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Featured researches published by Borko Jovanovic.


Burns | 1995

Nosocomial infections in a burn intensive care unit

Rebecca Wurtz; M. Karajovic; E. Dacumos; Borko Jovanovic; Marella Hanumadass

Although many studies have reviewed burn wound infections (BWIs) in burn patients, few have prospectively surveyed other nosocomial infections. Seriously burned patients are clearly at increased risk for infection due to the nature of the burn injury itself, immunocompromising effects of burn injury, prolonged hospital stays, and invasive diagnostic and therapeutic procedures. Over 6 months, we prospectively reviewed all patients admitted to our burn intensive care unit (BICU) for nosocomial infections. We used standard CDC definitions of nosocomial infections (NIs). Because we had previously documented a high incidence of nosocomial pneumonias in these patients, we were particularly interested in determining risk factors for nosocomial pneumonia. The total census during the study period was 57. There were 40 discharges and deaths. Surveillance demonstrated 36 nosocomial infections in 26 patients, for a total of 90 nosocomial infections per 100 discharges and deaths, or 32.3 NIs/1000 patient days. Infections included 22 pneumonias, 10 urinary tract infections, two bacteraemias, one BWI and one episode of cellulitis. Intubation was strongly associated with nosocomial infection, particularly with pneumonia, BWI and bacteraemia. Sixty per cent of all patients were intubated at some time during their BICU stay, but 88 per cent of those who developed a nosocomial infection were intubated (P < 0.001). Inhalation injury was less significant than intubation in the development of nosocomial infection. All patients who developed pneumonia or a BWI were intubated.(ABSTRACT TRUNCATED AT 250 WORDS)


Journal of Acquired Immune Deficiency Syndromes | 1996

Risk behavior and HIV seroincidence among out-of-treatment injection drug users : A four-year prospective study

Wayne Wiebel; Antonio D. Jimenez; Wendell A. Johnson; Lawrence J. Ouellet; Borko Jovanovic; Thomas M. Lampinen; James Murray; Mary Utne O'Brien

We monitored trends in HIV risk behaviors and seroconversion among out-of-treatment injection drug users (IDUs) receiving street-based outreach intervention. Beginning in 1988, 641 HIV-seronegative IDUs were recruited by targeted sampling methods to reflect broader IDU populations and were followed for 4 years (1988-1992). All were active injectors not in treatment when recruited. Cohort members were targets of HIV-prevention outreach. The intervention was guided by the Indigenous Leader Outreach Model: Exaddicts deliver HIV-prevention services targeting IDU social networks in community settings. Primary outcome measures were HIV seroconversion and HIV risk behaviors. Observed incidence of HIV infection decreased, from 8.4 to 2.4 per 100 person-years. Prevalence of drug risk behaviors also decreased, from 100 to 14%. Seroconversion was associated with injection risk behavior [risk ratio (RR) = 9.8]. Sex risk behavior also decreased, but less dramatically, from 71 to 45%. Out-of-treatment IDUs in Chicago have reduced their rates of new HIV infection by reducing their injection risk behavior. New infections were strongly associated with injection risk behavior but not with sex risk behavior.


Journal of Clinical Epidemiology | 1998

Prediction of relapse within eight weeks after an acute asthma exacerbation in adults

Madeline McCarren; Michael F. McDermott; Robert J. Zalenski; Borko Jovanovic; David Marder; Daniel G. Murphy; Linda M. Kampe; Virginia M. Misiewicz; Robert J. Rydman

Associations between historical, presenting, and treatment-related characteristics and relapse within 8 weeks after a moderate to severe asthma exacerbation were studied in a cohort of 284 adult asthmatics. Data were collected prospectively, and a multivariate model was developed and internally validated. Within 10 days, only 8% had relapsed, increasing to 45% by 8 weeks. Three variables that could be identified at the time of discharge were independently associated with relapse. These included: having made three or more visits to an emergency department in the prior 6 months (hazard ratio (HR) = 2.3, 95% CI = 1.6-3.4); difficulty performing work or activities as a result of physical health in the 4 weeks prior (HR = 2.7, 95% CI = 1.6-4.3); discontinuing hospital-based treatment for the exacerbation within 24 hours without having achieved a peak expiratory flow rate of at least 50% of predicted (HR = 2.6, 95% CI = 1.6-4.1). These risk factors may help to identify patients with poorly controlled asthma in need of more intensive and comprehensive management.


American Journal of Infection Control | 1994

Handwashing machines, handwashing compliance, and potential for cross-contamination

Rebecca Wurtz; Gloria Moye; Borko Jovanovic

Although handwashing is considered an important factor in the prevention of nosocomial infections, the optimal technique has not been determined and compliance is often difficult to obtain. Handwashing compliance is particularly important in intensive care areas of the hospital. In an effort to improve HW compliance, the surgical intensive care unit in our hospital purchased three handwashing machines. Four months after installation of the handwashing machines, an outbreak of methicillin-resistant Staphylococcus aureus occurred in the intensive care unit. As part of evaluating the outbreak, we cultured the handwashing machines, including the portholes and the paper towel dispenser. Cultures were positive for methicillin-resistant Staphylococcus epidermidis, Achromobacter species, and Streptococcus viridans. The design of the handwashing machines made contamination of sleeves and already-washed hands possible. An observational study revealed that handwashing compliance was poor but improved from 22% to 38% when the handwashing machines were in use. Nurses preferred handwashing at the sink and physicians preferred the handwashing machine. Handwashing machines may increase handwashing compliance because of their novelty, but they may also result in novel problems.


Surgery | 1999

Long-term outcome of a prospective trial of steroid withdrawal after kidney transplantation

Ty B. Dunn; Massimo Asolati; Dawn M. Holman; Vandad Raofi; Borko Jovanovic; Raymond Pollak; Enrico Benedetti

BACKGROUND Steroid withdrawal (SW) after kidney transplantation is desirable to avoid associated serious side effects. We studied the long-term outcome of a group of kidney transplant recipients who underwent SW. METHODS Between 1991 and 1993, kidney transplant recipients (N = 12) who had posttransplantation diabetes were entered in a prospective trial of SW. These patients were compared with a demographically similar comparison cohort (N = 66). End points of the study were patient and graft survival, incidence of late acute and chronic rejection, and changes in diabetes management. RESULTS Previously published data from the SW group at 15 months of follow-up indicated improvement in diabetes control without any adverse effect on patient or graft actuarial survival. At long-term follow-up (mean, 56 months) the improvement in diabetes management was not detectable. The incidence of late acute rejection in SW and cohort groups was 42% and 8%, respectively (P = .006). Likewise, the incidence of chronic rejection in the SW versus cohort group was 42% and 12%, respectively (P = .014). CONCLUSIONS Although SW appeared to be successful initially, our long-term data indicate that SW significantly increases the risk of late acute rejection and chronic rejection episodes without benefits in posttransplantation diabetes management. Steroid withdrawal in patients with posttransplantation diabetes should be approached with caution.


Journal of health and social policy | 2002

Leadership/citizen participation: perceived impact of advocacy activities by people with physical disabilities on access to health care, attendant care and social services.

Elaine T. Jurkowski; Borko Jovanovic; Louis Rowitz

Abstract Increasingly, the climate of shrinking health care resources will impact access to health care for the people most vulnerable- those with disabilities. This study looked at the perceived impact of leadership and participation by people with physical disabilities and at their ability to gain increased access to health care, attendant care and social services. Respondents were randomly selected from Canada and the United States, from a pool of participants with physical disabilities serving in leadership roles within disability organizations in either country. Responses from a mail-out survey questionnaire were tabulated using logistic regression procedures to identify the perceived impact of advocacy activity on improved access to health care, attendant care and social services. Findings suggest that those who participated in advocacy activities were significantly more likely to feel that their action improved access to health care resources, attendant care resources and social services. Advocates also perceived the impact of access for their family, local organizations, and at a regional/national level. This study highlights the value of consumer/citizen participation, and the vital role this action can play in collaboration with social work professionals for system changes, health resource planning and policy development.


Infection Control and Hospital Epidemiology | 1994

REAL AND APPARENT TUBERCULIN SKIN TEST CONVERSIONS IN A GROUP OF MEDICAL STUDENTS

Rebecca Wurtz; Jose Fernandez; Borko Jovanovic

OBJECTIVE To evaluate tuberculin skin test (TST) conversions among a group of medical students. DESIGN Questionnaire sent to a medical school class in whom a cluster of TST conversions was noted, and interview and repeat TST of students with conversion. SETTING County hospital and associated medical school. SUBJECTS Medical students, after their third year in medical school. RESULTS Of 165 students in the class, 115 (70%) responded; 10 reported TST conversions between the beginning of the third and the fourth year. Seven of 10 were interviewed, and all 10 were retested. Five students, all in a cohort who tested each other during a clinical clerkship with a tuberculin material previously reported to be associated with a high rate of false-positive TSTs, were TST negative on repeat. Five had persistently positive TSTs. One was exposed during a psychiatry clerkship to a resident with pulmonary tuberculosis. Four students appeared to have converted their TST during their third year in medical school. All four did their medicine clerkship at a large county hospital (P < 0.02; odds ratio = 16.4) that had few infection control measures in place for tuberculosis isolation during the time of their exposure. CONCLUSIONS We recommend that medical students, as well as other healthcare professions students, be educated about infection control practices and skin tested at least annually during clinical training years.


Nutrition Research | 1994

Nutrient density model revisited

Borko Jovanovic; Sally Freels; Faith G. Davis; Juliet VanEenwyk

Abstract One of the common obstacles in the analysis of nutrient data is the high correlation between nutrients (N) and total caloric intake (T) when used in a traditional multivariate model. This results in difficulties in separating the effect of N from the effect of T when they are simultaneously used in a statistical model. Using computer simulations and data from a case control study, we show that nutrient density N/T is weakly correlated with T even when N and T are highly correlated. As nutrient density has intuitive appeal to nutritional scientists and it is increasingly important to separate out the effect of specific nutrients from the effect of total calories on various health outcomes, the multivariate nutrient density model which includes both N/T and T should be utilized more often in nutritional epidemiology.


JAMA Internal Medicine | 1997

An evaluation of a chest pain diagnostic protocol to exclude acute cardiac ischemia in the emergency department

Robert J. Zalenski; Madeline McCarren; Rebecca R. Roberts; Robert J. Rydman; Borko Jovanovic; Krishna Das; Jose Mendez; Maan El-Khadra; Lesa D. Fraker; Michael W. McDermott


JAMA Internal Medicine | 1997

A comparison between emergency diagnostic and treatment unit and inpatient care in the management of acute asthma.

Michael F. McDermott; Daniel G. Murphy; Robert J. Zalenski; Robert J. Rydman; Madeline McCarren; David Marder; Borko Jovanovic; Kulvinder Kaur; Rebecca R. Roberts; Miriam L. Isola; Edward Mensah; Rosula Rajendran; Linda M. Kampe

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Madeline McCarren

University of Illinois at Chicago

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Robert J. Rydman

University of Illinois at Chicago

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Daniel G. Murphy

University of Illinois at Chicago

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Dawn M. Holman

University of Illinois at Chicago

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Enrico Benedetti

University of Illinois at Chicago

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Herbert M. Hazelkorn

University of Illinois at Chicago

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Linda M. Kampe

Rush University Medical Center

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Michael F. McDermott

University of Illinois at Chicago

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