%, p<.02); participants had 2.2 times the odds of completing a post-intervention colorectal cancer screening than did the control group (AOR=2.2, CI=1.2-4.0). Motivational interviewing was not associated with significant increase in post-intervention screening. Conclusions Tailored education showed promise as a feasible strategy to increase colorectal cancer screening. © The Society of Behavioral Medicine 2011.

Schwartz A.,University of Illinois at Chicago | Weiner S.J.,University of Illinois at Chicago | Weiner S.J.,Jesse Brown Veterans Administration Medical Center | Harris I.B.,University of Illinois at Chicago | Binns-Calvey A.,University of Illinois at Chicago
JAMA - Journal of the American Medical Association | Year: 2010

Context: A contextual error occurs when a physician does not identify elements of a patient's environment or behavior, such as access to care, that must be addressed to appropriately plan care. Research has demonstrated that contextual errors can be identified using standardized patients. Objective: To evaluate an educational intervention designed to increase physicians' skills in incorporating the patient's context in assessment and management of care and to thereby decrease the rate of contextual errors. Design, Setting, and Participants: Quasi-randomized controlled trial, with assessments by blinded observers. Fourth-year medical students (n=124) in internal medicine subinternships at the University of Illinois at Chicago or Jesse Brown Veterans Administration Medical Center between July 2008 and April 2009 and between August 2009 and April 2010 participated and were assessed. Intervention: A 4-hour course on contextualization. Main Outcome Measures: Probing for contextual issues in an encounter, probing for medical issues in an encounter, and developing an appropriate treatment plan. Outcomes were assessed using 4 previously validated standardized patient encounters performed by each participant and were adjusted for subinternship site, academic year, time of year, and case scenario. Results: Students who participated in the contextualization workshops were significantly more likely to probe for contextual issues in the standardized patient encounters than students who did not (90% [95% confidence interval {CI}, 87%-94% ] vs 62% [95% CI, 54%-69%], respectively) and significantly more likely to develop appropriate treatment plans for standardized patients with contextual issues (69% [95% CI, 57%-81%] vs 22% [95% CI, 12%-32%]. There was no difference between the groups in the rate of probing for medical issues (80% [95% CI, 75%-85%] vs 81% [95% CI, 76%-86%]) or developing appropriate treatment plans for standardized patients with medical issues (54% [95% CI, 42%-67%] vs 66% [95% CI, 53%-79%]). Conclusion: Medical students who underwent an educational intervention were more likely to contextualize care for individual standardized patients. ©2010 American Medical Association. All rights reserved.

Kessler C.S.,University of Illinois at Chicago | Kessler C.S.,Jesse Brown Veterans Administration Medical Center | McGuinn M.,University of Illinois at Chicago | McGuinn M.,Jesse Brown Veterans Administration Medical Center | And 4 more authors.
American Journal of Infection Control | Year: 2011

Background: It has been estimated that more than 8 million health care workers (HCWs) in the United States may be exposed to blood and body fluids via sharp and mucocutaneous exposures. Methods: An anonymous questionnaire was distributed among 505 HCWs. The target sample population included all the medical students; nursing professionals; dental professionals; and residents in internal medicine, emergency medicine, surgery, and obstetrics and gynecology at the University of Illinois Medical Center, Chicago, Illinois, a metropolitan tertiary care and referral center for Northern Illinois and Northwest Indiana. The sample was limited by the number of HCWs who were available to take the survey. The number and the characteristics of occupational exposures and reporting practices were recorded and compiled. Subsequently, a review of the English literature was performed using PubMed to analyze reasons for underreporting. Secondary and tertiary articles were located based on findings from the initial searches. Results: One hundred three of 455 (22.6%) HCWs reported a sharps exposure during their career, including their student years; thirty-four (33.0%) of these were not reported. One hundred five of 455 (23.1%) HCWs reported a mucocutaneous exposure during their career; 87 (82.9%) of these were not reported. The most common year of exposure was the intern year. The most common reason for not reporting was the belief that the exposure was not significant, followed by the combination of believing the exposure was not significant and being too busy. Conclusion: Underreporting of blood and body fluid exposures is common because of a belief that most exposures are not significant. More education of HCWs is needed to change this perspective.

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