Providence, RI, United States
Providence, RI, United States

The Miriam Hospital is a private, not-for-profit hospital at 164 Summit Avenue in Providence, in the U.S. state of Rhode Island. It is a major teaching affiliate of the Warren Alpert Medical School of Brown University. Wikipedia.

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News Article | February 15, 2017

The American Society of Nuclear Cardiology (ASNC) has named Raymond Russell III, MD, PhD, FASNC, FACC, as its 2017 President. Dr. Russell is an associate professor of medicine at the Warren Alpert Medical School of Brown University in Providence, R.I. He is program director of the cardiology fellowship at Brown as well as the director of both Nuclear Cardiology and Cardio-Oncology for the Cardiovascular Institute of Lifespan, which includes Rhode Island Hospital, The Miriam Hospital and Newport Hospital. “There are a number of exciting opportunities and challenges facing nuclear cardiologists today, revolving around the transition to value-based care, changing reimbursement models and using appropriate use criteria-based clinical decision support tools to ensure that patients receive the right tests and the lowest possible radiation dosages,” said Russell. “ASNC has identified several strategic areas to focus on over the next few years, including preparing our members and our referring colleagues to deliver optimal care as our healthcare system changes.” A member of ASNC since 2000 and a Fellow since 2006, Russell has participated in a number of ASNC programs and committees, including the Leadership Development Program. He has served on the faculty of numerous ASNC Scientific Sessions and is active in the Certification Board of Nuclear Cardiology and its parent organization, the Alliance for Physician Certification and Advancement. Russell received an MD and PhD from the University of Texas Medical School at Houston. He completed his residency and cardiology fellowship training at Yale School of Medicine. Nuclear cardiology studies play a critical role in the noninvasive diagnosis of coronary artery disease, the assessment of the pumping function of the heart and in the prediction of outcomes in patients with heart disease. The American Society of Nuclear Cardiology has been committed, since its inception, to support purposeful imaging through its expertise in education, health policy and quality initiatives. ASNC is the recognized leader in quality, education, advocacy and standards in cardiovascular imaging, with more than 4,000 members worldwide. ASNC is the only society dedicated solely to advocacy issues that impact the field of nuclear cardiology and is working with success to influence regulations to fight onerous private health plan policies – adverting reimbursement declines and fighting for improved payment and coverage. ASNC is dedicated to continuous quality improvement, education and patient-centered imaging, illustrating the ongoing commitment as a leader in the field of nuclear imaging and improving patient outcomes. ASNC establishes standards for excellence in cardiovascular imaging through the development of clinical guidelines, professional education, advocacy and research development. ASNC’s members are comprised of cardiologists, radiologists, physicians, scientists, technologists, imaging specialists and other professionals committed to the science and practice of nuclear cardiology. For more information, visit

Agency: Department of Health and Human Services | Branch: | Program: STTR | Phase: Phase I | Award Amount: 225.47K | Year: 2012

DESCRIPTION (provided by applicant): Overweight and obesity are major health problems, affecting over two-thirds of US adults. Standard behavioral treatments (SBT), which are the gold standard for mild and moderate obesity, have been adapted forInternet delivery to facilitate dissemination, reduce cost, and overcome barriers to treatment. However, the weight losses obtained via Internet-delivered treatment are about half the size of those obtained via in-person treatment, likely because of the lack of (1) hands-on training in behavioral weight control strategies, and (2) support and guidance from group leaders and peers, both of which are hallmarks of traditional in-person SBT. The goal of this application is to improve Internet-delivered behavioral obesity treatments by developing a virtual reality (VR) system that can be integrated into existing Internet weight control programs, such as those developed by our research team. The VR system will provide the experience of learning and implementing behavioral weight control strategies in controlled virtual settings with the support of a virtual coach that demonstrates skills and provides encouragement. The ability to see skills being used appropriately, practice skills repeatedly, and receive reinforcement, will improve the learning process that takes place. The VR system will: (a) increase awareness of barriers to weight control behaviors, (b) teach skills to cope with these barriers, (c) build confidence using these skills, and (d) increase commitment to using these skills in real-world situations. The design of the VR System is based on Social Cognitive Theory, which states that health behaviors are learned by observing and imitating peers and role models, and by receiving social reinforcement. The VR system we propose to develop will consist of two parts: (a) the VR software engine that is the core, or architecture, of the program, which makes it possible to create interactive VR environments for delivery via the Internet, increases scalability,and improves cost effectiveness of future content development, and (b) the behavioral intervention content, which is delivered via the software engine, and consists of a series of interactive vignettes (i.e., modules) that will teach and reinforce behavioral weight control strategies. The VR system will be designed for integration with existing Internet-delivered behavioral weight loss programs. Typically these programs provide users with a weekly weight loss lessons on topics such as eating in social situations and building environmental cues for physical activity. The VR vignettes will be designed to complement these topics. The vignettes will be set in fully rendered computer generated environments with virtual actors, and will allow the user to fullyexperience learning and implementing behavioral weight control strategies. A virtual coach will lead the user through each vignette, teach the user behavioral weight control strategies, and help the user cope with any consequences of using behavioral weight control strategies. In Phase I of this project, we will develop the VR software engine and one vignette focused on social eating situations that will be used to conduct initial feasibility and efficacy testing. In Phase II, we plan to develop additionalvignettes and test the complete VR system in a RCT of Internet-delivered obesity treatment. (End of Abstract)

Rabin C.,The Miriam Hospital
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2011

Approximately one-third of adults in the United States are physically inactive. This is a significant public health concern as physical activity (PA) can influence the risk of cardiovascular disease, diabetes, and certain forms of cancer. To minimize these health risks, effective PA interventions must be developed and disseminated to the vast number of individuals who remain sedentary. Smartphone technology presents an exciting opportunity for delivering PA interventions remotely. Although a number of PA applications are currently available for smartphones, these "apps" are not based on established theories of health behavior change and most do not include evidence-based features (e.g., reinforcement and goal setting). Our aim was to collect formative data to develop a smartphone PA app that is empirically and theoretically-based and incorporates user preferences. We recruited 15 sedentary adults to test three currently available PA smartphone apps and provide qualitative and quantitative feedback. Findings indicate that users have a number of specific preferences with regard to PA app features, including that apps provide automatic tracking of PA (e.g., steps taken and calories burned), track progress toward PA goals, and integrate a music feature. Participants also preferred that PA apps be flexible enough to be used with several types of PA, and have well-documented features and user-friendly interfaces (e.g., a one-click main page). When queried by the researcher, most participants endorsed including goal-setting and problem-solving features. These findings provide a blue print for developing a smartphone PA app that incorporates evidence-based components and user preferences.

Rabin C.,The Miriam Hospital
Journal of Behavioral Medicine | Year: 2011

It is imperative that young adult cancer survivors address any modifiable risk factors, given their increased health risks. Unfortunately, few behavioral interventions have been developed for this population. The literature on physical activity, smoking, and alcohol and drug use among young adult cancer survivors was reviewed in order to identify the behaviors most in need of intervention, the most vulnerable subsets of the population, and the health behavior theories that might guide intervention development. This literature indicates that young adult cancer survivors are not meeting physical activity recommendations though smoking and risky drinking appear less pervasive than in the general population. Several demographic and medical characteristics are associated with health behaviors, indicating subsets of the population particularly in need of intervention. The literature also indicates that a few different theories and models (e.g., social cognitive theory, self-determination theory) might be useful in guiding the development of interventions for this population. © 2010 Springer Science+Business Media, LLC.

Thomas J.G.,The Miriam Hospital | Bond D.S.,The Miriam Hospital
Current Diabetes Reports | Year: 2014

Advances in technology have contributed to the obesity epidemic and worsened health by reducing opportunities for physical activity and by the proliferation of inexpensive calorie-dense foods. However, much of the same technology can be used to counter these troublesome trends by fostering the development and maintenance of healthy eating and physical activity habits. In contrast to intensive face-to-face treatments, technology-based interventions also have the potential to reach large numbers of individuals at low cost. The purpose of this review is to discuss studies in which digital technology has been used for behavioral weight control, report on advances in consumer technology that are widely adopted but insufficiently tested, and explore potential future directions for both. Web-based, mobile (eg, smartphone), virtual reality, and gaming technologies are the focus of discussion. The best evidence exists to support the use of digital technology for self-monitoring of weight-related behaviors and outcomes. However, studies are underway that will provide additional, important information regarding how best to apply digital technology for behavioral weight control. © 2014 Springer Science+Business Media.

Aims/hypothesis: Both obesity and genetics contribute to cardiovascular disease (CVD). We examined whether a genetic risk score (GRS) prospectively predicted cardiovascular morbidity and mortality among overweight/obese individuals with type 2 diabetes and whether behavioural weight loss could diminish this association. Methods: Look AHEAD (Action for Health in Diabetes) is a randomised controlled trial to determine the effects of intensive lifestyle intervention (ILI), including weight loss and physical activity, relative to diabetes support and education, on cardiovascular outcomes among overweight/obese individuals with type 2 diabetes. Of the participants, 4,016 provided consent for genetic analyses and had DNA samples passing quality control procedures. These secondary data analyses focused on whether a GRS derived from 153 single nucleotide polymorphisms (SNPs) associated with coronary artery disease in the most recent genome-wide association study predicted cardiovascular morbidity and mortality over a median of 9.6 years of follow-up, and whether ILI would diminish this association. Results: The GRS significantly predicted the primary composite endpoint of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalisation for angina in the full sample (HR, 95% CI per 1 SD increase in GRS: 1.19 [1.10, 1.28]) and among individuals with no known history of CVD at baseline (HR 1.18 [95% CI 1.07, 1.30]). In no case did ILI significantly alter this association. Conclusions/interpretation: A GRS comprised of SNPs significantly predicts cardiovascular morbidity and mortality over 9.6 years of follow-up in Look AHEAD. Lifestyle intervention did not alter the genetic association. Clinical Trial Registration: NCT00017953; NCT01270763 © 2015, Springer-Verlag Berlin Heidelberg.

Miner M.M.,The Miriam Hospital
Postgraduate medicine | Year: 2011

Testosterone deficiency (TD) is prevalent among men seeking medical attention and may be associated with other comorbidities. The Testim(®) Registry in the United States (TRiUS), a large, multicenter, prospective, 12-month observational cohort registry, was established to quantify symptoms and comorbidities of hypogonadal men in real-world clinical settings and to evaluate the effect of testosterone replacement therapy (TRT). Eligible TRiUS participants were hypogonadal men prescribed Testim(®) (1% testosterone gel) for the first time. Evaluated baseline parameters included: total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), prostate-specific antigen (PSA), anthropometrics (height, weight, waist, hip, and body mass index [BMI]), lipids, blood glucose, sexual dysfunction, mood/depression, and cardiovascular and metabolic risk factors. Parameters were correlated to TT and age using bivariate correlation and to the combination of TT and age using multiple linear regression. TRiUS had 849 registrants (baseline TT: 286.5 ± 151.8 ng/dL; FT: 40.8 ± 62.1 pg/mL; SHBG: 28.2 ± 15.0 nmol/L; PSA: 1.12 ± 1.11 ng/mL). Eighty-six percent were overweight/obese, with a BMI ≥ 25 kg/m(2), and 57% were aged 40 to 59 years, with a mean (± standard deviation) age of 52.1 ± 12.3 years. Total testosterone levels were significantly lower in men aged ≥ 65 years. The most common comorbid conditions and cardiovascular risk factors included: smoking, metabolic syndrome, hypertension, dyslipidemia, and coronary artery disease. Weak but statistically significant inverse correlations were noted between TT and sexual dysfunction, fasting glucose, systolic blood pressure, BMI, and Framingham risk scores. Patients with obesity or metabolic syndrome had significantly lower TT levels, particularly among younger and middle-aged patients. Untreated hypogonadal middle-aged men exhibited a high prevalence of cardiometabolic risk factors that were correlated to TT levels. This suggests that TD is associated with adverse medical conditions that pose serious health risks, especially in a younger age demographic than previously thought. Clinicians may want to consider TT testing in unhealthy, middle-aged patients with symptoms of TD.

Wing R.R.,The Miriam Hospital
Obstetrics and Gynecology | Year: 2010

Objective: To examine the relationship between magnitude of weight loss and changes in urinary incontinence frequency. Methods: Overweight and obese women (N=338) with 10 or more urinary incontinence episodes per week were assigned randomly to an intensive 6-month behavioral weight loss program followed immediately by a 12-month weight maintenance program (intervention; n=226) or to a structured education program (control; n=112). The intervention and control groups were combined to examine the effects of the magnitude of weight loss on changes in urinary incontinence assessed by 7-day voiding diary, pad test, and self-reported satisfaction with change in urinary incontinence. Results: Compared with participants who gained weight (reference), those who lost 5% to less than 10% or 10% or more of their body weight had significantly greater percent reductions in urinary incontinence episodes and were more likely to achieve at least a 70% reduction in the frequency of total and urge urinary incontinence episodes at 6, 12, and 18 months. Satisfaction was also related to magnitude of weight loss; approximately 75% of women who lost 5% to less than 10% of their body weight reported being moderately or very satisfied with their changes in urine leakage. Conclusion: Weight losses between 5% and 10% of body weight were sufficient for significant urinary incontinence benefits. Thus, weight loss should be considered as initial treatment for incontinence in overweight and obese women. © 2010 by The American College of Obstetricians and Gynecologists.

Miner M.M.,The Miriam Hospital
Urologic Clinics of North America | Year: 2012

An office evaluation of men's health in primary care requires a thorough understanding of the implications of male sexual dysfunctions, hypogonadism, and cardiometabolic risk stratification and aggressive risk management. The paradigm of the men's health office visit in primary care is the recognition and assessment of male sexual dysfunction, specifically erectile dysfunction, and its value as a signal of overall cardiometabolic health, including the emerging evidence linking low testosterone and the metabolic syndrome. Indeed, erectile dysfunction may now be thought of as a harbinger of cardiovascular clinical events and other systemic vascular diseases in some men. © 2012 Elsevier Inc.

Miner M.M.,The Miriam Hospital
Journal of Andrology | Year: 2011

Erectile dysfunction (ED) is a marker of increased cardiovascular (CVS) risk and may indicate the need for aggressive evaluation for cardiovascular disease (CVD). In younger men with ED, the Framingham risk assessment has inadequate sensitivity. There is a need to develop a more sensitive risk-stratification protocol for this population. We sought to develop an algorithm for the evaluation and management of the ED patient. A search of literature published from 1998 to 2009 was performed. Search terms included the following: endothelial dysfunction; and erectile dysfunction combined with coronary artery disease (CAD), metabolic syndrome, or cardiac biomarkers. Searches revealed 107 references. These studies were evaluated with use of levels of evidence for the Centers of Evidence-Based Medicine. On the basis of these studies, recommendations for the evaluation and management of the patient with ED were developed. Newer, nontraditional markers and procedures may identify ED patients at risk for subsequent CVS events earlier or more easily than traditional risk assessments. Clear practice guidelines for risk stratification are being developed, and data are sufficient to propose an algorithm for these patients. The presence of ED should prompt assessment of cardiac risk and aggressive risk factor treatment. Available risk assessment factors should initially be used to stratify each patient. ED patients younger than 60 years of age and with no clinical CVD are at risk of CAD events (10%) and should undergo further risk assessment. Additional tests of arterial damage and biomarkers may aid in refinement of risk for future cardiac events. Patients with ED can be classified into low-, intermediate-, and highrisk categories. A proposed algorithm can be used to direct the assessment of cardiometabolic risk in patients with ED.

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