MedStar Health Blog

Since March, organized crime and other threat actors have used the COVID-19 crisis as a basis for increased attacks on computer systems and phishing campaigns designed to obtain sensitive or personal information. 

Through social engineering, these threat actors attempt to take advantage of the COVID-19 pandemic by prompting associates to provide personal information or passwords, click on or open malicious links or attachments, or transfer money. These attacks can come through phishing emails, texts or voice calls to a workstation, smartphone, or other devices.

The threat actor may spoof a known source for COVID-19 information, such as the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), MedStar Human Resources, or a local school district. Phishing attempts may also come from vendors purporting to have or sell Personal Protective Equipment (PPE) or other supplies. 

To avoid these risks, follow these important recommendations: 

• Take your time when reviewing email or text messages. Be careful before you click!
• Be alert for phishing messages in your email inbox. Since phishing emails arrive from outside of the network, determine whether the email is legitimate. All external emails include a tag of [EXTERNAL] in the email subject line and a banner:

** ATTENTION: This email originated from outside the MedStar network.
** DO NOT CLICK links or attachments unless you recognize the sender and know the content is safe.

• If you don’t know the sender and it looks suspicious, delete the email. Do not click on any attachments or links within the body of the email. 
• Look for spoofed addresses. For example, if an email appears to come from an associate and the sender’s address is not @medstar.net, it is not a legitimate email.
• If you receive a text message from a number you do not know, delete the text message. Do not click on any links within the text message. 
• Report suspicious emails to phish@medstar.net or spam@medstar.net. Call the IS Service Desk at 877-777-8787 with any questions.

Thank you for your efforts to protect our network, important data, systems, and organization.

Congratulations to all MedStar researchers who had articles published in June 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. 1. Sex-Associated Differences in Cardiac Reverse Remodeling in Patients Supported by Contemporary Left Ventricular Assist Devices
      Journal of Cardiac Failure, 2020. DOI: 10.1016/j.cardfail.2020.03.005
      Mehta N, Mazer-Amirshahi M, Schulman C, O'Connell F, Pourmand A.

   2. Differentiated Thyroid Cancer and Hashimoto Thyroiditis: Utility of the Afirma Gene Expression Classifier
      Journal of  Surgical Oncology, 2020. DOI: 10.1002/jso.25875
      Papoian V, Rosen JE, Lee W, Wartofsky L, Felger EA.

   3. Varying Rates of Patient Identity Verification When Using Computerized Provider Order Entry
      Journal of the American Medical Informatics Association, 2020. DOI: 10.1093/jamia/ocaa047
      Fortman E, Hettinger AZ, Howe JL, Fong A, Pruitt Z, Miller K, Ratwani RM.

   4. Racial Disparity in Postpartum Readmission Due to Hypertension Among Women With Pregnancy-Associated Hypertension
      American Journal of Perinatology, 2020. DOI: 10.1055/s-0040-1712530
      Chornock R, Iqbal SN, Kawakita T.

MedStar Health policies require that all individuals engaged in the conduct of research complete the annual conflict of interest disclosure. The annual research conflicts of interest disclosure process is designed to manage financial and nonfinancial research interests. As you probably know, MedStar Health Research Institute is required to manage conflicts of interests as a condition of receiving federal funding for research.

If you held a research role at MedStar in fiscal year 2020 (FY20), you may have already entered data into the COISmart system during the fiscal year. If you have completed the questionnaire as a researcher during FY20, a link to the conflict of interest disclosure will be sent to you in July. You will be required to ensure that the disclosure on file for FY20 accurately reflects any external relationships you have for the entire fiscal year. When you receive that email in July, please follow the link in that email to certify your previous disclosure if it already reflects all external relationships you have had during FY20. Use the “revision” links in the questionnaire to update your answers if necessary and resubmit the questionnaire to ensure that it accurately reflects a full fiscal year of reporting (July 1, 2019, through June 30, 2020).  As a researcher, the FY 2021 questionnaire is also available for you to complete between July 1, 2020, and June 30, 2021.

If you have any questions about the conflict of interest policy or accessing the COISmart system to make disclosures, contact Christine Kyak, Entity Compliance Officer at (202) 510-6876 or Christine.R.Kyak@medstar.net.

A collaborative team of researchers from across MedStar Health and partners published their work to assess the effect of race on in-hospital outcomes of takotsubo cardiomyopathy (TC) in a large nationwide sample. The team included investigators from MedStar Washington Hospital Center, MedStar Health Research Institute, MedStar Heart and Vascular Institute, Georgetown University, and National Heart, Lung and Blood Institute.

“Racial Differences in Takotsubo Cardiomyopathy Outcomes in a Large Nationwide Sample” was published in ESC Heart Failure. Takotsubo Cardiomyopathy or stress-induced cardiomyopathy is characterized by transient ventricular impairment, often preceded by emotional or physical stressors. Gender, racial, and ethnic differences have been reported with respect to incidence and prognosis of cardiovascular diseases including heart failure and acute myocardial infarction, in part due to variability in genetic, biological and socio-economic factors. Studies have reported increased in-hospital complications in African American patients presenting with TC; however, the effect of race on TC remains unknown

The research included data obtained from the National Inpatient Sample (NIS) database. Of 97, 650 patients included: 83,807 were women; 89, 624 identified as Caucasian; 8,026 identified as African American. Between the two races, demographic characteristics and insurance variables were significantly different.  African American patients were younger, having a higher percentage of men and lower median household income. The rate of TC hospitalizations increased in both races. Mortality rates initially increased from 50 cases (1–2%) to 340 cases (5–6%) and subsequently remained stable around 5–7% with fluctuations but with no overall significant difference between races.  Multivariate regression models were created to adjust for potential confounders.

In unadjusted analysis, African American patients had more cardiac arrests, invasive mechanical ventilation, tracheostomies, acute kidney injuries, and longer hospital stays compared with Caucasians.  After the adjustment for differences in age, gender, comorbidities, hospital location/teaching status, and socio-economic factors, all differences were significantly reduced or eliminated. The adjusted risk was lower in African Americans compared with Caucasians, for cardiogenic shock, mechanical ventilation and intra-aortic balloon pump insertion.

The research concluded that African American patients overall have worse outcomes including longer hospitalizations, higher rates of cardiac arrests, invasive mechanical ventilation, tracheostomies, and acute kidney injury compared with Caucasians. Overall, African American patients have more in-hospital complications; however, the differences are driven by racial disparities in demographics, comorbidities, and socio-economic factors.

The team included Raja Zaghlol,MD; Ana Barac, MD; Amit K. Dey; and Sameer Desale.

ESC Heart Failure, 2020.  DOI: 10.1002/ehf2.12664

The 4th of July holiday weekend is coming up, and many people will be spending their time outside in the sun. Whether you plan on having a backyard barbeque, swimming in the pool, or going out on a boat, taking action to protect your skin, along with practicing proper social distancing, should be a top priority.

In the U.S., more people are diagnosed with skin cancer than any other kind of cancer, according to the American Cancer Society. Since most skin cancers develop as a result of exposure to harmful ultraviolet (UV) rays, taking steps to protect your skin in the sun can help you reduce your risk of skin cancer.

It’s important to use sun protection while enjoying the benefits of getting outside.

Our skin makes vitamin D naturally when it’s exposed to the sun, which can positively impact our body’s mental and physical function. In fact, Vitamin D can help to boost your immune system and improve your mood by increasing serotonin levels in the body. Still, there are many dangers to the sun, which is why most doctors recommend getting vitamin D from what you eat or supplements.

While there are many benefits to getting outside, the sun’s UV rays can be harmful if we don’t take precautions to protect our skin in the sun. The sun gives off two different types of UV rays, both of which can be dangerous:

• UVA rays are responsible for sunburn, hyperpigmentation, and skin cancer.
• UVB rays can contribute to skin aging and skin cancer.

While both types of UV rays can negatively affect the skin, UVB rays are more likely to cause skin cancer, including melanoma.

Factors affecting UV exposure.

It’s important to protect your skin from both types of UV rays because neither one is safe. And, your environment can impact how strong they are. The following factors can impact how much your skin is exposed to UV rays:

• The time of day: 10 am to 4 pm is when UV rays are strongest.
• Distance from equator: The closer you are to the equator, the stronger the UV rays are.
• Elevation: Higher elevation means more exposure.
• Reflection off surfaces: Sand, snow, and water may reflect sunlight, increasing UV ray exposure.
• Length of time: The longer your skin is exposed, the greater your risk.

By taking the right steps to protect your skin in the sun, you can reduce your risk of getting skin cancer—and prevent premature skin aging, like wrinkles, dark spots, and leathery skin.

How to protect your skin in the sun.

Even if it’s not sunny, your skin is still exposed to harmful UV rays any time you’re outside. Here are seven simple ways you can limit your UV exposure and protect yourself in the sun.

1. Choose the right type of sunscreen.

Sunscreen is an effective way to minimize your risk of skin cancer and signs of early skin aging caused by the sun. Except for babies under the age of six months, everyone should wear sunscreen anytime they’re outdoors. When picking a sunscreen, it’s important to choose the right kind. The American Academy of Dermatology also recommends selecting a sunscreen that is:

• A broad-spectrum option, offering protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays.
• Sun protection factor (SPF) of 30 or higher.
• “Water-resistant”.

Keep in mind that while sunscreen can be “water-resistant”, it is not waterproof or sweatproof. As a result, it’s important to reapply frequently, especially if you are swimming or sweating.

2. Apply and reapply sunscreen regularly.

The way you apply sunscreen impacts how effectively it protects your skin. The best way to apply sunscreen is to lather it on 15 to 30 minutes before you expose your skin to the sun. That’s about how much time it takes for your skin to absorb it. After you apply, wait 10 to 20 minutes to avoid accidentally rubbing off the sunscreen. You can reduce your risk of sunburn by reapplying every two hours—or sooner if you’re swimming.

How much sunscreen do I need to apply?

Following the “teaspoon” rule is a great way to ensure you’ve used enough sunscreen to protect uncovered skin. The “teaspoon rule” suggests applying a teaspoon-sized amount of sunscreen according to these guidelines:

• One teaspoon on your face and neck.
• One teaspoon on each arm.
• Two teaspoons on your front torso.
• Two teaspoons on your back.
• Two teaspoons on each leg.

3. Wear protective clothing.

Covering up in clothing is a great way to minimize your exposure to UV rays, but different types of clothing offer varying levels of protection. The following types of clothing offer the most protection:

• Thicker fabrics (e.g. denim) compared to thin fabrics (e.g. cotton)
• Darker colors
• Dry fabrics

4. Cover your head with a wide-brimmed hat.

Hats with brims at least three inches in diameter are an effective way to limit your face’s exposure to UV rays. Baseball caps or other hats with a narrower brim may not protect all of the areas on your face that may be exposed to the sun, like your ears, nose, and neck.

5. Protect your eyes with sunglasses.

Sunglasses are important for protecting your eyes and the skin around your eyes from the sun. It’s hard to judge how well a pair of sunglasses can protect you from the sun just by looking at the color of the lenses. Instead, look for sunglasses that say they block 99% or 100% of UVA and UVB rays.

6. Avoid the sun during peak hours.

The sun’s UV rays are strongest between the hours of 10 am and 4 pm. Try to stay in the shade if you must be outside during that time of day—or avoid it altogether, if you can. Friday July 3 is also National Stay Out of the Sun Day, a day when staying indoors is encouraged to give your skin a break from the sun. But you don’t have to just lay around and watch Netflix all day to participate. You can relax in the shade, do an in-home workout, play a board game with family, anything that doesn’t involve being in the sun.

7. Seek shade wherever you can.

Staying under shade can be a great way to get outside while limiting your UV exposure. Whether you seek shelter under a tree or set up a tent on the beach, it’s important to find shade, especially during the sun’s strongest hours. This is especially true for babies who should avoid any unnecessary sun exposure. Babies younger than six months should always be protected from the sun with strollers, hats, and umbrellas.

What to do if you get a bad sunburn.

Most cases of sunburn are mild to moderate, which can be uncomfortable. Ibuprofen, aloe vera gel, or cold compresses can help to minimize swelling and pain while it heals. If you have any blisters, avoid picking them open. If they do rupture, clean them with soap and water and cover with a wet dressing to avoid any infection.

In more severe cases that result in vomiting, fever, or disorientation, you may need to seek medical attention from an urgent care center.

You don’t have to stay indoors altogether, but being cautious can help you protect your skin and minimize your risk of skin cancer. Limit unnecessary sun exposure by correctly applying sunscreen, covering up with clothes, hats, and sunglasses, and staying in the shade.

Get the care you need, now.

It’s important that you don’t delay your medical needs or ignore symptoms that would typically make you seek care. Early detection and treatment improve our ability to provide the most comprehensive and effective care.

Since the COVID-19 pandemic reached our region, MedStar Health has made innovations to ensure we are still the best and safest place to receive care.

We have worked hard to make sure we can provide the care you need in the most appropriate and safe setting. MedStar Health Video Visits are still options for a variety of appointment needs, but in some cases, an in-person visit may be best. We’re here to help you get the right care that reflects your needs and comfort level.

We’re open and prepared to safely offer the same high-quality care you expect from MedStar Health, when you are ready to see us.

This is an updated version of an article previously posted on May 20, 2020.