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News Article | May 1, 2017
Site: www.futurity.org

Among suicidal patients, an intervention with brief, post-discharge phone calls significantly reduced the likelihood of a future suicide attempt. In a clinical trial involving nearly 1,400 suicidal patients in the emergency departments of eight hospitals, researchers found that the intervention lowered the relative risk of new suicide attempts by 20 percent. In results published in JAMA Psychiatry, emergency department patients who received the intervention composed of specialized screening, safety planning guidance, and periodic follow-up phone check-ins made 30 percent fewer total suicide attempts compared to people who received standard ED care. “We were happy that we were able to find these results,” says Ivan Miller of Butler Hospital and the study’s lead and corresponding author. “We would like to have had an even stronger effect, but the fact that we were able to impact attempts with this population and with a relatively limited intervention is encouraging,” says Miller, professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University. While suicide prevention efforts such as hotlines are well known, published controlled trials of specific interventions have been much rarer, Miller says. This one focuses on an especially high-risk group: emergency department patients who said they had engaged in suicidal ideation or had made an attempt within a week before their ED visit. The trial took place in three phases to create three comparison groups. In the first phase, August 2010 to December 2011, 497 patients received each ED’s usual treatment as a control group. In the second phase, September 2011 to December 2012, 377 patients received additional suicide screening. In the third phase, July 2012 to November 2013, 502 patients received the experimental intervention. Those patients received additional suicide screening from ED physicians, suicide prevention information from nurses, and a personal safety plan that they could opt to fill out to be better prepared for times when they might begin to harbor suicidal thoughts again. Over the next year they also received brief, periodic phone calls from trained providers at Butler Hospital who would discuss suicide risk factors, personal values and goals, safety and future planning, treatment engagement, and problem solving. The intervention was designed to directly involve a designated loved one whenever feasible, as well. In all three phases, patients were briefly screened for suicidality at the ED and were also followed for a year with periodic assessment phone calls. Regardless of phase, patients who demonstrated a specific suicide risk during assessments were connected with the Boys Town suicide prevention hotline. Suicide attempts were not the only measure the researchers employed to understand the potential impact of the intervention. Fortunately, there were so few deaths by suicide among patients (five total deaths) that there could be no statistically valid conclusions drawn from that data point. But the researchers also created a broader suicide composite score, which included not only attempts and deaths, but also interrupted or aborted attempts, and acts to prepare an attempt. Across the three groups, 46.3 percent of the patients reported one or more of these behaviors, but the relative risk declined significantly among people in the intervention compared to the usual care group (by 15 percent), but not among people who received screening alone. While other interventions have also been found to reduce suicide risk, some of the most effective ones have involved providing patients with many hours of psychotherapy. “This intervention was significantly less costly than most other interventions,” he says. The research team is currently engaged in a cost-effectiveness analysis. He notes that the intervention was associated with significant declines in suicide attempts, even though not every patient engaged in the full intervention (e.g. only 37.4 percent reported receiving a safety plan and nearly 40 percent did not complete a follow-up phone call). The intervention’s apparent efficacy also persisted despite the study’s ethical design, in which even people in the control phases received suicide prevention counseling that could have prevented an attempt if they presented an urgent need. The report is one of several from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study led by Miller, Professor Edwin Boudreaux of the University of Massachusetts, and Carlos Camargo of Massachusetts General Hospital and Harvard University. In further studies, the ED-SAFE team is looking at whether more intensive safety planning while patients are in the ED could help further. Miller and his colleagues are also conducting further tests of the phone follow-ups with patients from Butler Hospital and the Providence Veterans Affairs Medical Center. Additional coauthors are from Massachusetts General Hospital; the University of Colorado; the National Institutes of Health; Cape Cod Healthcare; and Brown University. The National Institute of Mental Health funded the research.


News Article | May 8, 2017
Site: www.eurekalert.org

When treating depression, the goal is to help individuals achieve full recovery and normal functioning. While traditional treatment such as medication or psychotherapy is effective for many patients, some may not fully recover even with these treatments. Researchers sought to determine if the addition of hatha yoga would improve treatment outcomes for these patients. They found that the benefits of yoga were less pronounced early in treatment, but may accumulate over time. The research, entitled "Adjunctive yoga v. health education for persistent major depression: a randomized controlled trial," has been published in Psychological Medicine. The research was led by Lisa Uebelacker, PhD, a research psychologist in the Psychosocial Research Department at Butler Hospital, a Care New England hospital, and an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University. The team also included Gary Epstein-Lubow, MD; Ana M. Abrantes, PhD; Audrey Tyrka, MD, PhD; Brandon A. Gaudiano, PhD; and Ivan W. Miller III, PhD, of Butler Hospital and the Warren Alpert Medical School; Geoffrey Tremont, PhD and Tanya Tran of Rhode Island Hospital and the Warren Alpert Medical School; Tom Gillette of Eyes of the World Yoga; and David Strong of the University of California, San Diego. "The purpose of this study was to examine whether hatha yoga is effective for treating depression when used in addition to antidepressant medication," explained Dr. Uebelacker. "We did not see statistically significant differences between hatha yoga and a control group (health education) at 10 weeks, however, when we examined outcomes over a period of time including the three and six months after yoga classes ended, we found yoga was superior to health education in alleviating depression symptoms." According to Dr. Uebelacker, this is the largest study of yoga for depression to date. The team enrolled individuals with current or recent major depression who were receiving antidepressant medication and continued to have clinically significant depression symptoms. Participants were randomized into two groups - those who participated in a hatha yoga class and a control group who took part in a health education class. The intervention phase lasted 10 weeks and participants were followed for six months afterward. "We hypothesized that yoga participants would show lower depression severity over time as assessed by the Quick Inventory of Depression Symptomatology (QIDS), as well as better social and role functioning, better general health perceptions and physical functioning, and less physical pain relative to the control group," said Dr. Uebelacker. "We found that yoga did indeed have an impact on depression symptoms." Butler Hospital, a member of Care New England, is the only private, nonprofit psychiatric and substance abuse hospital serving adults, seniors and adolescents in Rhode Island and southeastern New England. Founded in 1844, it was the first hospital in Rhode Island and has earned a reputation as the leading provider of innovative psychiatric treatments in the region. The major affiliated teaching hospital for psychiatry and behavioral health at The Warren Alpert Medical School of Brown University, Butler is recognized worldwide as a pioneer in conducting cutting-edge research.


News Article | April 29, 2017
Site: www.eurekalert.org

PROVIDENCE, R.I. [Brown University] -- In a clinical trial involving nearly 1,400 suicidal patients in the emergency departments of eight hospitals, a team led by Brown University and Butler Hospital psychologist Ivan Miller found that a multifaceted intervention lowered the relative risk of new suicide attempts by 20 percent. In results published in JAMA Psychiatry, emergency department (ED) patients who received the intervention composed of specialized screening, safety planning guidance and periodic follow-up phone check-ins made 30 percent fewer total suicide attempts compared to people who received standard ED care. "We were happy that we were able to find these results," said Miller, the study's lead and corresponding author and a professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University. "We would like to have had an even stronger effect, but the fact that we were able to impact attempts with this population and with a relatively limited intervention is encouraging." While suicide prevention efforts such as hotlines are well known, published controlled trials of specific interventions have been much rarer, Miller said. This report was one of several from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study led by Miller, Professor Edwin Boudreaux of the University of Massachusetts and Dr. Carlos Camargo of Massachusetts General Hospital and Harvard University. This study might be the largest intervention trial conducted so far in the U.S., Miller said. It focused on an especially high-risk group: emergency department patients who said they had engaged in suicidal ideation or had made an attempt within a week before their ED visit. The trial took place in three phases to create three comparison groups. In the first phase, August 2010 to December 2011, 497 patients received each ED's usual treatment as a control group. In the second phase, September 2011 to December 2012, 377 patients received additional suicide screening. In the third phase, July 2012 to November 2013, 502 patients received the experimental intervention. Those patients received additional suicide screening from ED physicians, suicide prevention information from nurses and a personal safety plan that they could opt to fill out to be better prepared for times when they might begin to harbor suicidal thoughts again. Over the next year they also received brief, periodic phone calls from trained providers at Butler Hospital who would discuss suicide risk factors, personal values and goals, safety and future planning, treatment engagement, and problem solving. The intervention was designed to directly involve a designated loved one whenever feasible, as well. In all three phases, patients were briefly screened for suicidality at the ED and were also followed for a year with periodic assessment phone calls. Regardless of phase, patients who demonstrated a specific suicide risk during assessments were connected with the Boys Town suicide prevention hotline. The number of suicide attempts and the proportion of people attempting suicide declined significantly in the intervention group compared to treatment as usual. The middle group, which received only additional screening, did not show a significant drop compared to the treatment as usual group. Suicide attempts were not the only measure the researchers employed to understand the potential impact of the intervention. Fortunately, there were so few deaths by suicide among patients (only five total) that there could be no statistically valid conclusions drawn from that data point. But the researchers also created a broader suicide composite score which included not only attempts and deaths, but also interrupted or aborted attempts, and acts to prepare an attempt. Across the three groups, 46.3 percent of the patients reported one or more of these behaviors, but the relative risk declined significantly among people in the intervention compared to the usual care group (by 15 percent), but not among people who received screening alone. While other interventions have also been found to reduce suicide risk, some of the most effective ones have involved providing patients with many hours of psychotherapy. "This intervention was significantly less costly than most other interventions," he said. The research team is currently engaged in a cost-effectiveness analysis. He noted that the intervention was associated with significant declines in suicide attempts, even though not every patient engaged in the full intervention (e.g. only 37.4 percent reported receiving a safety plan and nearly 40 percent did not complete a follow-up phone call). The intervention's apparent efficacy also persisted despite the study's ethical design, in which even people in the control phases received suicide prevention counseling that could have prevented an attempt if they presented an urgent need. In further studies, the ED-SAFE team is looking at whether more intensive safety planning while patients are in the ED could help further. Miller and his colleagues are also conducting further tests of the phone follow-ups with patients from Butler Hospital and the Providence Veterans Affairs Medical Center. In addition to Miller, Boudreak and Camargo, the paper's other authors are Drs. Sarah Arias and Richard Jones of Brown; Ashley Sullivan, Janice Espinola and Dr. Kohei Hasegawa of Massachusetts General Hospital; Dr. Michael Allen of the University of Colorado; Dr. Amy Goldstein of the National Institutes of Health; and Dr. Anne Manton of Cape Cod Healthcare. Drs. Lisa Uebelacker, Brandon Gaudiano and Lauren Weinstock of Brown University also contributed to the work. The National Institute of Mental Health (grant: U01MH088278) funded the research.


News Article | May 1, 2017
Site: www.eurekalert.org

AURORA, Colo. (May 1, 2017) - In perhaps the largest national suicide intervention trial ever conducted, researchers at the University of Colorado Anschutz Medical Campus and Brown University found that phone calls to suicidal patients following discharge from Emergency Departments led to a 30 percent reduction in future suicide attempts. The study was published recently in JAMA Psychiatry. The year-long trial, which involved 1,376 patients in eight locations nationwide, provided suicidal patients with interventions that included specialized screening, safety planning guidance and follow-up telephone calls. "People who are suicidal are often disconnected and socially isolated," said study co-author Dr. Michael Allen, MD, professor of psychiatry and emergency medicine at the Helen and Arthur E. Johnson Depression Center at CU Anschutz. "So any positive contact with the world can make them feel better." Allen is also medical director of Rocky Mountain Crisis Partners in Denver which has already implemented a similar program where counselors call suicidal patients following their discharge from Emergency Departments (EDs). Suicide is the 10th leading cause of death in the U.S. In 2015, there were 44,193 deaths by suicide nationally. Over one million people attempt to take their own life every year. Colorado routinely ranks among the top 10 states for suicide with about 1,000 deaths a year. Last year, it was number seven in the country. The state Legislature has set a goal of reducing suicides by 20 percent by 2024. Allen said simply handing a suicidal patient a psychiatric referral when discharged isn't enough. "We call them up to seven times to check on them after discharge," he said. "If they aren't there we leave a message and call again. For many, this telephone call is all they get." The crisis center has worked with 17 of Colorado's 88 EDs and is hoping to increase that number and eventually go statewide. "We don't need more brick and mortar buildings, we can reduce suicide risk by simply calling people on the phone," Allen said. "Telephone follow-up programs offer a great way to help bridge an ED visit to outpatient mental health care and hopefully save lives," said Betz, an associate professor of emergency medicine at CU Anschutz who has conducted extensive research on suicide. "It would be great to see such programs become more widely implemented. Suicide is a leading cause of death, especially in Colorado, and a shortage of inpatient and outpatient mental health care options make innovative approaches like telephone counseling even more attractive." The study was led by Brown University and Butler Hospital psychologist Ivan Miller. Miller, a professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, said he was encouraged that they were able to impact suicide attempts among this population with a relatively limited intervention. While suicide prevention efforts such as hotlines are well known, published controlled trials of specific interventions are much rarer, Miller said. "We were happy that we were able to find these results," he said. This report was one of several from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study led by Miller, Professor Edwin Boudreaux of the University of Massachusetts and Dr. Carlos Camargo of Massachusetts General Hospital and Harvard University. Dr. Betz was the principal investigator for Colorado's ED-SAFE site. The trial took place in three phases to create three comparison groups. In the first phase, 497 patients received each ED's usual treatment as a control group. In phase two universal screening was implemented and 377 patients received additional attention in the ED. In the third phase, 502 patients received the experimental intervention. Those patients received the same Phase 2 care including additional suicide screening from ED physicians, suicide prevention information from nurses and a personal safety plan they could fill out to prepare for times when they might begin harboring suicidal thoughts again. Over the next year, they also received periodic phone calls from trained providers at Butler Hospital in Providence, R.I., who would discuss suicide risk factors, personal values and goals, safety and future planning, treatment engagement, and problem solving. The number of suicide attempts and the proportion of people attempting suicide declined significantly in the intervention group compared to treatment as usual. The middle group, which received only additional screening, did not show a significant drop compared to the treatment as usual group. "This is a remarkably low cost, low tech intervention that has achieved impressive results," Dr. Allen said.


News Article | April 17, 2017
Site: www.eurekalert.org

PROVIDENCE, R.I. [Brown University] -- The idea of sleep is supposed to evoke feelings of peace, relaxation and refreshment, but when expert Mary Carskadon talks about teen sleep in school districts with early start times, she uses far less comfortable words. "Social policy clashes with what we see from the biology," said Carskadon, a professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University. "For teens, when they have not gotten enough sleep and they have to get up too early, they are crushed in the morning." Over decades of study, Carskadon has shown that two systems that regulate sleep, circadian rhythms and sleep pressure, both change as children grow up. While they still need the same amount of sleep throughout childhood -- ideally 9 to 10 hours -- older kids naturally become inclined to go to sleep later (as their circadian rhythms skew later). That means they become biologically predisposed to sleep later, too, to fully relieve that sleep pressure - or biological need to sleep. Yet society frequently requires that they wake early. "They are incredibly sleepy from the sleep pressure, but also they have to be at school at a time when their circadian system wants them to be asleep," she said. Carskadon will share the insights from her research as one of many speakers at "Adolescent Sleep, Health, and School Start Times," a national conference in Washington, D.C., from April 27 to 28. Co-organized by Dr. Judy Owens, director of sleep medicine at Boston Children's Hospital and former professor at Brown University, the event will feature scientists, physicians and K-12 educators from across the country who will gather to discuss the health, educational and controversial policy implications of the issue. The issue is a hot button in several states, including Rhode Island where a newly proposed law would set a statewide high school start time of 8:30 a.m. Carskadon, meanwhile, has been invited to address the Rhode Island Association of School Committees in May even as she gears up for a new study this summer. Carskadon's work began in the 1970s when she was a graduate student at Stanford University. She surveyed teens about their sleep habits and preferences. Perhaps not surprisingly, the results showed that teens stayed up later and slept less than when they were younger. The prevailing assumption was that they needed less sleep. But when she experimentally put teens on a schedule that allowed them to sleep longer, they did. Teens didn't need less sleep than younger kids, she concluded. The fact that they also stopped waking on their own was apparent in the data, but was not Carskadon's focus at the time. "We kind of missed that clue until we started looking at it in different ways," she said. In a nationwide round of surveys in the early 1990s, she asked sixth graders when they felt best during the day and what their sleep preferences were. She also asked them to rate their maturity. She found an interesting trend. "The more mature they rated themselves, the more evening type they rated themselves," she said. "There was a hint that maybe something was going on around the time of pubertal development that has to do with the circadian system." In her Bradley Hospital sleep lab located on the campus of Butler Hospital in Rhode Island, Carskadon began to expand her research to incorporate biomarkers such as saliva levels of melatonin, a natural hormone driven by circadian rhythms that cues the onset of sleepiness. She found that given the same light/dark schedule, teens will produce melatonin at later times than younger kids, indicating their circadian rhythm grows fundamentally later as they age. One of her most seminal findings came in the late 1990s, when she studied 10th graders who had a high school start time of about 7:20 a.m. Wrist-worn sleep monitors showed they were getting about 7 hours of sleep a night. When she brought them into the lab, she'd wake them up for their regular school start time but then let them go back to sleep starting at 8:30 -- a time when in school they'd be expected to be well underway with taking exams or listening intently to lectures. "About half of them looked like they had a major sleep disorder -- narcolepsy," she said. "At 8:30, half of the kids fell asleep in under a minute and went directly into REM sleep which means that their brains were set up in a very strong way to be asleep. When you are trying to teach and learn, it's a non-starter." As her lab grew and she added expertise to the team, she also began to look at brain wave patterns of teens as they slept. That helped her observe the buildup of sleep pressure. Her lab's finding was that sleep pressure builds up more slowly in older kids. It's easier for them to stay awake longer. But what doesn't change is how quickly they relieve sleep pressure: they need just as much sleep. Her studies have continued all along. In 2014, she added more to the evidence of a later shift in sleep schedules with age, not by comparing groups of differently aged kids as before, but by comparing kids to themselves as they aged. Carskadon and colleagues published a study in PLOS ONE tracking the same children for more than two years. The data clearly showed that as they got older, they went to bed later. A recurring theme in Carskadon's studies is that later-to-bed and later-to-rise is not entirely a behavioral choice -- it's a physiological imperative. "The force behind the change that we see behaviorally is in the biology," she said. Even the newest threat to teen sleep -- the temptations of portable screens lit up with games and social media -- has direct and specific biological impact on sleep. In a 2015 study she found that the sleep biology of boys and girls aged 9 to 15 who were in the earlier stages of puberty was especially sensitive to light at night compared to older teens, meaning that late-night gadget use is particularly disruptive for young teens. For all the scientific evidence she has found, Carskadon acknowledges that policy is driven by many factors. Her studies have identified significant overall trends, but individuals vary widely, she said, and there are no doubt many households where teens are managing early school days just fine. Meanwhile, there are a lot of reasons why school districts start when they do, she said. For some families, for example, having older kids home from school before younger kids allows parents to be sure that younger kids have an older sibling to come home to. "The school system is central to community life," she acknowledged. But the biological evidence for letting teens sleep in longer is overwhelming, she said. So long as school starts at a time when they physiologically still need to be asleep, she said, teenagers on average may be consigned to suffer from a "social jetlag" in which the timing of life is not the timing of the body.


Tyrka A.R.,Butler Hospital | Price L.H.,Butler Hospital | Walters O.C.,Butler Hospital | Carpenter L.L.,Butler Hospital
PLoS ONE | Year: 2012

Background: A history of early adverse experiences is an important risk factor for adult psychopathology. Changes in stress sensitivity and functioning of the hypothalamic-pituitary-adrenal (HPA) axis may underlie the association between stress and risk for psychiatric disorders. Preclinical work in rodents has linked low levels of maternal care to increased methylation of the promoter region of the glucocorticoid receptor (GR) gene, as well as to exaggerated hormonal and behavioral responses to stress. Recent studies have begun to examine whether early-life stress leads to epigenetic modifications of the GR gene in humans. Methods: We examined the degree of methylation of a region of the promoter of the human GR gene (NR3C1) in leukocyte DNA from 99 healthy adults. Participants reported on their childhood experiences of parental behavior, parental death or desertion, and childhood maltreatment. On a separate day, participants completed the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test, a standardized neuroendocrine challenge test. Results: Disruption or lack of adequate nurturing, as measured by parental loss, childhood maltreatment, and parental care, was associated with increased NR3C1 promoter methylation (p<.05). In addition, NR3C1 promoter methylation was linked to attenuated cortisol responses to the Dex/CRH test (p<.05). Conclusions: These findings suggest that childhood maltreatment or adversity may lead to epigenetic modifications of the human GR gene. Alterations in methylation of this gene could underlie the associations between childhood adversity, alterations in stress reactivity, and risk for psychopathology. © 2012 Tyrka et al.


News Article | December 10, 2016
Site: www.prweb.com

Healthcare Real Estate Insights™ magazine has announced the Winners of the 2016 HREI Insights Awards™, the only national awards totally dedicated to recognizing excellence in the areas of healthcare real estate (HRE) development and executive leadership. The 2016 awards were presented today in nine different categories during the RealShare Healthcare Real Estate Conference in Scottsdale, Ariz. The awards were presented by Healthcare Real Estate Insights™, the first and only national magazine entirely devoted to covering healthcare real estate (HRE) development, financing and investment. HREI™ Publisher Murray Wolf noted, “The HREI Insights Awards™ have honored the best of the best in healthcare real estate since 2013.Yet we never fail to be astounded by the quality of the people and projects that are nominated. The projects that are submitted demonstrate the remarkable persistence and creativity of the development teams behind them. The development process is complicated and fraught with challenges. Yet, year after year, we receive dozens of entries demonstrating the amazing vision, creativity and hard work of the people in the healthcare real estate sector. The same goes for the individual awards. We are proud that this has become a very prestigious program with sought-after awards.” Sponsors of the 2016 HREI Insights Awards are: The 2016 Winners and Finalists will be featured in upcoming editions of Healthcare Real Estate Insights™ magazine, the 2017 HREI Resource Guide™ and on HREInsights.com. Best New Medical Office Building and Other Outpatient Facilities (Less than 25,000 square feet): Five Star ER, Pflugerville, Texas Developer: Lockard Lockard Emergency Service Partners had identified an optimal site in Pflugerville, an Austin, Texas, suburb, for its next freestanding emergency room under its Five Star ER brand. However, because the overall development plan had not been finalized, the lot needed for the project could not be sold individually. Lockard stepped in and worked directly with the land developer to finalize the development plan and expedite approval of other aspects of the agreement and process. In doing so, the company avoided costly delays. Construction on the 9,960 square foot facility got underway in March 2015 and was completed in October 2015. Best New Medical Office Building and Other Outpatient Facilities (25,000 to 49,999 square feet): Buck Creek Medical Plaza, Avon, Colo. Developer: NexCore Group LLC Colorado Mountain Medical needed to expand its service offerings in a new, centralized location with more parking. In a market with few buildable lots, NexCore found a 2.15-acre site in Avon that fit the bill. But there were challenges to overcome, and NexCore eventually acquired an adjacent lot and swapped parcels with the local fire district. Fast-tracking the project, NexCore opened the 48,300 square foot Buck Creek Medical Plaza in summer 2016. The company recruited Centennial, Colo.-based Centura Health as the emergency care anchor as well as a vibrant mix of providers to bring occupancy to 94 percent at the opening. Best New Medical Office Building and Other Outpatient Facilities (50,000 to 99,999 square feet): Penn Medicine Southern Chester County, West Grove, Penn. Developer: Anchor Health Properties Chester County Hospital wanted to grow its market share in the southernmost portion of its service area in Chester County and to position itself to deliver needed services well into the future. So the hospital sought to consolidate and expand services in a comprehensive new facility. Anchor Health Properties identified and then controlled a strategic, highly visible site and developed a 72,000 square foot “one-stop” healthcare destination. The MOB was fully occupied when it opened in summer 2015. Penn Medicine exceeded patient volume projections by 20 percent in Year 1 and increased outpatient registrations by 40 percent. Best New Medical Office Building and Other Outpatient Facilities (100,000 square feet or more): Hoag Health Center-Irvine-Sand Canyon, Irvine, Calif. Developer: PMB The Hoag Memorial system wanted to develop an outpatient facility adjacent to its Hoag Hospital Irvine to meet the healthcare needs of the rapidly growing area. The development team faced numerous challenges, including high voltage overhead power lines and underground issues, plus they wanted to link the MOB to the hospital with fiber-optic cable installed under a busy six-lane road. The team was able to deliver the 157,200 square foot facility below budget and on schedule. The facility was fully leased upon opening and is expected to achieve LEED Silver designation. Best Renovated or Repurposed Healthcare Facility: Clara Maass Medical Center MOBs, Belleville, N.J. Developer: Rendina Healthcare Real Estate Clara Maass Medical Center (CMMC) needed to significantly improve the condition of three MOBs on its campus and enhance the satisfaction of the tenant physicians. Rendina acquired the three buildings totaling 128,006 square feet and completely modernized and renovated all common areas. They also added new building systems, signage, wayfinding, artwork, furniture and handicap parking improvements. Since Rendina took ownership, occupancy has increased nearly 10 percent, many physician groups have shifted from short-term commitments to long-term leases, and overall satisfaction has increased 7 percent. Hospitals and Other Inpatient Facilities – Best New Ground-Up Development: TriHealth Bethesda Butler Hospital, Hamilton, Ohio Developer: Duke Realty TriHealth wanted to enter a Cincinnati sub-market and employ a physician practice that owned a six-building hospital campus. TriHealth needed to immediately add an ED and lab and in the future additional beds to accommodate its growing patient base. The development team orchestrated a four-phase expansion to minimize disruptions to the hospital’s daily operations. The expanded 90,788 square foot facility has enabled TriHealth to add more services, physicians and staff; treat more patients; and have room for future growth. It’s also helping it be more competitive in the Cincinnati market and serve as a convenient, full-service campus. Finalists Advocate Christ Medical Center, East Patient Tower, Oak Lawn, IL    Advocate Health Care Scripps Networks Tower at E. Tenn. Children’s Hospital, Knoxville, TN    Realty Trust Group Sibley Memorial Hospital New Patient Tower, Washington D.C.    Sibley Memorial Hospital Zuckerberg San Francisco General Hospital and Trauma Center, S.F.    San Francisco Health Network Post-Acute & Senior Living Facilities – Best New Ground-Up Development: Beach House Assisted Living and Memory Care, Naples, Fla. Developer: Prevarian Companies LP It has taken more than a decade for the site at 1000 Airport Pulling Road S. in Naples to finally be developed after years of delays caused by a long entitlement process and the recession. Making the project a reality was Prevarian, which started pursuing a development on the site just two years prior to opening the 113-unit Beach House Assisted Living and Memory Care community. The company had to make sure the design conformed to a previously approved footprint and site plan, and it received permits within four months of securing the land. Beach House is close to a shopping district and a community hospital. Healthcare Real Estate Executive of the Year: Jason Signor, Caddis Under Jason Signor’s leadership, Caddis has grown from seven employees to 47 and become an industry-leading, full-service developer, owner and property manager of MOBs, ASCs, hospitals and, under its Heartis brand, senior living communities. With offices in Dallas, Atlanta, Houston and Phoenix, the firm has developed and/or acquired more than 40 assets with a total value of more than $700 million spanning 2.7 million square feet of space and 1,500 beds. Caddis has deployed $150 million of equity and manages about 3 million square feet in seven states. During his time with Caddis, Mr. Signor also has spurred the creation of a proprietary, GIS mapping interface used for identifying market opportunities and allowing clients to make informed, evidence-based site selection decisions. Tim Oliver’s legacy includes being involved in the development and consulting engagements for more than 90 facilities totaling 5 million square feet in the past 40-plus years. Mr. Oliver has focused exclusively on medical real estate since 1974 and has cofounded several firms. Tim Oliver and John McWilliams were involved in the formation of Western Skies (WSI) in 1970, and led the company’s development of its first on-campus MOB in 1975. At the time, the concept of on-campus medical office buildings was in its infancy. WSI developed the second on-campus MOB in the Rocky Mountain region for Mercy Hospital. Over the next 16 years, WSI developed 1.5 million square feet of ambulatory facilities and managed over 1 million square feet of healthcare properties. In 1986, Tim was one of the original founders of Integrated Medical Campus, providing strategic planning/development services for over 50 medical projects. In 1987, IMC developed one of the nation’s first “medical mall” or “hospital without beds” projects that featured a freestanding emergency department, ambulatory surgery center, imaging, physical therapy and medical offices. In 2004, Mr. Oliver joined five other founders from The Neenan Company to form the Denver-based NexCore Group. To date, NexCore Group has developed and acquired 6.5 million square feet of real estate, executed leases totaling 3.5 million square feet, and now has 65 employees in seven offices across the United States. Today, Mr. Oliver is actively training the next generation of strategic-thinking development executives at NexCore Group. He has been a thought leader at NexCore, responsible for understanding the legislative and economic environment, best practices in the delivery of care, and population health management/wellness initiatives that affect the development of healthcare real estate. His strategic thinking continues to provide top-of-class service to NexCore’s national healthcare clients. Launched in 2003, HREI was the first and remains the only national magazine entirely dedicated to covering healthcare real estate development, financing and investment. This monthly, national, business-to-business magazine offers sophisticated players the most comprehensive coverage in the industry available anywhere. Introduced in 2008, the HREI Resource Guide was the first and is still the only annual directory of healthcare real estate services. And HREI’s companion website, HREInsights.com, has been totally redesigned and vastly expanded with more than 10 years of content, more than 2,000 articles and nearly 2 million words of copy, becoming the new hub for healthcare real estate news and information. For more information on HREI products and services, or to subscribe or advertise, please visit us at HREInsights.com.


Friedman J.H.,Butler Hospital | Friedman J.H.,Brown University
Expert Opinion on Pharmacotherapy | Year: 2013

Introduction: Parkinson's disease (PD) is a neurobehavioral disorder defined by its motor features. Its treatment is frequently complicated by the presence of psychotic symptoms, most prominently hallucinations and delusions. These cause major distress and are the primary cause for nursing home placement. Current treatment requires either a reduction in medications for mobility or the addition of atypical antipsychotics, none of which are approved in the United States, and which are associated with major potential drawbacks. Areas covered: Information from extensive personal experience, a Pubmed literature search plus a direct request to Acadia Pharmaceuticals was used for this review. A brief review of the clinical problem and its current state of treatment will be followed by a discussion of pimavanserin and its potential role in treating PD psychosis (PDP). Several observations have implicated serotonin in the physiology of psychotic symptoms. Lysergic acid diethylamide, phencyclidine, and similar drugs that activate 5HT2A serotonin receptors produce psychotic syndromes, and almost all antipsychotic neuroleptics share the property of blocking the 5HT2A receptor as well as the dopamine D2 receptor. The reduced motor side effects of the second-generation antipsychotics have been ascribed to these drugs having greater 5HT2A antagonism than the first generation. Studies in animal models of psychosis have suggested benefits from drugs blocking the 5HT2A receptor alone without the motor side effects seen with D2 receptor antagonism. Expert opinion: Pimavanserin, a 5HT2A inverse agonist, has no motor side effects, and a remarkable safety profile that is comparable to placebo. Its antipsychotic effects coupled with its lack of motor side effects could make it an ideal drug for treating psychotic symptoms in PD, a major unmet need. One Phase III trial in PDP has demonstrated excellent tolerability and significant benefit. The FDA agreed to the filing of a planned new drug approval (NDA) for an indication in the treatment of PDP. © 2013 Informa UK, Ltd.


Whisman M.A.,University of Colorado at Boulder | Uebelacker L.A.,Brown University | Uebelacker L.A.,Butler Hospital
Health Psychology | Year: 2012

Objective: Metabolic syndrome (MetS) is a constellation of features- central obesity, dyslipidemia, elevated blood pressure, and dysglycemia-that are associated with increased risk for cardiovascular disease, diabetes, stroke, and mortality. This longitudinal study was conducted to evaluate whether marital adjustment, which has been shown to predict a variety of health outcomes, increases risk for incidence of MetS. Methods: A population-based English sample of couples (N = 216 couples) completed a self-report measure of marital adjustment at baseline and nurse visits that included collection of blood pressure, blood samples, and anthropometric measures at baseline and 4-year follow-up. Multilevel modeling was used to evaluate the association between both partners' report of baseline marital adjustment and incidence of MetS, controlling for other baseline risk factors (demographics, current and previous smoking status, alcohol use, activity level, depressive symptoms, number of MetS criteria). Results: Gender moderated the association between marital adjustment and incidence of MetS. Follow-up analyses indicated that husbands' report of marital adjustment at baseline was significantly associated with incident MetS for wives at follow-up, controlling for baseline risk factors. Marital adjustment was not significantly associated with incident MetS for men. Conclusions: Findings suggest that MetS may be one mechanism by which poor marital adjustment increases risk for poor health outcomes in women. Improving marital adjustment may help prevent the incidence of MetS and improve health, particularly for women. © 2011 American Psychological Association.


Johnson J.E.,Brown University | Zlotnick C.,Brown University | Zlotnick C.,Butler Hospital
Journal of Psychiatric Research | Year: 2012

This study, the largest randomized controlled trial of treatment for major depressive disorder (MDD) in an incarcerated population to date, wave-randomized 38 incarcerated women (6 waves) with MDD who were attending prison substance use treatment to adjunctive group interpersonal psychotherapy (IPT) for MDD or to an attention-matched control condition. Intent-to-treat analyses found that IPT participants had significantly lower depressive symptoms at the end of 8 weeks of in-prison treatment than did control participants. Control participants improved later, after prison release. IPT's rapid effect on MDD within prison may reduce serious in-prison consequences of MDD. © 2012 Elsevier Ltd.

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