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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.
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    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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  • October 06, 2020

    By Edward F. Aulisi, MD

    MedStar Washington Hospital Center made history this summer when it became the first hospital in the United States to perform minimally invasive spine surgery using Brainlab’s Cirq® robotic arm.

    This giant step forward in surgical accuracy and safety was the result of months of effort and collaboration between our team, our hospital leadership, and our patients. Since then, we have performed more than 50 procedures with the help of Cirq, and it’s already proven itself a game changer.

    In fact, this technology has the potential to revolutionize complex neurosurgical surgeries. We are privileged to be the first in the country to adopt the new technology.

    A New Level of Accuracy

    In spinal surgery, accuracy is everything. The spinal column is composed of stacked bones, called vertebrae, that flex and support other components of the skeleton and protect the spinal cord. The spine is around 25 inches long in the average person, but the width of any single vertebra is only an inch or two. Within that small space, neurosurgeons must accurately identify and isolate bone, nerve, tendon, muscle, and other structures during surgery. Therefore, the surgeon must know the exact location of the surgical instruments at any given moment.

    Cirq and it’s 3D CT scanner, Airo®, work in tandem to help locate instruments more accurately than any other I have used to date. Beyond making surgery safer, it’s making it better, with sharpened control that lets our surgical team carefully tailor each procedure to each patient’s unique anatomy and disease state.

    MedStar Washington Hospital Center is first in the country to employ Cirq technology. Cirq, coupled with the 3D CT scanner, Airo, is revolutionizing our approach to complex surgeries. More from Dr. Edward Aulisi https://bit.ly/3kYk97z @MedStarWHC.
    Click to Tweet

    How It Works

    With cameras, a computer, and the Airo CT scanner, Cirq supports the procedure with rock-solid stability and sub-millimeter accuracy, finer than even the most agile and steady surgeon’s hand. It is a true robotic assistant: as the surgeon performs the procedure, the robot positions and holds tools and surgical instruments with the greatest accuracy.

    We have already employed Cirq to assist in spinal fusion, where we use strong rods to connect a weakened, diseased spinal vertebra to healthier neighboring vertebrae that can help share the load. Those rods are mounted to tiny screws that secure them firmly to bone. Previously, a surgeon would use their best judgment to do this, guided by traditional X-ray fluoroscopy. That technology takes longer, requires a significantly higher dose of X-ray, and delivers far less resolution than Airo.

    With Cirq and Airo, not only can we isolate bone, we can decide exactly which part of the bone to target, selecting the densest, healthiest tissue. And we can precisely control angle and depth for the strongest, safest mounting point—without affecting the spinal cord or other nearby structures.

    The Procedure

    Modeled on the human arm, Cirq is a small robotic device that mounts onto the operating table. It’s so light that one person can set it up without assistance. With the Cirq in place, we then make small incisions in the patient’s back, temporarily move the muscle aside and mount a small registration device directly to bone. The robot arm uses its camera to find the points on the registration device and determine exactly where everything is in the space.

    Then, we use the Airo to scan the area, with images captured at a very low dose in just 15–20 seconds. In a moment’s time, I have a full 3-dimensional view of the spinal column and can rotate the view in any orientation to choose the best possible mounting points.

    During the surgical process, I watch a monitor, very similar to the heads-up display in a fighter jet, the technology that inspired image guidance. When the screws are in place, we conduct another scan to ensure that the angle, depth, and connection are perfect.

    This is very important because everyone’s anatomy is unique. We must get the angle and depth just right. It’s like hanging a picture hook on the wall—the better the mounting point, the stronger it is and the more force it can withstand.

    Other Applications

    The system also excels for use in trauma cases and in revision surgery—for instance, when an older surgery develops problems and requires repair. With Cirq, we can install screws in places that were impossible to reach with older technology—so we have many more options. For example, we can carefully install 2 screws on either side of an area that isn’t strong enough to support 1.

    In surgery, knowledge is power. This is a whole new world that will increase the number of people who can be helped by surgery—even in cases considered inoperable in years past.

    For instance, Cirq will also become valuable in cranial surgery. We have already deployed the Airo scanner 600 times for cranial cases, becoming one of the fastest growing sites in the world. Now, adding Cirq to the mix will enhance speed and accuracy.

    Another area where I expect the technology to have particularly dramatic impact is in limb-saving cancer surgery. For example, we sometimes remove diseased bone and replace it with a prosthetic, an artificial implant. This is normally achieved over 2 surgeries. The first is to locate the disease, remove it, and allow us to devise an implant custom-fit to the patient’s unique anatomy, and, once that implant is manufactured, the second is to install it.

    With Cirq and Airo, we’ll determine exactly where the diseased tissue is before we make the incision. And we’ll know precisely how to make the implant, based on the 3D scan data. So we’ll be able to create the implant ahead of time, and then complete both treatment and implant in a single surgery—improving the patient’s recovery and reducing the risks of surgery by half.

    In other cancer procedures, the technology will likewise help the surgeon know exactly where the diseased tissue is before the incision—and will also help determine if disease has been completely removed before the incision is closed.

    In fact, this equipment is so compact and portable, we could theoretically use it anywhere, even in the Emergency Room. And it is a fantastic training tool: our surgical residents can view exactly what’s happening during surgery, in areas normally hidden from view.

    Leading the Way

    We’re not just improving surgery for our Hospital Center patients, the work we’re doing will benefit people all over the world.  The Hospital Center will play a leadership role in hosting surgeons from other institutions, who can observe our equipment and advance their own knowledge.

    We’ve had enthusiastic support from MedStar Health leadership in giving our doctors and patients access to the best possible tools available. Not every hospital will make that kind of investment in cutting-edge technology, but that commitment is part of our mission to be the best.

    Need spine surgery?

    Connect with our specialists.

    Call 202-877-3627 or Request an Appointment

  • October 03, 2020

    By MedStar Team

    Recently published collaborative research examined utilization patterns and predictors of computed tomography pulmonary angiography (CTPA) results in the emergency department. “High Scan Volume with Low Positive Scan Rate in Highest Utilizers: Computed Tomography Pulmonary Angiography in the Emergency Department” was published in The Journal of Emergency Medicine. This publication was the result of the Summer Research Student program with MedStar Health investigators mentoring rising second-year medical students from the Georgetown University School of Medicine. The team included investigators from MedStar Good Samaritan Hospital, MedStar Union Memorial Hospital, MedStar Washington Hospital Center and Georgetown University.

    The overutilization of CTPA is a serious concern in the emergency department because the potential of increased risk for radiation exposure, cost, and over diagnosis bias may occur. This study reviewed all CTPA studies performed in one year across a multisite medical system and focused on data for emergency department attendings and positive CTPA scan rates (PSR). The team manually reviewed all applicable scans and classified them as positive, negative, or indeterminate.

    The results show there were 10,032 total scans from the emergency department and 6,168 of those were ordered by 153 emergency department attendings. Most attendings (123/153; 80%) ordered 60 or fewer scans, with relatively high PSR (259/2927, PSR 8.8%; 95% confidence interval 7.8–9.9%). Of the emergency department attendings, 13 (3%) ordered more than 100 scans each (1981 scans; 32% of all scans), with PSR of 5.5% (95% confidence interval 4.5–6.5%).

    Overall, the study found that most emergency department attendings were low-to mid-volume utilizers of CTPA and had a relatively high PSR. However, the small percentage of attendings who ordered more than 100 scans each accounted for a large percentage of the total number of scans and had a relatively low PSR. These findings suggest that mentoring and/or sharing of performance feedback and best practices in the highest utilizers could help to improve CTPA PSR in the emergency department. 

    Dr. David Weisman, a mentor for the Scholars program and senior author for the publication shared his thoughts on the students and the program.  “I’ve have been extremely fortunate to have had the opportunity to work with so many wonderful Georgetown medical students for the past 4 years. Each student brings to the table their individual uniqueness and talents. I’ve been thankful and impressed by the dedication of MedStar Health and Georgetown University leadership to support this program which is so vital to introduce students to research early in their career. I look forward too many more years of collaboration and mentorship.”

    The research team included Himanshu Rawal, MD; Oluwatoyosi Ipaye, MS; Amit D. Kalaria, MD; Radhika Vij, MD, FACP; Jeffrey S. Dubin, MD, MBA; Lyn Camire, MA, ELS; and David S. Weisman, DO, FACP.

    The Journal of Emergency Medicine, 2020. DOI: 10.1016/j.jemermed.2020.04.008

  • October 03, 2020

    By MedStar Team

    Grant Gonzalez was awarded the SPIRIT of Excellence Award during the MHRI Virtual Town Hall.  Grant is the Director of Finance Operations for the Office of Financial Management. Nominated by Ron Migues, Executive Director, MedStar Health Research Institute, the award was presented by Tina Stanger, Assistant Vice President of Research Administration.

    Grant was recognized for his willingness to work with anyone and his infectious smile.  Grant is a problem solver and is dedicated to gather all the necessary components to make something more efficient.

    “Wanted to give you a huge thank you for taking the time to work with me and my team to ensure our finances are up to date and as accurate as possible,” said Ron Migues. “Given we encompass so many areas and have the most diverse areas of research, it usually takes a small village to accomplish anything, but you have stepped forward and are leading us to become financially sound.  We really see all you do and are extremely appreciative for the support!”

    The SPIRIT Award is given to recognize and reward one associate (management or non-management) each quarter, who excels in Service, Patient First, Integrity, Respect, Innovation, and Teamwork. 

    Nominations are based on submission to the MHRI Kudos program. Each quarter, the MHRI Executive Team will review the KUDOS submissions and select an associate or manager who best exemplifies all our SPIRIT values.

  • October 03, 2020

    By MedStar Team

    In recent years, there has been an increasing trend toward the use of a single IRB (sIRB) review for multi-site HSR projects funded through other sources.  Specifically, many commercial sponsors prefer single IRB review for their multi-site projects.

    The revised common rule includes a requirement for single IRB review of most federally funded multi-site non-exempt human subjects research projects. Initially, the Office of Human Research Protections (OHRP) indicated that compliance with this common rule requirement was required starting on January 20, 2020. Later, OHRP clarified that although sIRB review is required for all federally funded multi-site non-exempt HSR projects, the agency has granted an exemption for all projects approved prior to January 20, 2020. This eliminates the need to transition currently approve projects from review by multiple IRBs to sIRB review.

    For all future federally funded projects, it is strongly suggested that investigators include IRB review fees in the budget for their grant proposals. In most cases it is assumed that sIRB review will be conducted by a commercial IRB (such as WIRB or Advarra) or a larger academic/medical institution IRB. In some limited cases, the MHRI IRB may agree to serve as the IRB of record for a multi-site HSR project but this will not be the norm.

    In all cases (regardless of funding) for which a MedStar investigator intends to request the MHRI IRB serve as the IRB of record, they must submit a request to the ORI office. The request must be submitted before the investigator commits the MHRI IRB to the responsibility of serving as IRB of record for other sites and before discussing reliance with any outside institution. The request should include a copy of the research protocol, an indication of the source of funding (if any), a list of all sites that may be engaged in the project, and the scope of involvement for each site. The ORI Director will evaluate the request and in consultation with the Institutional Official determine if the request will be approved or should be declined.

    This process is similar to that for investigators requesting reliance on an external IRB. When an investigator would like to rely on an external IRB for review of their non-exempt HSR project, a request to cede review must be submitted to ORI in advance. In the case of the commercial IRBs for which there is a master reliance agreement (currently WIRB and Advarra), the investigator may simply submit an external IRB application through the Huron system. For other IRBs, a reliance agreement must be executed for each individual project. In the event that MedStar has not previously had an agreement with the intended external IRB, a request should be submitted to the ORI by email. The ORI Director will evaluate the request and in consultation with the Institutional Official determine if the request may be approved or should be declined. If approved the organization will be added to the Huron system and the investigator may submit the external IRB application for the project.

    Please note that in most cases request for reliance involving exempt HSR projects will not be approved. Generally speaking, it is more efficient for these projects to be reviewed individually by each institution and most institutions have not been willing to enter into a reliance agreement for these projects.

    In all cases, requests for reliance (either for the MHRI IRB to serve as the IRB of record or for MedStar to rely on an external IRB) will be considered with regard to the need for reliance, the feasibility of the arraignment and nature of the project. Ultimately the determination of reliance is left to the discretion of the ORI Director and the Institutional Official.

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

  • October 03, 2020

    By MedStar Team

    Congratulations to all MedStar researchers who had articles published in September 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. Diabetes Education for Behavioral Health Inpatients: Challenges and Opportunities
      Journal of the American Psychiatric Nurses Association, 2020. DOI: 10.1177/1078390319878781
      Bardsley JK, Baker KM, Smith KM, Magee MF.
    2. Measurement of Outlet Pressures Favors Rib Resection for Decompression of Thoracic Outlet Syndrome
      Annals of Thoracic Surgery, 2020. DOI: 10.1016/j.athoracsur.2019.12.059
      Assi PE, Hui-Chou HG, Giladi AM, Segalman KA.

    3. Biomechanical Analysis of Zone 2 Flexor Tendon Repair With a Coupler Device Versus Locking Cruciate Core Suture
      Journal of Hand Surgery, 2020. DOI: 10.1016/j.jhsa.2020.02.015
      Irwin CS, Parks BG, Means KR Jr.
    4. Bulla Formation and Tension Pneumothorax in a Patient with COVID-19
      The American Society of Tropical Medicine and Hygiene, 2020. DOI: 10.4269/ajtmh.20-0736
      Yasukawa K, Vamadevan A, Rollins R.

  • October 02, 2020

    By The MWHC Blog Team

    Growing up in Calgary, Alberta, Jennifer Tran, MD, MBA, was instilled with all the ingredients of healthy living. Her parents owned a farmers’ market, which meant fresh food was always on the dinner table, while the beauty and adventure of western Canada’s many recreational areas were close at hand.

    Dr. Tran might well have joined her parents’ business, but decided that medicine offered a different path toward managing health. Trading the foothills of the Rocky Mountains for the sunny climate of the Caribbean, she earned simultaneous medical and MBA degrees from St. George’s University in Grenada. “Learning both the science and business sides of medicine allows me to better advocate for my patients, because I see how both aspects affect them,” Dr. Tran explains.

    The ability to apply a holistic approach to patient care influenced her choice of internal medicine as a specialty. “By seeing the patient as a whole, you get a better understanding of how personal, socioeconomic and lifestyle factors influence the health of an individual,” she says.

    Finding a Home in the Nation’s Capital

    After completing her Internal Medicine residency through the MedStar Washington Hospital Center/MedStar Georgetown University Hospital program, Dr. Tran stayed on to become an attending physician and faculty member. Along with teaching students and residents, she also enjoys applying the growing range of technology options for primary care, many of which have been pressed into service during the coronavirus pandemic.

    “E-visits and apps for monitoring health are only going to grow in importance and versatility,” Dr. Tran says. “It’s a wonderful way to build a connection with patients and help them take ownership of their own health.”

    Having worked extensively in the Hospital Center’s COVID-19 clinic, Dr. Tran and her practice group are working on several conference papers on COVID symptoms and management. Her other research interests include improving healthcare delivery for patients of low socioeconomic status. As a member of Physicians for Human Rights, Dr. Tran is also interested in assisting immigrants with health issues. “In addition to helping them with insurance or legal issues, it’s an opportunity to understand how health and medicine are viewed in other cultures,” she says.

    Outside the Hospital

    Still very much a “farmers’ market daughter,” Dr. Tran enjoys visiting local outdoor markets and orchards. She also enjoys going on hiking trips with her dog and, yes, her cat.

    “The cat just follows the dog, and we have a great time,” she says with a laugh.

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