LifeNotes | Spring 2018

LifeNotes

Researchers’ discovery creates buzz in global search for superbug cure

Researchers’ discovery creates buzz in global search for superbug cure

Nature magazine publishes study on potential new antibiotics discovered by a team led by Eleftherios Mylonakis, MD, chief of infectious diseases at The Rhode Island and The Miriam Hospitals.

Learn More

Promising Research in Race for Antibiotics to Kill Superbugs

Brown University Health infectious disease researcher and physician Eleftherios Mylonakis, MD, is the senior author of a study published recently in Nature about the discovery of a new class of antibiotics that could one day combat the alarming emergence of drug-resistant “superbugs.”

Dr. Mylonakis, chief of infectious diseases at Rhode Island Hospital and The Miriam Hospital and Charles C.J. Carpenter Professor of Infectious Disease at The Warren Alpert Medical School of Brown University, led a multidisciplinary team of researchers searching for drugs to target bacteria that have developed a resistance to conventional antibiotics.

According to estimates from the Centers for Disease Control and Prevention, at least 2 million people in the United States become infected each year with bacteria that are resistant to antibiotics, and at least 23,000 people die from these infections. More than 80,000 people contract methicillin-resistant Staphylococcus aureus (MRSA) infections, and 11,000 of those die.

“This is an emergency,” Dr. Mylonakis says, citing a World Health Organization projection that “by 2050, superbugs will surpass cancer as the global No. 1 killer. This is a frightening situation. It affects more than individuals in the hospital or the very ill or the very old. It affects everybody.”

The team’s pioneering methods led to the discovery of a new synthetic class of antibiotics and the identification of two synthetic retinoids, both of which demonstrated the ability to kill MRSA. These compounds kill the so-called MRSA “persister” cells—the drug-resistant dormant cells that are not susceptible to current antibiotic therapies. MRSA poses a particularly acute threat to public health because it is omnipresent in the environment and on our skin, is highly virulent, and can cause serious blood, bone and organ infections.

Dr. Mylonakis led the collaborative project that included researchers at Rhode Island Hospital and experts from Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Brown University, Emory University, and Northwestern University. He says teams like his are filling a void left by the major pharmaceutical companies, which for a variety of reasons have not invested in the development of new antibiotics for many years.

“In a simplistic way, it’s a math problem,” says Dr. Mylonakis. “It takes the bugs an average of two years to develop resistance to antibiotics. It takes more than 10 to 15 years of work to get an antibiotic into clinical practice.”

The research team developed novel ways to screen a remarkable 82,000 synthetic compounds to identify those that would serve as effective antibiotics -- but not be toxic to humans. Ultimately, 185 compounds were identified that decreased the ability of MRSA to kill laboratory roundworms. Of those, the two synthetic retinoids were selected as the best candidates for further study. One of the original compounds and a completely novel, more active derivative were effective when tested on a mouse thigh infected with MRSA.

“The results were extremely positive. We are very optimistic,” said Dr. Mylonakis. But, he added, “This is still years away from coming to clinical trial.” The study was supported by National Institutes of Health grant P01 AI083214, National Science Foundation grant CMMI-156290 and National Institute of General Medical Sciences grant 1R35GM119426.

Brown University Health Total Joint Center

Total Joint Center

Located at The Miriam Hospital, the Total Joint Center is the region’s highest volume program for total hip replacement, knee replacement and shoulder replacement procedures - with clinical and quality outcomes that rank among the best in the nation.

Learn More

New Shoulder Procedures Address Unmet Clinical Needs

Orthopedic surgeons at the Total Joint Center of the Brown University Health Orthopedics Institute now offer several promising options for shoulder conditions that previously have been difficult to treat. Our team of experts is using newer techniques and technology, including reverse shoulder replacement, stemless shoulder replacement, and superior capsular reconstruction.

Shoulder Arthritis

Traditional total shoulder replacement is an excellent treatment option for many patients suffering from shoulder arthritis. Total shoulder replacement is the fastest-growing joint replacement procedure in the United States, increasing at a rate faster than both hip and knee replacement.

However, concerns exist regarding the longevity of the implants in younger patients. With a more active population, longer life spans, and our ability to treat younger patients with newer technology, this demographic is increasing. Some new technologies are better suited to serve this younger population.

Tornier Simpliciti Prosthesis

The Tornier Simpliciti prosthesis—the only stemless shoulder replacement on the market in the United States—is a new technology. Unlike traditional shoulder implants, it does not require a stem down the middle of the bone or cementation in the arm bone (humerus). This better preserves the structure of the bone and allows preservation of more bone, while also resurfacing both sides of the ball and socket joint to decrease pain and improve function. If a revision surgery becomes necessary in the future and the implant needs to be removed, it can be done more easily and with much less damage to the bone of the upper arm. Implanting a subsequent shoulder implant is likely to be more predictable and straightforward, and improve the eventual outcome—especially important in younger patients undergoing a shoulder replacement, who because of their age have a higher likelihood of revision surgery in the future.

Rotator Cuff Tears

Like shoulder arthritis, rotator cuff injuries can cause significant impairment and dysfunction for patients. Two newer options are available to treat patients with large tears of the rotator cuff that cannot be repaired.

  • Reverse Shoulder Replacement - For patients with large, irreparable rotator cuff tears accompanied by a specific type of arthritis resulting from these tears, reverse shoulder replacement provides an excellent option for pain relief and improved function. The typical patient is generally older, but this surgery is being done in younger and younger patients with very good results. This implant reverses the anatomy of the ball and socket joint (putting a ball where the socket was and a socket where the ball was). The design of this implant allows the other muscles and tendons of the shoulder that are still intact to take over the function of the torn rotator cuff tendons and restore function of the shoulder.
  • Superior Capsule Reconstruction - For patients with large, irreparable rotator cuff tears that have yet to show significant arthritis, a new procedure—Superior Capsular Reconstruction—using a tissue reconstruction with acellular allograft dermis, shows promise in improving function. Patients with large, irreparable tears generally have displacement of the ball to the upper edge of the socket, secondary to lack of the rotator cuff that helps hold the ball centered down in the socket. When the ball migrates upward, it can create pain and weakness. With this new procedure, the ball is held re-centered in the socket by the graft, improving function and decreasing pain. This is done arthroscopically and with preservation of the native joint. In this procedure, the allograft dermis is taken from a deceased human donor and processed in a sterile manner, leaving only the portion that provides strength behind.

Our Total Joint Center, the region’s highest-volume joint replacement program, has clinical and quality outcomes that rank among the best in the nation. Our surgeons have extensive experience performing all types of shoulder surgery, including joint preservation and replacement surgery, and are leaders in the development of techniques to better serve our patients and fill gaps in the current treatment options. The new procedures for both older and younger patients reflect our ongoing commitment to provide superior orthopedic care. Our team of shoulder surgery experts includes E. Scott Paxton, MD, Andrew Green, MD, and Ana Mata-Fink, MD. For more information or to refer a patient, call 401-793-5852.

Michael Mason, DO
Michael Mason, DO

New Orthopedic Surgeon Brings New Expertise to Brown University Health

Michael Mason, DO, is a board-certified orthopedic surgeon with Newport Orthopedics, a Brown Health Medical Group practice that is part of the Brown University Health Orthopedics Institute. He joined the practice last year from New England Baptist Hospital, where he developed significant expertise in joint replacement using Radlink GPS software, a real-time visualization technology that helps ensure excellent outcomes in orthopedic surgery.

Newport Hospital is now the only hospital in Rhode Island to offer the innovative Radlink GPS technology, which provides noninvasive, instant feedback during total joint replacement. The technology helps shorten hospital stays and speed recovery.

The technology creates an image of a patient’s unique anatomy both before and during surgery, using X-rays of the joint instead of a simulation. Before surgery, the software is used to analyze X-rays and apply mathematical algorithms to determine anatomical landmarks so the surgeon can plan the procedure and operate with pinpoint precision. During surgery, the tool uses real-time images to guide positioning of the hip or knee implant with near-perfect accuracy, allowing the surgeon to make informed decisions and adjustments.

Because of the extraordinary precision that Radlink allows, patients can often return to active lifestyles sooner. The accuracy of the implant placement also reduces risk of dislocation and wear on the joint, resulting in increased longevity and excellent long-term prognoses.

Dr. Mason received his medical degree from the Philadelphia College of Osteopathic Medicine. He completed his internship and orthopedic surgical residency at Community General Hospital in Harrisburg, Pennsylvania and continued his subspecialty fellowship training at Massachusetts General Hospital and Brigham and Women’s Hospital. He has designed and helped develop multiple artificial joints and has more than 20 years of experience in joint replacement and reconstructive surgery. For more information or to refer a patient, call 401-845-1474.

Brown University Health Recovery Center

Brown University Health Recovery Center Referral Information

For information or to make a referral, please call 401-606-8530. To help facilitate patient referrals, please complete the referral form and fax it to 401-606-8549.

You can download the referral form here.

Hours of Operation Monday, Tuesday, Thursday, Friday:
8:30 a.m. – 5 p.m.

Wednesday:
8:30 a.m. – 6 p.m.

Learn More

Program Offers Support for Families Struggling with Addiction and Recovery

The Brown University Health Recovery Center now offers a Family Education and Support Program. The program focuses on educating family members on how they can assist and support their loved one during recovery, as well as ensure their own well-being through the stresses that result.

For patients and their family members, the program sessions present accurate information about addiction, recovery, treatment, and the resulting interpersonal dynamics. Topics consist of a welcome and orientation, the approach to treatment and how to administer Naloxone (Narcan), differentiating between supportive and enabling behaviors, self-care to ensure the family's well-being, effective communication, and a wrap-up session for participants to ask questions and obtain suggestions. For more information about the Family Education and Support Program, please call 401-606-8530 or email LRCsupport@brownhealth.org.

Easy, Single Point of Access for Adult Mental Health Programs

The new Brown University Health Psychiatry and Behavioral Health access center for adult outpatient services now provides a simplified way to make an appointment or obtain a referral to the appropriate resource for all adult outpatient programs.

Services include assessment and treatment options and are provided by a multidisciplinary group of board-certified psychiatrists, psychologists, clinical nurse specialists and social workers. Several specialty programs include:

For more information, call the access center at 401-606-0606.

Newly Expanded Program for Co-occurring Mental Health and Substance Use Disorders

Newport Hospital now offers a second track in its established Partial Hospitalization Program for patients with co-occurring substance use and mental health diagnoses. The program provides short-term, group-based, comprehensive outpatient treatment. The multidisciplinary approach includes psychiatrists, psychologists, nurses, social workers, mental health counselors, and recreational therapists with expertise in both mental health and substance use disorders. The emphasis is on restoring a patient's health and emotional stability and preventing setbacks. The program runs six hours a day, five days a week, from one to two weeks. Intake includes medical and psychiatric evaluation, followed by therapies and education appropriate to each patient’s needs, including individual sessions with the psychologist, social worker or mental health counselor to manage therapeutic issues. Patients are expected to participate fully in their treatment so they can learn about their treatment options, manage their own feelings and behaviors, and focus on recovery. For more information or to refer a patient, call 401-845-1910, or visit us online. The referral form is available to download.

Brown University Health Bariatric Surgery Program

Center for Bariatric Surgery

The Center for Bariatric Surgery, a program of Rhode Island and The Miriam hospitals, offers a long-term solution.

Learn More

Less Invasive Endoscopic Revisions for Post-Bariatric Surgery Weight Gain

As effective as the bariatric gastric bypass procedure is for significant long-term weight loss, some patients experience weight gain after surgery. While there are many reasons why a person may gain weight after the bariatric gastric bypass procedure, one factor could be the gradual stretching of the opening in the stomach. As the opening increases, people may feel less full and be able to eat larger portions of food.

For those struggling to maintain a healthy weight, revision surgery is an option for certain patients. Two procedures are band-to-bypass or band-to-sleeve procedures, and a third option is the sleeve-to-bypass procedure. Another procedure—the endoscopic revision of gastrojejunal anastomosis for gastric bypass patients—involves decreasing the size of the opening. This is an endoscopic procedure in which the surgeon sutures the area, making the opening smaller.

Advantages of the endoscopic revision of gastrojejunal anastomosis

A physician may recommend the procedure to some patients because it offers certain benefits, including:

  • less invasive and requires no incisions
  • quicker procedure compared to traditional surgery
  • outpatient procedure–in and out of the hospital the same day
  • lower risk of complications during or after the procedure

Not every bariatric gastric bypass patient is a candidate for endoscopic revision of gastrojejunal anastomosis; it is appropriate only for those whose weight gain is the result of an enlarged opening into the stomach.

Spanish-speaking Support Group for Bariatric Surgery Patients

The Center for Bariatric Surgery now offers a Spanish-speaking support group at The Miriam Hospital. The group meets at 5:30 p.m. on the third Wednesday of every month in the Hurvitz 2 Conference Room. Please call 401-793-3922 for more information.

Bladder Cancer Treatment
Learn more about the of use blue light cystoscopy to treat bladder cancer.

The Miriam Is 1 of 3 New England Hospitals with Advanced Treatment for Bladder Cancer

Urinary bladder cancer is the sixth most common in the United States and has the highest recurrence rate of any form of cancer. It is the fifth most common cancer in Rhode Island, which has the nation's highest bladder cancer rate per capita. Now a new technology—blue light cystoscopy—helps decrease the rate of recurrence.

The Miriam Hospital is the only hospital in Southeastern New England, and one of just three in New England, to offer blue light cystoscopy. In 2016, the American Urological Association and Society of Urologic Oncology included blue light cystoscopy in their guidelines for patients with non-muscle-invasive bladder cancer, and The Miriam's Minimally Invasive Urology Institute strictly adheres to the guidelines.

While resection of bladder cancer tumors is a common treatment for bladder cancer, most of these surgeries rely on conventional white light only. Research shows that many tumors are missed using traditional white light cystoscopy, and a large percentage of patients have evidence of tumors on repeat transurethral resection of bladder tumor at two to six weeks.

Blue light cystoscopy is a major breakthrough in bladder cancer detection. During the procedure, hexaminolevulinate HCl (Cysview), an optical imaging agent, is delivered into the patient’s bladder about an hour before the procedure. This agent binds to cancerous areas and highlights them by causing them to glow pink, so they are highly visible and aid in the surgical identification and removal of bladder cancer tumors.

The surgeon first uses conventional white light to examine the bladder, and then switches to the blue light. When the equipment is switched to blue-light mode, additional hard-to-see tumors become more visible. Benefits include better visibility of the tumor, increased chance of complete removal, and decreased rates of tumor recurrence with better long-term outcomes. The Miriam Hospital is one of three New England hospitals to use blue-light cystoscopy to diagnose and treat bladder cancer.

The Miriam Hospital Opens Clinical Decision Unit

The Miriam Hospital’s emergency department now offers patients a better experience. The ED opened a clinical decision unit to alleviate overcrowding in the emergency department and the hospital by improving patient flow and reducing demand for inpatient beds.

Patients who are expected to need only a short stay—less than 24 hours—are sent to the clinical decision unit for observation and treatment. Before the unit opened, these patients might have been admitted, filling inpatient beds that could have been used for more acutely ill patients who are likely to need a longer stay.

The new unit accommodates ten patients. Each comfortable, private room is equipped with monitors, standard beds, and televisions, much like an inpatient room.

Rose struggled with her weight from childhood. Follow her journey to a healthier life.

New Name for Successful Weight Program

The Center for Weight and Wellness is the new name of what was The Miriam Hospital Weight Management Program. The new name better reflects the center’s integrated approach to weight loss, which includes medical supervision, nutrition, exercise, counseling, and ongoing support for long-term success and overall well-being.

For more than 30 years, the program team has helped moderately to severely overweight patients achieve their weight management goals. After 21 weeks in treatment, patients achieved an average weight loss of 43 pounds and reduction in blood pressure from 130/79 to 116/72.

The center offers a free maintenance program for one year, as well as specialty programs to address unique patient needs. In addition, there is on-site therapy for binge eating as well as for conditions such as depression or anxiety, which can have a negative impact on successful weight management.

Center for Weight and Wellness health educator and group leader Angelina Newbury, MS, provides clinical, educational, referral, and outreach services, as well as support for the maintenance of weight loss through specific behavioral strategies and education. Newbury earned her BS in community health outreach from Rhode Island College and her master's degree in allied health sciences from the University of Connecticut. The Center for Weight and Wellness offers two locations: 146 West River Street, Suite 11A, in Providence, and 1377 South County Trail, Unit 1, in East Greenwich. For more information, please call 401-793-8790.

Comprehensive Spine Center Opens at Newport Hospital

The Comprehensive Spine Center, anchored at Rhode Island Hospital, now offers its full range of services at Newport Hospital. Services are integrated with the outpatient Vanderbilt Rehabilitation Center on the first floor of the Turner Building.

The Comprehensive Spine Center brings together interventional and noninterventional physiatry, pain medicine and neurosurgery—using both medical and surgical approaches—to effectively address pain, with the most advanced diagnostic and therapeutic equipment and treatment options available.

Three specialists diagnose and treat patients: interventional pain specialist and physiatrist Kyle Silva, DO; neurosurgeon Jared Fridley, MD; and Alexios G. Carayannopoulos, DO, MPH, medical director of the Comprehensive Spine Center and division director of pain and rehabilitation medicine in the department of neurosurgery at Rhode Island Hospital.

Brown University Health Cancer Institute Now Live with RayStation V.5

The Brown University Health Cancer Institute recently implemented RaySearch’s RayStation V.5 treatment planning system, which addresses myriad workflow issues and provides a new platform that aligns with the technological advances seen throughout the academic radiation oncology community. This places Brown University Health at the forefront of advanced radiation oncology technology in southern New England.

RayStation V.5 improves treatment planning—perhaps the most important step in radiation oncology workflow. Its accuracy and optimization are paramount to delivering the best treatment plan. Advantages include:

  • Citrix-Based Environment - RayStation is accessed through Citrix, enabling physicians, physicists, and dosimetrists remote access to the system from any location. This setup is instrumental for any academic institution and allows for mindful and cost-effective delivery of safe, effective radiation therapy.
  • Research Potential - RaySearch research and development provides an opportunity, at this stage in both RayStation and RayCare (oncology information system), to partner with RaySearch to promote clinical and translational research.

New Uses for Align RT

Align RT, which provides a three-dimensional, video-based approach to ensuring a patient is in the optimal position for radiation therapy, is now being used for an expanded array of indications—including highly complex breast, lung, liver, and abdominal cancer irradiations to “gate” the radiation treatment to breathing movement. This allows for exceptionally high-precision treatment, which in turn allows us to escalate the radiation dose (for enhanced cure), while minimizing the risk of severe side effects to normal tissues such as the heart.

These new uses of the technology ensure that every patient is treated to the highest standard of positional accuracy throughout the entire radiation treatment session.

Sickle Cell Multidisciplinary Clinic

Sickle Cell Multidisciplinary Clinic

The Sickle Cell Multidisciplinary Clinic of the Brown University Health Cancer Institute provides the specialized care that adults with sickle cell disease require.

Learn More

Brown University Health Cancer Institute Launches Sickle Cell Multidisciplinary Clinic

With advances in newborn screenings and aggressive management of infections and anemia, life expectancy for patients with sickle cell disease and thalassemia is increasing significantly.

Brown University Health Cancer Institute now offers a sickle cell multidisciplinary clinic to provide the specialized care and support these patients need. Individualized care is coordinated among patients, families, and physicians and nurses from many specialties.

Clinic goals are to address the underlying disease process, treat pain, manage symptoms, and prevent or treat end-organ damage by providing:

  • routine outpatient care
  • ongoing pain management
  • medication management to lessen symptoms
  • blood transfusions of healthy red blood cells to treat or prevent complications
  • wound care
  • education and support
  • genetic counseling

Each patient meets with the team for an evaluation during the first visit. Based on the initial evaluation, each patient will meet with the psychiatrist and be referred to other disciplines as appropriate. The clinic team is committed to providing a medical home for patients with sickle cell disease and to decreasing the need for emergency department visits and inpatient admissions as much as possible. Currently, the Sickle Cell Disease Multidisciplinary Clinic meets every Tuesday at Rhode Island Hospital in APC 1. For appointments and referrals to the sickle cell multidisciplinary clinic please call 1-844-222-2881.

Drs. Andrew Nowak, Jon K. Lambrecht & Christopher Luttman
Drs. Andrew Nowak, Jon K. Lambrecht & Christopher Luttman

Brown University Health Cardiovascular Institute Welcomes Additional Physicians

In May, Brown University Health Cardiovascular Institute welcomed three board-certified cardiologists: Jon K. Lambrecht, MD; Christopher J. Luttman, MD; and Andrew Nowak, MD. They began seeing patients on May 1.

LCVI physicians provide the highest level of consultative, diagnostic, interventional, surgical and rehabilitative cardiac care. Services include inpatient and outpatient consultation, cardiac imaging and diagnostic testing and intervention, cardiac rehabilitation, and disease prevention at The Miriam and Newport hospitals and at multiple ambulatory center locations throughout the region.

As partners in your patients’ care, LCVI physicians keep you informed throughout the diagnostic and treatment process. To refer a patient, please call 1-855-332-8474.

New Services Locations

Brown Health Medical Group/Women's Medicine Collaborative Expands

Brown Health Medical Group and the Women’s Medicine Collaborative have an additional location for obstetrics and gynecology at 148 West River Street, Suite 8, Providence.

Hours: Monday – Friday, 8 a.m. – 4:30 p.m., with evening appointments available.
Phone: 401-606-3000
Fax: 401-331-8110

Brown University Health Rehabilitation Services Expands to Lincoln

Brown University Health Rehabilitation Services opened a new location in Lincoln that offers pediatric and adult occupational therapy and physical therapy. It features a rehabilitation gym, two private treatment rooms, and a larger pediatric sensory integration room. It is located at 1 Commerce Street, 2nd Floor, Lincoln, RI 02865.

Hours: Monday – Friday, 8 a.m. – 5 p.m.
Phone: 401-793-8501
Fax: 401-793-8502

LifeNotes - Physicians