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RHODE ISLAND M EDICAL J OURNAL THANKS TO RIMJ’s 2014 GuEST EDITORS The editor-in-chief describes the role guest editors serve in assembling the special theme sections of RIMJ on Page 14 R SPECIAL SECTION NEPHROLOGY GUEST EDITOR MAROUN AZAR, MD DEcember 2014 VOLUME 97• NUMBER 12 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 17 RI Clinicians Share Timely Reviews in Nephrology MAROUN AZAR, MD GUEST EDITOR M. Azar, MD 18 The Elderly Patient with Low eGFR: Beyond the Numbers MAROUN AZAR, MD 23 Anemia and Bone Disease of Chronic Kidney Disease: Pathogenesis, Diagnosis, and Management DOUGLAS SHEMIN, MD D. Shemin, MD 27 Ambulatory Blood Pressure Monitoring in Children: A Safe and Effective Diagnostic and Screening Tool for the Diagnosis of Hypertension in Children ROBIN KREMSDORF, MD; M. KHURRAM FAIZAN, MD, FAAP R. Kremsdorf, MD M. K. Faizan, MD 30 The Growing Prevalence of Kidney Stones and Opportunities for Prevention KATHERINE RICHMAN, MD; JOHN O’BELL, MD; GYAN PAREEK, MD K. Richman, MD J. O’Bell, MD G. Pareek, MD RHODE ISLAND M EDICAL J OURNAL 8 COMMENTARY Aiming Low Advice to residents considering a research project JOSEPH H. FRIEDMAN, MD A Refuge for the Medical Student, the Dissident and the Pilgrim STANLEY M. ARONSON, MD Thanks to our guest editors JOSEPH H. FRIEDMAN, MD 16 RIMJ AROUND THE WORLD We are read everywhere: Rwanda, Hawaii, San Francisco 41 RIMS NEWS Working for You Why You Should Join RIMS 58 PHYSICIAN’S LEXICON The Hesitant Pathway to the Humours STANLEY M. ARONSON, MD 60 HeritaGE December 1917: RI Medical Teams Rush to Halifax Disaster MARY KORR RHODE ISLAND M EDICAL J OURNAL IN THE NEWS IN MEMORIAM 44 47 MEMORIAL HOSPitaL David S. Greer, MD earns AHA ‘gold’ for stroke care 47 RI HOSPitaL DEPartment 46 OF HEALTH leads in LGBT equality index links PMP to 47 NEWPort HOSPitaL Connecticut recognized by Joint Commission CHARLES B. EATON, MD 46 48 NEWPort HOSPitaL study on statin, diabetes adds midwife service PEOPLE ANNIE DE GROOT, MD 50 53 HOSPitaL association Vaccine Group receives oF RHODE ISLAND $100,000 Gates grant honors hospital heroes 54 MEMORIAL SIMIN LIU, MD 52 HOSPitaL earns groundbreaking graduates nurse CVGPS grant anesthetists DINA MORRISSEY, MD 52 56 OBITUARIES named to national Steven Charles Brin, MD safety board David S. Greer, MD Howard A. Hall, MD DEcember 2014 VOLUME 97 • NUMBER 12 RHODE ISLAND Rhode Island Medical Society R I Med J (2013) 2327-2228 M EDICAL OURNAL PUBLISHER J 97 RHODE ISLAND MEDICAL SOCIETY 12 WITH SUPPOrt FROM RI DEPT. OF HEAltH 2014 PRESIDENT December PETER KARCZMAR, MD 2 PRESIDENT-ELECT RUSSELL A. SETTIPANE, MD VICE PRESIDENT PUBLIC HEALTH SARAH J. FESSLER, MD 35 Missed Opportunity to Provide HPV Vaccine and Educate secretary BRADLEY J. COLLINS, MD Adolescents: Rhode Island Middle and High School Students’ Self-Reported HPV Vaccination, 2013 RI YRBS TREASURER JOSE R. POLANCO, MD JUNHIE OH, BDS, MPH; TRICIA WASHBURN, BS; HANNA KIM, PhD IMMEDiate past PRESIDENT ELAINE C. JONES, MD 39 Vital Statistics EXECUTIVE DIRECTOR COLLEEN A. FONTANA, STATE REGISTRAR NEWELL E. WARDE, PhD EDITOR-IN-CHIEF JOSEPH H. FRIEDMAN, MD associate EDITOR SUN HO AHN, MD EDITOR EMERITUS STANLEY M. ARONSON, MD PUBLication StaFF MANAGING EDITOR MARY KORR [email protected] GRAPHIC DESIGNER MARIANNE MIGLIORI ADVertisinG STEVEN DETOY SARAH STEVENS [email protected] EDITORIAL BOARD STANLEY M. ARONSON, MD, MPH JOHN J. CRONAN, MD JAMES P. CROWLEY, MD EDWARD R. FELLER, MD JOHN P. FUltON, PhD PETER A. HOLLMANN, MD KENNETH S. KORR, MD RIMJ Mission Statement MARGUERITE A. NEILL, MD The Rhode Island Medical Journal (RIMJ), published by the Rhode Island Medical Society, is an FRANK J. SCHABERG, JR., MD independent, monthly, electronic publication which aims to reflect the views and purposes of the LAWRENCE W. VERNAGLIA, JD, MPH entire medical community of Rhode Island. NEWELL E. WARDE, PhD We see the Journal as a vehicle aimed at the practicing physicians of Rhode Island – whether they are in private practice, on the staff of the state’s hospitals or as part of the many colleges and universities of the state. It offers a venue for them to express their clinical or investigative RHODE ISLAND MEDICAL JOURNAL findings, and for the academic faculty to publish their clinical or research results. It also serves (USPS 464-820), a monthly publication, is as a platform for local medical students, resident physicians and fellows to contribute to the owned and published by the Rhode Island Medical Society, 235 Promenade Street, Suite medical literature while honing the rudiments of medical writing. 500, Providence RI 02908, 401-331-3207. In addition, it offers the opportunity for medical professionals to make the community aware All rights reserved. ISSN 2327-2228. Published of testing or clinical expertise that may not be widely known, even within our small state. And articles represent opinions of the authors and finally, RIMJ is a forum where allied health professions such as local schools of public health, do not necessarily reflect the official policy of the Rhode Island Medical Society, unless pharmacy and nursing may share their concerns and aspirations as the business of health care clearly specified. Advertisements do not im- takes on new and unanticipated challenges. ply sponsorship or endorsement by the Rhode Island Medical Society. Joseph H. Friedman, MD Sun Ho Ahn, MD Stanley M. Aronson, MD Advertisers contact: Sarah Stevens, RI Medical Editor-in-Chief Associate Editor Editor Emeritus Society, 401-331-3207, fax 401-751-8050, [email protected]. HavingHaving thethe rightright risk managementmanagement program is IMPORTANT Cover your risk withwith CoverysCoverys EveryEvery day,day, you’reyou’re exposed to risk. That‘s whywhy youyou should join the 25,000 physicians,physicians, dentists and allied healthcare professionals andand more thanthan 500 hundredhundred hospitals,hospitals, healthhealth centers andand clinicsclinics that choose Coverys for medical professional liability insurance and risk management. We bring the experience, fi nancial strength, support services, and strategic insight to protect you andand your practice.practice. Get Coverys.Coverys. Because it’s veryvery important. www.coverys.com 800.225.6168800.225.6168 ProSelectProSelect Insurance CompanyCompany commentary Aiming Low Advice to residents considering a research project JOSEPH H. FRIEDMAN, MD 8 [email protected] 9 EN I RECENTLY JOINED MY I am an enthusiastic try to gather as much data as possible colleagues in an evening researcher. Every day since the incremental effort is always meeting with neurology there are either ques- small. That slippery slope, of adding a residents. The objective tions raised that need test here and a measurement there, is was to share our research to be answered, or the often the cemetery of “doable” projects. interests. In part this was same question asked day Finally I recommended, “Aim low.” to let them know what after day that no one After I said this I realized that it we were doing, thus com- has yet answered. I want might have been a faux pas. After all, pleting their picture of others to do research. I these were doctors. They were all pretty us, expanding it beyond sometimes wonder how smart, all very hard working, dedicated the teaching and clinical the vast bulk of doctors and high achievers. Had they ever in care arenas. This is one do their work, seeing their lives heard anything after the word, area that partly distinguishes medical patients from morning to night, day “aim,” but “high?” I think I should have school faculty and private practitioners, after day, and not getting pulled in to said, “aim for low hanging fruit.” That’s although more about this later. The answer the many questions that must a common phrase that we use when we other objective was to try to excite an enter their minds every day. But, I’ve talk about projects that will have long- interest in some residents to try their learned many lessons in my lengthy term, sometimes difficult to achieve hands at research and for them to find career. One of them is that I’m consid- ends, but may, in the beginning, produce out if they might be as excited by doing ered opinionated. Not unreasonable, I some interesting and useful results, easy this sort of work as the faculty are. don’t think. Not irrational or dogmatic, to harvest. For example, I’m interested My colleagues were very good about just strongly skeptical. Another is that in the problem of fatigue in Parkinson’s describing their work. There were six clinical research takes a lot lot longer disease. I got interested because of one minutes allotted for each of us and than anyone would think possible in a particular patient in whom fatigue was they kept to it. They were succinct and universe where light travels at 186,000 his main problem and when I turned to positive. Some participated in large miles per second. I made two points to the literature on fatigue in PD I found clinical trials. Some used sophisticated the residents. One was that everything that there was none. It was not known equipment. All, most importantly, took at least four times longer than you to be a problem. The “low hanging fruit” were enthusiastic about their work.

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