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RHODEI S LA N DM E D I C A l J ourn a lwilliam binder, md, mamichael mello, md, mphelizabeth tobin-tyler, jd, maCharles A. Adams, Jr, MDnicholas asselin, do, msAdam C. levine, MD, mphStephanie N. Lueckel, MD, Scmalison S. hayward, MD, mphGerardo CARINO, md, PhDRIMJ GUEST EDITORS of 2019See story, page 7D e c ember 2 0 1 9VOLUM E 102 NUM BE R 10kenneth williams, mdISSN 2327-2228ANDREW LEVINSON, md, MPH
PAT I E N T C A R EQUALITY OUTCOMESFOCUS ON WHAT MATTERS MOST WITH COVERYS.Quality outcomes for better patient care are more easily achieved when distractions are reduced.At Coverys, we illuminate unforeseen risks so you can focus on patient satisfaction and reduce exposureto malpractice claims. As a premier provider of medical liability insurance, Coverys’ data insights andrisk recommendations will help you provide optimal healthcare outcomes that you can see clearly.Very clearly.Visit Coverys.com for more information or call 800.225.6168.Med ical Lia b ilit y I n su r a n c e Bus i ne s s A na l y ti c s R i s k Ma na g e me nt E duc at i onCOPYRIGHTED. Insurance products issued by ProSelect Insurance Company and Preferred Professional Insurance Company
RHODEI S LA N DM E D I C A l Jo u r n a l16 Updates in Critical Care Medicine:Evidence-based Practice in 2020Gerardo P. Carino, MD, PhDAndrew T. Levinson, MD, MPHGuest EditorsG. Carino, MD, PhDA. Levinson, MD, MPH18 Treatment of Patients with Severe Sepsis andSeptic Shock: Current Evidence-Based PracticesJisoo Lee, MDMitchell M. Levy, MD, MCCM, FCCP22 Acute Renal Failure in Critically Ill Patients:Current Evidence-Based PracticesKatherine Cox, MDDebasree Banerjee, MD, MS26 Red Blood Cell Transfusions in the ICUChanning Hui, DOGrant Cagle, MD, MPHGerardo Carino, MD, PhD30 Communication at the End-of-Life in the IntensiveCare Unit: A Review of Evidence-Based Best PracticesSarah Rhoads, MDTim Amass, MD, ScM34 Lung Ultrasound for Diagnosing Patients with SevereDyspnea and Acute Hypoxic Respiratory FailureMohammad Arabiat, MDAndrew E. Foderaro, MDAndrew T. Levinson, MD, MPH39 Extracorporeal Life Support in Adults with AcuteRespiratory Failure: Current Evidence-Based PracticesAdeel Abbasi, MDCynthia DeversNeel R. Sodha, MDCorey E. Ventetuolo, MD, MS43 High-Risk Pulmonary Embolism:Current Evidence-Based PracticesChristopher D. Theroux, MD, MSJason M. Aliotta, MDChristopher J. Mullin, MD, MHS3
RHODEI S LA N DM E D I C A l Jo u r n a l7 F rom the Ed itorsThanks to RIMJ’s Guest Editors,Contributors of 20191 2 C OMME NTA RY‘Good Initiative,Bad Judgement’Patrick M c Glone, BS, MD’211 4 RIMJ Around the WorldAmsterdam, The Netherlands6 3 RIMS NeW SAre you readingRIMS Notes?Working for You7 8 HERITA GEDr. H.P. Lovewell:Traversing the woods, bogsand backwaters in searchof Materia MedicaMary Korr4
RHODEI S LA N DM E D I C A l Jo u r n a lIn the newsRhode Island Hospital Researchers 68identify potential nanotechnologytherapy for chondrosarcomaBrown researchers 68receive 6.8M in NIH grants,partners with RI, to evaluate,expand opioid interventionsRI M oms PRN 70new statewide initiative,addresses maternal depression andrelated behavioral health needs70 Providence VAMCbreaks ground for Research Service71 Elizabeth Goldberg, MD,awarded 1.1M in NIH fundingto study fall prevention72 RI researchers, policymakersoutline new framework foropioid use disorder treatment73 Lifespandedicates new Ambulatory Care Centeron revitalized industrial siteP eople/ P LA C ESMatt Quin 74appointed presidentof Women & InfantsPeter Kim, MD, PhD 74joins pediatric surgeryteam at UniversitySurgical AssociatesLindsay Tse, DO 74joins Center for SurgicalWeight Loss at CNESouth County Health 75recognized with 2019 Gold LevelHealth Impact Award by AHA75 Women & Infantsraises more than 500,000to support Birth Center76 Newell E. Warde, PhDhonored with AMAMedical Executive LifetimeAchievement Award76 Arun K. Singh, MDreceives AHA LifetimeAchievement Award77 ObituariesRobert M. Dowben, MDHarold Milton Horwitz, MD5
D e c ember 2 0 1 9VOLUME 102 NUMBER 10publisherRh o d e Isla n d Medical SocietyRHODEI S LA N DM E D I C A l J ourn a lPresidentCh r i stin e B r ou sseau , MDP r e s i d e n t- e l e c tC athe r in e A . C u mmin gs , M DVice presidentEli z ab e th B. LA n ge, MDS e c r e ta ryT H O M AS A . B LED SOE , MDTreasurerC ontrib u tion48 Impact of a Novel Sex- and Gender-Based MedicinePreclinical ElectivePaa r i Gopalakr ish n an , M DRebecca Barron, MD, MPHChair of the BoardAngela F. Jarman, MD, MPHP e t e r A. H ollman n , MDTovy Kamine, MDExecutive DirectorTracy E. Madsen, MD, ScMN e w e ll E. Wa r de, PhDAlyson J. McGregor, MD, MAEditors-in-ChiefW i lli am Bin der , MDEd wa r d Feller , MDA s s o c i at e e d i t o rK e n n e th S. K or r , MDEditor-in-Chief EmeritusJ o s e ph H . Fr iedman , MD52 Evaluating the Impact of a Student-Run Women’s Clinicon Access to Gynecologic Care for Uninsured Womenin Rhode IslandNatasha R. Kumar, MDGabriele DuVernois, MD, MPHValerie Almeida-Monroe, RNNicole Siegert, MDP u bl i cation StaffAnne S. De Groot, MDManag i ng e d i t o rM a ry K or rm k o r r @ r i med.o rgG r ap h i c d e s i gn e rM a r i a n n e Migl ior iA d v e r t i s i ng A d m i n i s t r a t o rS a r ah Br ooke Stev en ssst e v e n s@ ri med.o rgP UBLI C HE A LTH57 H E A LT H B Y NUMB ER SHow Many Parents are Reading with their Young Infantsin Rhode Island?Karine Monteiro, MPHHyun (Hanna) Kim, PhDWilliam Arias, MPHPamela High, MS, MD61 Vital StatisticsRoseann Giorgianni, Deputy State RegistrarRH O D E I S L A N D M E D I C A L J O U R N A L(USPS 464-820), a monthly publication, isowned and published by the Rhode IslandMedical Society, 405 Promenade Street, SuiteA, Providence RI 02908, 401-331-3207. Allrights reserved. ISSN 2327-2228. Publishedarticles represent opinions of the authors anddo not necessarily reflect the official policyof the Rhode Island Medical Society, unlessclearly specified. Advertisements do not imply sponsorship or endorsement by the RhodeIsland Medical Society. Copyright 2013–2019, Rhode IslandMedical Society, All rights reserved.6
F ROM THE EDITORSThanks to RIMJ’s Guest Editors, Contributors of 2019As the Rhode Island Medical Journal (RIMJ) ends its 102nd year in publication, weThese sections and past issueswould like to thank the Journal’s guest editors of 2019. RIMJ’s mission, to reportof RIMJ can be viewed in theon innovations, initiatives and advances in medicine and healthcare in RhodeJournal’s archives atIsland, could not be accomplished without the commitment and hard work of itshttp://www.rimed.org/guest editors and contributors throughout the year.rimedicaljournal-archives.asp.February 2019WILDERNESS MEDICINEWilliam Binder, MD, MAGuest EditorFrom the Mountain Top to theSea Bottom: Training and Preparingfor Wilderness, EnvironmentalMedical EventsSailing Injuries: A Reviewof the LiteratureWilliam Binder, MD, MA, FACEPAccidental Hypothermia: ‘You’re NotDead Until You’re Warm and Dead’Learning from the Outside In:Incorporating Wilderness Medicineinto Traditional EmergencyMedicine EducationJohn L. Foggle, MD, MBA, FACEPDaniel Coleman, MDWilderness Dermatology:Bugs, Plants, and Other NuisancesThat May Ruin Your HikeAndrew Nathanson, MD, FACEP, FAWMChana Rich, MDDominic J. Wu, MDA Free Diver with Hemoptysisand Chest PainJennifer Lee, MdChana Rich, MDAfton Chavez, MDKristina M c Ateer, MDClimate Change: A Review of a PublicHealth Opportunity for the NortheastJohn C. Kawaoka, MDVictoria Leytin, MDRenee N. Salas, MD, MPH, MSHeather Rybasack-Smith, MDWilliam Binder, MDMarch 2019PRIMARY CARE/POPULATION MEDICINEPROGRAM AT BROWN (PC-PM)Michael J. Mello, MD, MPHGuest EditorThe Maturation of the PrimaryCare-Population Medicine (PC-PM)Program at the Warren AlpertMedical School of Brown UniversityPrevalence of Tobacco Useand Overweight/Obesity inRhode Island: Comparisonsof Survey and Claims DataMichael J. Mello, MD, MPHJulia G. Solomon, MD-ScM’19Perceptions of Mindfulness:A Qualitative Analysis of GroupWork in Addiction RecoveryPaul George, MD, MHPEKristina A. Monteiro, PhDMatthew B. Perry, MD-ScM’19Mark R. Zonfrillo, MD, MSCEKnowledge, Attitudes, and Confidencein Accountable Care Organization-BasedPayment Models Among RI PhysiciansIncarcerated Individuals’ Perspectiveson Living with Serious IllnessJonathan A. Staloff, MD-ScM’19Alexa N. Kanbergs, MD-ScM’19Impact of Participation in theCommodity Supplemental FoodProgram on Food Insecurity AmongLow-Income Elderly Rhode IslandersKristina A. Monteiro, PhDShayla N.M. Durfey, MD-ScM’20Faiz Khan, MD-ScM’19Michael J. Mello, MD, MPHAndrew Schiff, PhDIra B. Wilson, MD, MScMichael Mello, MD, MPHRI M J A r ch i v e s D E C E M B ER I S S UE W e bpag e RI M SDecember 2019 Rhode isl and m edical journal7
F ROM THE EDITORSMay 2019OUT-OF-HOSPITAL CARDIAC ARRESTNicholas Asselin, DO, MSKenneth Williams, MDGuest EditorsIntroduction: Out-of-HospitalCardiac Arrest (OHCA) in RhodeIsland: Can We Do Better?Comparison of EMS Provider In-TransitPerformance and Exertion with Standardand Experimental Resuscitation Protocolsduring Simulated Out-of-HospitalCardiac ArrestLeo Kobayashi, MDCase Report: Intact SurvivalFollowing Prolonged Out-of-HospitalCardiac Arrest CareNicholas Asselin, DO, MSJoseph Lauro, MD, FACEPBryan Choi, MD, MPHDavid Lindquist, MDJason Rhodes, MPA, AEMT-CMax Dannecker, NREMTEvan Katz, EMT-CKenneth Williams, MD, FACEP, FAEMSKenneth Williams, MD, FACEP, FAEMSNicholas Asselin, DO, MSA History and Overview ofTelecommunicator CardiopulmonaryResuscitation (T-CPR)Pediatric Out-of-Hospital CardiacArrest in Rhode Island: Conceptsand ControversiesHeather Rybasack-Smith, MD, MPHPilot Study of the Effect of a Protocolof 30 Minutes of Scene Care inOut-of-Hospital Cardiac Arrestin Rhode IslandJoseph Lauro, MD, FACEPJonathan Thorndike, MDNicholas Asselin, DO, MS;Carlin Chuck, NREMT;Linda Brown, MD, MSCENicholas Asselin, DO, MSKenneth Williams, MD, FACEP, FAEMSData Utilization in EmergencyMedical ServicesTanya Sutcliffe, MDJanette Baird, PhDNicholas Asselin, DO, MSJune 2019INTEGRATION of MEDICAL and SOCIAL CARE in Rhode IslandElizabeth Tobin-Tyler, JD, MAGuest EditorIntegration of Medical and SocialCare: Challenges, Opportunitiesand Next Steps for Rhode IslandElizabeth Tobin-Tyler, JD, MAAddressing the Social Determinantsof Health – The Rhode Island StateInnovation Model (RI SIM) ExperienceMarea B. Tumber, JD, MPHLibby Bunzli, MPHMarti Rosenberg, MACare Transformation Collaborativeof Rhode Island: Building a StrongFoundation for Comprehensive,High-Quality Affordable CareUp from the Streets: The RI MedicalNavigator Partnership as a Modelof Structurally-Informed Service,Education, and AdvocacyPano Yeracaris, MD, MPHMegan Smith, MSWSusanne Campbell, RN, MS, PCMH CCEPranav J. Sharma, BA, MD’22Mardia Coleman, MScGabrielle Dressler, MBE, MD’22Linda Cabral, MMDebra Hurwitz, MBA, BSN, RNProgram of All-Inclusive Care forthe Elderly (PACE): Integrating Healthand Social Care Since 1973Joan Kwiatkowski, MSWTsewang Gyurmey, MBBS, MD, CMDRI M J A r ch i v e s D E C E M B ER I S S UE W e bpag e RI M SDecember 2019 Rhode isl and m edical journal8
F ROM THE EDITORSSEPTEMBER 2019GLOBAL HEALTHAdam C. Levine, MD, MPH;Alison S. Hayward, MD, MPHGuest EditorsLittle Rhody Goes GlobalAdam C. Levine, MD, MPH;Alison S. Hayward, MD, MPHAddressing Global Human RightsViolations in Rhode Island: TheBrown Human Rights Asylum ClinicBuilding and SustainingPartnerships in HealthWorkforce and ResearchCapacity in RwandaStephanie C. Garbern, MD, MPHMarga Kempner, BA, MD ‘22Doris Lorette Uwamahoro, MDFrom Rhode Island to Colombia:Brown University Emergency PhysiciansLead a Collaborative Consortium ina Post-Conflict ColombiaSarah Hsu, BA, MD-ScM ‘22Adam R. Aluisio, MD, MScHeba Haleem, BA, MD ‘22Adam C. Levine, MD, MPHKatelyn Moretti, MDOdette Zero, BA, MD-ScM ‘22;Kyle D. Martin, MDCatalina Gonzalez-Marques, MDOlivier Félix Umuhire, MDAndrés Patiño, MDElizabeth Toll, MDLeonar Aguiar, MDElizabeth Tobin-Tyler, JD, MAAdrienne Fricke, JDMelanie Lippmann, MDObstetric Fistula Repair inSub-Saharan Africa: Partneringto Create Sustainable Impactfor Patients and TraineesJaclyn Caffrey, MDAshley Gray, MDMaria NavedoChristian Arbelaez, MD, MPHAmita Kulkarni, MDArlene Nishimwe, MDAn Overview of the Rhode IslandHospital-Cabral y Baez MedicalExchange ProgramB. Star Hampton, MDNeesha Nama, MDAnnetta Madsen, MDSarah Andiman, MDA Collaborative Family PlanningProgram in Rural Uganda UtilizingCommunity Health WorkersAlison Schroth Hayward, MD, MPHKelsey Brown, MD’22Tele-ECHO for Point-of-CareUltrasound in Rural Kenya:A Feasibility StudyDeveloping a Novel MobileHealth (mHealth) Tool to ImproveDehydration Assessment andManagement in Patients with AcuteDiarrhea in Resource-Limited SettingsMonique Gainey, MS, MPHMeagan Barry, MD, PhDAdam C. Levine, MD, MPHSabiha Nasrin, MBBS, MPHLindsay Dreizler, MD’21Grace W. Wanjiku, MD, MPHRI M J A r ch i v e s D E C E M B ER I S S UE W e bpag e RI M SMeghan M c Carthy, BSAmanda Noska, MDAmos Charles, MDMartha Sanchez, MDTuberculosis: An EpidemicPerpetuated by Health InequalitiesDaria Szkwarko, DO, MPHTara C. Bouton, MD, MPHNatasha R. Rybak, MDE. Jane Carter, MDSilvia S. Chiang, MDDecember 2019 Rhode isl and m edical journal9
F ROM THE EDITORSOCTOBER 2019UPDATE IN TRAUMA CARECharles A. Adams, Jr., MDStephanie N. Lueckel, MD, ScMGuest EditorsTrauma Surgery and Acute CareSurgery: Evolution in theEye of the StormCharles A. Adams, Jr., MDStephanie N. Lueckel, MD, ScMAnticoagulation and TraumaAndrew H. Stephen, MDAdvances in The Managementof Bleeding Trauma PatientsSean F. Monaghan, MD, FACSTareq Kheirbek, MD, ScMStephanie N. Lueckel, MD, ScMSean F. Monaghan, MDCharles A. Adams, Jr., MDEric Benoit, MDStephanie N. Lueckel, MD, ScMEric Benoit, MDPractice Makes Perfect:The Evolution of Blunt Chest TraumaAndrew H. Stephen, MDMichael D. Connolly, MDSean F. Monaghan, MDSean F. Monaghan, MDPredicting Outcomes in AcuteTraumatic Brain Injury (TBI)Stephanie N. Lueckel, MD, ScMDaithi S. Heffernan, MDStephanie N. Lueckel, MD, ScMStephanie N. Lueckel, MD, ScMAndrew H. Stephen, MDCharles A. Adams, Jr., MDSean F. Monaghan, MDGeriatric TraumaCharles A. Adams, Jr., MDCharles A. Adams, Jr., MDWilliam Binder, MDCharles A. Adams, Jr., MDDECEMBER 2019UPDATES IN CRITICAL CAREGerardo P. Carino, MD, PhDAndrew T. Levinson, MD, MPHGuest EditorsUpdates in Critical Care Medicine:Evidence-based Practice in 2020Red Blood Cell Transfusions in the ICUGerardo P. Carino, MD, PhDGrant Cagle, MD, MPHAndrew T. Levinson, MD, MPHGerardo Carino, MD, PhDTreatment of Patients withSevere Sepsis and Septic Shock:Current Evidenced-Based PracticesCommunication at the End-of-Lifein the Intensive Care Unit: A Reviewof Evidence-Based Best PracticesJisoo Lee, MDSarah Rhoads, MDMitchell M. Levy, MD, MCCM, FCCPTim Amass, MD, ScMAcute Renal Failurein Critically Ill Patients:Current Evidence-Based PracticesLung Ultrasound for DiagnosingPatients with Severe Dyspnea andAcute Hypoxic Respiratory FailureKatherine Cox, MDMohammad Arabiat, MDDebasree Banerjee, MD, MSAndrew E. Foderaro, MDChanning Hui, DOExtracorporeal Life Support in Adultswith Acute Respiratory Failure:Current Evidence-Based PracticesAdeel Abbasi, MDCynthia DeversNeel R. Sodha, MDCorey E. Ventetuolo, MD, MSHigh-Risk Pulmonary Embolism:Current Evidenced-Based PracticesChristopher D. Theroux, MD, MSJason M. Aliotta, MDChristopher J. Mullin, MD, MHSAndrew T. Levinson, MD, MPHRI M J A r ch i v e s D E C E M B ER I S S UE W e bpag e RI M SDecember 2019 Rhode isl and m edical journal10
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C omme ntary‘Good Initiative, Bad Judgement’Patrick M c Glone, BS, MD’21The Alpert Medical School of BrownUniversity on September 17 announcedchanging selection criteria for nomination into Alpha Omega Alpha (AOA)Honor Medical Society, part of an ongoing conversation between the nation’smedical schools and the Board of Directors of AOA, attempting to make AOAnomination better represent the diversity of medical students. No longer willpre-clinical grades and National Boardscore be weighted into AOA nomination,which will now be based more heavilyupon leadership, community engagement, scholarly activity, professionalism,and grades in the core clerkships.The AMS Senate, as part of a broaderannouncement in October 2019, included this statement about the changes:“ they instead recognize that equallysplendid students who are inherently disadvantaged may not fall under the olderqualifications. This change will allowfor students who had difficulty in theirtime at AMS, but still meet the standards of what AOA is meant to represent,to have the opportunity to be rightfullynominated.”This will not be a comment about diversity, structural bias, inclusion, or exclusion. I wish to present an argumentthat devaluing pre-clinical exam gradesin medical school is unethical and harmful to the profession. My thesis is intwo parts: 1. The sum of one’s grades inmedical school is a reasonable proxy forone’s effort to learn and understand theacademic content of medicine, and isa reasonable proxy for one’s actual understanding of the academic content ofmedicine. 2. It is ethically incumbent ontraining physicians that they devote theirgreatest level of effort into understandingthe academic content of medicine.We may all agree that sitting in aclassroom and taking a test is a flawedRI M J A r ch i v e s method of evaluating knowledge. Thereare numerous reasons why performanceon multiple choice tests may not be indicative of actual level of knowledge orcontent mastery, including learning disabilities, test anxiety, and perhaps mostconcerning, structural and systemic gapsdue to social factors since childhood. But,I posit that the sum of dozens of examstaken in the pre-clinical years of medicalschool does, in fact, have significance.When exams of the first two years andStep 1 are taken as a whole, they make areasonable approximation for a student’seffort at learning and achieving masteryof the academic content of medicine. Iacknowledge there is room for logicaldisagreement with this statement. Notevery student’s effort correlates one toone with test performance – these students deserve more academic support toachieve outcomes they desire. But if wecannot agree that every test taken overthe first two years correlates to somemeasure of student effort and knowledge,then the fundamentals of medical education are broken and need to be fixed. I donot believe this to be the case.Pass-fail curriculums and flexible standards are fantastic innovations to decreasethe toxic stress of medical school and allow students the opportunity to explorepassions outside of the classroom. But, atthe end of the day, we are paying 63,000in tuition alone to be taught the academic content of medicine, and this must remain the significant focus of the first twoyears. Community engagement, research,leadership activities, volunteerism, etc.are all amazing things which are important to the medical community – but the
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