LifeNotes
E-Newsletter for the Medical Community

LifeNotes | Spring 2023

A note from the President and CEO

john-fernandez

Dear Colleague:

I’m delighted to share this spring edition of LifeNotes, our biannual newsletter spotlighting the talented physicians and high-level services so fundamental to our mission of delivering exceptional patient care.

As the new president and CEO of Lifespan, I’m particularly proud of the impressive achievements highlighted here, from developing new stroke treatment protocols to improving the patient experience in the emergency room. The deep pool of talent and innovative thinking on display is what drew me to Rhode Island and to my new leadership role.

Expanding our research enterprise is a top priority of mine. I hope you’ll take a minute to read about an exciting breakthrough from a research team at the Rhode Island Hospital COBRE for Skeletal Health and Repair: after 12 years of research, the team announced it had developed an RNA delivery system to penetrate the brain-blood barrier and provide targeted treatment for cancer, arthritis, neurodegeneration and other diseases.

You can also read about the results of a new clinical trial for a glioblastoma vaccine found to significantly extend life expectancy for people with this type of brain tumor. A Lifespan neurologist is the lead investigator for the local arm of the trial, the first in nearly 20 years to show such an improvement in survival in glioblastoma patients.

Innovation doesn’t only happen in the lab or at the bedside. Sometimes it’s about sharing our unique expertise with partners in the community. Bradley Hospital is partnering with state agencies and three Rhode Island school districts to address the emerging pediatric mental health crisis, providing training for school personnel to detect and respond to mental health issues, and connecting the affected students’ families to needed services.

We’ve also highlighted useful information on new services and technologies, such as the latest laser technology used to treat enlarged prostate; magnetic tumor markers used to facilitate breast cancer surgery; a new wearable robotic exoskeleton used to help rehab patients relearn to walk, and much more.

Thank you for your commitment to patients and families across our state, and for your partnership in creating a healthier Rhode Island.

Kind Regards,
John Fernandez
President and CEO, Lifespan

LifeNotes updates

Rhode Island Hospital First to Perform Lung Biopsies Using Ion Robotic Surgery

In January, Rhode Island Hospital performed its first, single anesthetic, robotic bronchoscopy for localization of a lung nodule followed by robotic removal, all during the same procedure. A new robotic-navigational bronchoscope called Ion is changing the game when it comes to finding and removing nodules in the lung.

“The Ion is minimally invasive and a perfect option for patients who have nodules identified during lung cancer screenings, especially when they are caught when they're small and more curable,” says Abbas El-Sayed Abbas, MD, chief of thoracic surgery at Lifespan and chief of thoracic oncology at the Lifespan Cancer Institute. Abbas, an internationally recognized expert, helped pioneer the use of this technology years ago at a health system in Pennsylvania.

"We can navigate to these tiny nodules in much the same way as we use GPS for driving directions. When I inject the nodule with a special substance, the software reconstructs the pathway and actually gives us directions," explains Abbas. "It's a beacon, leading us directly to the nodule.” Once located, the DaVinci robot is then used to remove the nodule.

"In one procedure and with one anesthetic, we can confirm that this is the nodule, it's malignant, we've localized it, and we can remove it along with the smallest segment of lung possible," Abbas says.

doctor and ion robot

Find Out More

Watch the segment from Channel 10 news to learn more about the robotic surgery for lung biopsies. 

FDA Approves Bilateral Use of High-Intensity Focused Ultrasound to Treat Tremors

High Intensity Focused Ultrasound

Since 2021, Neurosurgeons at the Norman Prince Neurosciences Institute (NPNI) have been using high-intensity focused ultrasound (HIFU) to perform incisionless brain surgery in patients with essential tremor and some forms of Parkinson’s disease.

The initial FDA approval was specifically for use on one side of the brain. Now, the FDA has approved HIFU for bilateral use, giving more patients access to this life-changing treatment.

HIFU uses MRI-guided focused ultrasound energy to treat the brain circuit responsible for the tremors. This incisionless procedure is performed while the patient is awake to immediately confirm optimal treatment effect: immediate and long-lasting cessation of tremor with minimal side effects.

Because this outpatient procedure does not require an incision, it boasts several advantages, including reduced risk of infection and quicker recovery time, along with the immediate and considerable reduction in hand tremors. Patients who may benefit from HIFU include those who no longer receive benefit from taking medication and those who are not candidates for deep brain stimulation.

“While essential tremor is relatively common and often fairly mild, a significant number of patients experience severe and debilitating tremors that impact their daily lives,” notes Wael Asaad, MD, PhD, neurosurgeon at the NPNI. “For those who do not find relief through medications, this procedure offers an effective, cutting-edge option without the cutting.”

With the ability to reduce both recovery time and the risk of infection, the entire process takes two to three hours. “It’s a one-day outpatient procedure,” Dr. Asaad explains. “Because our patients are awake, we can immediately assess how they’re doing.”

While HIFU is specifically intended for treating essential tremor and Parkinson’s disease, it has potential for use in other neurogenerative diseases and possibly even chemotherapy delivery.

“There’s a lot of potential for this technology to be used broadly in neurosurgery. But currently the uses are pretty remarkable,” notes Asaad.

For more information about the procedure, contact Dr. Asaad at 401-793-9166 or visit the Movement Disorders Program website. Detailed information on HIFU can also be found here on brownneurosurgery.com.

Researchers Announce New Glioblastoma Vaccine Increases Life Expectancy

Lifespan Cancer Institute recently announced the results of a clinical trial for a glioblastoma vaccine found to extend life expectancy for individuals with this type of brain tumor.

Among its key findings, the Phase III clinical trial of the DCVax-L cancer vaccine extended survival for patients with both newly diagnosed and recurrent glioblastoma, the most common and lethal form of brain cancer. This is the first time in nearly 20 years that a Phase III trial of a systemic treatment has shown such an improvement in survival in newly diagnosed glioblastoma patients.

Patients who are diagnosed with glioblastoma typically survive for 15 to 17 months. The five-year survival rate for glioblastoma is only five percent. The results of the DCVax-L vaccine trial involving more than 300 patients show the median survival rate for newly diagnosed patients increased to 22.4 months, and the five-year survival rate more than doubled, increasing from 5 to 13 percent.

At Lifespan, neurologist Heinrich Elinzano, MD, is the lead investigator for the local arm of the trial, which is of particular interest here in Rhode Island. “There is a high incidence of glioblastoma in Rhode Island relative to its population,” says Elinzano, noting that there are 60 to 70 patients treated each year at Rhode Island Hospital.

“The non-toxic injections seem to activate the patient’s neuroimmune cells to attack the cancer and reduce the chances of this malignancy coming back,” Elinzano adds. “For patients with glioblastoma, the vaccine is a new lease on life, and combined with other treatments, can help patients survive longer.”

Learn more about the Brain and Spine Tumor Center

doctor and patient

Clinical Trial Results

Watch coverage of the media conference announcing the results of the clinical trial for the glioblastoma vaccine.

Shadi Yaghi, MD, Develops New Protocol for Treating Wake-up Strokes

yaghi-shadi

During an ischemic stroke, time to treatment is critical. Unfortunately, when patients wake up with their symptoms, they may have exceeded the timeframe for safely administering life-saving treatment. Neurologist Shadi Yaghi, MD, co-director of the Comprehensive Stroke Center at Rhode Island Hospital, hopes to change that with a new protocol for treating “wake-up strokes” – strokes that occur during sleep.

Yaghi notes that about 15 to 20 percent of stroke patients experience wake-up strokes. "The vast majority of these patients were last seen ‘normal’ and without stroke symptoms the night before. So, technically they're outside of the four-and-a-half-hour window to be able to safely give them the clot-busting medication," Yaghi said.

Yaghi is hoping to extend that timeframe by implementing a new screening protocol for patients who present with stroke symptoms after waking up. Rather than immediately excluding them from treatment, the protocol calls for the use of a CT scan to rule out a bleeding-type stroke, followed by an MRI to measure tissue damage. Dr. Yaghi explains that these screenings can show whether the patient is within a safe time frame to administer clot busting medication, effectively saving brain tissue at risk and reversing the symptoms of the stroke.

“As the only comprehensive stroke center in the state and with an interventional suite in the Emergency Department, Rhode Island Hospital is the best location to test the new protocol,” adds Yaghi.

The protocol has had promising results thus far. In one case, a 44-year-old female patient woke up with stroke symptoms and was treated using the new protocol. Four weeks later, she was back to normal. Without treatment, this patient’s outcome would have been vastly different, with long lasting stroke-related disability.

For more information on the new wake-up stroke protocol, visit the Comprehensive Stroke Center website or call 401-444-8806

Tele-ICU now available at Newport Hospital

hicuity tele-ICU

Newport Hospital is adding an extra layer of care for its ICU patients by partnering with Hicuity Health to provide continuous monitoring and expertise.

Hicuity is the largest, most experienced acute care telemedicine provider in the nation, caring for more than 16,000 patients annually in more than 130 hospitals and health systems. These highly skilled and extensively trained professionals use leading technology to continuously monitor real-time patient vital signs, lab results, and clinical status from a remote operations center.

“It is clear from medical literature that 24/7 monitoring of patients using an intensivist-led tele-ICU model results in better patient care and lower mortality,” says Jeffrey Gaines, MD, Newport Hospital chief medical officer and vice president of medical affairs. “To support the current staff at Newport Hospital, we have partnered with Hicuity Health to provide this added layer of care for our most critically ill patients, at no additional cost to them.”

The Newport Hospital care team maintains control of the patient’s care, while the Hicuity team provides round-the-clock monitoring through data and audio/video connections in each ICU room. Its data management tools help the tele-care team proactively intervene before a situation becomes urgent, and constant monitoring ensures that help is available when needed.

The goals of the Hicuity Health partnership are to:

  • ensure the physician’s care plan is carried out
  • ensure patient care issues are identified and acted upon urgently
  • consistently implement best practices designed to deliver high-quality care

The Hicuity Health partnership launched on March 8. Learn more about the Hicuity and Tele-ICU at Newport Hospital.

Lifespan Cardiovascular Institute Implants 500th Watchman Device

In January, the Lifespan Cardiovascular Institute reached a milestone, implanting the 500th WATCHMAN device in a patient with atrial fibrillation.

Approved by the FDA in 2015, the WATCHMAN is the most implanted device of its kind for reducing the risk of stroke in people with atrial fibrillation not caused by a heart valve problem. Lifespan’s first implant of the device was in 2017. The device is placed permanently using a catheter-based procedure to prevent clots from forming, without the long-term use of blood thinners.

“While blood thinners reduce the risk of stroke for patients with AFib, they can cause excessive bleeding and not everyone can and should be taking them,” says Paul Gordon, MD, interventional cardiologist at the Lifespan Cardiovascular Institute. “That is why implantable devices may be a better option for some patients. It is a permanent fix, and it’s a really safe procedure.”

The patient who received the landmark implant was an 83-year-old Rhode Island woman with an extensive family history of heart disease. The Lifespan Cardiovascular Institute at Rhode Island Hospital is one of only three hospitals in New England to reach the 500-implant mark, along with Massachusetts General and Catholic Memorial in New Hampshire.

You can watch a segment on the milestone here on turnto10.com, and learn more about the Watchman and our valve and structural heart program.

Miriam Hospital Improving Emergency Department Patient Experience

The Miriam Hospital main building

The Miriam Hospital is improving the patient experience in its Emergency Department (ED) through several new initiatives.

New ED flow

In January 2023, The Miriam ED launched a redesigned patient flow model. The new model includes a streamlined intake process and vertical treatment space which is supported by a Results Pending Area (RPA) for the largest group of patients seeking care in the ED.

The RPA allows treatment to continue, and patients to receive their disposition, freeing up space for new patients to be seen. This redesigned model includes a dedicated fast-track space for low-acuity patients.

“We moved the providers and nurses, expanded the number of intake rooms, and allow for workups to be started earlier by nurses,” says David Curley, MD, medical director of The Miriam Hospital ED. “We created a system in which the attending physicians continue to participate more closely in care and disposition to improve our efficiency.” The changes allow for a quicker visit and reserves other treatment space for higher acuity patients. There is also a designated space to cohort admitted patients and behavioral health patients who are boarding in the ED.

“We essentially changed the way we used our existing space, providers, and staff. We also improved our ability to cohort patients by their level of acuity,” says Denise Brennan, MSN, RN, CNL, director of emergency services.

“At The Miriam Hospital, we are fortunate to work with very talented individuals who feel empowered by our culture to share innovative ideas,” adds Brennan. “Cassandra Algier, BSN, RN, CEN, our advanced practice manager in the ED, developed the conceptual design and many of the processes for this project. Her ideas, coupled with feedback from our staff, providers and other ED leaders led to the model we have in place today.”

Early results show patients can see providers and begin their treatment sooner. Patient experience and access to care has improved, which is evident by the decreased number of patients who leave without being seen.

“While we have seen an improvement in the patient experience over the past several weeks, we have also received many positive comments from staff as well. Happier patients often equate to happier staff. The changes have been very well received by physicians and advanced practice providers who value being able to work side by side caring for our patients,” says Curley.

New patient experience coordinator

In addition to the new flow model, the ED created a new position –Patient Experience Coordinator. Dann Gwann is the first to hold this position and came on board in January at the same time the redesigned flow model was introduced.

In his role, Gwann rounds on all patients in the treatment and waiting areas of the ED to check-in on them and evaluate their care experience. As Brennan notes, “He talks to patients, acknowledges any wait, and does what he can to make patients more comfortable, whether that be a blanket, a glass of water, nutrition, or an ice pack.”

He is also a liaison between the staff, patients, and family members. He assists patients to make phone calls, obtains updates for patients or families, and provides social support and service recovery. Part of Gwann’s service recovery is contacting patients who have left without being seen the day before to see how they are feeling and offer support to them.

Brennan notes that his efforts have already made a difference, and he's already been mentioned in patient satisfaction survey comments. Gwann is now a member of the hospital’s Patient Experience Committee and the Patient Family Advisory Council.

Behavioral health navigators

In late 2021, the ED also initiated a new Behavioral Health Navigator position. These nurse specialists work solely with the behavioral health population.

“Together with providers, consultants, and staff they work to ensure that some of our most vulnerable patients, who often experience extended lengths of stay, have a good experience in our ED,” says Brennan. They ensure patients’ home medications are collected and ordered, recommendations made from specialists are communicated and implemented, and safety screenings are completed. They also provide assistance with daily living activities for each of these patients, including ordering meals, bathing, and providing social interactions to fulfill basic needs. They work closely with the psychiatry department to assist with access to inpatient and outpatient services.

Brennan notes that they’ve even started an activities program, which includes stress relief activities, coloring, crafts, music, reading, card games and even bright light therapy to improve mood, anxiety, and depression. In recent months the nurses have also started screening patients for social determinants of health, such as access to care, food, transportation, utilities, and housing. They then help patients connect with appropriate resources to address their social needs while they are still in the ED.

New palliative care physician

A palliative care physician with Brown Emergency Medicine has now joined The Miriam ED team of providers. This dedicated role in the ED is to help enroll patients in palliative or hospice care directly from the outpatient setting. This helps patients get the specialty services they need sooner. Learn more about the Palliative Care program.

Centralized bed placement throughout system

As of March 1, Lifespan centralized its bed placement services through the Lifespan Epicenter located at Rhode Island Hospital.

As Brennan explains, “Centralized coordinated flow for bed placement is already helping us improve our bed request to depart time. We are getting patients into inpatient beds sooner.” While it’s still early, Brennan is hopeful that it will continue to help improve the patient experience. “In the first week of centralized bed placement, we experienced the fastest ever times from a bed being requested to it being assigned. We hope to see this trend continue,” Brennan notes.

Promising preliminary metrics

While some of the initiatives are still recent, Brennan reports that the changes are already making a difference. “The preliminary results are promising and we’re seeing improvements in our metrics, including fewer patients who left without being seen, reduced length of stay, and shorter time from door to doctor,” she says. “And most importantly, patient experience has improved.”

While there is still more work to come. Brennan is thrilled with the results to date. “Our leaders, providers, and staff have been open-minded and creative in their approach to helping us address our ED flow issues. I can’t thank everyone enough for how much we’ve accomplished in such a short time and look forward to making more improvements with their help,” she says.

For more details, contact Denise Brennan, MSN, RN, CNL at DBrennan@lifespan.org or David Curley, MD at DCurley@lifespan.org.

Bradley REACH Expands into Florida to Offer Virtual Pediatric Behavioral Health Treatment

The crisis in pediatric behavioral healthcare in the United States is real, due to a shortage of providers combined with a dramatic increase in mental health disorders in children and adolescents. That’s why the Bradley REACH program was established in 2021. This program partners with providers and payors across the country to offer safe, intensive therapy to adolescents in their own homes.

The program originally launched with partnerships in Massachusetts and Connecticut, making Bradley Hospital’s care available to families in need across the New England region. Now, thanks to a new partnership with the Apalachee Center, the program is available to adolescents across Florida, a region hit hard by the provider shortage.

Bradley REACH in Florida offers a partial hospital program (PHP) six hours a day and an intensive outpatient program (IOP) three hours a day, five days a week. Treatment includes individual, family, and group therapy along with medication management by a multidisciplinary team, including psychiatrists, psychologists, social workers, nurses and behavioral health specialists.

“Our partnership with the Apalachee Center is an exciting new stage in our plans to expand Bradley REACH’s quality partial and IOP programs to adolescents and families in need throughout the United States,” says Ellen Hallsworth, director, Bradley REACH program.

Hallsworth notes that Bradley REACH has resulted in significant improvements for patients. “In fact, parents and families tell us that virtual care makes it easier for them to support their child’s participation,” she said.

“We are thrilled to bring Bradley Hospital’s excellent and innovative care to our children and families in this region and across Florida,” says Jay Reeve, president of the Apalachee Center. “We know this will make a huge difference in families’ ability to access care where and when they need it.”

For more information on Bradley REACH or to refer a patient in New England, visit the Bradley REACH website. To make a referral in Florida, please contact Bradleyreferrals@apalacheecenter.org.

If you are interested in partnering with Bradley REACH and bringing Bradley’s expert care to your patients, please email bradleyreach@lifespan.org.

Pappas Center Now Offering Magseed Tumor Marker for Breast Cancer Surgery

The Anne C. Pappas Center for Breast Imaging is now offering Magseed, a magnetic stainless-steel bead used to mark the location of breast abnormalities needing surgical excision.

A radiologist uses ultrasound or mammography guidance to insert the five-millimeter magnetic seed into the tissue to help surgeons locate non-palpable breast cancers during lumpectomy in eligible patients. The surgeon then uses a handheld probe to locate the seed during surgery.

“We are excited to offer patients a new option for localizing tumors prior to surgery,” says Martha Mainiero, MD, medical director, Anne C. Pappas Center for Breast Imaging. “Our radiologists and surgeons work closely together to determine the best localization method for each individual patient, and Magseed gives us more options than ever.”

There are numerous benefits to using Magseed.

  • The small, single-use device can be implanted up to 30 days prior to surgery.
  • Patients cannot feel the seed once it is in place and can return to normal daily life immediately following implant.
  • The device allows for accurate marking of the cancer or other lesion for surgical removal.
  • Using Magseed can help reduce delays on the day of surgery.
  • The seed is low in nickel content, non-radioactive and is removed with the tumor during surgery.

For more information on Magseed or the Pappas Center, call us at 401-444-7770 or visit the Anne C. Pappas Center for Breast Imaging website.

New EksoNR Exoskeleton is helping patients learn to walk again at Vanderbilt Rehabilitation

woman walking with exoskeleton

Patients who haven’t taken steps in years are able to walk again, thanks to new technology now available at the Vanderbilt Rehabilitation Center at Newport Hospital.

The EksoNR system is a wearable robotic exoskeleton developed to support and promote mobility for patients with stroke, acquired brain injury, spinal cord injuries, and multiple sclerosis. It is the first device of its kind to receive FDA clearance for such use.

The robotic device enables patients to stand and relearn to walk while gaining confidence and freedom. Its smart software allows clinicians to adjust settings and tailor each rehab session to an individual’s needs. Thanks to the support from the exoskeleton, patients can begin their rehabilitation earlier in their recovery process.

Melissa Fournier, PT, director of Lifespan inpatient rehabilitation services, said, “It reteaches what patients lost from their illness or injury. It allows the brain to remember what walking feels like and helps patients get stronger.”

Vanderbilt Rehab is already seeing optimal outcomes. Fournier noted that the Ekso gets patients on their feet faster and safely eliminates the chance of falls. Patients can return home sooner and continue outpatient treatment.

For patients, the EksoNR has been transformational. One patient, a man with a 14-year history of multiple sclerosis who hadn’t walked in about five years, was among the first to use the exoskeleton in his rehab. With its support, he walked across the room and later walked in the parallel bars without the device.

At this time, the EksoNR is used for inpatient services only. For more information on the new device, watch the video here. 

Lifespan Partners with RI Schools to Address Children’s Mental Health and Sudden Cardiac Arrest

Bradley Hospital and Hasbro Children’s Hospital are partnering with schools in Rhode Island through programs to address two critical issues: the children’s mental health crisis and preparing schools for sudden cardiac arrest events.

Bradley Hospital and Project AWARE

Bradley Hospital was awarded a five-year $8.6 million federal grant to help address the mental health crisis among children and support mental and behavioral health in Rhode Island schools. The grant from the U.S. Department of Health & Human Services’ Substance Abuse and Mental Health Services Administration will support the hospital’s participation in Project AWARE (Advancing Wellness and Resiliency in Education).

In Rhode Island, one in five children ages six to 17 has a diagnosable mental health problem and one in 10 has a significant functional impairment. Project AWARE is a partnership with the Rhode Island Department of Education, the Rhode Island Department of Children, Youth and Families and three Rhode Island school districts, developed to address the emerging mental health challenges facing children today. Its goal is to increase awareness of mental health issues among school-aged youth and provide training for school personnel to detect mental health issues, respond to them, and connect the affected students’ families to needed services.

“Too many children and young adults are experiencing depression, anxiety, trauma, suicidality, addiction, substance use, or other conditions that negatively impact their well-being,” said Henry Sachs, MD, Bradley Hospital president. “It is imperative that our schools are supported in having culturally competent and developmentally appropriate mental wellness programs that can connect students in need to effective behavioral health services and interventions.”

In 2018, initial AWARE funding awarded to the Rhode Island Department of Education provided programing in Pawtucket, Providence, and Woonsocket, and demonstrated proven results in increasing knowledge of student mental health and improving access to effective services and supports. The grant will allow for the continuation of Project AWARE in these three districts for five more years, providing comfort to students and simultaneously expanding access to critical behavioral health services.

In Pawtucket, Providence, and Woonsocket, the program will impact more than 35,000 students and 3,000 school personnel annually, as the partners implement professional and paraprofessional training, intervention, and resilience activities to ensure that students and families have access to appropriate and effective behavioral health services.

For more information on project AWARE, contact Dr. Marge Paccione at mpaccione@lifespan.org.

Hasbro Children’s Hospital and Project Adam

Hasbro Children’s Hospital has partnered with Project Adam, a national organization that helps prepare schools for sudden cardiac arrest, by enlisting pediatric systems to do the training. Here in Rhode Island, Elizabeth Jacobs, MD, a pediatric emergency medicine physician at Hasbro Children’s Hospital, is leading an initiative called “Heart Safe Schools RI” to teach CPR and how to use an automated external defibrillator.

Sudden cardiac arrest can happen anytime, anywhere, and knowing how to respond is a matter of life and death. "The program is about assessing whether schools have an appropriate, correctly labeled AED, and assembling teams in each school,” says Jacobs. “If a child or even a staff member collapses from a sudden cardiac arrest, the team can get activated." The hope is that all public high schools in the state will participate.

"Just like any rare event, practicing is key. When you talk to the people who saved Damar Hamlin, they practiced and drilled over and over again for this exact emergency," notes Jacobs.

Dr. Jacobs' efforts are supported through an American Academy of Pediatrics CATCH Grant. Physicians from the departments of pediatrics, emergency medicine, cardiology, and family medicine are acting as champions and partnering to assist in developing cardiac emergency response plans.

dr. elizabeth jacobs

Watch Dr. Jacobs on Channel 10 News

Watch Dr. Jacobs discuss Hasbro Children's Hospital's partnership with Project Adam on Channel 10 news. 

Gateway Healthcare to Increase RI Access to Intensive Home-Based Trauma Therapy for Kids Through Two-Year Grant

Gateway Healthcare main

Gateway Healthcare received a two-year $796,757 National Child Traumatic Stress Initiative grant from the Substance Abuse and Mental Health Services Administration. The funding will support the training of 65 clinicians in evidence-based trauma therapy to treat 1,100 Rhode Island children and teens.

The project is called “Scaling Up Access to Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Children in Rhode Island.” Its intent is to increase the number of children in Rhode Island who have access to TF-CBT, a specific evidence-based trauma treatment, by increasing the number of trained providers. The focus will be on children and their families who are black, indigenous and people of color (BIPOC).

“Gateway is a known local provider of trauma services for children and families in need. This new community effort is particularly exciting because we will be training more providers in a well-researched trauma treatment model,” says psychologist Deidre Donaldson, PhD, ABPP, project manager for the grant award. “Our goal is to provide Rhode Island children, and particularly those who are BIPOC, with better access to effective trauma treatment,” she adds.

The work will focus on Rhode Island children ages five to 18 who have experienced significant trauma and exhibit symptoms of anxiety, depression, self-harm, eating or sleeping disorders, physical ailments, and/or co-occurring mental and substance use disorders.

For more information, visit the Gateway website.

MIUI Only Program in SE New England to Offer New Laser Treatment for Enlarged Prostate

The Minimally Invasive Urology Institute (MIUI) at The Miriam Hospital is the only program in southeastern New England to offer a new type of laser treatment for enlarged prostate.

Thulium Fiber Laser Enucleation (ThuLEP) utilizes the latest technology for endoscopic management of BPH. Enucleation is a procedure that allows for efficient removal of obstructing prostate tissue and is the only treatment that is effective for nearly any size prostate. It is more durable than standard treatments such as TURP and has lower risks of bleeding.

Urologist Sam Eaton, MD, explains that while numerous techniques can be effective for management of BPH, “ThuLEP is an excellent procedure for any size prostate, and offers an incision free procedure for management of large prostates that previously would have required more invasive surgery. This shortens recovery time and gets patients back to what they want to be doing more quickly and more safely.”

“There are a number of options available for successful management of BPH symptoms and the MIUI is able to offer a broad range of treatments to best match the right option to our patients’ specific clinical needs. It’s important for patients to know that there are effective treatments available and these issues aren’t something you just need to live with.”

The urologists at the MIUI are here to provide their expertise in management. Learn more about MIUI and other treatments for BPH here.

New Normal Pressure Hydrocephalus Multidisciplinary Program

The Norman Prince Neurosciences Institute is launching a new multidisciplinary program to treat normal pressure hydrocephalus (NPH) at Rhode Island Hospital.

NPH is an abnormal buildup of cerebrospinal fluid (CSF) in the brain, causing neurological symptoms. Diagnosing and treating this complex, chronic condition requires a specialized team.

The new NPH multidisciplinary program at Rhode Island Hospital is one of the few in New England with an experienced team of experts to offer effective diagnosis and personalized care for those with NPH. Under the direction of neurologist Umer Akbar, MD and neurosurgeon Petra Klinge, MD, PhD, the team consists of neurologists, neurosurgeons, physical therapists, and neuropsychologists. The NPH team will evaluate patients in a comprehensive, one-day visit that includes an assessment, a diagnosis, and discussion of treatment options.

“For people with NPH, a thorough evaluation is critical for accurate diagnosis and subsequent treatment to improve the lives of our patients. The expertise of the team allows us to do just that in an effective and efficient manner,” says Akbar.

NPH symptoms develop slowly and may mimic other disorders such as Alzheimer's disease, Parkinson's disease, and other memory, movement, and orthopedic disorders. The constellation of symptoms may be confused with other disorders and may not be easily recognized as NPH, which causes memory and cognitive impairment, gait difficulty and urinary problems.

Accurate diagnosis and appropriate treatment may result in improved quality of life. Unlike some other brain-related conditions, NPH does not respond to medications, though they can be used to treat some of its symptoms. The most common and effective treatment for NPH is surgery to implant a shunt.

“We are excited to bring this program to our colleagues, the physicians, and to our patients in the local community,” says Klinge. “We also want to recognize the incredible medical team who will manage this program and make a tremendous difference in the lives of our patients.” Learn more about the NPH team.

To refer a patient, contact the NPH Multidisciplinary program at 401-444-6528 or learn more about the NPH Multidisciplinary program on our website.

Close up of an older woman and man in front of their house, smiling.

Contact the NPH Multidisciplinary Clinic

NPH is complex and can be difficult to diagnose. Contact the NPH Multidisciplinary Clinic at Rhode Island Hospital for a consultation. Phone: 401-444-6528

New Locations

New Electrophysiology Lab Opens at RIH

A new electrophysiology lab is now open at Rhode Island Hospital, expanding its cardiac and arrhythmia services to address increased demand. 

The electrophysiology labs at Rhode Island Hospital are the only labs in the state to perform ablations for atrial fibrillation. With the arrival of two new attending physicians in 2022, the program performed 470 ablations last year alone.

The need for these services continues to grow. The Centers for Disease Control and Prevention estimates there are more than 450,000 hospitalizations each year with a primary diagnosis of AFib. This rate has been rising for more than two decades, and AFib is said to be responsible for more than 158,000 deaths each year.

“Our new electrophysiology lab and its state-of-the-art equipment will help us meet the increased demand for residents in our area,” says Daniel Philbin, MD, FACC, FHRS, director, arrhythmia service at Lifespan Cardiovascular Institute. “The additional lab means more capacity for us to offer ablations and other life-saving procedures as well as implanted devices such as pacemakers and defibrillators.”

The new lab will allow the team to perform an estimated 200 additional ablations at Rhode Island Hospital just this year. “We know that increased access to these procedures helps AFib patients avoid emergency visits for care, and our new lab helps us to offer exceptional heart rhythm care to even more individuals, close to home,” adds Renee Bernard, MSN APRN, director of cardiovascular services.

For more information on the EP lab and other cardiac and arrhythmia services, visit our website.

Adult Gender Program Moving to West River Street in Providence

146 West River Street, Providence Rhode Island

The Lifespan Adult Gender and Sexuality Behavioral Health Program moved from its location in East Providence to a new home at 146 West River Street, Suite 11A, in Providence in April.

The program offers psychosocial support, behavioral health, and wellness services for individuals over 18 years of age who are exploring issues associated with their gender identity.

The program’s goal is to provide care for transgender and nonbinary individuals in a safe, affirming, and respectful environment that welcomes gender exploration across the spectrum, including nonbinary identities.

For more information on the program, call 401-606-0606 or visit the Lifespan Adult Gender and Sexuality Behavioral Health Program website.

LifeNotes physicians

Kristen Kichefski Appointed New Chief Nursing Officer at Bradley Hospital

kristen kichefski

In February, Kristen Kichefski, MSN, MBA, RN, PMH-BC, NEA-BC, was named Chief Nursing Officer at Bradley Hospital following an extensive national search.

Kichefski comes to Bradley Hospital from the Massachusetts Department of Mental Health (DMH) Dr. Solomon Carter Fuller Mental Health Center, a 60-bed inpatient psychiatric hospital affiliated with Tufts Medical School, where she served as Director of Nursing.

“Ms. Kichefski has dedicated her career to the advancement of high-quality, patient-centric care. We are very fortunate to have her as a member of the Bradley Hospital and Lifespan community, and look forward to the significant positive contributions she will bring to the organization,” said Henry Sachs, MD, president, Bradley Hospital.

Her past experience also includes nursing leadership roles at the DMH Cape Cod and Islands Community Mental Health Center, McLean Hospital, and Butler Hospital. She brings an impressive array of skills to the role in administration, operations, education, policy, quality initiatives, workforce development standards, and patient safety practices.

“It’s a thrill for me to have the opportunity to join Bradley Hospital, internationally known for providing expert care to so many children and families. I look forward to continuing to build the unique and cutting-edge psychiatric nursing care that is available here,” said Kichefski.

A registered nurse (RN) with ANCC board certifications in psychiatric mental health nursing and as an advance nurse executive, Kichefski obtained a bachelor of science in nursing from Rhode Island College and a master of science in nursing from the University of Texas at Tyler. She is currently pursuing a doctor of nursing practice at UMASS Medical School. She holds a faculty appointment at the Massachusetts College of Pharmacy and Health Services and has also held appointments at Rhode Island College and the University of Rhode Island.

Gyan Pareek, MD, FACS, Named Chief of Urology

Gyan Pareek

Urologist Gyan Pareek, MD, FACS, has been named chief of the division of urology and Krishnamurthi Family Professor of Urology at Brown University and president of Brown Urology, Inc.

Dr. Pareek, an internationally recognized expert in robotic surgery and kidney stone disease, joined Lifespan in 2005, serving as director of the Kidney Stone Center at The Miriam Hospital. A year later, he led the team that performed the first robotic surgery in Southeastern New England. In 2014, he developed the Minimally Invasive Urology Institute (MIUI) at The Miriam, serving as its co-director and helping the hospital achieve national status as one of the top 50 urology programs in the United States.

Dr. Pareek was also the 2019 recipient of the Riesman Family Excellence in Teaching Award. He has held a number of leadership roles at the New England American Urological Association and the Rhode Island Urological Association. His areas of expertise include kidney stones, prostate cancer, and benign prostatic hyperplasia.

Elias Hyams, MD, Appointed Director of Prostate Cancer Program at MIUI

elias hyams

Elias Hyams, MD, a urologist, has been appointed director of the prostate cancer program at Lifespan’s Minimally Invasive Urology Institute at The Miriam Hospital.

In his new role, he will oversee the clinical, education, and research arms of prostate cancer care at the MIUI. The clinical side will focus on integrating cutting-edge care from screening to treatment of advanced disease. He will also direct prostate cancer education and training for medical students, residents, and fellows. Finally, Hyams will oversee the MIUI’s research studies, clinical trials, and quality improvement efforts.

Hyams is an associate professor in surgery (urology) at The Warren Alpert Medical School of Brown University, and has practiced at the MIUI at Miriam Hospital since 2021. His areas of expertise include prostate cancer, kidney cancer, bladder cancer, and benign prostatic hyperplasia (BPH).

Hyams is a member of the American Urological Association, the Society of Urological Oncology and the Endourological Society. He has more than 100 published peer-reviewed articles, reviews, and chapters. Hyams has been involved in the development of multiple shared decision-making aids for patients being screened and treated for prostate cancer, and is an experienced robotic surgeon.

John Conte, MD, and Phillip Lucas, MD, Receive Arthritis Foundation Lifetime Achievement Award

Phillip R. Lucas, MD

Congratulations to rheumatologist John Conte, MD, and orthopedic surgeon Phillip Lucas, MD, recipients of the Dr. Hal Horwitz Lifetime Achievement Award for Physician Excellence from the Arthritis Foundation.

The award is in memory of Dr. Horwitz, a prominent rheumatologist and one of Rhode Island’s first, who served as the president of the RI Chapter of the Arthritis Foundation. He passed away in 2019.

The event’s program noted, “Dr. Conte and Dr. Lucas both have distinguished careers helping people in Rhode Island living with arthritis and we are grateful to have them as our Dr. Hal Horwitz Lifetime Achievement Award honorees.”


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Zachary Bohart, MD

Physiatrist

Zachary Bohart, MD, is a specialist in physical medicine and rehabilitation at the Lifespan Orthopedics Institute.

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Daniel B. Gilman, DO Headshot

Daniel B. Gilman, DO

Assistant Medical Director, Lifespan Urgent Care

Daniel Gilman, DO, a family medicine practitioner, recently joined Lifespan Physician Group as associate medical director for Lifespan Urgent Care.

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Rebecca A. Karb, MD, PhD Headshot

Rebecca A. Karb, MD, PhD

Co-Director, Comprehensive Stroke Center, Rhode Island Hospital; Co-Director, Primary Stroke Center, The Miriam Hospital; Medical Director, Lifespan Community Health Worker Program and Community Outreach

Emergency medicine specialist Rebecca Karb, MD, was named co-director of the Comprehensive Stroke Center at Rhode Island Hospital.

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Amy Kite, MD Headshot

Amy Kite, MD

Plastic and Reconstructive Surgeon

Amy Kite, MD, a plastic and reconstructive surgeon, recently joined Lifespan Physician Group Plastic Surgery.

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Joanna MacLean, MD Headshot

Joanna MacLean, MD

Interim Division Director for Women’s Behavioral Medicine

Psychiatrist Joanna MacLean, MD, was named interim division director for Women’s Behavioral Medicine at the Women’s Medicine Collaborative.

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Michela Muggeo, PsyD Headshot

Michela Muggeo, PsyD

Clinical Psychologist

Michela Muggeo, PsyD, psychologist, has joined Lifespan Psychiatry and Behavioral Health.

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Sohaib Siddiqui, MD Headshot

Sohaib Siddiqui, MD

Family medicine physician Sohaib Siddiqui, MD, practices with Lifespan Physician Group Primary Care in Warwick.

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LifeNotes research

Lifespan Cardiovascular Institute Receives Prestigious NIH Training Grant

Dr. Selke

The Lifespan Cardiovascular Institute has received a National Heart, Lung and Blood Institute T32 Cardiovascular Surgery training grant.

The five-year award will support training the next generation of scientists or clinical scientists, led by Frank Sellke, MD, chief of cardiothoracic surgery at Rhode Island and The Miriam hospitals.

“There are fewer scientists in this field, and a growing need for them,” says Sellke. The grant will allow trainees to spend between one and three years in the lab.

"The Lifespan Cardiovascular Institute has some really brilliant basic scientists in cardiology and also cardiovascular surgery who are on the grant, so it's very well structured, and very difficult to get,” Sellke adds.

That’s why he believes Lifespan was chosen as one of only three sites to receive the prestigious grant. "You have to have a very well-balanced program, with very qualified mentors," notes Sellke. Baylor University and University of Virginia are the other grant recipients.

Candidates have already been recruited for the intense cardiovascular surgery research training program and are working on research already in progress.

You can learn more about the grant in this WJAR-TV Channel 10 segment.

New Nanotube Technology Developed at Lifespan Penetrates the Blood-Brain Barrier

qian chen PhD

Qian Chen, PhD, and his team at the Rhode Island Hospital Center of Biomedical Research and Excellence (COBRE) for Skeletal Health and Repair have developed a delivery system of RNA therapeutics to penetrate tissue matrix and the brain-blood barrier and provide targeted treatment for cancer, arthritis, neurodegeneration and other diseases.

Following 12 years of research, the team of scientists, clinicians, and engineers at the COBRE have created Nanopieces drug delivery system – a potential game changer for treating patients with specific cancers, brain diseases and musculoskeletal diseases. Nanopieces provide a unique, non-harmful way to penetrate the blood-brain barrier, the network of blood vessel cells and tight junctions that prevent harmful substances from reaching the brain.

While the research was initially focused on discovering new treatments for osteoarthritis, it now has the potential for treatment of other diseases including bone cancers, dementia, and autoimmune diseases.

“The blood-brain barrier has been a stumbling block to most drugs that are intended to reach the brain,” said Dr. Chen, a researcher and director of the Rhode Island Hospital COBRE for Skeletal Health and Repair. “Our research into treatment for debilitating conditions such as osteoarthritis has led to a novel discovery that we hope can be further utilized to develop treatments for cancer and dementia patients.”

The miniscule tube-like vehicle specifically targets a disease gene with a sustained, efficient, and nontoxic therapy. Nanopieces allows nucleic acid therapeutics to inhibit diseases at the genetic source rather than targeting symptoms or by-products of the disease.

The breakthrough technology is a product of NanoDe Therapeutics, Inc., a development-stage company dedicated to developing a new generation of nucleic acid therapeutics. It was founded around technology developed at Lifespan and Brown University. A stream of federal funding from the National Institutes of Health through a Small Business Innovation Research (SBIR) grant, contract, and other sources, including Rhode Island Commerce Corporation, has funded the research.

Learn more about this exciting research at NanoDe Therapeutics website and discover what’s happening at the Center for Biomedical Research Excellence. To contact Qian Chen, PhD, email qian_chen@brown.edu.

Orthopedic Spine Surgeons Take Part in International Spine Study Group Inaugural Fellows Course

Alan Daniels

Orthopedic spine surgeons from the Lifespan Orthopedics Institute (LOI) recently participated in the exclusive International Spine Study Group (ISSG) Inaugural Fellows Course in Las Vegas. Alan Daniels, MD, served as faculty alongside other leaders in orthopedic spinal deformity treatment.

ISSG is considered a leader among the world’s study groups, and includes top U.S and international physicians and researchers who gather to share ideas and produce unique and cutting edge research for patients with spinal deformity. The orthopedic spine team at the LOI currently enrolls patients in the ISSG studies and has successfully published more than 85 studies since joining this prestigious foundation.

In addition to Dr. Daniels, resident Eren Kuris, MD, and fellows Bassel Diebo, MD, (also a member of the ISSG), and Leland McCluskey, MD, attended the meeting to bring back the highest level of care and most advanced treatments of spinal deformity to Lifespan.

For more on the latest advances in orthopedic spine technology and surgery, visit the Lifespan Orthopedics Institute.