MedStar Health Blog

Congratulations to all MedStar researchers who had articles published in April 2021. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research

View the full list of publications on PubMed.gov here.

Selected research:

1. The Impact of Smoking on Early Postoperative Complications in Hand Surgery
   Journal of Hand Surgery, 2021.DOI: 10.1016/j.jhsa.2020.07.014
   Cho BH, Aziz KT, Giladi AM. 

    

2. Comparison of Characteristics and Outcomes of Patients With Acute Myocardial Infarction With Versus Without Coronarvirus-19
   The American Journal of Cardiology, 2021. DOI: 10.1016/j.amjcard.2020.12.059
   Case BC, Yerasi C, Forrestal BJ, Shea C, Rappaport H, Medranda GA, Zhang C, Satler LF, Ben-Dor I, Hashim H, Rogers T, Waksman R.

3. Providing Care for Caregivers During COVID-19
   American Journal of Nursing, 2021. DOI: 10.1097/01.NAJ.0000749752.80198.c0
   Morales C, Brown MM.

4. Does Scalp Cooling Have the Same Efficacy in Black Patients Receiving Chemotherapy for Breast Cancer?
   The Oncologist, 2021. DOI: 10.1002/onco.13690
   Dilawari A, Gallagher C, Alintah P, Chitalia A, Tiwari S, Paxman R, Adams-Campbell L, Dash C.

    

5. Representation Matters: An Assessment of Diversity in Current Major Textbooks on Burn Care.
   Journal of Burn Care and Research, 2021. DOI: 10.1093/jbcr/irab066 
   Shivega WG, McLawhorn MM, Tejiram S, Travis TE, Shupp JW, Johnson LS.

What is HIPAA?

The Health Insurance Portability and Accountability Act (“HIPAA”) governs how healthcare data is shared, both in terms of research and in medical care.  It has several components, which govern specific situations.

• Security Rule (45 CFR Part 164): Safeguards to ensure confidentiality, integrity, availability of electronic PHI
• HITECH: Debuted “Breach Notification Rule,” increased penalties for non-compliance
• HHS Omnibus Rule: Extended regulations directly to business associates, required subcontractor compliance
• Breach Notification Rule: Sets rules for notification to HHS and to individuals in the event of breach

Who does HIPAA apply to?

Health Plans (i.e., insurers), Clearinghouses (“billing services”), and Health Care Providers, including hospitals are considered covered entities for HIPAA. This means that they are required to follow the rules and regulations of HIPAA.

In addition, HIPAA can apply to business associates. Business associates are considered persons that create, receive, maintain, or transmit protected health information on behalf of a covered entity or another business associate. The role of business associates is to support the ability of a covered entity to execute on its ability to provided healthcare, and their access to health information is limited to what is necessary to support that work. This work can include payments/healthcare operations activities, claims processing, utilization review, quality assurance, and data analysis/aggregation. HIPAA does not consider research to be a business associate function.

HIPAA Privacy Rule

Protected Health Information is defined as “individually identifiable health information held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral communication”. This data can be in the context of an individual’s past, present, or future physical or mental health condition; or provision of health care to the individual; or past, present or future payment for providing health care to the individual. It contains enough detail that there is a reasonable basis to believe that the information can be used to identify the individual.

Under HIPAA, a covered entity may not use of disclose protected heath information, except as the privacy rule permits or requires, or the individual whose protected health information it is provides written authorization.

There are specific instances where disclosure is permitted without authorization, but those are limited to:

• To the individual
• Treatment, Payment, Healthcare Operation
• Public Interest and Benefit Activities (which includes research with waiver)
• Limited Data Set (with a Data Use Agreement)

Use and Disclosure of Protected Health Information for Research

With authorization (i.e., HIPAA Authorization embedded into or separate from the Informed Consent Form), protected heath information can be used for research purposes.

If the research team does not seek authorization from individuals, protected heath information can be accessed through the following processes:

• Documented IRB/Privacy Board Approval of an alteration or waiver of the requirement to obtain an individual’s authorization.
• Representations from researcher that use or disclosure of PHI is solely for a purpose preparatory to research (i.e., preparing a protocol)
• PHI of Decedents
• Limited Data Set

De-identified data is not considered protected heath information and not regulated by the Privacy Rule.

Questions?

If you have questions specific to your research, please contact our Office of Research Integrity at MHRI-ORIHelpDesk@medstar.net. If you have questions regarding data use agreements, business associates, or other contract vehicles for research, contact our Office of Contracts and Grants Management at MRI-OCGM@medstar.net.

While many MedStar Washington Hospital Center associates can trace their careers back to the beginning at our hospital, not many started here as a student like Robert Molyneaux. It was 1981 when Robert came for a rotation with MedSTAR Trauma as a physician assistant (PA) student. His learning experience taught him not only the skills to become a PA, but also that this was a place he would want to return to during his career. After a stop at Capitol Hill Hospital (a part of Medlantic Healthcare Group, a pre-cursor to MedStar Health) as a surgical and hospitalist PA, and Prince George’s Hospital Center’s Critical Care unit as a critical care PA, Robert came back to MedStar Washington in 1995.

Here, Robert has worked in Surgical Critical Care and the Cardiovascular Recovery Room, advancing to become chief PA for Surgical Critical Care in 1999. He worked on initiatives that brought professional growth to our advanced practice providers (APPs) and helped reduce the hospital’s central line-associated bloodstream infection (CLABSI) rate. He also helped establish the Procedure Service in 2012 and write the job description for the position he would take on next.

Because of these initiatives, Robert became the clinical director of the Procedure Service, a job that fit in perfectly with his lifestyle as a father of teenagers. His job gave him the flexibility to get his children off to school before coming in to work. In this role, Robert was also part of a team that drastically reduced CLABSI by 85%.

One key to Robert’s success has been learning from other leaders. One leader who became a mentor, Arthur St. Andre, MD, taught Robert lessons on how to take what he calls “well-intentioned” risks, make mistakes, and grow from those lessons. He says he continues to get similar support from the director of Critical Care, Alexandra Pratt, MD.

“The Hospital Center provides a lot of training for leaders,” said Robert. “This is an innovative staff and we implemented management and leadership techniques that allow leaders to grow because of what is offered here.”

Robert said he has enjoyed his career at MedStar Washington, is humbled and appreciative of his colleagues who helped reduce CLABSI, and will always appreciate the hospital where his wife was born and where his career thrived.

Compassion is a requirement for every medical specialty, but some specialties require doctors to have an exceptional ability to listen to patients’ most hard-to-talk-about problems. Candid conversations about issues surrounding urination and sexual matters can be difficult for many patients.

These sensitive, highly personal conversations are what led Rachael Sussman, MD, to choose urology for her medical specialty. She is the first female urologist at MedStar Washington Hospital Center Urology, and one of only 10 percent nationwide.

For men and women, urology deals with diseases of the urinary tract, from the kidneys that clean the blood and extract the urine, to ureters that carry urine to the bladder for storage, and on to the urethra that carries urine out of the body. For men, urology also deals with the male reproductive organs, including the penis, testicles and prostate gland.

Problems with urination and leakage of urine are common and can greatly impact a person’s quality of life. Honest, open conversations can lead to solutions that dramatically improve a person’s life. “Urology gives me a good opportunity to make people happy,” Dr. Sussman explains. “I like to focus on these quality-of-life issues where I can help people.”

Some of the more common conditions she treats are urinary leakage, frequent urination or an urgent need to urinate—changes that many men and women experience as they get older. For women, these conditions can be a result of childbearing. For men, these conditions can result from an enlarged prostate, which also may be due to aging.

After training as a urologist, Dr. Sussman completed a fellowship in female pelvic medicine, also called urogynecology, a specialty that treats women with urinary problems that result from uterine prolapse and other conditions associated with aging and childbearing. Highly specialized surgeries can offer relief by lifting sagging structures and restoring vaginal anatomy.

Whatever the cause, Dr. Sussman uses a step-by-step approach to identify the best treatment. “I use the least invasive treatment methods first,” Dr. Sussman explains. This can include exercises to strengthen the muscles that control urination plus other behavioral approaches. Medications can also be used to relax the bladder or improve the flow of urine.

“We tailor our treatments to each patient’s goals and desires,” she says. That’s where her sensitivity and compassion come into play. When it comes to the treatment of pelvic organ prolapse in women, she is an expert in vaginal surgery, which allows her to treat problems without any visible incision. She also offers robotic surgery that can be performed through tiny incisions, which reduce pain and speed recovery. Men with enlarged prostates also benefit from new treatments. For example, a laser treatment can help reduce the size of the prostate to ease urination with a lower risk of bleeding than traditional surgery.

Dr. Sussman is part of a urology practice at MedStar Washington Hospital Center that includes seven urologists. “The value of a large urology practice is that each of us can be really specialized in what we do and stay up to date on the newest findings in the practice of urology. Patients can be sure that they have access to the best specialist for their particular condition.”

It’s never too early to seek treatment, Dr. Sussman concludes. “Things change as we age,” she says. “Early intervention can help problems from becoming worse over time. There are a lot of new treatments that are very effective.”

A viable surgical treatment for deep vein post-thrombotic syndrome (PTS) and similar obstructive venous conditions is being pioneered by MedStar Heart & Vascular Institute’s Steven Abramowitz, MD.  

Using a reconstructive technique called endovenectomy, Dr. Abramowitz carefully removes scar tissue from within a vein, which creates a clean channel for flow into an inserted stent, allowing blood to flow freely. “The procedure requires a connection between healthy sections of the vein,” says Dr. Abramowitz. “Usually a clean path, just over three inches, is all we need.” 

Post-thrombotic syndrome is an under-recognized disease that affects patients’ quality of life, says Vascular Surgeon Misaki Kiguchi, MD, who teams up with Dr. Abramowitz on some cases.  

“After deep vein thrombosis, the scar that forms in the vein often narrows the channel in which blood can flow back to the heart, increasing venous pressure in the legs. This leads to symptoms of heaviness, swelling, and in the most severe cases, ulcers. Dr. Abramowitz’s endovenectomy skill adds to the comprehensive venous team at MedStar Heart & Vascular Institute, by increasing the population of patients who can be treated endovascularly by adjuvant endovenectomy. These patients otherwise would have limited surgical options and limited success in revascularization without an endovenectomy.” 

Dr. Abramowitz has used the procedure to treat PTS in the external iliac vein, femoral vein, and profunda vein. He reports that the two-to-four hour-long procedure has so far yielded good outcomes, and any patient with PTS is a candidate. 

“Rather than having to rely on wound care and compression to treat chronic, non-healing venous wounds, we’re able to improve the patient’s own venous drainage, addressing the root of the problem,” Dr. Abramowitz says. “Many patients are healed within a matter of months.” 

Dr. Abramowitz is using the results of adjuvant endovenectomy with endovascular stenting to study ways to refine the technique, from varying segment lengths to investigating ways to accelerate the healing process. Although there may also be ways endovenectomy can help address conditions in other parts of the body, Dr. Abramowitz says the procedure’s most promising area of treatment is in the legs, where deep vein clots and other occlusions most frequently occur. 

Dr. Kiguchi adds, “At the MedStar Health Vein Centers, I treat a wide range of venous disease, from cosmetic varicose veins to large venous ulcers. Having a colleague like Dr. Abramowitz, and his success with endovenectomy to improve venous hypertension in many patients with PTS, is an asset to the comprehensive venous disease treatment paradigm.”