Mermel points out five variables in preventing the transmission of the virus to HCWs: the dynamics of disease transmission; the availability of personal protective equipment (PPE); compliance among HCWs in the use of PPE; cost of PPE; and immune status of HCWs.

He notes that in two studies, one already published and one recently presented at the Infectious Diseases Society of America Annual Meeting, researchers found no statistically significant reduction in influenza-like illness among HCWs wearing N95 respirators compared with surgical masks.

Mermel points out that there is tremendous variability in the bioaeorosols produced by influenza-infected patients. He suggests that the inability to easily identify those individuals who produce large amounts of bioaerosols (i.e., superspreaders) is “The Achilles’ heel of infection control” and he says, “Our limited understanding of such events leaves us vulnerable since we cannot predict which influenza-infected person is a superspreader.”

Mermel notes the paramount importance of source control (i.e., influenza-infected patients wearing surgical masks, as tolerated) to minimize risk of transmission to HCWs. Mermel also refers to the risk of HCW-to-HCW influenza transmission if influenza-infected HCWs work while ill.

As a physician, Mermel believes that, “Science will guide us as we care for patients infected with
H1N1 2009 but a lack of attention to our understanding of the transmission of human influenza has left us debating which procedures create influenza superspreading events, what is appropriate personal protective equipment, use of suboptimum engineered respirators that need fit testing and are poorly tolerated for prolonged use, and limited industrial capacity to meet our needs. For now, infection-control experts at each institution must weigh the variables noted to establish not only what is best, but what is realistic in reducing risk to their staff, their visitors, and their patients.”

Mermel is a past president of the Society for Healthcare Epidemiology of America.

The SDBP is an international interdisciplinary academic organization whose members are developmental-behavioral pediatricians, neurodevelopmentalists, pediatric psychologists, nurse practitioners, child psychiatrists, academic generalists and trainees in these professions with a broad range of interests across the field of developmental-behavioral pediatrics.

“Dr. High has been an integral part of our department of pediatrics for more than 15 years,” said Robert B. Klein, MD, pediatrician-in-chief at Hasbro Children’s Hospital. “Her expertise and dedication to children with developmental and behavioral issues make her a natural choice to lead the Society of Developmental and Behavioral Pediatrics.”

High, of Providence, has been a member of the SDBP since 1988 and has served in various SDBP roles including member of the executive council; book review editor of the Journal of Developmental and Behavioral Pediatrics; delegate to the American Board of Pediatrics for maintenance of certification in pediatric subspecialties; chair of the Autism Special Interest Group; and liaison to the American Academy of Pediatrics section on developmental and behavioral pediatrics, among others.

“The SDBP is a tremendous resource for clinicians treating children with developmental and behavioral issues,” High said. “The organization strives to provide clinicians with the tools they need to provide the highest level of care for patients and their families. The society promotes an understanding of social, educational, and cultural influences on children. I have been involved with the society for more than two decades and am proud to lead an extraordinary group of professionals who have clearly demonstrated their commitment to their patients and to research of evidence-based practices that improve child outcomes in this field.”

High is a member of the American Academy of Pediatrics (AAP) and serves as chair of its national committee on early childhood, adoption and dependent care;. In Rhode Island, she is on the executive committee of the state chapter of the AAP; is a member of the RI Department of Health Pregnancy Risk Assessment Monitoring System steering committee; the Birth Defects Advisory Council; the RI Department of Health Successful Start developmental screening and services workgroup; Reach Out and Read Rhode Island advisory board and the Rhode Island Kids Count board of directors.

Her clinical and research interests include infant behavioral issues such as colic; sleep problems and feeding problems; literacy promotion as part of well child care; autism and developmental disorders; and the interrelationship of medical and psychological problems in childhood. She sees patients as a member of interdisciplinary teams in the Children’s Neurodevelopment Center and the Partial Hospital Program at Hasbro Children’s Hospital and at the Brown Center for the Study of Children at Risk at Women and Infants’ Hospital.

The SDBP, formed in 1982, is an interdisciplinary professional organization with more than 700 members that promotes the developmental and behavioral health of all infants, children, adolescents and their families by advancing research, education, evidence-based clinical practice and advocacy.

According to experts at Bradley Hospital, it’s common for children to feel anxious about the unknown and they will look to their parents to provide support and comfort. “Children follow their parents’ cues, so if mom or dad seem stressed or are constantly talking about how worried they are, a child will pick up on that. But if parents cope well, their child will also cope better,” says Henry T. Sachs, MD, medical director at Bradley Hospital.

The key to helping children manage their anxiety is to address and acknowledge their fears without causing alarm or panic. “Reassure your child that everyone in the family is fine and that you will all work together to stay healthy. Being calm and confident will do wonders in helping a child feel safe and secure,” says Sachs.

He suggests parents proactively ask their children what they have heard about H1N1, which will indicate whether there are any rumors or misinformation that need to be addressed. Information and knowledge can help children feel a sense of control, so parents should also be prepared to provide some simple, age-appropriate facts about H1N1.

“Younger children will need equal amounts of fact and reassurance, but older kids and teens will likely have more specific questions or may need help separating fact from fiction,” Sachs says. “Although we want to shelter our children, it’s important to be honest and accurate about the situation.”

Sachs points out that these conversations also provide a good opportunity to remind children that good hygiene – particularly frequent hand-washing and covering coughs or sneezes – is the best way to stay healthy and avoid spreading disease, including H1N1.

Other ways parents can help ease their child’s H1N1 anxiety and help them stay healthy include:

• Make sure you are up to the date on the latest information on H1N1, including symptoms, vaccinations and how the disease spreads. The RI Department of Health website, http://www.health.ri.gov/, and www.flu.gov are good resources.
• Allow your children to express their feelings and let them know it is okay to be afraid or upset. Keep in mind that when children are uncertain about situations and feel frightened, they may need even more affection and attention.
• Even if the family’s normal routine is disrupted due to school or work closures, try and keep activities as consistent and normal as possible. Children are most comfortable when they can stick with their routines.
• Encourage healthy behaviors – such as eating well, getting a good night’s sleep, and playing outside – that can help children build a strong immune system.
• Remind your children not to share their food or drinks with others.
• Try to limit your child’s exposure to media coverage about the H1N1 virus.
• If your children are being vaccinated, remind them why this is important and how the vaccine will help keep them safe and healthy.
• Keep your children home when they are sick. They should remain out of school until they are free of fever for 24 hours without the use of a fever-reducing medication.

NOTE: Some information provided by the National Association of School Psychologists and the Centers for Disease Control and Prevention.

The grant will allow Quesenberry and investigators at Rhode Island Hospital to focus their research efforts on determining the true phenotype (what the cells actually looks like as a result of their interaction with their environment) of marrow stem cells and their fate as tissue. The researchers’ goal is to translate basic stem cell studies into clinical trials on tissue restoration or correction in patients with chronic obstructive lung disease and malignant blood diseases. Through the grant they will study how the phenotype information is transferred via microvesicles from injured tissue. They will then define the mechanisms by which the cells are differentiated.

Quesenberry, who is also a physician with the University Medicine Foundation, says, “The beauty of the COBRE grant is not only will it allow us to develop a stem cell research center at Rhode Island Hospital, but it will also help us to assemble a group of outstanding, talented investigators who excel in these areas.” He adds, “Those investigators can then serve as mentors to young, up-and-coming researchers, who we can recruit and then retain right here at this research center.” Their research will be conducted in a new 10,000 square foot lab in the Coro building, where Rhode Island Hospital has established other major research labs.

Senator Jack Reed commented on the hospital’s grant. “Rhode Island Hospital is nationally renowned for pioneering efforts in stem cell research. This federal award will allow the hospital to expand and enhance existing research initiatives and help attract more talented researchers and promising young scientists to the state,” said Reed, a member of the Appropriations subcommittee, which oversees federal funding for NIH programs. Reed wrote a letter in support of Rhode Island Hospital’s application earlier this spring.
Congressman Jim Langevin also said, “I have long believed that stem cell research will help change the direction of medicine for the better,” said Langevin. “I congratulate Dr. Quesenberry and the entire Rhode Island Hospital research community for securing this prestigious award. Grants such as this will drive both scientific innovation and economic development in our state. I look forward to following this study and learning about its outcomes.”
The work in the stem cell research center will also include general stem cell biology. An experienced group of scientists will be mentoring three promising young investigators, and potentially more in three specific studies. Quesenberry, who also holds the Paul Calabresi, MD, professorship in oncology and is director of the division of Hematology/Oncology at The Warren Alpert Medical School of Brown University, comments further, “This grant holds real promise for expanding our understanding of stem cell biology. We appreciate the support of the National Center for Research Resources.”

Peter Snyder, PhD, Lifespan’s vice president of research, says, “A grant of this magnitude is especially welcome during these difficult economic times and is a definite boon for the research sector of our state. Dr. Quesenberry is already a renowned scientist, and this grant will undoubtedly result in breakthroughs that will have a direct impact on the care of patients who will benefit from advances in tissue restoration. I know we all look forward to that day.”

Most children with flu have required no medications at discharge. Very young patients, those with underlying medical conditions and those living in homes with family members who are pregnant or have underlying conditions have been prescribed “Tamiflu” in accordance with national guidelines. “Tamiflu” is a prescription medicine that acts on the flu virus to lessen the duration of illness. It should not be confused with the non-prescription brand name medicine “Theraflu” that is available for purchase. In addition, some preparations of Theraflu have high doses of acetaminophen and may be unsuitable for children.

Tamiflu:
• Prescription medication
• Lessens severity and duration of flu symptoms
• Only effective when given within 24-48 hours of the onset of flu symptoms

Theraflu:
PLEASE consult your pediatrician before giving your child Theraflu as many preparations of Theraflu have high doses of acetaminophen and may be unsuitable for children.

• Over-the-counter medication
• May reduce fever or ease body aches and nasal congestion, similar to other over-the-counter products
• Does NOT lessen severity and duration of flu symptoms

The benchmarks that hospitals measure include high conversion rates (the number of deceased potential organ donors whose families agree to donation), high rate of organs transplanted per donor and high percentage of donors who donate following cardiac death (as compared to following brain death, which is more common).

“Rhode Island Hospital is in a unique position, serving as a donor hospital for all organs as well as a kidney and pancreas transplant center,” said William J. Kirkpatrick, LICSW, director of clinical social work, and member of the Organ Donor Advisory Committee. “Our success in reaching these goals is attributable to the dedication and compassion of everyone on the health care team that provides wonderful support to patients and families while they are dealing with illness and end-of-life care, our strong collaboration with The New England Organ Bank and of course, the commitment of the donor families.”

“Many of our dialysis patients must continue to work and care for families,” said Douglas Shemin, MD, director of the outpatient dialysis center and member of the University Medicine Foundation. “The new facility gives our patients the freedom to schedule dialysis around their other responsibilities and commitments, and provides a warm, comfortable and inviting environment.”

The 18-chair dialysis center uses the most advanced technology and can accommodate 108 hemodialysis patients. Creature comforts include a television at each station and free Wi-Fi access. There is ample free parking in a well-lit parking lot.

The center is staffed by a multi-disciplinary team that includes a physician, clinical manager, social worker, dietitian, registered nurses and patient care technicians, providing a patient to staff ratio of 3:1.

“Dialysis treatments require a significant time commitment from the patient,” Shemin said. “We recognize that this is often a burden, and we are confident that this new outpatient dialysis center will exceed the needs of our patients, enabling them to receive the necessary treatment at a time that is convenient to them, including nights and weekends.”

The center is located at 117 Chapman Street, Suite 110, in Providence. Hours of operation are: 7 a.m. to 11 p.m. Monday through Saturday. For more information or to set up an appointment, please call 401-444-4440; fax number is 401-785-1517.

Under the direction of Howard Safran, MD, a specialist in pancreatic cancer, Lifespan’s oncology clinical research department will recruit patients from both Rhode Island Hospital and its partner, The Miriam Hospital, to evaluate a new vaccine designed to activate the immune system. The vaccine, called NewLink Genetics’ HyperAcute Pancreatic Cancer Vaccine, will be used in patients who have already been treated surgically, and will be used along with conventional therapy.

The clinical trial will allow Safran and other researchers to evaluate treatment response and monitor any side effects. It will examine the potential of the vaccine to stimulate the immune system to respond to the patient’s own cancer cells, with the hope of extending survival rates, improving quality of life and reducing the chance for tumor recurrence.

Traditionally, the body’s immune system does not fight cancer cells on its own because cancer cells differ only slightly from normal cells. As a result, it is difficult for the body’s immune system to identify and attack the cancer cells’ abnormal proteins. Vaccines such as the one used in this study are meant to boost the immune system’s ability to identify “foreign invaders,” and generate an immune response.

Individuals who are 18 years and older who have been diagnosed with Stage I or II pancreatic cancer, have undergone surgical resection of the pancreas and show no evidence of disease following surgery may be eligible to participate in the trial. Additional criteria must also be met and eligibility for participation will be determined by the research team. Participants will receive vaccine treatment for six months, during which blood samples will be drawn on a monthly basis. Patient follow-up visits will be scheduled every two months for the remainder of the first year, and every three months for the next two years.

The trial is sponsored by NewLink Genetics, located in Ames, IA. For more information, patients should call Howard Safran, MD, through the Lifespan Oncology Clinical Research Office at Rhode Island Hospital at 401-444-8856.

Their study appears in the Volume 54, No. 4 October 2009 edition of Annals of Emergency Medicine and is currently available online in advance of publication. An editorial on the study also appears in the journal.

Treatment of injuries from motor vehicle crashes accounts for four percent of the 120 million ED visits in the United States each year. It is estimated that alcohol is involved in as many as one in eight of these crashes, bringing the total to 600,000 cases each year. Alcohol complicates the clinical assessment of patients within an ED as the patient’s perception of pain may be blunted and a period of observation may be warranted until the patient is judged to be coherent enough for an accurate examination.

In the past, research into the cost of treating alcohol impaired drivers focused on the inpatient population. Researchers at the Injury Prevention Center at Rhode Island Hospital led by emergency medicine physician Michael Lee, MD, felt that this was an incomplete representation of the medical costs of drinking and driving as it is estimated that up to 80 percent of alcohol impaired drivers treated in EDs are discharged to home and are not admitted.

The researchers performed a retrospective study of 1,618 patients who had alcohol in their systemand were treated in an urban Level I trauma center and discharged home directly from the ED. The patients ranged in age from 21 to 65.

The study found that the median charges for patients under the influence of alcohol were higher by $4,538. Lee notes, “A large percentage of that cost can be directly correlated to a higher frequency of and costlier diagnostic imaging studies. Imaging itself represents 69 percent of the charge differential.” In addition, the median length of stay for alcohol-positive patients was higher by 3.3 hours when compared to alcohol-negative patients.

Lee says, “While an alcohol-impaired driver may be treated for only minor injuries and discharged to home, there is still a considerably higher cost to treat that patient in an ED. Further, the time spent on them with a longer length of stay results in delays for other patients who need care in an ED.”

Lee concludes, “The magnitudes are striking for this minimally injured population. This represents a burden of alcohol-impaired driving that was underreported in the past.”

Other researchers working with Lee include Michael Mello, MD, director of the Injury Prevention Center at Rhode Island Hospital and Steven Reinert, MS, of Lifespan’s information systems department.

“This group was started in memory of Sal Gelsomino, Laura DeAngelis and Anna Mazzulla, who were a husband, father, wife, mother, grandparents and friends to many,” said Mike Mazzulla, committee member. “What better way to honor their memory than to help children fighting cancer? Our hope is that this donation will help the children of the Hasbro Children’s Hospital hematology and oncology program.”

Sponsors for the events included Frank Chiello, Mario’s Showplace; David Levesque, Brewed Awakenings; Len Curreri, Curreri Collision; David & Judi Graham, Graham Builders, Inc. and Brian Crum, Gentry Relocation.

The group will continue to raise funds for Hasbro Children’s Hospital with future events. There will be another golf tournament on May 22, 2010, and the next Campfires for Cancer will be held on June 26, 2010.