News from Lifespan

Lifespan and Gateway Healthcare Sign Intent to Affiliate Agreement

Thu, 3 May 2012 00:00:00 EDT

Agreement will strengthen and expand behavioral health services in Rhode Island

In a move designed to enhance behavioral health care coordination and patient access, Lifespan, Rhode Island’s largest health care system and Gateway Healthcare, the largest community behavioral health care organization in Rhode Island, have signed a letter of intent to affiliate. The affiliation is intended to help make behavioral health care services more accessible, affordable and financially sustainable in this evolving health care marketplace.

Under the proposed affiliation agreement, Gateway Healthcare will become part of Lifespan, which includes Rhode Island Hospital and its pediatric division Hasbro Children’s Hospital, The Miriam Hospital, Newport Hospital and Bradley Hospital, the nation’s first psychiatric hospital for children. Gateway Healthcare, which provides integrated treatment and prevention through residential, outpatient and community-based programs that reach more than 15,000 residents annually in 42 locations, will fall under the Lifespan umbrella.

“This is an exciting affiliation for Lifespan and one that builds on our commitment to a new model of health care that provides patients with new ways to access the care they need. This is essential as health care delivery continues to shift outside the traditional hospital setting,” said George Vecchione, Lifespan’s president and CEO. “Gateway Healthcare is well known in the region for providing top-notch care to the vast populations it serves and is a strong advocate for those needing mental health and substance abuse services. We look forward to completing a due diligence process so we can work together to provide even better care to the people of our region.”

According to Richard Leclerc, Gateway’s president, the affiliation with Lifespan will help Gateway maintain its critical role in an increasingly integrated health care delivery system. “By partnering with a system such as Lifespan, Gateway will be positioned for a pivotal role in the care models emerging from national and state health reform,” he said. “These models call for full integration of mental health and substance abuse treatment with primary medical services. Lifespan has the full breadth of services and support to make this a reality.” Leclerc added, “Ultimately, we will be better positioned to fulfill our mission of providing assistance and care to individuals of all ages with behavioral and substance abuse issues throughout Rhode Island.”

This affiliation represents a logical step at a time of limited public resources for behavioral health services and increased calls for interdisciplinary care in which individuals can have all their needs from one system of providers sharing their clinical expertise. Gateway already has gained significant experience through integrated care projects in a variety of health settings, including hospitals, community health centers and private-practice settings.

In addition, Gateway has a demonstrated track record of successful affiliations with other health and human-services organizations in Rhode Island, partnerships that have benefited the patients and families that these providers serve. Among the entities that have become part of Gateway in recent years are Capital City Community Centers, Caritas, Inc., FRIENDS WAY, The Autism Project, New Hope for Families and South Shore Center.

The affiliation with Lifespan will position Gateway to assume a more prominent role in providing behavioral health services in a coordinated fashion that will benefit patients and improve the affordability at a time of increasing health care costs.

More about Lifespan

About Gateway Healthcare
Established in 1995, Gateway Healthcare is Rhode Island’s largest provider of community behavioral healthcare, offering integrated treatment and prevention through residential, outpatient and community-based programs. With its staff of over 700, Gateway’s tenure in the Rhode Island community boasts an annual clientele of over 15,000 unduplicated men, women and children, providing a comprehensive continuum of services 24 hours a day, 365 days a year. Our network of affiliates includes The Autism Project, Capital City Community Centers, Caritas, Inc., FRIENDS WAY, Lighthouse for Youth, New Hope for Families and South Shore Center. Gateway (www.gatewayhealth.org) proudly stands alongside its affiliates in a mutual effort to address creative solutions for community care. This impressive continuum places Gateway at the forefront in assisting individuals in the community in a myriad of ways.

Lifespan to Contribute $2.4M to City of Providence Over Three Years

Tue, 1 May 2012 00:00:00 EDT

Hospital system is first health care institution to make voluntary payment

Mayor Angel Taveras and Lifespan announced today that the City of Providence and the health care provider have reached an agreement that will have Lifespan contribute $800,000 annually for the next three years in a voluntary agreement. Mayor Taveras heralded the agreement as a groundbreaking partnership that helps Providence immediately. Lifespan, Providence’s largest employer, is the first hospital system to make a voluntary contribution to the city.

“The agreement we have reached with Lifespan is a groundbreaking partnership that helps Providence take another step forward to strengthen our fiscal ground. This agreement is the first between the city and any hospital, and I hope it inspires the other hospitals who rely on a strong Providence to be a part of the solution that positions our capital city for the future,” said Mayor Taveras. “Lifespan has long been a responsible community partner and a leader in the effort to make Providence a healthier city – especially for our most vulnerable neighbors.”

The agreement between Lifespan and Providence is completely voluntary. The hospital system will contribute $2.4 million in the next three years. Citing the three-year period for the agreement, both the Mayor and officials from Lifespan pointed to the uncertainty of the rapidly changing health care environment.

"We recognize that these continue to be challenging times for the city and we understand a strong Providence is central to the health of the entire state." said Scott Laurans, chairman of the Lifespan board of directors. “This is an important time to stand together and we are pleased to work with Mayor Taveras and other city officials to assist in the economic recovery of the capital city. As both the largest health care provider and employer in the state, we have worked diligently to be an economic engine for Rhode Island. Our action today further demonstrates our commitment to help ensure a strong and vital Providence.”

Lifespan is a vital community partner in Providence. The network provides charity care for individuals at or below twice the federal poverty level and offers a sliding scale for individuals up to four times the poverty level. In all, Lifespan spent more than $100 million last year on uncompensated care, which has increased dramatically over the past several years.

In addition, the Lifespan system supports the Institute for the Study and Practice of Nonviolence’s Street Workers program by donating the cost of the street workers’ health care premiums – a $150,000 investment each year. The system has also committed $5 million over 10 years as an anchor tenant in the Prairie Avenue Revitalization Initiative. Also, over the past two years Lifespan has moved more than 300 employees to buildings off Allens Avenue, helping to revitalize an underserved area of Providence and contributing important tax dollars to the City of Providence.

Lifespan is an economic driver in Providence. The system is an anchor of the city’s Knowledge District and is a leading source of outside investment for Rhode Island. In 2011, the system received $80 million in out-of-state research funding and employees over 800 researchers and investigators. In addition, Lifespan contributed $65 million to the academic mission and $15 million in additional research funding.

Silvia Degli Esposti, M.D., Honored By The National Organization Of Italian American Women

Thu, 9 Feb 2012 00:00:00 EST

Silvia Degli Esposti, M.D., director of the Center for Women’s Gastrointestinal Medicine at the Women’s Medicine Collaborative, was recently honored by the Rhode Island Region of the National Organization of Italian American Women (NOIAW) at its first Epiphany celebration in Providence.

Degli Esposti was named one of “Four Wise Women,” joining the Honorable Jeanne E. LaFazia, chief judge of the Rhode Island District Court, and Lois Scialo Ellis and Carol Scialo Gaeta, co-owners of Scialo Bakery.

As a pioneer in the field of women’s health in gastroenterology and expert in gastrointestinal and liver disease in pregnancy, Degli Esposti works at a national level to develop programs addressing the needs of women. She founded one of the first centers in the nation to address the gastrointestinal needs of women by providing an all-women environment of care, including a colonoscopy and endoscopy setting designed with the female patient in mind.

She currently serves as director of the Center for Women’s Gastrointestinal Medicine (www.womensGIRI.org) in Providence. The Center, part of the Women’s Medicine Collaborative, offers a comprehensive, multidisciplinary approach to women’s gastrointestinal issues. Led by Degli Esposti, the highly trained, all-female staff cares for women with major diseases and conditions of the intestine and liver at every stage of life, including pregnancy.

Degli Esposti is also a state advocate for women’s health, leading the Rhode Island Perinatal Hepatitis Prevention Program, an award-winning, collaborative program with the Rhode Island Department of Health focused on caring for pregnant women with viral hepatitis and their children.

Board certified in both internal medicine and gastroenterology, Degli Esposti is an associate professor of medicine (clinical) at The Warren Alpert Medical School of Brown University, where she is also director of the fellowship pathway in women’s gastrointestinal diseases. Her clinical and research interests include liver disease and gastrointestinal diseases in women. She is currently leading several studies in inflammatory bowel disease and hepatitis in pregnancy.

Fluent in both English and Italian, Degli Esposti graduated summa cum laude from the University of Bologna Medical School in Bologna, Italy.

The NOIAW is the premier organization for women of Italian heritage that is committed to preserving Italian heritage, language and culture by promoting and supporting the advancement of women of Italian ancestry. NOIAW serves its members through cultural programs and networking opportunities, and supports young women through nationally acclaimed scholarship, mentoring and cultural exchange programs.

Rhode Island and The Miriam hospitals announce new board members

Thu, 2 Feb 2012 00:00:00 EST

The joint board of trustees of Rhode Island Hospital and The Miriam Hospital recently welcomed new trustees Lawrence B. Sadwin and Roger Begin and announced the appointment of Alan H. Litwin, CPA, MST, MBA, as chair of The Miriam Hospital board of trustees. Edward D. Feldstein, Esq., also was recently named chair of The Miriam Hospital Foundation board of trustees.

Litwin, a longtime hospital trustee and active member of The Miriam community, assumes the role previously held by Feldstein, who served as chair of The Miriam Hospital board of trustees for three years before being elected to his new position. Feldstein succeeds Jeffrey G. Brier, who completed his three-year term as chair of the Foundation board of trustees and has been involved with The Miriam Hospital for more than 30 years. Brier, a former chair of the hospital board of trustees, will remain on the Foundation board.

“The combined boards of Rhode Island and The Miriam hospitals are made up of Rhode Islanders with a vast array of talent and experience, but all share something in common -- their commitment to helping lead our institutions” said Timothy J. Babineau, M.D., president and chief executive officer of Rhode Island Hospital and The Miriam Hospital. “I am confident that Alan (Litwin) will be a strong leader on The Miriam Hospital board, I congratulate Ed (Feldstein) on his new role as chair of the Foundation board and thank Jeff Brier for his leadership and service. Additionally, I am looking forward to working closely with our two new members, Roger Begin and Larry Sadwin, as they join the board of trustees.”

Roger Begin
Begin, of Woonsocket, is sales director at BNY Mellon Wealth Management. He served as lieutenant governor of the State of Rhode Island from 1989 to 1993, and as the general treasurer from 1985 to 1988. Begin is active in numerous organizations throughout Rhode Island, including the advisory council of Hasbro Children’s Hospital. He also serves as past board chair of the Rhode Island Historical Society, trustee and past chair of the Meeting Street Center, Honorary Consul of France in Rhode Island, and is a trustee on the boards of Bryant University, the Rhode Island Public Expenditure Council and the Greater Providence Chamber of Commerce.

Jeffrey G. Brier
Brier, a resident of Providence, is a partner in the insurance and employee benefits firm of Brier & Brier. He is a past chair of The Miriam Hospital board of trustees and has been a member of various other hospital and Lifespan committees over the last three decades, including the Lifespan board of directors. Brier, co-chair of The Miriam’s Emek Medical Center exchange program, is a member of the board of directors of LIFEcycle, Inc. and has been involved in many other community organizations, including the Jewish Federation of Rhode Island (now Jewish Alliance of Greater Rhode Island), Jewish Community Center of Rhode Island, Camp Jori, Temple Emanu-El and Hospice of Nursing Placement.

Edward D. Feldstein, Esq.
Feldstein is a co-managing partner of Roberts, Carroll, Feldstein & Peirce, where he is the head of its non-litigation practice area and the firm’s senior attorney in that area. A former chair of the hospital’s professional and academic affairs committee – which he has served on for more than 20 years – Feldstein has also served on various other hospital and Foundation committees and was a member of the Lifespan board of directors. He has held leadership positions with the Jewish Federation of Rhode Island (now Jewish Alliance of Greater Rhode Island), Temple Emanu-El, Camp Jori and the Providence College President’s Council. Feldstein, who resides in Providence, is a founding director and current chairman of the board of The Key Program, Inc., a large Massachusetts-based nonprofit organization that provides youth services by contracting with state agencies in Massachusetts and Rhode Island.

Alan H. Litwin, CPA, MST, MBA
Litwin, is managing director of the Providence-based accounting firm of Kahn, Litwin, Renza & Co. A resident of Providence, he has been an active member of The Miriam community for more than 25 years, serving as treasurer of the board of trustees and assuming leadership roles in several philanthropy-related initiatives. He is currently chair of the finance committee for The Miriam Hospital and Rhode Island Hospital and is a member of the Rhode Island Hospital board of trustees. Litwin has received numerous awards for his many charitable and community service activities. Outside of The Miriam, he is a past chair of the board of the Wheeler School and the Jewish Community Center and has held leadership positions with dozens of area organizations, including the Jewish Federation of Rhode Island (now Jewish Alliance of Greater Rhode Island), YMCA-Camp Fuller, Temple Emanu-El, Brown-RISD Hillel, Jewish Family Service, Jewish Home Corporation, Jewish Seniors Agency and Fox Point East Side Little League. In addition, Litwin was one of the founding board members of Rhode Island Kids Count and is a current member of the board of directors of The Providence Mutual Fire Insurance Company.

Lawrence B. Sadwin
Sadwin, of Warren, serves as vice president of business development for The Torbot Group. He has spent the last 30 years as a patient advocate, having survived both heart disease and cancer. He has served in a variety of leadership roles at the local, national and international levels. Sadwin currently serves as chairman of the board of directors for the Center for Medical Technology Policy; president of Friends of the World Heart Federation in Geneva, Switzerland; and as liaison for the American Heart Association and the Army National Guard Decade of Health Initiative. He has been very involved in the American Heart Association, serving in numerous roles including as chairman of the board for the national board of directors as well as the Rhode Island and New England affiliates. He also has served as president of the Landmark Healthcare Foundation and chairman of the board of Landmark Medical Center; a member and liaison for the National Institutes of Health; and as a member of the public advisory board of the Joint Commission, among other organizations. Sadwin is the recipient of numerous awards, including the Gold Heart Award from the American Heart Association, the John H. Chafee Award for Leadership in Healthcare, and the Partner in Philanthropy Award from the United Way of Southeastern New England.

“Seasons of Safety” Coloring Program in Hasbro Children’s Hospital Emergency Department Raises Awareness of Potentially Deadly Behaviors

Thu, 2 Feb 2012 00:00:00 EST

Hasbro Children’s Hospital is helping increase awareness of accidental injuries through new coloring calendar pages created by cartoonist Jim Weicherding. The “Seasons of Safety” pages, which are given to children in the hospital’s emergency department, will help children and their families learn about common, avoidable injuries.

This is important since, according to the Rhode Island Hospital Trauma Registry, approximately 500 children per year are admitted to Hasbro Children’s Hospital for trauma injuries. Hundreds more may be treated and released with the same types of injuries. The top causes of all accidental traumatic injuries seen at the hospital include those from: falls, motor vehicle accidents, bicycle accidents, sports, playground and recreational activities, burns and snow sports such as skiing and sledding.

Since more families are now using portable space heaters to keep warm during the winter months, the first of the coloring books will focus on the dangers of space heaters. If not used properly, space heaters can cause serious injury.

“We typically see one or two children coming in each winter with either burns from space heaters, or toxic injuries from exposure to kerosene or gas heaters without proper ventilation,” said Susan Duffy, M.D., medical director of the Hasbro Children’s Hospital emergency department. “While the numbers are not large, these are injuries that can be very serious. If we can prevent just one fire, or one child coming in with burns or chemical exposure, then this program is a success.”

Duffy offered the following tips to help prevent avoidable injury from space heaters:
Make sure space heaters have plenty of space around them. They should be at least three feet away on all sides from anything that can burn – including furniture, papers, bedding, people, pets and curtains.
There should always be an adult in the room when a space heater is in use. Turn off space heaters before leaving the room, going to sleep or leaving the house.
Never use space heaters to dry clothing or blankets.
Never use a space heater if you suspect it may be damaged. Before use, inspect the heater, cord and plug for damage.
Be sure the space heater plug fits tightly into the wall outlet. If not, do not use the outlet to power the heater.
During use, check frequently to determine if the heater plug or cord, wall outlet or faceplate is hot. If it is, discontinue use immediately and call for service or repair.
Never power space heaters with an extension cord or power strip.
A space heater should always be placed at ground-level on a stable surface and out of the way where it will not be knocked over.
When purchasing a space heater, make sure it has been safety certified, and has a safety certification mark.
Never run a space heater cord under rugs or carpeting. This can damage the cord, causing it and nearby objects to burn. Always unplug cords when not in use.
To prevent electrical shocks and electrocutions, always keep electric heaters away from water, and never touch an electric heater if you are wet.
Only use kerosene or gas-powered space heaters in well-ventilated areas.

Examples of the Seasons of Safety coloring pages can be found at the following link: http://www.safekids.org/educators/coloring-sheets.html

Rhode Island Hospital and The Miriam Hospital name neuropathologist Douglas C. Anthony, M.D., Ph.D., chief of pathology

Tue, 31 Jan 2012 00:00:00 EST

Rhode Island Hospital and The Miriam Hospital have appointed Douglas C. Anthony, M.D., Ph.D., as chief of pathology. In this role, which becomes effective Feb. 1, 2012, Anthony will lead the clinical, educational and research pathology programs for Lifespan. Additionally, Anthony will help bridge pathology and the neurosciences through the Norman Prince Neuroscience Institute, and will help to further develop the personalized medicine model.

“Dr. Anthony’s neurology experience is a significant complement to his pathology training, and makes him an invaluable addition to our clinical staff,” said Timothy J. Babineau, M.D., president and chief executive officer of Rhode Island Hospital and The Miriam Hospital. “This appointment further demonstrates our commitment to becoming a leader in the neurosciences. I am confident that Dr. Anthony will play a pivotal role on our clinical team, and will further enhance our efforts to improve patient care and the patient experience.”

Anthony comes to Rhode Island and The Miriam hospitals from the University of Missouri, where he served as chair of the department of pathology and anatomical sciences and professor of neurology. At the University of Missouri Health Care he served as chief of pathology and medical director of pathology clinical laboratories. He also served as a pathologist at the Harry S. Truman Veterans Administration Medical Center, Women and Children’s Hospital, and the Ellis Fischel Cancer Center, and as a neuropathologist for the Office of the Medical Examiner in Boone, Callaway and Greene counties in Missouri. Previously, he was on the faculty at Harvard Medical School and served as a neuropathologist at Boston Children’s Hospital, Brigham and Women’s Hospital, and as a neuropathologist consultant to the Office of the Chief Medical Examiner for the Commonwealth of Massachusetts.

Anthony earned his bachelor’s degree in chemical engineering from Washington University in St. Louis, Mo.; his doctoral degree in experimental pathology from Duke University; and his medical degree from Duke University. He completed his residency in pathology and a fellowship in neuropathology at Duke University Medical Center.

He is a member of the United States and Canadian Academy of Pathology; the American Association of Neuropathologists; the College of American Pathologists; the Society for Neuroscience; Society of Toxicology; and the American Society for Neurochemistry, among others. He has served on several editorial boards, including the Journal of Neuropathology and Experimental Neurology; Advances in Anatomic Pathology; and Pediatric Pathology and Molecular Medicine, and is an author of the neuroscience sections of Robbins and Cotran Pathologic Basis of Disease. He has won numerous awards, including the Dr. Edison H. and Sallie Y. Miyawaki Teaching Award in Neurosciences at Harvard Medical School; the Excellence in Education Award in pre-clinical sciences at the University of Missouri; and the Order of Socrates award at the School of Medicine at the University of Missouri.

Anthony’s research interests include the biology of axons and its relevance to diseases of peripheral nerves, and the pathobiology of brain tumors.

Rhode Island Hospital cardiologist James Arrighi, M.D., appointed chair-elect of ACGME Residency Review Committee

Tue, 31 Jan 2012 00:00:00 EST

James A. Arrighi, MD, director of nuclear cardiology at Rhode Island Hospital, has been appointed chair-elect of the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for internal medicine, effective July 1, 2012. The ACGME is a private, nonprofit council that evaluates and accredits residency programs in the U.S. Arrighi has been a member of the review committee since 2009.

The ACGME has 28 review committees – one for each of the 26 specialties, one for a special one-year transitional-year general clinical program and one for institutional review. Each review committee is made up of six to 15 volunteer physicians. Members of the review committees are appointed by the American Medical Association Council on Medical Education and the appropriate medical specialty boards and organizations.

“The ACGME plays a pivotal role in the training of our future physicians, and this is a wonderful opportunity to help programs throughout the country best educate and prepare future physicians,” Arrighi said. “It is critical for the successful training of our doctors that residency programs be accredited and in accordance with best practices. I am grateful for the opportunity, and excited to lead the team to review internal medicine residency programs.”

The ACGME is responsible for the accreditation of post-M.D. medical training programs within the United States. Accreditation is accomplished through a peer review process and is based on established standards and guidelines. The function of the Residency Review Committee (RRC) in internal medicine is to set accreditation standards for all residency and fellowship training programs in internal medicine and its specialties.

In addition to serving as director of nuclear cardiology at Rhode Island Hospital, Arrighi, of Providence, is an associate professor of medicine and diagnostic imaging at The Warren Alpert Medical School of Brown University and the program director of Brown’s fellowship program in cardiovascular disease. His clinical research activities relate to the application of nuclear cardiology studies in clinical practice.

The Accreditation Council for Graduate Medical Education is a private, nonprofit council that evaluates and accredits residency programs in the United States. Established in 1981, the ACGME was created in response to the medical community’s need for an independent accrediting organization. The mission of the ACGME is to improve health care by assessing and advancing the quality of resident physicians' education through exemplary accreditation. In academic year 2010-2011, there were 8,887 ACGME-accredited residency programs in 133 specialties and subspecialties, and 113,142 active full-time and part-time residents.

The Impact Of Deleting Five Personality Disorders In The New DSM-5

Tue, 24 Jan 2012 00:00:00 EST

A newly published paper from Rhode Island Hospital reports on the impact to patients if five personality disorders are removed from the upcoming revision to the Diagnostic and Statistical Manual, 5th edition (DSM-5). Based on their study, the researchers believe these changes could result in false-negative diagnoses for patients. The paper is published in the Journal of Clinical Psychiatry and is now available online in advance of print.

The DSM-5 Personality and Personality Disorders work group made several recommendations to change the approach toward diagnosing personality disorders. One of those recommendations is to delete five personality disorders as a way to reduce the level of comorbidity among the disorders. The ones originally slated to be removed include paranoid, schizoid, histrionic, narcissistic and dependent personality disorders. More recently, the Work Group recommended that narcissistic be retained. Lead author Mark Zimmerman, M.D., director of outpatient psychiatry at Rhode Island Hospital, points out, however, that no data were cited describing the impact this deletion had, or might have, on the overall prevalence of personality disorders. Likewise, no research was cited for the Work Group’s reversal in deciding to retain narcissistic personality disorder.

“When it comes to revising the official diagnostic classification system, the guiding principle should be that criteria should not be changed in the absence of research demonstrating that the new approach is superior to the old in either validity or clinical utility, preferably both,” Zimmerman states. “Despite assurances that only data-driven modification would be made, with each new edition of the DSM, we have witnessed repeated instances of changes being made in the absence of sufficient data demonstrating the new criteria is superior.”

To evaluate the proposed changes of deleting five personality disorders from the DSM-5, Zimmerman and his colleagues evaluated 2,150 psychiatric outpatients, more than one-quarter of whom were diagnosed with one of the 10 DSM-IV personality disorders. When removing the proposed deleted disorders, 59 patients who were diagnosed with a personality disorder according to the DSM-IV criteria would no longer be so diagnosed. Thus, the findings suggest that patients will have false-negative diagnoses based on the proposed revisions to the DSM-IV.

Zimmerman comments, “The findings of the present study highlight our concerns about adopting changes in the diagnostic manual without adequate empirical evaluation beforehand. To be sure, there are problems with the classification of personality disorders, however, the identification of a problem is only the first step of a process resulting in a change to diagnostic criteria.”

He concludes, “The classification of personality disorders would not be improved if the new criteria or diagnostic material were more clinically useful but less reliable and valid.”

Zimmerman’s principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island. The researcher is also an Associate Professor of Psychiatry and Human Behavior at The Warren Alpert Medical School of Brown University. Other researchers involved in the study with Zimmerman include Iwona Chelminski, Ph.D.; Diane Young, Ph.D., Kristy Dalrymple, Ph.D., and Jennifer Martinez, B.A., all of Rhode Island Hospital and Alpert Medical School.

Hooray for snow days! Injury Prevention Center at Rhode Island Hospital urges children to stay safe and avoid the emergency room while enjoying winter fun

Tue, 24 Jan 2012 00:00:00 EST

During the most recent snowstorm, five children were admitted to Hasbro Children’s Hospital with injuries sustained while sledding. The children ranged in age from 5 to 17 years old, and sustained a number of injuries, including spinal fractures, rib fractures, internal organ injury and concussions. According to a study done by the American Academy of Pediatrics, approximately 20,000 children visit an emergency room each year as a result of a sledding accident. About one third have head injuries and approximately 800 require hospital admission.

The Injury Prevention Center and Hasbro Children’s Hospital have worked together to offer a program again this year that gives a free snow sport helmet to each child who comes in to the Hasbro Children’s Hospital emergency department following a snow sport injury. The helmets are provided through a gift to the Injury Prevention Center from the junior division of the Rhode Island State Grange.

In addition, the Injury Prevention Center offers the following sledding safety tips:

Parents should always inspect the sledding hill carefully. The hill should be smooth and not too steep. It should also be free of obstacles such as trees and rocks. It is very important that the hill have a long, clear run off at the end.
Never sled toward a road or pond.
Sleds that have some type of steering mechanism are safest. Never use a sled substitute, such as a cafeteria tray.
Always slide feet first, one person at a time.
Sledders should walk up the side of the hill and leave the middle open for other sledders.
Children should dress appropriately and always wear a helmet.

Rhode Island National Guard Presented Hasbro Children’s Hospital With $115,000 In Open House Air Show Proceeds

Thu, 19 Jan 2012 00:00:00 EST

On Tuesday, January 17, Hasbro Children’s Hospital welcomed personnel from the Rhode Island National Guard, who presented the hospital with a check for $115,000, which was raised during the 2011 Rhode Island National Guard Open House Air Show.

The Air Show was established in 1991 as a major community event that offers aerial and static displays along with activities for people of all ages. This year’s event will take place on June 16 and 17, 2012, at Quonset Point in North Kingstown, featuring the USAF Thunderbirds.

Rhode Island Hospital Is First In The World To Acquire Portable CT Body Scanner For Use In Operating rooms

Wed, 18 Jan 2012 00:00:00 EST

Rhode Island Hospital is the first hospital in the world to acquire the BodyTom™ CT scanner, a portable, intra-operative, multi-slice CT body scanner. The new technology, developed by NeuroLogica of Massachusetts, will be used in the surgical treatment of patients with neurological disorders such as epilepsy, Parkinson’s disease, stroke, cerebral palsy, brain and spine tumors.

The first of its kind, the scanner will allow imaging to be performed in the operating room, thereby reducing the need to transport patients to and from the radiology department. Unlike other CT- or MRI-guided surgical systems, this device will provide real-time updates as the surgical procedure unfolds, while the patient is still on the operating table. Additionally, the portable CT body scanner will allow advanced intra-operative imaging of the brain and spine for image-guided surgery, and will increase accuracy of a wide range of neurological and spinal procedures.

“The BodyTom’s ground-breaking technology will allow our surgical teams to collaborate with radiology in ways not seen before, and will provide our neurosurgeons with the tools to perform more intricate and precise image-guided surgical procedures,” said G. Rees Cosgrove, M.D., chief of neurosurgery at Rhode Island Hospital and The Miriam Hospital, and clinical director of the Norman Prince Neurosciences Institute. “The real-time radiology updates will allow Rhode Island Hospital to provide the highest quality care, and will serve to enhance patient safety and improve surgical outcomes.”

Cosgrove continued, “This acquisition is another exciting step in the creation of the Norman Prince Neurosciences Institute, and demonstrates our commitment to providing the best possible care, cutting-edge technology and pioneering research in the brain sciences. It is a very exciting step, and we are thrilled to partner with Dr. Eric Bailey of NeuroLogica, and to be the first in the world to acquire the BodyTom.”

The BodyTom™ is a 32-slice portable CT scanner that provides high-quality imaging of bone and soft tissue, and boasts an 85 cm gantry and 60 cm field of view – one of the largest bore and field of view combinations in the world. It includes advanced visualization software that allows for two-dimensional, three-dimensional and multiplanar reconstructed (MPR) viewing. Radiation shielding is built into the scanner, reducing scatter radiation in the room.

The BodyTom™ can obtain images of the entire spine in one pass, providing high-quality three-dimensional images of both bone and soft tissue. It is battery powered, plugs into a standard wall outlet and has wireless communications capabilities which enable the BodyTom™ to interface with modern hospital information systems. The BodyTom™ also comes with two Apple iPad tablet computers with a secure application, allowing physicians to transfer images directly to the iPad to share with other clinicians, the patient or family members. Images also can be retrieved with a USB port, wireless transmission, or direct connect.

“As a Rhode Island native, nothing brings me more pleasure than delivering the world’s first BodyTom to Rhode Island Hospital,” said Eric Bailey, PhD, chief executive officer of NeuroLogica Corporation. “I am truly honored that the BodyTom will serve the people of my home state and be used at one of the premier medical institutions in the country for clinical and academic neuroscience, under the expertise and direction of Dr. Cosgrove.”

Bailey continued, “My brother’s death, caused by a traumatic brain injury, inspired me to make medical imaging more accessible, to push the boundaries of medical imaging technology and design CT scanners like the BodyTom, which is going to revolutionize intra-operative medical imaging.”

This unique portable unit has an internal drive system that allows a single operator to move the scanner easily in and out of elevators, over doorway thresholds and on any type of flooring, and can fit in rooms as small as 10’x10’. The BodyTom™ will be used among three operating rooms at Rhode Island Hospital, providing real-time results during surgery. The purchase of the BodyTom™ inter-operative portable CT scanner was made possible by a Champlin Foundations grant awarded to Rhode Island Hospital in January 2011.

Rhode Island Hospital Studies Uncover Keys In Sudden Cardiac Death

Tue, 17 Jan 2012 00:00:00 EST

Researchers in Rhode Island Hospital’s Cardiovascular Research Center have published two new studies focusing on the causes of arrhythmia and sudden cardiac death (SCD) when a genetic disorder is present. The studies use a first-ever genetic animal model the researchers developed in 2008 to further their understanding of a genetic disorder known as Long QT Syndrome (LQTS).

The first study identified differential conditions and cellular mechanisms that can trigger SCD when LQTS is a factor, and the second study, for the first time, directly links sex hormones to the incidence of arrhythmia and SCD. Their findings are published in the Journal of Physiology and the HeartRhythm Journal.

It is known that genetic mutations can predispose individuals to arrhythmia and/or SCD, a leading cause of death in the United States. Between one in 2,500 and one in 5,000 individuals are born with mutations that cause LQTS, a disorder of the heart’s electric system, and a determining factor in the development of arrhythmia and/or SCD. Ninety percent of the known mutations cause loss of function of ion channels responsible for LQTS types 1 and 2 (LQT1 and LQT2).

LQTS leads to a prolonged “QT interval” on electrocardiograms. The QT interval refers to the time it takes the chambers of the heart to “repolarize” themselves so that the heart is ready for another contraction cycle. When this timeframe is lengthened, it is associated with triggering irregular arrhythmia that can cause sudden cardiac arrest.

In 2008, Gideon Koren, M.D., a physician researcher and director of the Cardiovascular Research Center at Rhode Island Hospital, and his colleagues developed a first-of-its-kind genetic rabbit model to study arrhythmia and SCD that mirrors what happens in individuals who have mutations of the LQT1 or LQT2 genes.

In a new study published in the Journal of Physiology, the researchers used this animal model to identify differential conditions and cellular mechanisms that trigger arrhythmia in LQT1 or in LQT2 syndrome. In this study, Koren and the researchers studied early afterdepolarizations (EADs), an abnormal depolarization during the plateau phase of the heart electrical activity (action potential) that can initiate arrhythmia, and is a hallmark of LQTS. The focus was on mechanisms underlying different high-risk conditions that trigger EADs.

Their findings indicate that the conditions required for EAD to occur in the animal models are genotype specific. For LQT2, the researchers found that conditions such as a slow heart rate or a slightly lower potassium ion concentration outside the heart cells (as seen in hypokalemia) can cause a dramatic prolongation of action potential and produce EADs. In LQT1, however, these conditions result in relatively limited prolongation and no EADs. In contrast, isoproterenol that mimics cardiac stimulation by the sympathetic nervous system causes arrhythmias in single cells only in LQT1 heart cells.

Koren summarizes, “This study takes single cells out of the heart and reveals how arrhythmias are being initiated. What we are showing in this study is that single cells are responsible for generating an arrhythmia. Further, we found that different types of increased autonomic nervous system activity play a critical role in the cause of arrhythmias and sudden cardiac death, but it differs based on genotype.”

The autonomic nervous system is what controls “fight or flight” response. In their research, Koren and his colleagues found that sympathetic “surge” activity was responsible for triggering arrhythmia in LQT2. In LQT1, however, an increased steady sympathetic tone was associated with arrhythmias.

Surge is a sudden rise of the sympathetic tone. That surge is very important in triggering arrhythmia in LQT2. As Koren explains, “In LQT2, you need the startle response — like an alarm clock. However, in LQT1, we found the increased steady sympathetic tone is very important in inducing arrhythmia, like in patients swimming for an extended period of time. So there are different ways that arrhythmia will be induced depending on the genotype.”

In a second study, published in the HeartRhythm Journal, Koren and his colleagues furthered their understanding of arrhythmias by studying the impact of sex hormones, and confirming for the first time a direct link between the hormones and SCD.

Koren explains, “Quite simply, we demonstrate that estrogen promotes major cardiac events – such as polymorphic ventricular tachycardia (pVT) and SCD – while progesterone prevents them when LQT2 is a factor. Estrogen has a pro-arrhythmic effect.”

Sex differences in long-QT-related arrhythmias with a higher risk of pVT and SCD have been well-documented in the clinical setting, and the risk is higher in women than in men, particularly during the postpartum period. In this study, Koren says, “We show for the first time a direct link between sex hormones and the incidence of arrhythmias and sudden cardiac death. Through our research in our animal models, we have demonstrated that progesterone significantly reduces triggers for polymorphic ventricular tachycardia. At the same time, we were able to show that progesterone is protective and prevents SCD when LQT2 is present.”

Koren explains that this finding suggests that high progesterone levels during pregnancy likely account for the reduced risk of SCD in LQT2 patients during pregnancy. The marked reduction in progesterone during the postpartum period, however, likely promotes arrhythmias and SCD in these patients. Their findings also indicate that estrogen increases both trigger and sustainability of pVT, and thereby promotes major cardiac events.

He concludes that while further studies are needed in clinical trials, the clinical implications of this study will impact on the standard treatment of patients who are diagnosed with LQT2. Specific hormone-based therapies may be prescribed to protect them from arrhythmia and potentially avoid sudden cardiac death.

The National Institutes of Health provided funding for these studies. Koren’s principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island. He is also a professor of medicine at The Warren Alpert Medical School of Brown University.

Other researchers with Koren involved in the study published in the Journal of Physiology include Gong-Xin Liu, Bum-Rak Choi, Ohad Ziv, Weiyan Li also of Rhode Island Hospital and Alpert Medical School as well as Enno de Lange and Zhilin Qu of the David Geffen School of Medicine at the University of California. Other researchers involved in the study in HeartRhythm Journal include Katja Odening, Bum-Rak Choi, Gong-Xin Liu, Kathryn Hartmann, Ohad Ziv, Leonard Chaves, Lorraine Schofield and Jason Centracchio, all of Rhode Island Hospital and Alpert Medical School, Manfred Zehender and Michael Brunner of the University Medical Center Freiburg, in Germany, and Xuwen Peng of the Pennsylvania State University College of Medicine.

Recent Increase In Ice Skating Injuries: Injury Prevention Center At Rhode Island Hospital Urges Increased Ice Safety

Mon, 16 Jan 2012 00:00:00 EST

The cold winter weather marks the start of what can be a high-volume injury season for children. In fact, since January 1, two young children, neither of whom were wearing a helmet, required admission to Hasbro Children’s Hospital for treatment of head injuries sustained while ice skating. And, according to data from the American Academy of Pediatrics, approximately 10,000 children are treated in emergency departments each year for ice skating-related injuries.

Ice-related injuries can include everything from scrapes, bruises, concussions and broken bones while ice skating, to hypothermia and drowning when using unsafe outdoor ice, such as lakes and ponds. Studies published in the journal Pediatrics have found that head injuries and concussions are more common among ice skaters when compared with in-line skating and roller skating. These incidents have led the Injury Prevention Center at Rhode Island Hospital to urge parents and children to use increased caution and safety tactics to avoid these preventable ice-related injuries.

“Rhode Island law requires that all children fifteen and under wear a helmet when roller skating or rollerblading. Since head injuries and concussions are actually more common while ice skating compared with these sports, wouldn’t it make sense to wear a helmet while ice skating as well?” said Dina Morrissey, M.D., program coordinator for the Injury Prevention Center.

The Injury Prevention Center offers the following safety tips to help prevent unintentional ice-related injuries:

Make sure ice skates fit comfortably and provide ankle support. Poor fitting skates can cause blisters. Lack of ankle support makes ankles wobbly and can lead to injuries.
Inexperienced skaters should learn some ice skating basics, which include learning how to stop and fall safely, as well as basic safety rules.
Always look where you are going, even when skating backward.
Always obey rink rules, such as skating in the same direction as other skaters.
Always be alert and aware of surroundings. Never wear earphones or talk on a cell phone while ice skating.
Wear a helmet. This is especially important for young children or beginner skaters.
Consider wearing other safety equipment such as knee pads and wrist guards, especially young children and inexperienced skaters.
Dress appropriately to avoid cold-related injury.
Make sure you rest when you become tired or cold. More skating accidents happen when you’re tired.

If skating on an outdoor pond or lake you should also take the following precautions:

Never skate on an untested lake or pond.
The ice should be a minimum of six inches thick to be safe.
Never skate alone. Children should always be supervised by an adult.
Only skate during the day or if the area is lit.
Have a cell phone available to call for help if necessary.
Never cross a frozen pond as a shortcut.
Never go out on a frozen pond after an animal.

The Hasbro Children’s Hospital trauma registry collects data on all children admitted to the hospital as a result of a traumatic event. The trauma registry is a crucial tool used to track injury trends seen in the hospital’s emergency room, which can then be used to guide injury prevention efforts. Any parents with questions about ice safety, or other accidental injury topics, can call the Injury Prevention Center at 401-444-5018. These safety tips and more information can be found online at www.ipc.rhodeislandhospital.org.

Using Behavioral Management To Reduce Substance Abuse, Crime And Re-Arrest Among Drug-Involved Parolees

Tue, 10 Jan 2012 00:00:00 EST

A study from Rhode Island Hospital has found that collaborative behavioral management may be effective in reducing substance abuse among convicted marijuana users who are paroled. The findings have important implications for the management of a substantial proportion of the U.S. community correctional population. The study is published in Addiction and is available online in advance of print.

In the U.S., over 700,000 inmates leave prisons each year and over two-thirds of those inmates have a drug problem. The return of these inmates to the community is a critical issue for public health and safety. Relapse following release contributes to the re-arrest of more than two-thirds of parolees and re-incarceration of over half of inmates in the three years after release. While treatment can reduce relapse, drug-involved ex-inmates give limited priority to addiction treatment. Surveillance with the threat of sanction by parole officers is the traditional method of following parolees, yet many ex-offenders fall into the same pattern and are arrested again.

Knowing that contingency management can be an effective treatment for drug abuse and addiction, researchers at Rhode Island Hospital and nationwide, led by Peter D. Friedmann, M.D., performed a clinical trial called “Step ‘n Out” to determine whether collaborative behavioral management would be effective in reducing substance abuse, crime and re-arrest among drug-involved parolees. This study was funded by the National Institute on Drug Abuse of the National Institutes of Health.

Friedmann, a physician and an addiction health services researcher at Rhode Island Hospital, explains, “Because of the so-called War on Drugs, an unprecedented number of people have been put in prison for drug use and the great majority of them return to the community. Community reentry is a difficult period – having a criminal record makes it hard to get a job and you usually return to the same environment you came from with the same people and temptations. Thus, a large proportion of drug-involved ex-offenders return to drugs and crime.”

Addiction treatment during the transition period can reduce relapse, but competing priorities such as the need for housing and finding work often limit ex-offenders willingness to participate in treatment. Parole and probation are supposed to encourage treatment and prevent a return drugs and crime, but they are poorly designed to do so. Probation and parole are based on supervision and punishment for bad behavior. For example, if a parolee tests positive for drugs, he/she might be returned to jail.

Behavioral theory holds that effective reinforcers or punishments must be both immediate (close in time to the behavior) and reliable (happen every time the behavior happens). “Any parent knows that punishment alone is not the optimal way to motivate behavior – it is best to have both carrots and sticks,” Friedmann says. “The problem is that punishment is neither immediate nor reliable — in part because of due process, but also because surveillance is imperfect and offenders have a disincentive to get caught. Conversely, drug use produces both immediate and reliable reinforcement, where a user gets a good feeling with every use.”

Friedmann explains, “The everyday reinforcers of daily life such as a good job and good family life can’t compete – they are delayed and not guaranteed.” Thus, behavioral theory explains what we see – the reentry period is extremely challenging and many ex-offenders end up returning to drugs and crime.”

Through the Step’n Out study, the researchers developed a system of “bridge reinforcement” to provide incentives for good behavior. Weekly over 12 weeks, officers, treatment counselors and clients worked together to agree on a behavioral contract in which there were three target behaviors. If the client met the behaviors then they were rewarded through a system of points that led to positive social reinforcers or material reinforcers like gift cards. A computer program helped track and manage the points and reinforcers. The motto of the study was “Catching People Doing Things Right” because the clients now had a reason to report their successes and the parole officers to recognize them. This intervention was studied in a randomized clinical trial in six parole offices in five states.

The Step ‘n Out trial reported that collaborative behavioral management worked to reduce primary drug use among “non-hard drug” users, primarily marijuana. Since marijuana users comprise a large proportion of individuals arrested for drug use, this study suggests that this behavioral approach to community corrections might reduce drug use and ultimately reincarceration. The findings, however, could not demonstrate benefit among parolees who preferred stimulants or opiates.

Friedmann notes, “Since the majority of drug violation arrests in the U.S. are for marijuana, these findings have important implications for the management of a substantial proportion of parolees. The study shows that an intervention grounded in behavioral science is feasible and effective in real-world correctional settings.”

Friedmann’s principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island. He also has an academic appointment at The Warren Alpert Medical School of Brown University. He is also a physician with University Medicine Foundation http://www.umfmed.org/ and the Providence Veterans Affairs Medical Center.. Other researchers involved in the study with Friedmann include Traci C. Green, Faye S. Taxman, Magdalena Harrington, Anne G. Rhodes, Elizabeth Katz, Daniel O’Connell, Steven S. Martin, Linda K. Frisman, Mark Litt, William Burdon, Jennifer G. Clarke and Bennett W. Fletcher for the Step ‘n Out Research Group of the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS).

CJ-DATS is funded through a cooperative agreement from the National Institute on Drug Abuse, National Institutes of Health (NIDA/NIH), with support from the Center for Substance Abuse Treatment; the Centers for Disease Control and Prevention; the National Institution on Alcohol Abuse and Alcoholism (all part of the U.S. Department of Health and Human Services) and from the Bureau of Justice Assistance of the U.S. Department of Justice.

Hasbro Children's Hospital Names Director of Genetics

Wed, 4 Jan 2012 00:00:00 EST

Chanika Phornphutkul, M.D., has been named division director of the Division of Human Genetics at Hasbro Children’s Hospital. In her role, Phornphutkul will lead the hospital’s Genetic Counseling Center.

“After a full review of an international panel of candidates, we discovered we had an exceptional internal candidate. Dr. Phornphutkul has a deep understanding of our hospital community and possesses the knowledge, determination and passion to advance our genetics program to meet the growing needs of children both locally and nationwide with rare genetic disorders,” said Robert B. Klein, M.D., pediatrician-in-chief at Hasbro Children’s Hospital.

Phornphutkul first joined Hasbro Children’s Hospital in 1999 as a pediatric endocrinologist. In 2002, she took on a role as a biochemical geneticist and director of the hospital’s metabolic clinic since 2002.

As the leader of the Genetic Counseling Center, Phornphutkul will oversee the treatment patients of all ages, from newborns to teenagers as well as adults. Newborn children are referred because of suspected birth defects, abnormal newborn screening, genetic disorders, congenital malformations and/or dysmorphic features. Older children are treated for the same issues, as well as for developmental delay or learning disability.

The Center also offers genetic counseling and carrier testing for people with family histories of genetic conditions, such as cystic fibrosis and Duchenne muscular dystrophy. Evaluation, counseling and testing are also available for hereditary cancer syndromes, such as hereditary breast and ovarian cancer (HBOC), familial polyposis (FAP), and hereditary nonpolyposis colon cancer (HNPCC), as well as other disorders like Huntington’s disease.

Since 2002, Phornphutkul has served on the Rhode Island Department of Health Newborn Screening Advisory Committee, as well as its Genetics Advisory Committee. She also currently takes part in the New England Genetics Collaborative Advisory Council. Phornphutkul’s efforts with each of these groups are to screen every newborn child for several genetic conditions. If discovered early, serious problems, including mental retardation and death, can be prevented.

“Many childhood disorders have an inherited or genetic cause,” said Phornphutkul. “With the growing knowledge in genetics, we can provide families with the best knowledge and treatment. Newborn screening has been a major tool of identifying patients at the earliest stage and allows us to treat our young patients from the very beginning of their lives, and learn together how to better manage their health and provide answers to families.”

As the author of more than 20 scientific journal articles, Phornphutkul has been invited to lecture on a variety of genetics topics, both locally and nationally, and has led multiple Grand Rounds presentations to share her expertise in Genetics and endocrinology with the pediatrics community. She has made more than 30 presentations at pediatrics, endocrine and genetics meetings and conferences across the country.

Phornphutkul received her undergraduate and doctor of medicine degrees from Chiangmai University in Thailand. She completed residencies in pediatrics at both C.S. Mott Children’s Hospital in Ann Arbor, Mich., and Hasbro Children’s Hospital. She also completed a fellowship in the division of pediatric endocrinology and metabolism at Hasbro Children’s Hospital and a fellowship in clinical biochemical genetics at the National Human Genome Research Institute of the National Institutes of Health in Bethesda, Md.