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  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 


    Follow these six tips to prevent and treat skin damage caused by winter dryness.


    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 


    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.


    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.


    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.


    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.


    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.


    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.


    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 


    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.


    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 


    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog: https://bit.ly/3KbVUA1.
    Click to Tweet

     

    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.


    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.

     

    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

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  • March 07, 2021

    By MedStar Team

    MedStar Health regularly updates, revises and creates new policies and procedures for the operational efficiency of the organization.

    Please be advised, the following policies and procedures are now in effect.

    Effort Commitment and Certification

    The Effort Commitment and Certification policy was updated to incorporate changes mandated in the Uniform Guidance to match MHRI Office of Contract & Grants processes in our current accounting system, and to provide a tool for collecting effort information for those staff employed by MedStar but external to MHRI.

    There are no substantial changes to our business practices. However, one change does close the loop on a known audit gap regarding the reconciliation of the committed effort and the actual effort expending on a federal award or any award that invokes the federal regulations regarding effort commitment.

    Government Inquiries

    These policies have been updated as part of the three year periodic review.

    Emergency Response Management

    It is recommended by MedStar Health ER One Institute that ERM policies are reviewed annually. During the annual review, we work with ER One and they inform us of any MedStar Health changes. In addition, we confirm all contact information (e.g., telephone numbers) are still accurate.

    Any questions regarding the new policy and procedure should be directed to MHRI-OCGM@medstar.net.

  • March 07, 2021

    By MedStar Team

    When conducting research, some populations of research participants require special considerations. The Code of Federal Regulations (CFR 45 part 46) Protection of Human Subjects includes Subparts B, C and D, that describe special protections and criteria for inclusion of pregnant women, prisoners and children. These protections are meant to safeguard of rights, welfare, and safety of these participants but does not mean they should automatically be excluded from research.

    • Pregnant women, human fetuses, and neonates (Subparts B): Because research may pose additional and/or unknown risks to pregnant women, human fetuses and neonates, the regulations require additional safeguards in research. It is important to include pregnant women in research, as their exclusion from research creates a wider gap in understanding and knowledge.

    • Prisoners (Subparts C): Because prisoners may not be free to make a truly voluntary and uncoerced decision regarding research participation, the regulations require additional safeguards for the protection of prisoners. For example: In order for an IRB to approve research involving prisoners the membership of the Board must include one or more prisoner representatives and that representative must be involved in the review of the research.

    • Children (Subparts D): The CFR defines children as “persons who have not attained the legal age for consent to treatments or procedures involved in the research, under the applicable law of the jurisdiction in which the research will be conducted.” It is important to include, where appropriate, children as part of a research study. Children of all ages present different disease manifestations than adults, have different pharmacokinetics/ pharmacodynamics than adults and have a different psychology/psychiatry as part of their developing brain.
    While the populations afforded special protections have traditionally been labeled “vulnerable” it should be noted that they are not specifically defined as such in Sub Parts B, C and D. The common rule does not define the term “vulnerable population”. The existence of additional protections should not specifically discourage inclusion of these populations in research. Rather, the protections are intended to guide the inclusion of these populations in such a way as to protect the rights and welfare of the individuals.

    Although the regulation does not define the term vulnerable they do provide examples of research subjects “that are likely to be vulnerable to coercion or undue influence.” This is different from the special populations traditionally referred to as “vulnerable populations” description of sub parts B, C, and D. While children and prisoners are included in the current list of examples, pregnant women are no longer included as of the 2018 Revised Common Rule. The types of study populations that are likely to be vulnerable to coercion or undue influence may including but are not necessarily limited to:

    • Children/minors
    • Prisoners
    • Employees
    • Military persons and students/trainees in hierarchical organizations
    • Terminally ill, comatose, physically and intellectually challenged individuals
    • Institutionalized, elderly individuals
    • Ethnic minorities
    • Refugees
    • Economically and educationally disadvantaged

    When some or all participants are likely to be vulnerable to coercion or undue influence the regulations mandated that the IRB ensure “…additional safeguards have been included in the study to protect the rights and welfare of subjects.”

    As previously noted, there has been an historical categorization of pregnant women and women of reproductive potential as a “vulnerable population.” While Sub Part B of the Common Rule describes special protections for pregnant women there is nothing about pregnancy, in and of itself, that renders a woman susceptible to coercion or undue influence. This categorization typically results in a tendency to exclude women, particularly pregnant women, from research. This exclusion may be intended to protect women from potential risk or may be done out of a misunderstanding of the special protection’s provision. Rather than serving to protect women from risk this broad exclusion of women from research has had a detrimental impact. Instead of shielding women and their fetuses from adverse effects, exclusion from clinical research in which they may be able to safely participate has served to limit understanding of pharmacokinetic and pharmacodynamic differences in women’s responses to treatment. Without scientific evidence this has drove the medical community to make potentially faulty assumptions about safety and efficacy of therapeutics when used with pregnant women.

    While it is important to protect human subjects in research from coercion, undue influence and unjustified risks, it is equally important to ensure equitable selection of research subjects. This includes (but is not limited to) the inclusion of pregnant women and women of reproductive potential in research. Broad exclusion of any population, absent regulatory restriction or legitimate safety concerns, can serve to create a knowledge gap around the appropriate treatment modalities, appropriate dosing and the potential need to modify treatment modalities for some populations.

    The table below includes the populations used as exemplars in the common rule for subjects that “…likely to be vulnerable to coercion or undue influence…” The table includes a notation for those included as examples in the pre-2018 Common Rule (Former Common Rule) and those now listed in the 2018 Revised Common Rule.

    If you have any questions or concerns, please contact MHRI’s Office of Research Integrity Director, Jim Boscoe, at James.H.Boscoe@medstar.net.

  • March 07, 2021

    By MedStar Team

    Diabetes researches from across MedStar Health sought to develop a strategy to enable hospital nursing unit staff to deliver diabetes survival skills education to adults with type 2 diabetes within their usual workflow using an adaptation of the Diabetes to Go (D2Go) program to fill the gap in education delivery on inpatient units.

    Diabetes survival skills education (DSSE) focuses on core knowledge and skills necessary for safe, effective, short-term diabetes self-care. Inpatient diabetes survival skills education delivery approaches are needed. “Diabetes to Go-Inpatient: Pragmatic Lessons Learned from Implementation of Technology-Enabled Diabetes Survival Skills Education Within Nursing Unit Workflow in an Urban, Tertiary Care Hospital” was published in The Joint Commission Journal on Quality and Patient Safety. Diabetes to Go is an evidence-based diabetes survival skills education program originally designed for outpatients.

    The Practical, Robust Implementation and Sustainability Model (PRISM) was used to help redesign D2Go for delivery and evaluate the feasibility of integrating a high-tech tablet computer-enabled DSSE program for hospital inpatients. The study team conducted interviews and focus groups with stakeholders to identify perceived barriers and facilitators for implementation; redesigned the D2Go program via stakeholder feedback and education and human factors principles; developed implementation design for tablet delivery and patient engagement by unit staff; and completed a prospective cohort implementation feasibility study on three medical/surgical units.

    The results identified 596 adults with type 2 diabetes on three medical/surgical units, 415 (69.6%) were program eligible. Of those eligible, 59 (14.2%) received, accessed, and engaged with the platform; and among those, 43 (72.9%) completed the intervention, representing just 10.4% of those eligible. Multilevel implementation barriers were encountered: staff (receptivity, time, production pressures, culture); process (electronic health record [EHR] integration, patient identification, data tracking, bedside delivery); and patient (receptivity, acuity, availability, accessibility).

    In conclusion, strategies are needed to enable effective delivery of diabetes survival skills education to inpatients with type 2 diabetes. System and staffing barriers coupled with patient and technology barriers limited successful implementation of the delivery of diabetes education at the bedside. As a result, adoption of a tablet-based diabetes survival skills e-learning program in a high-acuity care setting was limited.

    The Joint Commission Journal on Quality and Patient Safety, 2021. DOI: 10.1016/j.jcjq.2020.10.007

  • March 07, 2021

    By MedStar Team

    Every February at MedStar Health Research Institute, we celebrate “Heart Healthy” and take the time to “Go Red!” for heart health. Associates were invited to wear red in support of the American Heart Association’s (AHA) fight against heart disease in February. Throughout the month, associates submitted photos with their teams to show their commitment to heart health. 

    As we have for the last nine years, we accepted submissions for a photo challenge! Associates showed off in their red outfits and team spirit to show their commitment to heart health. View all the photo submissions from Research Institute teams below. 

    Thank you to all who showed their support for this important cause!

     

     

  • March 07, 2021

    By MedStar Team

    Researchers from MedStar Health evaluated emergency department care coordination processes and their perceived effectiveness across Maryland’s hospital system, which were seeking to reduce hospital admissions due to financial considerations led by Maryland-state governance. “Emergency Department Care Coordination Strategies and Perceived Impact Under Maryland’s Hospital Payment Reforms” was published in the American Journal of Emergency Medicine. The goals of the study were to characterize the scope and variation of emergency department care coordination strategies in response to Maryland reforms and describe how physician leaders and care coordination staff perceive the effectiveness of specific strategies.

    In 2014, Maryland expanded its all-payer hospital rate-setting model into a population-based global budget revenue model, which replaced fee-for-service hospital payments and introduced quality pay-for performance incentives for acute-care hospitals. The model has incentivized a shift towards non-hospital care and reduced hospital admissions. The research team conducted a total of 25 semi-structured interviews across 18 different hospital emergency departments with emergency department physician leadership (n = 14) and care coordination staff (n = 11) to examine emergency department care coordination processes and understand the focus of care coordination efforts. The interviews assessed the perceived efficacy of care coordination and identified barriers to success, as well as the influence of Maryland’s payment reform model on emergency department care coordination strategies.

    The results showed that across all emergency departments, there was significant variation in the hours and types of care coordination staff coverage and the number of initiatives implemented to improve care coordination. Most participants perceived Maryland’s reform with global budgeting as having a mixed impact on emergency department care coordination and overall emergency department care. Participants perceived emergency department care coordination as effective in facilitating safer discharges, improving outpatient follow-up and addressing social determinants of health; however, adequate access to outpatient providers was a significant barrier. Emergency department physician leaders identified improved care transitions and patient care but experienced increased workloads to avoid admissions and support safe transitions among their discharged patients.

    Although the observed care coordination initiatives were perceived to produce positive results, Maryland's global budgeting policies were also perceived to produce barriers to improving emergency department care. Further research is needed to determine the association of the different strategies to improve emergency department care coordination with patient outcomes to inform practice leaders and policymakers on the efficacy of the various approaches.  This research was led by Dr. Jessica Galarraga, a MedStar Health economics investigator and emergency medicine physician.

    American Journal of Emergency Medicine, 2021. DOI: 1016/j.ajem.2020.12.048

  • March 05, 2021

    By Harjit K. Chahal, MD

    Every year on March 30, we recognize the impact that physicians and caregivers have on our lives and our loved one’s lives. And while the day is called “Doctor’s Day”, it’s also an opportunity to express gratitude for all healthcare workers, not just those in white coats. From physician assistants and nurses to administrative staff and environmental service workers, our hospitals are filled with dedicated men and women who have sacrificed so much to improve the lives of others, especially over the past year.

    This #DoctorsDay, consider how expressing thanks to a healthcare worker could positively impact them and you. On the #LiveWellHealthy blog, Dr. Chahal shares 3 benefits of living with an attitude of #Gratitude: https://bit.ly/3kQsZoR.

    Click to Tweet


    The trauma and stress that resulted from the COVID-19 pandemic has undoubtedly taken a toll on our healthcare workers who have remained on the frontlines. Yet, I am proud to have witnessed the resilience of my colleagues as they’ve struggled through feelings of inadequacy as we learned how to care for patients suffering from COVID-19—a new disease that we knew little about.

    That’s why this year, more than ever, I’ve resolved to live with an “attitude of gratitude”, acknowledging and appreciating all that I’ve received, both material and intangible. I’ve learned there are many benefits of showing gratitude to healthcare workers and everyone around me. These benefits positively impact the recipient, and they also benefit me. Here’s how.

    Benefits of showing gratitude.

    1. Giving thanks can make you live a happier and longer life.

    Gratitude is derived from a Latin word meaning grace, favor, goodwill, kindness, and thanks. These words remind me of Thanksgiving, a season where we’re encouraged to be mindful and appreciative of the blessings in our lives. During Thanksgiving, don’t many of us feel closer to our family and loved ones? In turn, we feel more loved and happy. What if we lived that way all year long?

    Research shows that gratitude is strongly associated with greater happiness because it helps us to form better emotions and cope with problems and stressors more effectively. The University of California conducted a study asking one group of participants to write down what they are thankful for and another group to journal things that irritate them. At the end of the ten-week study, those who expressed gratitude felt more hope and a general sense of wellbeing about their lives. And, they also had fewer visits to the doctor than those who wrote negative comments in the journal.

    In another study, participants were asked to write and personally deliver a letter of gratitude to someone they were thankful for. Participants who did that had very high happiness scores and a general sense of well-being for a long time compared to those who did not.

    This Doctor’s Day, consider writing a letter to a healthcare worker to let them know how they’re making a difference. It will certainly make their day, and it will make you feel good, too.

    2. An attitude of gratitude leads to improved relationships.

    When we express gratitude, we acknowledge what we have—both things we can hold and things we cannot, like relationships. In the process, we recognize that much of the good and happiness in our lives comes from the people around us. As a result, we feel even more gratitude and these feelings strengthen our community and improve our relational bonds.

    In another study, researchers discovered that couples who expressed gratitude to their partner had better relationships, felt more positive feelings towards each other, and were more comfortable working through problems in their relationship.

    That’s why as healthcare workers, it’s also important for us to express gratitude to our hospital leaders, colleagues, and employees that we work with daily. Doing so helps us to foster better camaraderie and strengthens our ability to work together through adverse situations.

    3. Saying “thank you” to healthcare workers helps reduce burnout.

    Many healthcare workers experience feelings of burnout, depression, and anxiety regularly. The nature of our job is to care for people in their most vulnerable state, and this is incredibly difficult when the outcome isn’t good. Many of us entered the healthcare profession wanting to change lives for the better, and when we don’t see that outcome, it’s hard to stay positive.

    However, a simple expression of gratitude can cause our spirits to soar. When someone recognizes our efforts and lets us know how they’ve positively impacted their life, we feel as though we’ve done meaningful work. In turn, healthcare workers who feel appreciated are more motivated to continue delivering the best care possible. In fact, research shows that in work environments, managers who said “thank you” to their employees found that they worked harder and better as a team.

    Expressing gratitude to healthcare workers doesn’t have to cost anything. Some of the most meaningful expressions of appreciation that I’ve received are notes or pictures from my patients sharing what they’ve been able to do after receiving my care.

    How will you express gratitude to a healthcare worker this month?

    Gratitude can be expressed in many ways. Living with an attitude of gratitude means being thankful for what you have now or even things from the past, such as memories. Being thankful helps you to maintain a hopeful and optimistic attitude, and it snowballs into positive feelings for others when you express your appreciation to someone else.

    This Doctor’s Day, I encourage you to consider how you can express your gratitude for all of our healthcare heroes, regardless of the uniform they wear to work. It will make their day and it just might change your life, too.


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