“Nearly seven years ago, 65 people were brought to our emergency department following The Station nightclub fire, many with life-threatening burn injuries,” said William Cioffi, MD, surgeon-in-chief and physician with University Surgical Associates. “Our physicians, surgeons, nurses and other staff did an outstanding job caring for these patients, saving many lives in a short period of time, and providing on-going burn care for many of those patients. This certification is recognition of the high-quality burn care we provided on Feb. 20, 2003, and in the days, weeks and months that followed.”

In order to achieve certification from the American Burn Association, a burn center must employ a medical director who demonstrates ongoing involvement in burn-related research, must have timely access to operating rooms; the director must oversee total burn care for 50 or more acutely burned patients each year, and the attending staff surgeons must participate in the care of 50 or more acutely burned patients each year. The Rhode Island Burn Center is directed by David Harrington, MD, who specializes in trauma and burn care and is also with University Surgical Associates.

“Our burn surgeons and nursing staff do tremendous work every day, and this recognition by the American Burn Association and American College of Surgeons is further proof of those efforts,” said Timothy J. Babineau, MD, president and chief executive officer of Rhode Island Hospital. “Receiving certification shows our community and our peers that the burn care at Rhode Island Hospital is among the best in the country.”

The American Burn Association is dedicated to improving the lives of everyone affected by burn injury through patient care, education, research and advocacy. The ABA and its members dedicate their efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention. It has more than 3,500 members in the United States, Canada, Europe, Asia, and Latin America, including physicians, nurses, occupational and physical therapists, researchers, social workers, firefighters and hospitals with burn centers.

“This important, national designation recognizes the top quality orthopedic care that we provide to thousands of patients each year,” said Timothy J. Babineau, MD, president and chief executive officer, Rhode Island Hospital and The Miriam Hospital. “Earning Blue Distinction is a testament to the hard work and dedication of the orthopedic surgeons, doctors, nurses and staff at both hospitals.”
Since 2006, the Blue Distinction program has recognized facilities that meet objective, evidence-based thresholds for clinical quality, developed in collaboration with expert physicians and medical organizations. The program provides BCBSRI members with a credible means of identifying hospitals that meet their individual healthcare needs for select procedures and conditions.

“BCBSRI is committed to working collaboratively with physicians and hospitals to raise the quality of healthcare in our state,” said James E. Purcell, president and CEO of BCBSRI. “The Blue Distinction designation identifies institutions that lead the way in delivering positive outcomes, and we congratulate Rhode Island Hospital and The Miriam Hospital on their designation as providers of high-quality healthcare services.” The selection criteria used to evaluate facilities were developed with input from a panel of expert physicians. To be designated as a Blue Distinction Center for Spine Surgery or a Blue

Distinction Center for Knee and Hip Replacement, the following criteria were evaluated:

• Established acute care inpatient facility, including intensive care, emergency care, and a full range of patient support services with full accreditation by a CMS-deemed national accreditation organization
• Experience and training of program surgeons, including case volume.
• Quality management programs, including surgical checklists as well as tracking and evaluation of clinical outcomes and process of care.
• Multi-disciplinary clinical pathways and teams to coordinate and streamline care, including transitions of care.
• Shared decision making and preoperative patient education.

More detailed information on the selection criteria can be found on www.bcbsa.com.

The Blue Distinction designation is awarded by the Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality healthcare in the areas of bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery and transplants. The program is part of The Blues® efforts to collaborate with physicians and medical facilities to improve the overall quality and safety of specialty care.

The additional Blue Distinction Centers for Spine Surgery and Blue Distinction Centers for Knee and Hip Replacement designations for Rhode Island Hospital and The Miriam Hospital will bring the nation’s number of Blue Distinction designations to more than 1,600-and this number is expected to increase in the coming years.

The criteria for MDD in DSM-IV have remained relatively unchanged for nearly 30 years. In a previous study, Zimmerman and colleagues questioned the clinical utility of the criteria. This study looks at the habits of physicians in using the criteria. The researchers asked physicians attending a continuing medical education conference to complete a brief questionnaire. A total of 291 physicians responded to the six questions, with one question asking about the use of the diagnostic criteria for depression.

The question read: “When diagnosing depression, how often do you determine whether the patients meet the DSM-IV diagnostic criteria for major depressive disorder?” A multiple choice response offered the following answers: a) less than 25% of the time; b) 26-50% of the time; c) 51-75% of the time and d) more than 75% of the time.

Nearly 25 percent of the psychiatrists indicated that they used the DSM-IV MDD criteria to diagnose depression less than half of the time. In contrast, more than two-thirds of the non-psychiatrist physicians indicated that they used the DSM-IV MDD criteria less than half of the time when diagnosing MDD. The difference between the psychiatrists’ and the non-psychiatrists use of the criteria was significant.

Zimmerman, director of outpatient psychiatry at Rhode Island Hospital, says, “Our results suggest that a minority of psychiatrists and majority of non-psychiatrist physicians do not use the DSM-IV MDD criteria the majority of the time. These findings are disconcerting. While the symptom criteria for diagnosing MDD have not been changed much over the last 30 years, psychiatrists, especially older psychiatrists, apparently have not uniformly embraced their use and non-psychiatrist physicians seem to have rejected the formal application of the criteria.”

Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, theorizes that doctors are not using the DSM-IV MDD criteria because of the length of the criteria, and some may not be able to recall all of the criteria. He says that if incomplete recall of the criteria is the reason it is not being used to diagnose MDD, then a shortened definition of MDD may help to facilitate appropriate application of the criteria across all practitioners.

The researchers suggest that if physicians are not determining whether the criteria for MDD are met, then it is possible that many patients who are diagnosed as depressed do not have major depression. This is of critical importance because there is little evidence that antidepressants are effective for patients who do not have major depression; thus, some patients may be prescribed medications unnecessarily.

Zimmerman found that the older psychiatrists reported that they were less likely to use the DSM-IV diagnostic criteria than younger psychiatrists. He offers the following as a possible explanation. “Perhaps older psychiatrists who were training in the pre-DSM-III era never bought into the importance of using operational criteria to make a diagnosis.”

The researchers note that the study has limitations in that the reasons for not following DSM-IV guidelines were not asked, and interpretation of the question about the use of diagnostic criteria for MDD may not be consistent for all respondents. The results of the present study should be interpreted with caution because they did not conduct a random survey of psychiatrists and non-psychiatrist physicians practicing in the country and the physicians who did respond may not be representative of all physicians.

Janine Galone, BS, also of Rhode Island Hospital, assisted with this research study. No funding was required for this study.

Lifespan was one of only seven integrated health networks in New England to be included in the Top 100. Lifespan has been included on the Top 100 list seven times in prior years by SDI, a data and analytics firm, which has tracked integrated health networks and looked at critical success factors since 1994. The survey was previously performed by Verispan, which was acquired by SDI in 2008.

Lifespan President and CEO George Vecchione said, “We are pleased to again receive this distinction, which recognizes our continued progress toward integrating safety and quality throughout our four hospitals. We have implemented system-wide initiatives, such as electronic health records, medication safety and computerized physician order entry, and have centralized many functions thereby allowing our hospitals to focus on providing even better care for our patients.”

“Dr. Botelho is a natural leader, both as a clinician and a teacher, so it is only fitting that he was selected to direct our residency program,” said John B. Murphy, MD, vice president of medical affairs and chief medical officer. “His commitment and dedication to his co-workers and patients not only make him an outstanding physician, but are qualities that are sure to help him lead residents and fellows by example.”

Botelho, of Fall River, MA, has been a staff ophthalmologist at Rhode Island Hospital since 2005. He also serves an ophthalmologist in private practice in Fall River, and previously served as a staff ophthalmologist at The Johns Hopkins University Hospitals. He is a member of the American Society of Cataract and Refractive Surgery; American Academy of Ophthalmology; the Association for Research in Vision and Ophthalmology and the American Society of Ocular Trauma.

Botelho earned his bachelor’s degree at the College of the Holy Cross in Massachusetts, and his medical degree at Boston University’s School of Medicine. He completed his internship at Newton-Wellesley Hospital; his residency at the University of Missouri-Columbia; and a fellowship in external disease, cornea and refractive surgery at The Wilmer Eye Institute at Johns Hopkins University. He also served in the United States Air force as a major and chief of ophthalmology at Scott Medical Center, Scott Air Force Base in Illinois.

His research interests include advances in corneal transplant surgery, improved outcomes following laser vision correction, and new techniques and implant technology to reduce the dependence on reading glasses following cataract surgery.

Body dysmorphic disorder (BDD) is an under recognized psychiatric disorder characterized by excessive preoccupation with imagined or slight defects in physical appearance (for example, “scarred” skin, a “large” nose, or “thinning” hair). Those who suffer from BDD obsess over their appearance for an average of three to eight hours per day. They usually have excessive compulsive behaviors such as looking in the mirror or other reflective surfaces, excessive grooming, or skin picking. Some undergo repeated elective surgical or dermatologic procedures to try to correct their perceived flaws; such treatment appears to usually be ineffective for BDD. The disorder can be debilitating for some people, forcing them to avoid social contact, relationships and work, and can leave some individuals house-bound for years.

“Body dysmorphic disorder affects a relatively small percentage of the population, approximately 1 to 2.4 percent worldwide, but those affected often suffer from extraordinary fears and compulsions,” said Richard Goldberg, MD, psychiatrist-in-chief at Rhode Island Hospital and The Miriam Hospital. “We are fortunate to have Dr. Phillips join us at Rhode Island Hospital, where she will treat patients from the state, region and around the world for this debilitating disorder, as well as launch and complete many clinical research trials.”

“As with any illness, the severity of BDD varies from patient to patient,” Phillips said. “It can range from milder to life-threatening. Some who suffer from BDD are unable to function in daily life. It is our goal to help these individuals with medication or therapy, and learn to manage their disorder so they can move forward and live life to their fullest potential.”

Phillips is currently the recipient of a number of research grants on body dysmorphic disorder, including several funded by the National Institute of Mental Health. She has received numerous honors and awards for her research, research mentoring, and other academic accomplishments, including a Special Presidential Commendation from the American Psychiatric Association for her research on body dysmorphic disorder. She is conducting research that includes pharmacotherapy studies of BDD and the development of effective psychotherapy for BDD.

She comes to Rhode Island Hospital from Butler Hospital, where she served as director of the body dysmorphic disorder program. She also served as associate medical director of ambulatory services and chief of outpatient services, both at Butler Hospital. Prior to
joining Butler, she served in various capacities at McLean Hospital in Belmont, MA. Phillips is a noted author, having written books on body dysmorphic disorder and more than 230 scientific articles. She is chair of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) anxiety, obsessive-compulsive spectrum, post-traumatic, and dissociative disorders work group. She is also a sought-after speaker. She has repeatedly been included in Best Doctors in America.

She is a member of many professional organizations, including the American College of Psychiatrists and the American College of Neuropsychopharmacology, and she is a Distinguished Fellow of the American Psychiatric Association. She received her bachelor’s degree from Dartmouth College, her medical degree from Dartmouth Medical School, and completed her residency in general psychiatry at McLean Hospital/Harvard Medical School.

The program’s first three years of operation will be funded through a $300,000 gift from Hasbro, Inc., in Pawtucket, RI. Since the hospital’s inception in 1994, Hasbro, Inc., and its employees have contributed millions of dollars in ongoing support to its namesake children’s hospital to fund projects such as the establishment of the hospital, the pediatric diagnostic imaging center, the Child Life program, the Big Apple Clown Care program, and provide annual major sponsorship support for the Hasbro Children’s Hospital Gala, the largest annual fundraiser for the hospital, among other programs.

“This gift further exemplifies our partnership with Hasbro, Inc., and demonstrates the tremendous support Hasbro has shown the hospital,” said Timothy J. Babineau, MD, president and chief executive officer of Rhode Island Hospital and Hasbro Children’s Hospital. “Their continued support helps us to develop programs and services, such as the family-centered care program, which have a direct impact on the quality of patient care and help us to improve the patient experience.”

The hospital adopted a family-centered care philosophy several years ago, focusing on the “four Cs” of care giving: caring, communication, cooperation and competence.
This gift will enable Hasbro Children’s Hospital to formalize its commitment to these relationships through the hiring of a program director who will be responsible for developing and maintaining the advisory council.

“The formalization of the family-centered patient care program will provide us with the necessary tools to actively engage patients and families in the development of patient care programs,” said Robert B. Klein, MD, pediatrician-in-chief. “Involving families in the care decisions of their loved ones is vital, and getting their input and feedback in larger decisions about programs and services will go a long way toward ensuring that we are working to the best of our ability with, and on behalf of, our community.”

The advisory council, a critical component of this program, will be made up of patients, family members, community members and staff to collaborate on policy and program development, implementation and evaluation; as well as facility design and professional education

“We are pleased to support the establishment of the Family Centered Care Program at Hasbro Children’s Hospital,” said Brian Goldner, president and chief executive officer of Hasbro, Inc. “This program will mean so much to the children and their families and will help the hospital continue to provide the best possible care.”

The program will be managed by a registered nurse or licensed clinical social worker who will work closely with a designated physician director. The search for a director has begun and the program will be launched upon this appointment.

Led by Suzanne de la Monte, MD, MPH, of Rhode Island Hospital, researchers studied the effects of Thymosin Alpha 1 (Talpha1/thymalfasin), a synthetic form of the naturally occurring hormone Thymosin produced by the thymus gland. De la Monte, who is also a professor of neuroscience at The Warren Alpert Medical School of Brown University, says, “Our hypothesis was that the immune system basically needs a boost to kill the cancer cells. We know that Thymosin is currently being used in Europe to treat cancer, so we set out to see what effect this could have on glioblastomas.”

What the investigators found is that when Talpha1 was used alone, the tumor continued to eventually grow. When they combined the Talpha1 with a common chemotherapeutic agent, there was a dramatic effect. De la Monte explains, “We looked at giving chemo plus Talpha1 as a sort of immune booster. What we found is that when you give Talpha1 and the chemo agent together, not only do you have a slower rate of tumor growth with cells being killed, but there have also been cures. We achieved a 25 percent cure rate in these animal models.”

Co-investigator Jack Wands, MD, also a physician with University Medicine Foundation and a professor Alpert Medical School, says, “In this study we used a natural hormone that’s been produced in the thymus gland, which by itself has no anti-tumor effect and in fact can be harmful in high doses. What’s important in this study is that we have found with low to moderate doses in combination with a well-known chemotherapeutic agent, it has a striking ability to inhibit the growth of a glioblastoma in animal models.”

The researchers went on to further investigate how the Talpha1 was achieving this response. What they discovered is that it sensitizes the tumor cells to the chemotherapeutic agent, giving the agent more of an impact upon the tumor than it would have on its own. De la Monte explains, “The thymic hormone is actually working to boost immune response and basically activates a killing of the tumor cells.”

De la Monte says the next step is to bring this to a Phase I clinical trial. “You’re talking about a disease where people are dead within months. There is no cure.” Wands agrees and says, “Our pre-clinical studies have shown this striking effect and we believe the next step is to try this approach in patients with this devastating illness.”

Other researchers involved in the study with de la Monte and Wands include Arno Sungarian, Deus Cielo, Prakash Sampath, Nathaniel Bowling and Peter Moskal from the departments of pathology, neurology and medicine at Rhode Island Hospital and The Warren Alpert Medical School of Brown University.

The study was funded through grants from the National Institutes of Health (NIH) and a training grant from the NIH’s National Institute of Environmental Health Sciences (NIEHS).

As vice president, she will direct a comprehensive risk management program for the Lifespan-affiliated hospitals, Rhode Island Hospital and its Hasbro Children’s Hospital, The Miriam Hospital, Bradley Hospital and Newport Hospital, including overseeing all hospital-based clinical risk management services and the procurement of all insurance coverage. She is also responsible for Lifespan’s self-insurance program, including its underwriting and claims management activities.

Kenneth Arnold, Lifespan senior vice president and general counsel said, “Joan has been an intelligent, reasoned and invaluable voice through the years. She is an advocate for patients, families and clinicians, and a champion for best practices in health care. We are fortunate to have someone with Joan’s ethical standards, institutional knowledge and expertise serving in this capacity.”

As director of risk management, Flynn managed all clinical risk management activities for the Lifespan-affiliated hospitals. She also helped design and implement system-wide patient safety and performance improvement activities.