Medical Journal

RHODE ISLAND M EDICAL J OURNAL SPECIAL SECTION TRANSITIONS/END-OF-LIFE CARE IN RI GUEST EDITOR RENÉE R. SHIELD, PhD APRIL 2015 VOLUME 98 • NUMBER 4 ISSN 2327-2228 Your records are secure. Until they’re not. Data theft can happen to anyone, anytime. A misplaced mobile device can compromise your personal or patient records. RIMS-IBC can get you the cyber liability insurance you need to protect yourself and your patients. Call us. 401-272-1050 IN COOPERATION WITH RIMS-IBC 235 PROMENADE STREET, SUITE 500, PROVIDENCE RI 02908 MEDICAL PROFESSIONAL/CYBER LIABILITY PROPERTY/CASUALTY LIFE/HEALTH/DISABILITY RHODE ISLAND M EDICAL J OURNAL D h D, P L IE H 14 Journeys in Long-Term Care RENÉE R. SHIELD, PhD GUEST EDITOR F RENÉE R. S O Y S E T UR O R. Shield, PhD C The cover image is a painting by Stanley M. Aronson, MD. 15 Healthcare Transitions of Older Adults: An Overview for the General Practitioner LIDIA VOGNAR, MD; NADIA MUJAHID, MD 19 Health Care Transitions: Perceptions from L. Vognar, MD Older Patients in Rhode Island RENÉE R. SHIELD, PhD; KALI S. THOMAS, MA, PhD; RACHEL RatchFORD, ScB 23 The Goals of Care Conversation: A tool to improve patient care in the E. Martin, MD nursing home at the end of life EDWARD W. MARTIN, MD, MPH 29 Hospice and Palliative Care in Nursing Homes: Challenges and Opportunities for Enhanced Access SUSAN C. MILLER, PhD S. Miller, PhD RHODE ISLAND M EDICAL J OURNAL 8 COMMENTARY Brain Warfare: Primates To Humans? Yawning: Monkey see, monkey do JOSEPH H. FRIEDMAN, MD 11 RIMJ AROUND THE WORLD We are read everywhere: Sausalito, San Diego, Austin 52 RIMS NEWS Medical Student event Working for You Why You Should Join RIMS 70 BOOKS New Book Explores Acceptance and Mindfulness Therapy for Psychosis 72 HeritaGE 100 Years Ago: First EKG Machine Arrives in RI MARY KORR RHODE ISLAND M EDICAL J OURNAL IN THE NEWS NICOLE ALEXANDER-SCOTT, MD 56 58 KENT HOSPITAL named Director of the RI approved to perform angioplasty Department of Health 60 BRADLEY HOSPITAL RI HOSPITAL 56 awarded $168K to support offers RI’s first medical residency training fellowship in Addiction Medicine 60 CARE NEW ENGLAND VPs selected for National Fellows Program RICHARD AXEL, MD 57 delivers keynote at 63 ALPERT MEDICAL SCHOOL Brown’s Brain Day students celebrate Match Day PEOPLE THOMAS DREW, MD 65 68 RENEE EGER, MD honored with named Medical Director of Hamolsky Award Women’s Primary Care Center STAR HAMPTON, MD 65 68 MICHAEL STANCHINA, MD brings specialty care named Medical Director of RWMC’s to women in Rwanda Sleep Disorders Center ZIYA GOKASLAN, MD 66 68 KATE LALLY, MD named Chief of Neurosurgery named Inspirational Leader at RIH, Miriam; Neurosurgery in Hospice and Palliative Chair at Alpert Medical School Medicine APRIL 2015 VOLUME 98 • NUMBER 4 RHODE ISLAND Rhode Island Medical Society R I Med J (2013) 2327-2228 M EDICAL J OURNAL 98 PUBLISHER RHODE ISLAND MEDICAL SOCIETY 4 PRESIDENT 2014 PETER KARCZMAR, MD April PRESIDENT-ELECT 1 RUSSELL A. SETTIpaNE, MD VICE PRESIDENT SARAH J. FESSLER, MD CONTRIBUTIONS secretary BRADLEY J. COLLINS, MD 30 Comparison of Substance-Use Prevalence among Rhode Island TREASURER and The Miriam Hospital Emergency Department Patients to JOSE R. POLANCO, MD State and National General Population Prevalence Estimates IMMEDiate PAST PRESIDENT VERA L. BERNARDINO, BSC, RN; JANETTE R. BAIRD, PhD; TAO LIU, PhD; ELAINE C. JONES, MD ROLAND C. MERCHANT, MD, MPH, ScD EXECUTIVE DIRECTOR NEWELL E. WARDE, PhD 35 Training Family Medicine Residents to Build and Remodel a Patient Centered Medical Home in Rhode Island: EDITOR-IN-CHIEF JOSEPH H. FRIEDMAN, MD A Team Based Approach to PCMH Education RABIN CHANDRAN, MD; CHRISTOPHER FUREY, MD; ARNOLD GOLDBERG, MD; associate EDITOR SUN HO AHN, MD DavID ASHLEY, MD; GOWRI ANANDARAJAH, MD PUBLication StaFF MANAGING EDITOR MARY KORR EMERGENCY MEDICINE RESIDENCY CPC [email protected] 42 Too Weak to Move GRAPHIC DESIGNER WENDY H. WONG, MD; NathaN HUDEPOHL, MD; MARIANNE MIGLIORI BRUCE BECKER, MD; WILLIAM BINDER, MD ADVertisinG STEVEN DETOY SARAH STEVENS [email protected] PUBLIC HEALTH EDITORIAL BOARD 46 HEalth BY NUMBERS JOHN J. CRONAN, MD Uninsurance is only half the problem: JAMES P. CROWLEY, MD EDWARD R. FELLER, MD Underinsurance and healthcare-related financial burden in RI JOHN P. FUltoN, PhD DORA DUMONT, PhD, MPH; TARA COOPER, MPH; YONGWEN JIANG, PhD PETER A. HOLLMANN, MD KENNETH S. KORR, MD 50 VItal StatISTICS MARGUERITE A. NEILL, MD FRANK J. SCHABERG, JR., MD COLLEEN A. FONtaNA, StatE REGISTRAR LAWRENCE W. VERNAGLIA, JD, MPH NEWELL E. WaRDE, PhD RHODE ISLAND MEDICAL JOURNAL (USPS 464-820), a monthly publication, is owned and published by the Rhode Island Medical Society, 235 Promenade Street, Suite 500, Providence RI 02908, 401-331-3207. All rights reserved. ISSN 2327-2228. Published articles represent opinions of the authors and do not necessarily reflect the official policy THIS ISSUE SPONSORED BY of the Rhode Island Medical Society, unless clearly specified. Advertisements do not im- ply sponsorship or endorsement by the Rhode Island Medical Society. Advertisers contact: Sarah Stevens, RI Medical Society, 401-331-3207, fax 401-751-8050, [email protected]. In a healthcare system where physicians and By harnessing data and leveraging analytics, we’re hospitals are called upon daily to improve the able to put our business intelligence, proven risk quality of care while reducing costs, we believe reduction strategies and innovative educational there is an opportunity for innovative solutions programs to work, so that you can anticipate risk to influence outcomes. and improve overall outcomes. To go beyond reacting to events to actually If you’re ready to change the way you think about anticipating them before they happen. medical malpractice insurance, call 800.225.6168 or visit ThinkCoverys.com Better Intelligence for Better OutcomesSM ProSelect Insurance Company 800.225.6168 www.coverys.com commentary Brain Warfare: Primates To Humans? Yawning: Monkey see, monkey do JOSEPH H. FRIEDMAN, MD 8 [email protected] 9 EN MANY READERS PROBABLY One can imagine that The chimp saw a yawn and the brain are familiar with the persistent yawning may said, “boring,” and so another yawn was surprising observation provoke a reaction from born. But the experiment did not include published recently show- the other chimps that blind or blindfolded primates. And why ing that young chimpan- could possibly lead to should a chimp, which spends 8 hours zees, but not juveniles, embarrassment, possi- eating and 16 hours sleeping, get bored were immune from the bly ostracism. Was this by a yawn? No blind or blindfolded contagious form of yawn- protocol sensitive to the chimps were tested. Perhaps there are ing (Madsen EA.) Chim- needs of its subjects? brain waves or exhaled particles which panzees show a develop- One must also consider communicate yawning. We also do mental increase in sus- the other aspects of this not learn from this project whether a ceptibility to contagious protocol. What if “gap- yawning chimp, caged by itself, will yawning: a test of ontogeny and emo- ing” was contagious? How stigmatizing continue to yawn, or whether it lessens tional closeness on yawn contagion. is it to be a gaping chimp? Would gaping (PLoS One 2013;8(10)e76266). In a interfere with socialization? Might a Imagine how hard life surprise development, a study of 33 gaping chimp provoke antagonism, orphaned chimps showed that juveniles especially if it was also yawning? Imag- might be for a chimp which only “caught” yawning when a human ine how hard life might be for a chimp not only was yawning but yawned, but that young chimps did not. which not only was yawning but was was gaping? I’ve seen Moveover, there was something special gaping? I’ve seen chimps suffer for lesser chimps suffer for lesser about yawning, in contrast to certain social miscues than these. social miscues than these. other stereotypic behaviors. Juveniles I suspect contagious nose wiping didn’t develop contagious gaping or might pose different and lesser prob- contagious nose wiping, stereotypes lems. Nose wiping, especially in chimps, or increases. Can the yawn be con- in chimps. Equally interesting was the which probably were not given tissues trolled? Does contagious yawning have observation that the strength of the or handkerchiefs, probably looks like a half-life? contagion didn’t matter if the yawning scratching an itch to another chimp, and Most importantly, can this be used by model, ie, the yawner, was their adoptive not necessarily a reflection of boredom, the state department to undermine our human mother or an unknown human. stupidity or dumfounded-ness. Other foreign opponents by putting yawning I was surprised that the IRB had chimps might not react so badly to a people in prominent advertisements approved a plan that didn’t include chimp which spent a lot of time rubbing to encourage yawning? Might there be a description of how the researchers its nose. They might steer clear though a “critical mass” for yawning, so that were going to deal with the chimps if they interpreted the behavior as a sign after a number of chimps, or people, which were caught yawning. Is there of an infestation of nose mites. develop contagious yawning, most of the treatment for yawning? It’s presum- I have not addressed the issue of con- chimp/human colony become yawners? ably not life threatening but could it tagion. The authors assumed, of course, At this point, the shoe may shift to the be? Is there a cure? Once present can it as you, the reader did as well, that the other foot so that the chimps which are worsen? Does it lead to other problems? contagion was based on observation.

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