Leading Alzheimer's experts release appropriate use recommendations for new Alzheimer's drug, Aduhelm
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IN THE N E WS Leading Alzheimer’s experts release appropriate use recommendations for new Alzheimer’s drug, Aduhelm LAS VEGAS – JULY 27, 2021 – A group of six leading Alzhei- how to carefully monitor for safety. The evidence we have is mer’s experts has presented the first recommendations for that patients with early Alzheimer’s disease, mild cognitive the appropriate use of aducanumab (Aduhelm, Biogen/Eisai), impairment and mild dementia, are most likely to benefit a newly approved treatment for early Alzheimer’s disease and we will need close collaboration between primary care (AD). The recommendations will help provide clinicians and specialty providers to identify these patients.” with greater clarity and more specific use of the new treat- The appropriate use recommendations made by the panel ment, which was granted accelerated approval by the U.S. include a list of 11 factors that they say should be satisfied Food and Drug Administration (FDA) in June. for a patient to be considered eligible for treatment with The recommendations were presented last week at the Aduhelm. Those factors include, in part: a clinical diagno- annual Alzheimer’s Association International Conference sis of mild cognitive impairment (MCI) due to AD or mild (AAIC) and were simultaneously published in a special stage AD dementia after a comprehensive evaluation; the article of The Journal of Prevention of Alzheimer’s Disease presence of amyloid plaques in the brain as demonstrated (JPAD) and in Alzheimer’s & Dementia®: The Journal of The on PET imaging or by AD signature pattern on cerebrospinal Alzheimer’s Association. STEPHEN SALLOWAY, MD, MS , fluid (CSF) testing; the attainment of certain specific cogni- director of Neurology and the Memory and Aging Program tive assessment scores; stable psychiatric and medical con- at Butler Hospital, the Martin M. Zucker professor of Psychi- ditions including stable cardiovascular and cardiopulmonary atry and Human Behavior and professor of Neurology at the health, no organ failure or active cancer, no evidence of neu- Warren Alpert Medical School of Brown University, and asso- rological disorders other than AD, and a baseline MRI with ciate director of Brown University’s Center for Alzheimer’s no evidence of acute or subacute hemorrhage, among other Research, was among the panel of experts and co-authored factors. The article containing the complete list of appropri- the JPAD article. ate use criteria is available on the JPAD website at jpreven- University of Nevada, Las Vegas neuroscientist DR. tionalzheimer.com. The summary article from Alzheimer’s JEFFREY CUMMINGS co-chaired the expert panel presen- & Dementia® is also available at alz-journals.onlinelibrary. tation at AAIC along with Alzheimer’s Association Chief wiley.com. Science Officer MARIA C. CARRILLO, PhD , and co-authored In addition to Drs. Cummings and Salloway, the expert the JPAD article along with Dr. Salloway. panel included: PAUL AISEN, MD , Alzheimer’s Treatment “Many details of the clinical use of this new agent are Research Institute, University of Southern California, San not in the FDA’s prescribing information,” Cummings said. Diego, CA; LIANA APOSTOLOVA, MD, FAAN , Departments “These recommendations fill the gap between the prescrib- of Neurology, Radiology, Medical and Molecular Genetics, ing information and the real-world implementation of this Indiana University School of Medicine, Indianapolis, IN; treatment.” ALIREZA ATRI, MD, PhD , Banner Sun Health Research “The recommendations made by this expert panel today Institute, Banner Health, Sun City, AZ; Center for Brain/ and in the JPAD article mirror the guidelines used during Mind Medicine, Harvard Medical School, Boston, MA; and the clinical trial of aducanumab,” Dr. Salloway said. “Our MICHAEL WEINER, MD , Departments of Radiology and goal is to guide clinicians on the selection of patients most Biomedical Imaging, Medicine, Psychiatry and Neurology, likely to benefit from treatment with recommendations on University of California San Francisco, San Francisco, CA. v RIMJ ARCHIVES | AUGUST ISSUE WEBPAGE | RIMS AUGUST 2021 RHODE ISL AND MEDICAL JOURNAL 84
IN THE N E WS CDC summary of recent changes in COVID-19 recommendations The following updates were released by the Centers for Diseases Control (CDC) on July 27th for fully vacci- nated people given new evidence on the B.1.617.2 (Delta) variant currently circulating in the United States: • Added a recommendation for fully vaccinated people to wear a mask in public indoor settings in areas of substantial or high transmission. • Added information that fully vaccinated people might choose to wear a mask regardless of the level of transmission, particularly if they are immunocompromised or at increased risk for severe disease from COVID-19, or if they have someone in their household who is immunocompromised, at increased risk of severe disease or not fully vaccinated. • Added a recommendation for fully vaccinated people who have a known exposure to someone with suspected or confirmed COVID-19 to be tested 3–5 days after expo- sure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result. CDC transmission map as of July 27. https://covid.cdc.gov/covid-data-tracker/#county-view • CDC recommends universal in- door masking for all teachers, staff, View all guidelines and charts of areas of high transmission at: students, and visitors to schools, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/ regardless of vaccination status fully-vaccinated-guidance.html Legionnaire’s Disease cases on the upswing The Rhode Island Department of Health (RIDOH) has “We know that Legionella bacteria grow best in complex observed an increase in the number of reported cases of water systems that are not well maintained. When this Legionnaires’ disease (LD). Between 2014 and 2020, there water becomes aerosolized in small droplets, such as in a was an average of 10 cases during the months of June and cooling tower, shower, or decorative fountain, people can July each year, ranging from 0–11 cases in a single month. accidentally breathe in the contaminated water. This is of From June 2, 2021 to July 26, 2021 there have been 30 cases particular concern now as some buildings’ water systems of Legionnaire’s disease, 29 of which have illness onset dates have been offline for a prolonged period due to the COVID- between June 17 and July 21. Twenty-eight of the 30 people 19 pandemic and are just now returning to service.” have been hospitalized. No common source of exposure has Legionella is especially a concern in buildings that pri- been identified, although an investigation is ongoing. marily house people older than 65, buildings with multiple “This is another example that underscores the value of housing units and a centralized hot water system (like hotels RIDOH’s routine monitoring for communicable diseases,” said or high-rise apartment complexes), and buildings higher Director of Health NICOLE ALEXANDER-SCOTT, MD, MPH . than 10 stories. v RIMJ ARCHIVES | AUGUST ISSUE WEBPAGE | RIMS AUGUST 2021 RHODE ISL AND MEDICAL JOURNAL 85
IN THE N E WS
CNE, Lifespan to require COVID-19 vaccination VA mandates COVID-19
for employees vaccines among its medical
PROVIDENCE – Care New England announced on July 27th that they are employees, including VHA
moving toward a mandatory vaccination program for all staff across all facilities staff
operating units. CNE has required COVID-19 vaccination of students, vol-
unteers, and new hires since July 1st, 2021. The next step is to require all WASHINGTON – On July 26, the Depart-
managers to begin the vaccination series prior to Labor Day. ment of Veterans Affairs Secretary DENIS
“It is our responsibility to keep our patients, and our staff, safe. This M C DONOUGH announced he will make
program will be based on the best evidence that we have to date about COVID-19 vaccines mandatory for Title
preventing transmission of COVID-19,” said JAMES E. FANALE, MD , 38 VA health care personnel – including
President and CEO, Care New England. physicians, dentists, podiatrists, optome-
Complete details of the program, and its implementation for all staff trists, registered nurses, physician assis-
across the system, will be released in the next 7–10 days. tants, expanded-function dental auxiliaries
Shortly after Care New England’s statement, Lifespan said it will require and chiropractors – who work in Veterans
all employees to be vaccinated. It said the requirement would go into Health Administration facilities, visit VHA
effect September 1 and that “our goal is for all employees to show proof of facilities or provide direct care to those
immunization within 60 days.” VA serves.
The organization cited the transmission rates and contagiousness of the VA is taking this necessary step to keep
Delta variant, recommendations from leading healthcare organizations, the Veterans it serves safe.
and the well-being of its patients as reasons for the mandate. Each employee will have eight weeks to
“This change is being made only after extensive and thoughtful review, be fully vaccinated.
and with our employees and patients’ safety as our top priority. We value “We’re mandating vaccines for Title 38
and appreciate every member of our Lifespan team who contributes to our employees because it’s the best way to keep
mission to deliver health with care,” the statement read. v Veterans safe, especially as the Delta variant
spreads across the country,” McDonough
said. “Whenever a Veteran or VA employee
sets foot in a VA facility, they deserve to
HHS, DOJ issue guidance on ‘Long COVID’ know that we have done everything in our
and disability rights under the ADA power to protect them from COVID-19.
WASHINGTON, D.C . – At the recent commemoration of the 31st anniversary With this mandate, we can once again make
of the Americans with Disabilities Act (ADA), the U.S. Department of – and keep – that fundamental promise.”
Health and Human Services (HHS) and the U.S. Department of Justice The department’s decision is supported by
(DOJ) jointly published guidance on how “long COVID” can be a disability numerous medical organizations including
under the ADA, Section 504 of the Rehabilitation Act, and Section 1557 the American Hospital Association, Amer-
of the Affordable Care Act. The guidance is on the HHS website at https:// ica’s Essential Hospitals and a Multisoci-
www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/index.html ety group of the leading Infectious Disease
and on the DOJ web-site at https://www.ada.gov/long_covid_joint_guid- Societies. The American Medical Associa-
ance.pdf [PDF]. tion, American Nurses Association, Ameri-
“It’s critical that we ensure people who have disabilities as a result of can College of Physicians, American Acad-
long COVID are aware of their rights under federal nondiscrimination emy of Pediatrics, Association of Ameri-
laws,” said ALISON BARKOF f, Acting Administrator and Assistant Sec- can Medical Colleges, and National Asso-
retary for Aging at the Administration for Community Living at HHS. ciation for Home Care and Hospice also
“It also is crucial that they know how to connect to services and supports endorsed mandating COVID-19 vaccination
available if they now need assistance to live in their own homes, go to for health care workers.
school or work, or participate in their communities.” In recent weeks, VA has lost four employ-
The ACL directory of resources for those with long COVID may be ees to COVID-19 – all of whom were unvac-
found at https://acl.gov/sites/default/files/COVID19/ACL_LongCOVID. cinated. At least three of those employees
pdf [PDF]. died because of the increasingly prevalent
In February HHS launched a new initiative to study long COVID. Led by Delta variant. There has also been an out-
NIH, the goal of the initiative is to learn more about how COVID-19 may lead break among unvaccinated employees and
to widespread and lasting symptoms, and to develop ways to treat or prevent trainees at a VA Law Enforcement Training
these symptoms. v Center, the third such outbreak during the
pandemic. v
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RI first in nation to pilot harm reduction Anchor Recovery Community Center makes
centers to prevent drug ODs naloxone boxes accessible on Block Island
PROVIDENCE – Gov. DAN M C KEE signed legislation in July PROVIDENCE – The Providence Center’s Anchor Recov-
that authorizes a two-year pilot program to prevent drug ery Community Center, along with local businesses, their
overdoses through the establishment of harm reduction employees, and residents of Block Island, recently partnered
centers, a community-based resource for health screen- to make life-saving resources for people with substance use
ing, disease prevention and recovery assistance where issues available on the island.
persons may safely consume pre-obtained substances. During their recent trip, certified peer recovery specialists
The law (2021-H 5245A, 2021-S 0016B), effective provided Ballard’s Beach Resort and New Shoreham’s Island
March 1, 2022, authorizes facilities where people may Free Library with Naloxboxes, 2 dozen naloxone kits, as well
safely consume those substances under the supervision as opioid overdose prevention and rescue training. The effort is
of health care professionals. It requires the approval of part of the Governor’s Overdose Prevention and Intervention
the city or Town Council of any municipality where the Task Force, which launched Rhode Island’s 10,000 Chances
center would operate. Project, an initiative to reduce overdose deaths and save lives.
While 10 countries sanction the operation of harm “We are very excited that the Anchor MORE (Mobile Out-
reduction centers, this legislation makes Rhode Island reach Recovery Efforts) team has been able to expand its
the first in the United States to authorize such a pilot outreach across the state. We are also grateful to have been
program. awarded funding through the RI DOH’s Drug Overdose Pre-
vention Program, the 10K chances grant. This funding has
Advisory committee allowed us to expand our services to include meeting with
The law also creates an advisory committee to make rec- local businesses to provide them with education, training and
ommendations to the Department of Health on ways to naloxone kits which can be used to save the lives of patrons in
maximize the potential public health and safety benefits crisis. The response from the local community leaders has been
of harm reduction centers, as well as the proper disposal quite remarkable, and we are thankful,” said HOLLY FITTING ,
of hypodermic needles and syringes, the recovery of peo- VP of Addiction, Recovery, Residential Services, and Grants
ple utilizing the centers, and ways to adhere to federal, Administration, Anchor Recovery Community Center. v
state and local laws impacting the creation and operation
of the centers.
“Rhode Island’s teamwork and trust in evidence-based
New suicide prevention law requires
medical decision making and strong public health
policy led the nation in tackling COVID-19, and with training/awareness for school personnel
that same spirit we are expanding our fight against sub- STATE HOUSE – A new law signed in July will require all public
stance use disorders and drug overdose deaths,” said school districts to adopt suicide prevention policies and train
CATHERINE CUMMINGS, MD , Rhode Island Medical all personnel in suicide awareness and prevention annually.
Society President. The Nathan Bruno and Jason Flatt Act (2021-H 5353,
Studies of supervised injection facilities in other coun- 2021-S 0031) will require all school personnel – including
tries have demonstrated that they reduce overdose deaths teachers, administration, custodians, lunch personnel, substi-
and transmission rates for infectious disease, and increase tutes, nurses, coaches, and coaching staff, even if volunteers
the number of individuals who seek addiction treatment, – to be trained in suicide prevention and awareness. The state
without increasing drug trafficking or crime in the areas Department of Education would establish the guidelines for
where they are located, according the American Medical the training curriculum.
Association. The bill is named for Nathan Bruno, a 15-year-old Ports-
“By enacting the nation’s first law in support of a mouth High School student who took his life in 2018. Part of
pilot harm reduction center, Rhode Island is taking an the bill is modeled after a state law passed in Tennessee and
important step to save lives from drug-related overdose 19 other states, which was named after Jason Flatt, a 16-year-
and death,” said AMA Opioid Task Force Chair BOBBY old from Nashville who died by suicide.
MUKKAMALA, MD . “The AMA strongly supports the According to the Department of Health, suicide is the sec-
development and implementation of harm reduction cen- ond leading cause of death for Rhode Islanders between the
ters in the United States. These facilities are designed, ages of 15 and 34. In 2017, 15.9% of surveyed Rhode Island
monitored, and evaluated to generate data to inform high school students they had considered suicide and 10.5%
policymakers on the feasibility, effectiveness, and legal said they had attempted suicide. One in nine middle school
aspects of reducing harms and health care costs related to students surveyed in Rhode Island that year reported having
injection drug use.” v made a suicide plan. v
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AMA adopts policy to address increases in youth suicide
CHICAGO – With an alarming increase in sui- Under the new policy, the AMA will:
cide and suicide risk in youth and young adults • Encourage the development and dissemination of educational
across the US, the American Medical Associa- resources and tools for physicians, especially those more likely to
tion (AMA) adopted policy during the Special encounter youth or young adult patients, that address effective suicide
Meeting of its House of Delegates aimed at prevention. This includes screening tools, methods to identify risk
preventing suicide in young people. factors and acuity, safety planning, and appropriate follow-up care –
The adopted policy report outlines risk fac- including treatment and linkages to appropriate counseling resources;
tors for youth suicide, including the role of
mental health, substance use disorder, adverse • Support collaboration with federal agencies, relevant state and spe-
childhood experiences, increased use of digi- cialty medical societies, schools, public health agencies, community
tal devices, bullying and cyberbullying, and organizations, and other stakeholders to enhance awareness of the
the impact of the COVID-19 pandemic. The increase in youth and young adult suicide and to promote protective
report also identifies evidence-based interven- factors, raise awareness of risk factors, support evidence-based preven-
tions, protective factors, as well as resources tion strategies and interventions, encourage awareness of community
to enhance resiliency aimed at mitigating mental health resources, and improve care for youth and young adults
youth suicide risk. at risk of suicide;
According to a recent Centers for Disease • Encourage efforts to provide youth and young adults better and more
Control and Prevention (CDC) study, there equitable access to treatment and care for depression, substance use
was a 31% increase in the proportion of men- disorder, and other disorders that contribute to suicide risk;
tal health–related emergency department vis- • Encourage continued research to better understand suicide risk and
its for youth aged 12–17 years during 2020 as effective prevention efforts in youth and young adults, especially in
compared to 2019. Particularly concerning, higher risk sub-populations such as Black, LGBTQ+, Hispanic/Latinx,
CDC data also showed increased rates of sui- and Indigenous/Native Alaskan youth and young adult populations,
cide ideation and suicide attempts in 2020 and among youth and young adults with disabilities;
during the COVID-19 pandemic as compared
• Support the development of novel technologies and therapeutics, along
with 2019 rates.
with improved utilization of existing medications to address acute
“We were deeply concerned by the dramatic
suicidality and underlying risk factors in youth and young adults;
increases we were seeing in youth suicide and
suicide risk even before the mitigation mea- • Support research to identify evidence-based universal and targeted
sures and disruptions caused by the COVID-19 suicide prevention programs for implementation in middle schools
pandemic. As a nation we must do everything and high schools;
we can to prioritize children’s mental, emo- • Advocate at the state and national level for policies to prioritize
tional and behavioral health and step up our children’s mental, emotional and behavioral health;
efforts to prevent suicide and mitigate suicide
• Advocate for a comprehensive system of care including prevention,
risk among our nation’s youth,” said AMA
management and crisis care to address mental and behavioral health
Board Member WILLIE UNDERWOOD III,
needs for infants, children and adolescents;
MD, MSc, MPH . “Physicians play a vital role
and we must ensure that all physicians who • Support increased screening for Adverse Childhood Experiences (ACEs)
see youth patients, not solely pediatric psy- in medical settings, in recognition of the intersectionality of ACEs
chiatrists and addiction medicine physicians, with significant increased risk of suicide, negative substance-use
have the ability, capacity, and access to the related outcomes including overdose, and a multitude of downstream
tools needed to identify when a young person negative health outcomes;
is experiencing a period of imminent risk and • Support the inclusion of ACEs and trauma-informed care into
help prevent suicide attempts.” undergraduate and graduate medical education curricula. v
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Applications for BCBSRI’s LGBTQ Safe Zone Program due August 16th
PROVIDENCE – Blue Cross & Blue Shield who, like other underserved groups, and mental health practices, substance
of Rhode Island (BCBSRI) is accepting are often alienated due to experiencing abuse and sexual trauma centers, and
applications from Rhode Island-based discrimination when seeking care.” even assisted living facilities for older
healthcare providers – including all Certification requirements for BC- adults. View the full list of providers at
practices, facilities and services - for its BSRI LGBTQ Safe Zones include staff bcbsri.com/safezones.
latest round of LGBTQ Safe Zone prac- training specific to the care of LGBTQ To qualify as an LGBTQ Safe Zone,
tice certification. This new cohort will patients, protection for patients and providers must meet certification re-
join more than 30 sites statewide that staff from discrimination based on gen- quirements. Upon certification, prac-
are providing safe, affirming and inclu- der identity or expression, gender neu- tices are provided with a window cling
sive care to the LGBTQ community. tral bathrooms, inclusive forms and and plaque so that patients visiting the
Applications are due Aug. 16, 2021. procedures, and a public commitment practice site will recognize it as a place
“Health equity is a top priority for our to connecting with, and serving, the where safe and affirming care is offered
company,” said MATTHEW COLLINS, LGBTQ community. to the LGBTQ community. Learn more
MD, MBA , BCBSRI executive vice pres- BCBSRI launched its LGBTQ Safe and apply online at bcbsri.com/provid-
ident and chief medical officer. “Every- Zone program in 2016. The program ers/safezone-program. Applications are
one deserves the right to culturally has now certified more than 30 Safe due by 5 p.m. on August 16, 2021 and
competent, inclusive and affirming Zone providers in towns and cities those who have been approved for cer-
healthcare. This can be a challenge for across Rhode Island representing a tification will be notified in October
members of the LGBTQ community number of specialties, including dental 2021. v
High screen time linked to cognitive, behavioral problems in children
born extreme preterm, NIH-funded study finds
PROVIDENCE – BETTY R. VOHR, MD , Medi- 238 had more than two hours of screen time
cal Director of the Follow-up Clinic Program, per day and 266 had a television or computer
Department of Pediatrics at Women & Infants in their bedroom. Compared to children with
Hospital, is the lead author of a manuscript less screen time per day, in adjusted analyses,
published in JAMA Pediatrics titled: “Associa- those with high screen time scored an average
tion of High Screen-Time Use With School-age of nearly 8 points higher on global executive
Cognitive, Executive Function, and Behavior function percentile scores, roughly .8 points
Outcomes in Extremely Preterm Children.” lower on impulse control (inhibition) and more
According to Dr. Vohr’s research, among than 3 points higher on inattention, all reflect-
6- and 7-year-olds who were born extremely ing increased risk of greater deficits. Children
preterm – before the 28th week of pregnancy– with a television or computer in their bedroom
Betty R Vohr, MD
those who had more than two hours of screen also had increased risk of inhibition, hyper-
time a day were more likely to have deficits in overall activity, and impulsivity problems.
I.Q., executive functioning (problem solving skills), diffi- The authors concluded that the findings support the need
culty with impulse control and difficulty paying attention, for physicians to discuss the potential effects of screen time
according to a National Institutes of Health funded study. with families of children born extremely preterm.
Similarly, those who had a television or computer in their ELISABETH M C GOWAN, MD , is a coauthor, and other
bedroom were more likely to have problems with impulse healthcare experts at Women & Infants Hospital contributed.
control and paying attention. The findings suggest that Funding for the study was provided by NIH’s Eunice
high amounts of screen time may exacerbate the cognitive Kennedy Shriver National Institute of Child Health and Hu-
deficits and behavioral problems common to children born man Development, National Heart, Lung, and Blood Institute
extremely preterm. and National Center for Research Resources (now part of the
The researchers analyzed data from a follow-up study National Center for Advancing Translational Sciences). v
of children born at 28 weeks or earlier. Of 414 children,
RIMJ ARCHIVES | AUGUST ISSUE WEBPAGE | RIMS AUGUST 2021 RHODE ISL AND MEDICAL JOURNAL 89IN THE N E WS Hasbro to participate in Accelerating New law protects hospital employees Child Health Care Transformation from violence, harassment on the job PROVIDENCE – Hasbro Children’s Hospital was competitively STATE HOUSE – A new law passed the by General Assembly selected to participate in Accelerating Child Health Care will help protect hospital staff from violence and harass- Transformation, a national initiative funded by the Robert ment at work. Wood Johnson Foundation to transform child health care The legislation (2021-S 0055A, 2021-H 6018A), which delivery. Hasbro Children’s Hospital is one of 12 leading was passed by the Assembly July 1 and was recently signed pediatric practices across the country that will work with into law by the governor, establishes procedures for hospi- the Center for Health Care Strategies (CHCS) to develop tal employees to file complaints with the hospital or the strategies for making child health care more equitable and Department of Health for any assaultive behavior or other family focused. violation of law occurring on hospital grounds, and requires “Hasbro Children’s Hospital plays an essential role in our hospitals to develop plans to protect and respond to vio- community. Hasbro Children’s exists to serve our neigh- lence and employee safety issues and institute safety train- bors and community, including and especially the most ing for employees. vulnerable among us. Being selected to work together in The new law, which takes effect January 15, 2022, will this partnership will allow us to continue to fulfill that require that every hospital in Rhode Island create a work- commitment to the individuals and the communities we place safety committee that shall conduct periodic security serve,” said SAUL N. WEINGART, MD , president of Rhode and safety assessments to identify existing or potential haz- Island Hospital and its Hasbro Children’s Hospital. ards for assaults committed against employees. It directs “As an academic medical center, we have opportunities hospitals to develop and implement an assault prevention to be at the cutting edge of medicine for children through and protection program for employees, and provide assault research and through some of our collaborations, such as prevention and protection training on a regular basis for the Accelerating Child Health Care Transformation. These employees. important partnerships enable us to do what’s best for It also ensures that any hospital employee may report kids, which means not only treating the child, but advo- any violation of law or safety or health violation to either cating for the child,” said PHYLLIS DENNERY, MD , pedia- their hospital or the Department of Health, may maintain trician-in-chief and medical director of Hasbro Children’s anonymity if they want, and shall be protected from retal- Hospital. iation. The bill lays out the procedures for how such com- Over nine months, the learning community participants plaints should be investigated and addressed. will collaborate on three key goals: (1) adopting anti-racist During testimony for the bill the United Nurses and practices to advance health equity; (2) co-creating equitable Allied Professionals (UNAP), which represents nurses, partnerships with families and providers; and (3) identifying technologists, therapists, pharmacists, mental health family strengths and health-related social needs to promote workers and support staff, reported that there has been a resilience. OLUTOSIN OJUGBELE, MD , led Hasbro Chil- dramatic increase of instances in which frontline health dren’s application process for the joint initiative. workers are on the receiving end of violent and often trau- “Our team is extremely proud to have been chosen to matic instances of physical and mental abuse from patients, participate in this important effort. The health and well- their families and visitors, and that more often than not, it being of children is our top priority, and working collabo- goes unreported and undocumented. ratively with other select organizations on this initiative A UNAP survey of its members working in hospitals will only strengthen our efforts to provide a high-quality found that 42% said their unit had experienced a violent family- and patient-centered medical home for children and or near miss violent episode requiring intervention by the youth,” said CAROL LEWIS, MD , medical director, Hasbro local police; 67.8% said they had personally experienced Children’s Hospital Pediatric Primary Care and director, workplace violence on the job; and 63.7% said they have at Refugee Health Program. v times felt unsafe working in their unit. v RIMJ ARCHIVES | AUGUST ISSUE WEBPAGE | RIMS AUGUST 2021 RHODE ISL AND MEDICAL JOURNAL 90
IN THE N E WS RIH study shows smartphone photos can screen for anemia PROVIDENCE – A picture of a person’s color resolution as well as a predic- to screen for anemia in a telehealth or inner eyelid taken with a standard tion model linking conjunctiva color, remote setting where the infrastruc- smartphone camera can be used to compared to the surrounding skin ture for blood tests is not available. screen for anemia, according to a new and whites of the eyes, to hemoglobin “Others have used photos of the study published recently in PLOS ONE levels. Then, the team tested the new creases in the palms, fingernail beds, by authors, including SELIM SUNER, algorithms on photos collected from and other parts to devise algorithms MD , JAMES RAYNER, MD, MEng , and 202 new patients. to predict anemia,” said Dr. Suner. GREGORY JAY, MD, PhD , all emer- When analyzing the new set of photo- “Because those areas can be affected gency physicians at Rhode Island Hos- graphs, the model was 72.6% accurate more readily by temperature changes pital and The Miriam Hospital, and (CI 71.4–73.8), 72.8% sensitive (71– or other conditions affecting blood faculty at The Warren Alpert Medical 74.6), and 72.5% specific (70.8–74.1) at flow, the eyelid gives us a more reliable School of Brown University; predicting anemia. Accuracy for trans- way to make this prediction.” In the new study, researchers ob- fusion thresholds was higher, at 94.4% Dr. Suner added that the next iter- tained smartphone images of the pal- accurate (93.7–95.0) for a low transfu- ation of an app designed for this pur- pebral conjunctiva from 142 patients sion threshold and 86% accurate (85.0– pose will allow novice users to take the with a wide range of hemoglobin lev- 86.9) for a higher threshold. Skin tone photo with sufficient quality for accu- els. They zoomed into a small region did not change results, but image qual- racy, honing focus and lighting to min- of the conjunctiva in each photo and ity had some effect. The results suggest imize error. That app will be validated developed a new algorithm optimizing that a smartphone app could be used with a new cohort of patients. v RIDOH announces new Health Equity Zones PROVIDENCE – The Rhode Island Department of Health The goal of Central Providence Opportunities is to improve (RIDOH) announced that it is expanding support and funding economic opportunity in the 02908 and 02909 ZIP codes to establish four new Health Equity Zones (HEZs). Warwick, of Providence through affordable housing development, Warren, Blackstone Valley (including Cumberland, North wage growth, local business development, and early educa- Smithfield, and Lincoln), and the 02905 ZIP code (includ- tion supports. The aim is to scale this pilot effort to other ing lower South Providence and nearby neighborhoods) were communities in Rhode Island by working with residents, chosen through a competitive process that drew applicants community partners, and State agencies. from communities across the State. The investment to expand Rhode Island’s HEZ initiative The ongoing expansion of RIDOH’s HEZ initiative has will be managed by the Rhode Island Foundation in partner- been made possible in part through support from a pilot ship with the Rhode Island Executive Office of Health and investment in place-based transformation in Rhode Island Human Services (EOHHS) and RIDOH, and the funding will by Blue Meridian Partners and in partnership with ONE be leveraged to expand the impact of the HEZ model into Neighborhood Builders (ONE|NB). Blue Meridian Partners additional communities. is a national philanthropic organization that finds and funds Like the 11 existing HEZs, the four new HEZs will annu- scalable solutions to the problems that limit economic ally receive $150,000 in core funding and support to ensure mobility and trap America’s young people and families in that these communities ground their work in public health poverty. ONE|NB is the backbone, or convening entity, of the principles and best practices, so that measurable outcomes pilot initiative, known as Central Providence Opportunities. are reached and evaluated. v RIMJ ARCHIVES | AUGUST ISSUE WEBPAGE | RIMS AUGUST 2021 RHODE ISL AND MEDICAL JOURNAL 91
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