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  • January 18, 2022

    By MedStar Team

    Structural racism is one of the most pressing issues facing healthcare today.  Unfortunately, academic medicine historically exacerbating the exploitation of vulnerable communities to achieve educational and research goals, especially in Black, Indigenous, and People of Color (BIPOC) communities. For example, many traditional research practices among marginalized communities highlight and, in most cases, magnify inequities in care. These can include:   

    • Community members are under informed about research methods and strategies. 

    • Researchers prioritize extraction of information from communities rather than community ownership of information.

    • Researchers accrue funding, prestige, and publications (in which academics’ voices predominate over the narrative perspective of community members) without similar accrual to participating communities.  

    • Researchers’ understanding of questions to be answered may lack cultural context because of their incomplete comprehension of community conditions.  

    The relationship between research institutions and many BIPOC communities is estranged and needs mending to dismantle racial disparities and inequitable research practices. As the area’s largest healthcare provider, MedStar Health is committed to do the work needed to address these issues in everything we do in order to advance health equity for everyone we serve.

    “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

    (March 25, 1966 speech to the Medical Committee for Human Rights)

     

    Advancing Health Equity in Early Childhood and Family Mental Health Research

    MedStar Health investigators Arrealia Gavins, Celene E. Domitrovich, Christina Morris, Jessica X. Ouyang, and Matthew G. Biel recently published research emphasizing the need to co-learn and to co-develop research with community members themselves to prioritize benefits for both participants and researchers. “Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health” was published in the Journal of the American Academy of Child & Adolescent Psychiatry. This work was done through the Early Childhood Innovation Network (ECIN),  a community-based partnership between two academic medical centers (MedStar Georgetown University Hospital & Children’s National Health System) and several community-based organizations in Washington, DC that strives to provide support to families through caregiver and child mental health services, family peer support, child social and emotional learning, initiatives to address social determinants of physical and mental health for families, and place-based support to families within select communities.  

    In this study, researchers found that to begin to undo the inherent inequities within academic medical research, particularly in studies involving children and caregivers, investigators need to consider how best to build equitable, long-term partnerships with communities through Community-Engaged Research (CEnR) or more specifically, Community-Based Participatory Research (CBPR). CBPR offers an alternative to traditional non-participatory research with a collaborative, strengths-based orientation that equitably involves researchers, community members and other stakeholders in all phases of research while embracing their unique expertise. 

    Recently documented increasing rates of depression, anxiety, and suicide in BIPOC youth, compounded by the disproportionate impact of the COVID-19 pandemic on BIPOC communities, has heightened the urgency for progress in community-based research.

    The research team started to utilize CBPR practices to advance antiracism in their clinical research work in child and family health along with working with BIPOC communities. This approach to integrate CBPR practices into the development, implementation, and evaluation of community-based interventions seeks to support early childhood mental health in primarily Black communities in Washington, DC. 

    Making an Impact: Insights & Lessons Learned from CBPR

    Through this work of the EICN, the research team found five valuable lessons from applying CBRP principles to research collaborations in community settings. 

    Intervention Practices

    Lessons Learned and Applied

    ECIN launched a group-based mindfulness parenting program to explore how to support the emotional health of parents at a Head Start early education center with the intention to reduce caregiver stress and enhance caregiver-child relationships.

     

    Lesson 1: Invest the time to build trusting relationships

    Providers set up several discussion groups with community partners and medical center-based researchers to review proposed assessment tools to be used with children and families receiving psychotherapy services.

    Lesson 2: Involve community partners in the development of the intervention theory of change and measurement strategy

     

    Clinical staff organized peer specialists to provide support to families with young children through 3 evidence-based strategies: enhancing parents’ knowledge about caregiving with young children;optimizingparent use of existing resources; and increasing parents’ access to social supports.

     

    Lesson 3: Create interventions in partnership with community members

    Clinical staff providedearly childhood mental health consultation (ECMHC) in preschool classrooms to enhance educators’capacitiesto support early childhood development and to recognize early signs of mental health concerns

    Lesson 4: Interpret findings in partnership with community members

    ECIN membersparticipatedin formal antiracism training with external experts to incorporate antiracism principles into ECIN’s operations and into the culture of the Network. ECIN formed a Racial Equity Community of Practice (RECOP), that supports 8 intervention teams in developing practices that advance racial equity goals.

    Lesson 5: Embed an antiracism focus in research structures and processes

     

    The research team found this community-based approach to be helpful in conducting research that will have a long-lasting impact on not only the community, but also on members of the research team. During a time where BIPOC families are experiencing the effect of COVID-related deaths and grief, unemployment, housing instability, and police violence; researchers have an opportunity to be engaged in the community and work to eliminate racial inequities within academic medicine and research. 

    Journal of the American Academy of Child & Adolescent Psychiatry, DOI: 10.1016/j.jaac.2021.06.018

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  • January 17, 2017

    By MedStar Health

    Whether for an old ache or a new sports injury, Dr. Evan Argintar explains the options that can help return you to fighting form.
  • January 16, 2017

    By MedStar Health

    Bunions—those unsightly bony protrusions that can develop over the first metatarsal bone or big toe joint—remain a bit of a mystery. Aside from their definition, everything else varies, including how and why they develop, who gets them and when, and what symptoms they may cause. But one thing is certain:  Bunions can be hard to ignore, especially when they’re painful.

    Fortunately, there are early steps you can take that may help you from ever reaching that stage.

    "My best advice is to have an evaluation with a foot specialist when you first see a bunion developing or have any pain in your big toe joint,” says Katherine Raspovic, DPM, a podiatric surgeon at MedStar Washington Hospital Center. “There are a few conservative treatment options that can help improve discomfort.”

    The luck of the draw, genetics, often plays a role in determining who gets bunions. But shoes are another likely culprit, with high heels and shoes with narrow toe areas leading the list of suspects. While many high-heel wearers may never have problems, Dr. Raspovic advises those who do to step away from the stilettos, pointy toes and any other shoe that aggravates the sore joint.

    "One of the best preventative and therapeutic measures for bunions is wearing the right shoe for your foot, especially one that avoids excessive pressure on your toes,” she says. “It can be helpful to go to a good store where you can get your feet accurately measured so you can then find the proper size and fit.”

    Beyond a change of footwear, other helpful tactics include using orthotics for arch support, modifying or taking a break from some activities for a time and taking anti-inflammatory medication.

    Surgery is only recommended when other approaches have failed and the pain is so severe that daily activities and quality of life are affected. Depending on the type of surgical correction, some patients are completely off their feet for six weeks, followed by a walking boot and physical therapy. Post-surgical swelling—which may quickly subside or last for several months—can affect a patient’s ability to wear regular shoes for 10 to12 weeks after surgery. The recovery can be different for each patient based on what surgical intervention is needed to correct the bunion properly.

    But with early detection and specialty medical care, many people can avoid surgery, says Dr. Raspovic.

    Tune in to the full podcast interview with Dr. Raspovic.

    Our specialists are experts in the diagnosis and treatment bunion and other podiatric conditions. Ready to schedule an appointment? Call us at

    202-877-3627

    Katherine Raspovic, DPM Bunion

    Dr. Katherine Raspovic, DPM

    For an appointment, call 240-273-1915.

  • January 13, 2017

    By MedStar Health

    This year, we celebrate Martin Luther King, Jr. Day by supporting Wheatley Elementary School.
  • January 10, 2017

    By MedStar Health

    Esophageal cancer is found in the esophagus, the tube that connects the mouth to the stomach. It can occur at any point on that route and will be treated differently depending on its location and severity.

    While the treatment for esophageal cancer has changed drastically over the decades, recent trends have seen the treatment options shift from highly invasive and destructive procedures to more minimally invasive procedures designed to uphold the patient's health and well-being throughout treatment.

    Treatment Options for Various Types of Esophageal Cancer

    Over the last several decades, adenocarcinoma (a type of esophageal cancer near the stomach) has become more widespread.

    Unfortunately, because of the widespread availability of over-the-counter acid reflux medications, patients may not ever know they have this type of cancer and may write their chronic acid reflux off as nothing to worry about.

    Cancer can present very few or no symptoms, so in most cases, patients with esophageal cancer don't know they have the disease until it's in an advanced stage. In many instances, esophageal cancer is diagnosed by accident when it has reached an advanced stage. At one point the only available treatment for late stage patients was a highly invasive" open case" treatment which involve large incisions in the abdominal and chest cavities), with a 50 percent risk of complications and chronic pain.

    Fortunately, minimally invasive procedures are available that offer minimal pain, fast healing and the ability to go home and eat normally, rather than through feeding tubes.

    Procedures for Early-Stage Patients

    On the other hand, patients with very early-stage cancers can avoid to the removal of their esophagus, and instead only remove a portion of the tissue around the cancer, leaving the remainder of the stomach and esophagus without damaging the nerves or the valve that prevents reflux.

    On the other hand, patients with later stages will need to remove more extensive amounts of tissue including the nerves to the stomach. While patients will have reflux and potential long-term stomach issues, it is a life-saving procedure for many.

    Patients who have had previous open operations will still be able to access minimally invasive approaches, although it may take longer and be more challenging because of scar tissue.

    What Minimally Invasive Options Mean for Patient Care

    Minimally invasive surgery is the preferred, and often the best option vs. an open method. In addition to providing a faster healing time, minimally invasive procedures may offer a better cancer outcome than more invasive open approaches. Though doctors aren't exactly sure why this is true, it could be attributed to the fact that minimally invasive procedures minimize damage and are less stressful on the body during recovery.

    It should be noted that minimally invasive surgical options are not the right course of action for all esophageal cancer patients. However, they can go a long way toward minimizing damage and expediting the healing process for these patients.

    Looking Ahead

    While further treatment options are sure to be developed in coming years, the current treatment options show great promise to patients and their families who are struggling through the murky waters of esophageal cancer and its many invasive and minimally invasive treatment options.

    Between better outcomes and faster recovery times, it's easy to see why minimally invasive treatment options are becoming so popular among patients today.

  • January 10, 2017

    By MedStar Health

    Exercising, eating right, getting plenty of sleep, and not smoking are four New Year’s resolutions you can make to improve your health. But it’s also important to get the right screening tests at the right time. This year, resolve to get the screenings you need to prevent and catch potential health problems before they become major concerns. Knowing which tests to get and when to get them can be a challenge, given that screening guidelines are changing frequently, as concerns grow that overusing such tests might lead to unnecessary procedures.

    To make this as simple as possible, Sadaf Mustafa, MD, a primary care physician on the medical staff of MedStar Good Samaritan Hospital, has prepared the following guides tailored to the unique needs of men and women of any age. While these are useful general guidelines, she recommends, “Each individual should talk to their doctor first, who will then be able to take the personal and family history into account and suggest the screening test that‘s right for you.”

    Dr. Mustafa highlights three important preventive health measures that are especially prone to being overlooked: mental health screenings, Human Papilloma Virus (HPV) vaccinations and osteoporosis screenings for both men and women. She believes that having your doctor ask a few questions about your mental health is as equally important as many of the other health screenings.

    “The single most important screening is for your mental health,” she explains. “Your physician can use one of several short, validated questionnaires that are available to check your mental health every time you get your routine physical exam.” She recommends starting these brief screenings as early as 18 years of age. Dr. Mustafa also recommends that young people should get the HPV vaccines to help prevent a variety of cancers.

    This article appeared in the winter 2016 issue of Good Health. Read more articles from this issue.

    Location Information

    Sadaf Mustafa, MD, Internal Medicine
    201 E. University Parkway
    Baltimore, MD 21218
    410-554-2284

    Learn More

    Download Our Screening Guides

    Click below to view and download our FREE screening guides.

    A Man’s Guide to Health Screenings

    Click below to download and print the screening guide below.

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    A Woman’s Guide to Health Screenings

    Click below to download and print the screening guide below.

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  • January 10, 2017

    By MedStar Health

    For people with thyroid cancer surgery is usually the best treatment. Yet how the procedure is done and by whom can make a telltale difference.