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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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  • May 03, 2020

    By MedStar Health

    Theresa Moriarty was awarded the SPIRIT of Excellence Award for the first quarter of 2020 during MHRI's April virtual town hall meeting.

    Theresa, known as Terry, is a Research Nurse Coordinator for MedStar Clinical Research Center at MedStar Health Research Institute. She was selected by our Executive Committee, based on KUDOS submissions during the first quarter (January through March) of 2020. 

    Ron Migues, Executive Director for MedStar Medical and Surgical Research Network said “Terry knows the protocols inside and out, back and forth. You truly are a role model associate and are someone any member of the team can look up to and for guidance.” 

    Terry was recognized for her excellent work in support of the many clinical trials she puts her all into and for always being a true team player and making herself available to assist where needed.  There were a number of KUDOS submitted that spoke highly of Terry and make this award well deserved:

    • “Terry, I truly want to thank you for all the time and work spent on teaching me to become a research nurse. There is not a better mentor/ teacher/ preceptor that I could have worked with.”
    • “Terry I cannot thank you enough for your dedication and guidance during this very difficult time.  I really don't know how we could have pulled it off without you.”
    • “Terry, you are a great help, and prompt to reply back. You are an awesome team player. I can always count on you. MHRI should be very proud of you.”
    • "Terry, you deserve all the kudos for leading the charge getting the Regeneron-sponsored COVID-19 clinical trial going, on the ground. You have made MedStar proud being counted amongst the top enrolling sites for the study, all because of your tireless commitment to seeing to the success of this study at MWHC/MHRI. This has been an example for the rest of us on the team to follow, and we will work as diligently as you have shown to make sure your outstanding contribution is not in vain."
    • “Theresa, thank you for all of your assistance with pre-screening patients for SELECT. You are appreciated”
    • “Thanks, Terry, for your continued excellent work in support of the Sarilumab study and your consideration for co-workers and patients.  You consistently display the highest level of compassion and professionalism in all that you do.  Your willingness to do whatever is required to ensure that studies you are involved with are conducted in accordance with the highest ethical and professional standards is a model for us all.”

    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. 

    Terry, thank you for your dedication  to advancing health and your commitment to MedStar Health's SPIRIT values. You are part of what makes MedStar Health great!

     

  • May 03, 2020

    By MedStar Health

    Congratulations to all MedStar researchers who had articles published in April 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.

    1. Pertuzumab, Trastuzumab, and Docetaxel for HER2-positive Metastatic Breast Cancer (CLEOPATRA): End-Of-Study Results From a Double-Blind, Randomised, Placebo-Controlled, Phase 3 Study

      The Lancet Oncology, 2020. DOI: 1016/j.ajem.2020.04.035

      Swain SM, Miles D, Kim SB, Im YH, Im SA, Semiglazov V, Ciruelos E, Schneeweiss A, Loi S, Monturus E, Clark E, Knott A, Restuccia E, Benyunes MC, Cortés J; CLEOPATRA study group.

    1. Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Proximal Scaphoid Reconstruction

      Journal of Hand Surgery, 2020. DOI: 10.1016/j.jhsa.2019.08.008

      Pet MA, Assi PE, Yousaf IS, Giladi AM, Higgins JP.

    1. MitraClip 30-day Readmissions and Impact of Early Discharge: An Analysis From the Nationwide Readmissions Database 2016

      Cardiovascular Revascularization Medicine, 2020. DOI: 1016/j.carrev.2020.04.004

      Case BC, Yerasi C, Forrestal BJ, Wang Y, Musallam A, Hahm J, Torguson R, Ben-Dor I, Satler LF, Rogers T, Waksman R.

    1. A Philosophical Approach to the Rehabilitation of the Patient with Persistent Pain

      American Journal of Hypnosis, 2020. DOI: 1080/00029157.2019.1709152

      Appel PR.

    1. Timing of Intervention May Influence Outcomes in Blunt Injury to the Carotid Artery

      Journal of Vascular Surgery, 2020. DOI: 1016/j.jvs.2019.05.059

      Blitzer DN, Ottochian M, O'Connor JV, Feliciano DV, Morrison JJ, DuBose JJ, Scalea TM.

  • May 03, 2020

    By MedStar Health

    A new issue brief was released by the Agency for Health Research and Quality (AHRQ) as part of their contract with MedStar Health and partners, focused on developing additional capacity related to understanding and improving diagnostic safety.

    Operational Measurement of Diagnostic Safety: State of the Science is an issue brief from AHRQ’s Patient Safety Program, reports that although few healthcare organizations have implemented systematic measurement of diagnostic errors, nearly all can use existing resources to monitor diagnostic safety for learning and improvement. Diagnostic errors affect approximately 1 in 20 U.S. adults each year, and reducing their incidence is an AHRQ priority. The issue brief includes a “call to action” for healthcare organizations to begin measurement efforts using data sources currently available to them to identify and learn from diagnostic errors.

    This issue brief was authored by Hardeep Singh, M.D., M.P.H. and Andrea Bradford, Ph. D from the Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX. and Christine Goeschel, Sc.D., RN, FAAN, MedStar Health Institute for Quality and Safety, AHRQ Patient Safety Learning Lab Grantee, and AHRQ National Advisory Council member. Dr. Goeschel is also a Professor of Medicine at Georgetown University.

    “Measurement of diagnostic performance is necessary for any systematic effort to improve diagnostic quality and safety, yet the development of diagnostic safety measures remains in its infancy. Our intent is to provide pragmatic and feasible ways for organizations to start using measurement to identify, prioritize, and address local diagnostic safety opportunities.” said Dr. Goeschel.

    The issue brief has been accepted for publication in the peer-reviewed journal Diagnosis.

    This work is part of a multi-year MedStar AHRQ ACTION contract that funds work and expertise related to building capacity to improve diagnostic safety and clinical quality. MedStar Health has partnered with Dr. Singh and his team to develop novel resources, tools and programs aimed at reducing diagnostic errors and related patient harm. Read the press release on the contract here.

  • May 03, 2020

    By MedStar Health

    Researchers at MedStar Health sought to understand how communication between emergency medicine (EM) providers plays a critical role in delivering safe and effective care to patients. “Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication” led by A. Zachary Hettinger, MD, MS, from the MedStar Health National Center for Human Factors in Healthcare was published in The Journal of Emergency Medicine. This study identified communication needs of emergency medicine nurses and physicians, in particular, what information should be conveyed, by whom and the most appropriate time to convey the information based on the clinical scenario.

    The research used semi-structured focus groups and interviews to identify communication strategies and barriers associated with information sharing in emergency medicine. Nine EM nurses, eight EM attending physicians, and four EM resident physicians participated in five focus groups and one interview to address questions regarding how EM personnel use and share information about patients and clinical work, what information tends to be exchanged, and what additional information would be helpful to share.

    The interview sessions were audio recorded and transcripts were analyzed using a concept mapping approach. Eleven maps were developed to describe the role communication plays in patient outcomes comprised of: categories of information physicians needed from nurses and vice versa; methods of communication that could be utilized; barriers or obstacles to effective communication; strategies to enhance or ensure effective communication; and environmental or situational factors that impact communication.

    Participants described several communication-enhancing strategies and the research team produced ten strategies to help support effective nurse-physician communication. These strategies include:

    1. Communicate diagnostic assessment, plan of care and, especially, disposition plan to other team members as early as possible. Update the team of any changes to the plan.
    2. Communicate pending tasks/steps in the patient’s care as well as information regarding changes or holdups to tasks or orders.
    3. Communicate details regarding proactive diagnostic testing and therapeutic interventions.
    4. Don’t assume everyone has a shared understanding: recognized that you might have unique access to information and make sure that it is shared in a timely manner.
    5. Notify providers of any critical or unexpected changes in vital signs or patient status.
    6. Do not assume electronic orders substitute for verbal communication
    7. Use asynchronous communication for lower priority items to aid in prioritization.
    8. Adapt communication strategies based on team members’ experience level and existing relationships.
    9. Adapt communication strategies to the physical layout of the ED, especially in those facilities where nurses and physicians may have workstations out of sight from one another or where it is not obvious which staff members are on different care teams
    10. Use strategies that exploit provider experience level regardless of role hierarchy.

    The key findings of this study help provide insight on how to improve communication and patient care within the EM department. While the information needed by physicians and nurses was similar, discrepancies in knowledge occurred from timing of when a patient or family member was spoken to; differential access times to the EHR; complexities in information sharing among trainees, nurses, and physicians; or because each role may have had unique opportunities to access information.

    This research was supported by the Agency for Healthcare Research and Quality, United States (R01HS022542).

    The research team included A. Zachary Hettinger, MD, MS; Natalie Benda, PhD; Daniel Hoffman, BS; Akhila Iyer, MS; Ella Franklin, MSN, RN; R. J. Fairbanks, MD, MS from MedStar Health National Center for Human Factors in Healthcare in collaboration with researchers from Roth Cognitive Engineering; Department of Emergency Medicine, University of Florida, Jacksonville Medical Center; Department of Emergency Medicine, Georgetown University School of Medicine; and the Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York.

    The Journal of Emergency Medicine, 2019. DOI: 10.1016/j.jemermed.2019.10.035

  • May 01, 2020

    By MedStar Health

    Join MedStar Health in recognizing the work of our nurses during National Nurses Week, from May 6 to 12, 2020. As our nurses continue to care for patients in the new world with COVID-19, MedStar Health will be featuring some of our nurses’ stories on our social media accounts, as a way to highlight their above-and-beyond care and show our gratitude. Stories will be shared from all over the MedStar Health system.

    Because one week is not enough, the American Nurses Association will celebrate nurses for the entire month of May. In honor of the 200th anniversary of Florence Nightingale’s birthday, commonly considered the founder of modern nursing research, the World Health Organization has declared 2020 the International Year of the Nurse and Midwife. We want to celebrate and thank nurses throughout our system for their commitment to patient and associate care and wellness.

    Joan K. Bardsley, MBA, RN, assistant vice president at MHRI, serves as MHRI’s representative to MedStar’s Chief Nursing Council and the Nursing Research Council. Ms. Bardsley says, “Nursing needs are met from multiple perspectives. Our MHRI nurses have shown incredible flexibility and tenacity to ensure our research participants are safe. Our nurses are supporting COVID-19 projects that will help us learn more about this pandemic in the future. In addition, many have volunteered for projects to call associates with testing results and advising on follow up. It is gratifying that so many are having the opportunity to learn about what our nurses do in general and how they contribute to research.”

    During National Nurses Week, we would like to extend a special thanks to all our clinical research nurses, and all nurses in the MedStar Health system, as they continue to provide the highest level of quality care to our patients. They are critical in helping provide the best care to our community and are dedicated to advancing health. We appreciate you for what you do.

  • May 01, 2020

    By MedStar Health

    When you’re recovering from an injury or surgery, it’s common to see a physical therapist who can help you regain function and restore motion in your body. But did you know that there are many other reasons why you may need physical therapy (PT), even if you aren’t an athlete or bouncing back from an operation?

    Did you know there are many other benefits of #PhysicalTherapy other than recovery after injury or surgery? Physical therapist Jared Miller shares 8 ways PT can help #TreatPeople on the #LiveWellHealthy blog: https://bit.ly/2YkOogZ

    Click to Tweet

    A physical therapist is a healthcare specialist who can treat many lesser-known conditions beyond just sports-related injuries or post-operative therapy. They can provide evaluation and treatment in the clinic or often-times via video visit. Here are eight surprising reasons you may need physical therapy.

    1. Pelvic floor conditions.

    The pelvic floor consists of muscles and tissues that help men and women maintain correct posture as well as bladder, bowel, and sexual activity. When pelvic floor muscles are overused or injured, you may experience pain, incontinence, or other symptoms related to pelvic floor dysfunction (PFD). While it can be difficult to pinpoint the cause of pelvic problems, most frequently PFD occurs after childbirth, infection, injury, or trauma to the pelvis.

    Many people are surprised to know pelvic floor conditions can be diagnosed and treated by a physical therapist with advanced training in pelvic floor therapy. A pelvic floor specialist can help with the following:

    • Endometriosis
    • Menopause symptoms
    • Painful intercourse
    • Pelvic pain
    • Pregnancy and postpartum recovery
    • Urinary incontinence

    Although common, pelvic pain is not normal. If you’re experiencing pelvic pain, sexual dysfunction, or incontinence, a physical therapist specializing in pelvic floor therapy can help.

    2. Cervicogenic headaches.

    If you’ve experienced an ache that works its way from the base of your neck and up your head, then you know what it feels like to have a cervicogenic headache. Fortunately, a physical therapist may be able to provide relief through manual therapy and mobilization techniques that target tight neck muscles and restore motion. By releasing tension around the head and neck, many physical therapists are able to reduce or eliminate cervicogenic headaches. Most importantly, a physical therapist can address the cause of them and help you prevent them from coming back.

    3. Jaw pain.

    Temporomandibular joint dysfunction, called TMD, is a common cause of jaw pain that often results from poor posture and stress. If you have TMD, a physical therapist with advanced training in TMD can use manual therapy and targeted exercises to relieve pain and other symptoms from TMD, such as dizziness or trouble opening and closing the mouth. They can also help you improve your posture and positioning, especially for work-related activities that often worsen TMD symptoms.

    4. Vertigo.

    If you suffer from a false spinning sensation or dizziness, commonly known as vertigo, a physical therapist may be able to help. Often, vertigo is caused by something called benign paroxysmal positional vertigo (BPPV) which occurs when tiny calcium particles are dislodged in the inner ear. A physical therapist with specialized training in vestibular therapy can easily diagnose and correct BPPV using the Dix-Hallpike test and the canalith repositioning maneuver (CRM). This generally corrects the positioning, relieving vertigo and associated symptoms, such as nausea and pain.

    5. Balance issues.

    Watching people fall on “America’s Funniest Home Videos” may be cause for laughter, but the reality is that falls can be serious, especially as we age. That’s why physical therapy can play an important role in helping improve your balance and reduce your chances of fall-related injury. Whether you’re recovering from a stroke or taking preventative measures against falling, you may benefit from a fun, interactive balance program that will minimize your risk of falling and help you build confidence in your ability to move around safely.

    6. Rehabilitation after heart disease.

    If you’ve survived a heart attack or your heart has been weakened from coronary artery disease, cardiac rehabilitation is a critical part of recovery and getting you back to the activities you enjoy. During cardiac rehabilitation, you’ll work with a physical therapist to strengthen your heart, improve your cardiovascular fitness, and return to a high quality of life. Your plan will be tailored to your unique needs and goals so that when physical therapy is over, you’re prepared and motivated to maintain your healthy lifestyle.

    7. Arthritis.

    When you find that you’re having a harder time doing things you used to because of a loss of function or pain caused by arthritis, a physical therapist can help your body to get moving again. By strengthening the muscles surrounding the joints affected by arthritis, physical therapy can increase your mobility and strength, which improves your ability to participate in daily activities with fewer limits.

    8. General pain.

    If you’re living with body aches, especially before and after movement, a physical therapist may help you get moving again with less pain. Some people think that pain is normal as you age, but a physical therapist can help to relieve and maybe even eliminate your pain. Whether your knees hurt after squatting or you have lower back pain, physical therapy can help you regain strength and restore range of motion in the muscles affected by your pain. A trained physical therapist can also help retrain how you move to minimize pain in the future.

    Do you need physical therapy?

    If you could benefit from physical therapy, here’s what you need to know before you make an appointment.

    • Insurance coverage. In many cases, physical therapy is covered by major insurance plans. During COVID-19, most insurance providers are covering video visits for physical therapy. MedStar Health Physical Therapy can help you determine your coverage options.
    • Physician referral. Some insurance providers require a physician referral for physical therapy. If you do not have one, we are happy to arrange a convenient video visit with a MedStar Health physician specialist, at no cost to you.
    • Decide on your goals. A physical therapist will help you determine what your goals are but it’s helpful to prepare ahead of time so that they can design a PT program that helps you get where you want to be.
    • Find the right physical therapist. Not all physical therapists are trained to treat every condition, so it’s important to find one who has specialized education and experience in an area related to your needs. MedStar Health will pair you up with a therapist who specializes in the care you need.

    In need of physical therapy? MedStar Health is here to help.

    MedStar Health Physical Therapy Locations

    MedStar Health Video Visits