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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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  • October 30, 2020

    By MedStar Team

    Annual Enrollment is the time to assess your healthcare options for next year and select the coverage that best meets your needs. You have until Nov. 16 to make your selections during 2021 Annual Enrollment. Visit myHR from StarPort or myHRMedStar.net from any computer or mobile device.

    If you wish to keep your current benefits coverage for 2021, you do not need to enroll online. Your 2020 benefit selections and eligible dependents will roll over to 2021, except for Flexible Spending Accounts (FSAs)—you must enroll each year to participate.

    FSAs allow you to set aside pre-tax dollars from your paycheck to use for out-of-pocket expenses, such as eligible medical, dental and vision costs, as well as child care and adult day care services.

    Contact the HR Solution Center at 855-674-myHR (6947), select option 4for questions about your benefits offerings.


    Save $360 on your medical premium

    Complete the MyHealth Questionnaire at MedStarMyHealth.org by Nov. 30 and save approximately $360 a year on your MedStar Select or CareFirst medical premium for 2021.

  • October 30, 2020

    By MedStar Team

    Oftentimes, there is confusion surrounding with Exempt research and the requirements for IRB or institutional review. This is perfectly understandable, particularly given that the Common Rule has been revised in recent years and more research involving human subjects may fall into an exempt category.

    Although federal regulations do not require IRB review of exempt research, federal agencies have issued guidance recommending that exempt determinations should be made by an individual that is not otherwise affiliated with the research. In other words, institutions should not permit study investigators to make exempt determination for their own projects.

    To ensure that exempt determinations are issued by individuals that are not directly involved with the research, MedStar Health Research Institute policy states that exempt determinations must be made by either an IRB member or qualified / trained / designated members of the ORI staff.

    In order to make these determinations, a formal submission is required through the Huron system. As with all other Human Subjects Research projects the formal determination must be issued before any research activities may begin.

    If you have any questions regarding this process, please contact MHRI’s ORI Director, Jim Boscoe, at James.H.Boscoe@medstar.net.

  • October 30, 2020

    By MedStar Team

    Congratulations to all MedStar researchers who had articles published in October 2020. 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. Pharmacologic Management of Gout in Patients with Cardiovascular Disease and Heart Failure
      American Journal of Cardiovascular Drugs, 2020. DOI: 10.1007/s40256-020-00400-6
      Mouradjian MT, Plazak ME, Gale SE, Noel ZR, Watson K, Devabhakthuni S

       

    2. Externally Validated Prediction Model of Vaginal Delivery After Preterm Induction With Unfavorable Cervix
      Obstetrics & Gynecology, 2020. DOI: 10.1097/AOG.0000000000004039
      Kawakita T, Reddy UM, Huang JC, Auguste TC, Bauer D, Overcash RT.

    3. Galectin-1 production is elevated in hypertrophic scar
      Wound Repair and Regeneration, 2020. DOI: 10.1111/wrr.12869
      Kirkpatrick LD, Shupp JW, Smith RD, Alkhalil A, Moffatt LT, Carney BC.

    4. Micropuncture technique for femoral access is associated with lower vascular complications compared to standard needleCatheter Cardiovasc Interv, 2020. DOI: 10.1002/ccd.29330
      Ben-Dor I, Sharma A, Rogers T, Yerasi C, Case BC, Chezar-Azerrad C, Musallam A, Forrestal BJ, Zhang C, Hashim H, Bernardo N, Satler LF, Waksman R.

    5. Management of recurrent granulosa cell tumor of the ovary: Contemporary literature review and a proposal of hyperthermic intraperitoneal chemotherapy as novel therapeutic option
      The Journal of Obsetrics and Gynaecology Research, 2020. DOI: 10.1111/jog.14494

  • October 29, 2020

    By Stanley J. Pietrak, MD

    Those with nagging digestive issues have probably heard or read about probiotics and prebiotics by now. Often touted as a cure-all for digestive worries, they seem to pop up everywhere these days—from yogurt to baby formula to pet food!

    So, do they live up to the hype? That’s actually difficult to say, given the current limited amount of reliable data supporting them as a treatment option.

    But they may very well be an unnecessary addition to most people’s diets. In fact, the American Gastroenterological Association (AGA) recently issued a statement recommending against their use in any but a few specific digestive health issues. Let’s answer a few common questions:

    Exactly what are probiotics and prebiotics?

    Believe it or not, our guts have been home to a thousand different bacteria, fungi and microscopic organisms called protists since the day we were born. Approximately 30 or 40 of these will influence 99% of our digestive health. These helpful organisms are known as probiotics. Yogurt and sauerkraut are some examples of probiotic-rich foods.

    Prebiotics, on the other hand, are fiber-rich foods like fruits, vegetables and whole grains that help the probiotic strains to grow and flourish in the gut.

    Why the hype about them?

    Probiotics can be helpful in many ways. Without them, the complex digestive process would run less smoothly. They help break down the food we consume to produce vitamins and amino acids that regulate our body’s functions. Plus, they also promote immune functions in the gastrointestinal (GI) tract and protect us against harmful pathogens. There is evidence they may even help to improve mental health.

    Why are the right bacteria in the gut so important?

    Let’s say your colon contracted a C difficile infection. The probiotic microbiota already present in your gut would likely fight it off successfully. But if you’re perhaps taking a high-powered antibiotic or other medication that suppresses the immune system, or if you have a chronic disease, bad bacteria may be able to grab hold and do damage within the gut. This is why it’s so important to consistently maintain good gut microbes through a healthy diet.

    There’s not much conclusive evidence that probiotics are effective, says Dr. Stanley Pietrak. A healthy diet is still the best solution. https://bit.ly/2IWA4FT via @MedStarWHC
    Click to Tweet

    So why the current pushback against probiotics from the AGA and others?

    That’s the tricky part. There are so many formulations of single- and multi-strain probiotics—and so many different recommended dosages with randomized research trials—that it’s still difficult to conclude their effectiveness as a viable treatment option. This is a relatively new area of ongoing research, so there’s not much scientific evidence to refer to.

    Is there any documented proof they’re helpful?

    Yes. A type of probiotic called VSL#3 was found to be beneficial in rigorous studies in a small group, such as ulcerative colitis patients with surgically removed colons. Subsequent inflammation within the remaining part of their small intestines responded to treatment with VSL#3. But since testing involved a very small group, there is no way to standardize the result.

    If I do want to try probiotics, what should I choose?

    If you really want to try probiotics for minor digestive issues, go for the multi-strain type, and continue with it only if you start feeling better. Otherwise, it’s too early in our research to prescribe a particular type for a specific condition and discuss the pros and cons.

    Are there any natural remedies for improving gut health?

    Yes, absolutely. To be specific, there currently aren’t many options for accurate food-sensitivity testing, but we do know that, in 75% of people living with functional GI disorders, dietary triggers can worsen symptoms. So, it’s a little difficult to point out which foods may cause those triggers and which to continue eating.

    The general rule: eat healthy. Consume less processed food, red meat, alcohol, fats and sugars. Switch to more natural foods, like fresh fruit, vegetables and other fiber-rich options instead.

    To sum up, in 2020, there isn’t much conclusive research on the efficacy of probiotics. We can’t definitively state they are a good treatment for specific GI disorders, although the risk in trying them seems low at this point. If you choose to give them a try, stick to the multi-strain varieties and see if they work for you. Most importantly, eat a healthy diet full of natural food for long-term benefits.

    Concerned about gut health?

    Schedule time with a specialist.

    Call 202-644-9526 or  Request an Appointment

  • October 27, 2020

    By John F. Lazar, MD

    Are you a tea drinker, sometimes drinking multiple cups a day? It may be time to “cool things down.” A recent study suggests a significant link between hot tea and esophageal cancer.

    Surprising? Don’t worry, there’s plenty you can do to minimize your risk of developing this cancer. Let’s look at the tea-drinkers’ study and explore other risk factors for esophageal cancer, then review the options for patients diagnosed with this cancer.

    What is Cancer of the Esophagus?

    Esophageal cancer occurs in your “food pipe,” also known as your gullet or esophagus, the long tube that runs from your throat to your stomach.

    This cancer, while relatively rare, can be one of two types, based on its location and the cells lining that area of the esophagus. In the upper part of the gullet, it is referred to as squamous cell carcinoma; in the lower two-thirds, adenocarcinoma. Treatment differs for each type.

    This year, more than 16,000 patients will die of esophageal cancer, and another 18,000 will be diagnosed with it. Unfortunately, if this cancer is not caught in its early stages, the five-year survival rate for patients is only about 20%.

    Hot Tea and the Esophagus

    A recent transformational study found links between hot tea and squamous-cell carcinoma in the upper part of the esophagus. Based on 50,000 patients tracked over 10 years, the study took a close, long-term look at patients’ behavioral characteristics, such as their smoking and drinking habits and the socioeconomics of their lifestyles.

    Researchers looked carefully at the type, quantity and temperature of the tea that these patients consumed. They found that all types of tea, particularly black tea, showed a connection to esophageal cancer; however, the main differentiators were not type of tea, but temperature and amount consumed. The study indicated that people who like their tea really hot—above 140 degrees F—and who drink at least 50 ounces of it daily have a 90 percent greater risk of squamous-cell esophageal cancer than those who drink cooler tea or none at all. Hot water alone does not seem to constitute a risk, it is the combination of very hot water with tea that creates the issue.

    Fortunately, most people in the U.S. don’t drink as much scalding hot tea as do other regions of the world. But for Americans, it may be advisable to stick to one or two cups of tea a day, allowing your cup to cool a bit before drinking to avoid damage to the esophagus.

    Other Risk Factors

    Esophageal cancer is on the rise in America, mostly in middle-aged white men. We believe that long-standing gastroesophageal reflux disease, commonly known as GERD or reflux, is a critical risk factor. Typical candidates may be overweight and in their 50s and have pursued a generally unhealthy diet for years. For these patients, acid has regularly traveled up from the stomach and burned the lining of the esophagus. The scar tissue that forms in that region can become pre-cancerous, and then, over time, cancerous.

    Years of reflux can cause long-term damage to the esophagus. Dr. Lazar addresses this risk and others. @jflazar @MedStarWHC https://bit.ly/3jkkTT6
    Click to Tweet

    If you’ve experienced reflux for several years, inform your primary care doctor if you’ve been on antacid medication for a long time or have regularly used over-the-counter options (like Tums® or Rolaids®) and ask if you may need to move to stronger medication. Your health care professional may recommend an endoscopy—a procedure allowing the specialist to take a look at your stomach via a scope inserted through the mouth and throat.

    Beyond factors like acid reflux and hot tea, other risk factors for esophageal cancer can include long-term smoking or alcohol consumption, as well as a family history of this type of cancer.

    Treatments

    At MedStar Washington Hospital Center, we use a multi-modality plan to treat adenocarcinoma in the lower portion of the esophagus. This includes chemotherapy and radiation to shrink the tumor and help with microscopic disease, then surgery to remove any cancerous cells potentially left behind.

    In the case of squamous cell carcinoma, because the upper portion of the esophagus is difficult to reconstruct and because this carcinoma responds well to current chemotherapy agents, we typically opt for chemotherapy and radiation treatment.

    When surgery is called for, we must essentially remove the portion of the esophagus with the cancer and replace it with another organ that can continue its function of moving food from mouth to intestines. We reconstruct the stomach from a sac into a tube, bring it up to your chest, and connect it to the part of the esophagus that has no cancer.

    Previously, this four- to five-hour procedure was performed through two openings, one in the abdomen to create the tube, the other in the chest to remove the cancer and connect the tube. Today, we use minimally invasive laparoscopy, using a long scope with a camera at the end. In addition, many surgeons are moving toward robotics, which allow a very precise 3D approach to the procedure.

    After Surgery

    Because surgery of this type affects two areas of the body, patients are generally in the hospital for five to ten days, followed by recovery at home for two to four weeks.

    Surgical removal of the cancer requires the surgeon to sever the nerves along the esophagus, so it loses the ability to contract and push food to the intestines. What remains are a muscle and a tube that depend on gravity to push food along. For this reason, post-surgery, the patient must adhere to a softer diet and cut solid food into very small pieces.

    At MedStar Washington Hospital Center, our care team is very involved in supporting the patient’s recovery. Our interaction with patients is an ongoing, collaborative process, working through all the options and any challenges together.

    It is important to understand potential risk factors and, if you are deemed high-risk, to visit your primary care doctor or a gastroenterologist regularly for diagnoses and advice on medication. High-risk individuals should adjust their diet and adopt a fitness plan to maintain a healthy weight and control GERD.

    This is a tough disease but, if identified early, the odds of curing it can be much better.

    LISTEN: Dr. Lazar discusses esophageal cancer in the Medical Intel podcast.

    Struggling with reflux?

    Our specialists are here to help.

    Call 202-644-9526 or Request an Appointment

  • October 23, 2020

    By David E. Stein, MD, Colorectal Surgeon and Regional Chief of Surgery in the Baltimore region at MedStar Health

    You may be surprised to hear that everyone has hemorrhoids. In fact, I often introduce the topic to my medical students by walking around the room and pointing to unsuspecting individuals exclaiming, “I know you have hemorrhoids!”

    Did you know you have #Hemorrhoids? Everyone does, but they’re practically invisible until they become inflamed. On the #LiveWellHealthy blog, Dr. Stein shares everything you wanted to know about hemorrhoid treatment but were afraid to ask: https://bit.ly/2Tn10At.

    Click to Tweet


    So, what are hemorrhoids?

    Hemorrhoids are a normal part of the anal canal that help us to control bowel function. There are two locations where hemorrhoids can be found. Internal hemorrhoids exist within the lining of the rectum and anal area, or the inside of the body. In contrast, external hemorrhoids are located on the outside of the body where the skin has very sensitive nerve endings.

    When hemorrhoids become inflamed, they can become extremely painful, especially if they’re located externally. Unfortunately, over 10 million people suffer from inflamed hemorrhoids every year. How can something so small cause so much pain and discomfort?

    Symptoms of hemorrhoids.

    Hemorrhoid symptoms vary based on which ones are causing the problem.

    External hemorrhoids often bring on abrupt excruciating—and sometimes debilitating—pain. Bleeding and a formed clot that stretches the skin of the anal area are the cause of the pain.

    Internal hemorrhoids are graded on a scale of one to four, with painful symptoms that increase as the grade does. They’re rarely painful, although you can experience some bleeding and burning.

    • Grade 1: Painless rectal bleeding
    • Grade 2: Pain and discomfort from prolapsing or protruding from the anal opening
    • Grade 3: Pain and discomfort from prolapsing or protruding from the anal opening that requires you to manually push them back inside
    • Grade 4: Pain and discomfort from hemorrhoids that are stuck in the prolapsed position and generally require surgery

    It’s important to note that some symptoms may be similar to other conditions, such as colon cancer. If you are over the age of 40 and experiencing bleeding, talk to your doctor about getting screened for colon cancer to rule out anything life-threatening.

    Causes of hemorrhoids.

    A lack of fiber. There are a variety of things that can cause hemorrhoids to inflame, but the most common reason is a lack of fiber in your diet. The United States Department of Agriculture (USDA) recommends that women eat a minimum of 25 grams of fiber and men consume over 30 grams of fiber every day. Yet many of us don’t eat enough fiber.

    Irregular bathroom habits. Still, even if you eat enough fiber, it’s possible to develop an inflamed hemorrhoid. Constipation, straining, and irregular bowel habits are also common causes of hemorrhoids. That’s why expecting women are also prone to developing inflamed hemorrhoids—as if they don’t suffer enough uncomfortable symptoms during pregnancy. Individuals with Inflammatory Bowel Disease (IBD) may also be at an increased risk of developing hemorrhoids.

    Genetics. Unfortunately, if your parents frequently developed inflamed hemorrhoids, there’s a greater likelihood that you will, too. Over fifty percent of patients with hemorrhoids have a family history of dealing with the same affliction.

    Treating hemorrhoids.

    Sometimes, people with inflamed hemorrhoids don’t experience any symptoms. Other times, symptoms may dissipate quickly as hemorrhoids can resolve themselves within a few days. However, for some unlucky individuals, the only way to get hemorrhoid relief is by seeking treatment from a doctor.

    Request an appointment.

    Treating hemorrhoids at home.

    Over-the-counter medications like Preparation H may offer some pain relief for hemorrhoids. But unless you modify your fiber intake, they’ll probably keep coming back. If you have internal hemorrhoids, I will almost always recommend diet modifications to incorporate more fiber. A high-fiber diet is the best way to eliminate and prevent most cases of hemorrhoids, as fiber helps to regulate bowel movement. 70% of the time, eating more fiber will relieve symptoms of internal hemorrhoids.

    Consider upping your fiber intake with the following high-fiber foods:

    • Berries
    • Nuts
    • Legumes
    • Veggies
    • Whole grains

    Treating hemorrhoids at the doctor.

    No one dies from hemorrhoids. But if you’ve had one, you may wish that you had! Living with persistent hemorrhoid pain is miserable and there are many treatment options available so you don’t have to. Treatment options vary based on the location and severity of your hemorrhoid.

    Treatment for internal hemorrhoids.

    When dietary adjustments don’t relieve pain, you may benefit from a quick, in-office procedure to remove internal hemorrhoids grading one or two. Called rubber band ligation, this simple procedure involves placing a small rubber band around the hemorrhoid to help it naturally fall off within ten days. It can be uncomfortable, but it’s not painful and it’s extremely effective.

    If neither diet nor rubber band ligation provide relief, there are numerous surgical options that, while painful, are effective in eliminating hemorrhoids. These include:

    • Hemorrhoidectomy: When a large piece of skin is prolapsing every time you go to the bathroom, you may need surgery to remove hemorrhoids. An anesthetic will help to keep you comfortable during the procedure. However, you will likely experience pain for about two to three weeks of recovery.
    • Stapled hemorrhoidopexy: This procedure pulls the hemorrhoids back into their usual position with the use of a stapling device. The recovery is significantly less painful than the classic excision.
    • Hemorrhoid artery ligation: This new technique uses ultrasound to detect blood vessels supplying the hemorrhoids. Then, your doctor will suture the arteries so no blood enters the hemorrhoids, causing them to shrink.

    Treatment for external hemorrhoids.

    If you have an external hemorrhoid and see a doctor within three to four days of experiencing symptoms, your doctor can treat it using a procedure called thrombosis. During thrombosis, your doctor will numb the area before removing the inflamed hemorrhoid, resulting in instant relief. Unfortunately, if you’ve experienced symptoms for at least five days, the best thing to do is wait it out as the clot inside the hemorrhoid is likely already going away.

    The new Surgical Pavilion at MedStar Franklin Square Medical Center.

    If you need surgery for hemorrhoid relief, our new patient-centered Surgical Pavilion is now open. This 82,000-square-foot facility was designed with input from doctors, surgeons, nurses, technicians, and staff who understand the features and amenities that will make your surgery the best experience it can be. The spacious building offers ample suites for privacy, comfort, and social distancing, as well as large operating rooms equipped with state-of-the-art technology to facilitate collaboration across specialties.

    While it’s important to be cautious while COVID-19 is still around, you need to take care of your health. If you have painful symptoms that suggest you may have an inflamed hemorrhoid but you’re not sure, talk to your doctor. Your doctor can help to rule out polyps or something more serious while suggesting your best treatment options if you have a confirmed hemorrhoid. If surgery is your best option, you can count on MedStar Health to provide the highest levels of care in a safe environment.

    Do you have a hemorrhoid that’s causing you discomfort?
    Request an appointment with a MedStar Health specialist today.

    Request an appointment.