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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.
    Click to Tweet

     

    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, 2021

    By Jennifer Son, MD

    Starting at age 40—or sooner, based on your personal and family health history—mammography should become a central tool in your annual health checkups. Your health care team will use your mammogram results year after year to:

    • Look for changes in your breast tissue over time
    • Spot suspicious lumps or masses early in the disease process
    • Check up on you after you’ve had breast cancer treatment
    Most women are familiar with screening mammography, an annual exam in which we check for suspicious lumps, masses, or changes in your breast tissue from year to year. Getting a mammogram each year helps us detect changes sooner. That means we can rule out breast cancer faster—or catch it at an earlier, more treatable stage.

    If your screening mammogram shows suspicious tissue, we’ll order a diagnostic mammogram to get a closer look at the size, shape, and location of a mass or lump. We can zoom in on specific areas of your breast to help your doctor decide whether you might need a biopsy—taking a small sample of suspicious tissue to test for cancer.

    Diagnostic mammography results, combined with other imaging tools, helps your doctor recommend treatment options. For example, I am a breast cancer surgeon, and my team relies on the information we get from diagnostic mammograms to plan effective breast cancer surgeries.  

    Who should get a screening mammogram?

    Age 40 and older with average risk of breast cancer.

    Women with no personal or known family history of breast cancer—should get a screening mammogram every year starting at age 40 through your senior years, until you and your doctor agree it is safe to stop.

    You should also have a clinical breast exam (CBE) by a health care provider every year. A CBE is when a doctor feels your breasts for lumps, divots, or other abnormal tissue problems.


    Age 29-39.

    Women in this group should get a CBE every year. Your doctor may recommend starting annual mammograms before age 40 if you are at increased risk for breast cancer.

    Risk factors include:

    • Family history of breast or ovarian cancer
    • Known genetic mutation associated with breast cancer, such as BRCA1 or BRCA2 mutations
    • Radiation exposure in childhood
    • Personal history of breast or another type of cancer

    If you had breast cancer in your 20s or 30s, it is important to get a diagnostic mammogram and a CBE every year to check for changes in your breast tissue.

    Women with a family history of breast cancer—a mother, aunt, or sister—may also need annual mammograms before age 40. Talk with your doctor about when you should start getting mammograms and how often.

    Please note: Breast self-exams (BSEs) are not a safe substitute for clinical breast exams or mammography. Only advanced imaging can detect small growths or tissue changes deep in the breast. However, it is important to know your own body, and BSE can help you detect lumps or tissue changes between mammograms.

     

    Breast self-exams are not a safe substitute for clinical breast exams or #mammography. While it is important to know your own body, getting an annual #mammogram can detect small #BreastCancer tumors deep in the breast: https://bit.ly/2YxTY1Z.
    Click to Tweet


    High-tech imaging can be comfortable!

    Getting a mammogram is no longer the tedious, uncomfortable experience it used to be. Modern equipment and streamlined scheduling have made getting this important exam quicker and more comfortable than ever before.

    Our high-tech mammography equipment delivers clearer imaging, which reduces unnecessary follow-up visits—if we call you back to the office, it’s because we’ve seen something that warrants a closer look.

    Two of our new machines are giving patients better experiences with less time spent in the clinic:

    • SmartCurve™ Mammography is a revolutionary machine that gives 93% of women a more comfortable 3D mammography experience. The machine’s paddles are curved to fit your breast, which more evenly distributes pressure and reduces pinching. You can get clear, precise imaging while spending less time in the exam.
    • Intelligent2D delivers 2D reconstructed images, which show us fine details in the tissue layers of your breasts. Using these images, we can see subtle changes in your breast tissue and potentially detect lesions earlier.

    What to expect at your screening mammogram.

    A nurse will take you to a private screening room and give you a poncho-like garment to wear. An imaging specialist will help you position your breast between two thin, plastic paddles that are curved like a breast.

    The paddles will firmly but gently flatten your breast temporarily while the machine takes images of your breast tissue. It shouldn’t hurt but you might feel a little pinching or discomfort. After a minute or so, the machine will release, and we’ll repeat the process on your other breast.

    After the exam, a nurse will call you within 24-48 hours to discuss your results. If your imaging is normal, that’s all you need to do, and we’ll see you next year! If your mammogram reveals a suspicious lump or growth, we will ask you to come back for advanced imaging.

    Unusual imaging does not automatically mean you have breast cancer—you may have healthy-but-lumpy or dense breast tissue that requires advanced imaging. But if you do have cancer, your doctor will talk with you about your treatment options. When caught early, breast cancer is highly treatable. Your dedicated team of breast cancer experts will work together to give you the very best breast cancer care, which may include a combination of chemotherapy, radiation therapy, and/or surgery.

    How breast surgeons use diagnostic mammogram results.

    When we look at your imaging prior to surgery, we are looking for abnormal calcifications or abnormal shapes in the breast tissue. Having calcifications does not mean that you have breast cancer, but it can indicate changes in your breast tissue over time—another reason to get a mammogram each year.

    If your diagnostic mammogram clearly shows a mass, we use the results plus more advanced imaging to analyze its size and location. Mammogram results help breast surgeons determine which advanced imaging tests we need to order for surgical planning, such as:

    • Ultrasound allows us to examine nearby lymph nodes to which the cancer may have spread.
    • CT scans can help us determine whether the cancer has spread to far away lymph nodes or organs.
    • Breast MR, a non-invasive, radiation-free imaging tool, can give us a better view of dense breast tissue, which helps us create a map of your breast for surgery.

    Mammography’s role after breast cancer surgery.

    The American Cancer Society does not have specific guidelines for mammography after breast cancer surgery. The types and extensiveness of surgeries vary, as do patients’ personal needs and risk factors.

    MedStar Health patients typically see their surgeon for follow-up six months after breast cancer surgery. Then, we will want to see you each year for five years post-surgery—the highest risk period for cancer to return. Diagnostic mammograms may be part of your follow-up care, depending in part on the type of surgery you had:

    • Full mastectomy with or without reconstruction: You are done with mammograms for the rest of your life. Generally, women with fully reconstructed breasts do not have enough remaining tissue to warrant mammography. However, you will need regular physical exams to ensure no tumors develop in your chest tissue.
    • Unilateral mastectomy: If you had one breast removed, you will need an annual mammogram of the remaining breast and a regular exam of the chest tissue that remains after surgery.
    • Lumpectomy: If you had just the diseased portion of one or both breasts removed—which is the procedure 60-70% of our patients choose—you’ll need a diagnostic mammogram annually.

    We can schedule your surgical follow-up visits and mammograms for the same day so you can get the care you need in fewer trips. Your surgeon will work with the radiology team to ensure you get the most accurate imaging exams.

    Though getting a mammogram isn’t anyone’s idea of fun, it’s an essential exam to protect your breast health. If you feel a suspicious lump, don’t wait until your next well-woman visit to get it checked out. Schedule a mammogram—it’s better to know than to leave a potential tumor untreated.

     

    Time for a mammogram?

    Click the button below to schedule an appointment or learn more.

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  • October 02, 2021

    By MedStar Team

    Collaborative research from MedStar Health Research Institute, MedStar Washington Hospital Center, Georgetown University School of Medicine and the Rutgers New Jersey Medical School evaluated trends in the number of patients with positive substance use screens and those presenting with a clinical diagnosis of acute alcohol or substance intoxication/overdose in the Emergency Departments (EDs) of the MedStar Health system before and after the first wave of the COVID-19 pandemic (March 2019-2020, April 2020-June 2020). “Impact of COVID-19 pandemic on emergency department substance use screens and overdose presentations” was published in The American Journal of Emergency Medicine.

    The health system utilizes a validated screening program for substance use, Screening, Brief Intervention, and Referral to Treatment (SBIRT), for emergency department patients who are clinically stable and willing to complete screenings. SBIRT is a comprehensive public health approach to deliver intervention and treatment for individuals who are at risk for or who currently use alcohol or other substances.

    The retrospective chart review included all emergency visits data from seven EDs. The results showed that out of 107,930 screens performed in the EDs, positive SBIRT screens increased from 12.5% to 15.8% during COVID. Alcohol intoxication presentations increased as a proportion of positive screens from 12.6% to 14.4%. A higher percentage of screened patients reported problem drinking during the pandemic (2.4% pre vs 3.2% post). Substance intoxication/overdoses among all screened increased from 2.1% to 3.1% and as a percentage of positive screens during the pandemic (16.8% to 20%). The proportion of opioid vs. non-opioid overdoses remained unchanged before (67%) and during the pandemic (64%).

    The study team concluded that there was a significant increase in positive substance use screens and visits for acute overdose and intoxication during the first wave of COVID-19 in the EDs. With the increase in substance abuse associated with the COVID-19 pandemic, there is a need to expand the already limited availability of resources for substance use disorders, early intervention, and treatment. Additional focus is needed to increase access to these resources for patients with substance use disorders.

    The research team included Maryann Mazer-Amirshahi, PharmD, MD, MPH, PhD, from MedStar Washington Hospital Center; Mihriye Mete, PhD and Sameer Desale, MS from MedStar Health Research Institute; Kira Chandran and Nikash Shankar from Georgetown University School of Medicine and Lewis Nelson, MD from Rutgers New Jersey Medical School.

    The American Journal of Emergency Medicine, DOI: 10.1016/j.ajem.2021.08.058

  • October 02, 2021

    By MedStar Team

    In her first federal award (AHRQ R21), Jessica E. Galarraga, MD, MPH will study, “An EHR-Based Screening Tool to Support Safe Discharges of COVID-19 Patients in the Emergency Department”. This study will develop a screening tool with electronic health record data using artificial intelligence/machine learning techniques to predict the risk of emergency department return and associated morbidity or mortality for COVID-19 patients. By developing a health IT solution that combines the use of natural language processing with a decision support tool, Dr. Galarraga seeks to turn unstructured clinical data into knowledge that can be applied to practice.

    Oftentimes emergency clinicians must make rapid clinical decisions with limited information, which has heightened due to the challenges of COVID-19. Using predictive modeling with natural language processing and machine learning techniques can leverage the data-rich environment of the emergency department to improve the quality of care delivered to patients with COVID-19. This study has three aims: 1) Iteratively develop a concept map using mixed methods which will serve as the ontology categorizing predictive factors for COVID-19 emergency department returns and inform machine learning model development; 2) Develop and evaluate machine learning algorithms predictive of emergency department return risk for COVID-19 patients; 3) Prospectively validate a COVID-19 emergency department return screening tool (CERST) using real-time data.

    This study will generate findings to improve the quality of care for COVID-19 patients in the emergency department. Findings will also be used to further optimize machine learning model, operationalize CERST as an EHR-integrated tool to support COVID-19 emergency department disposition decisions, and evaluate CERST’s performance on patient outcomes. Future studies will also employ mixed methods to develop guidelines on interventions by clinical and care transition staff using the tool to prevent emergency department returns and adverse outcomes among COVID-19 patients.

    The study team hypothesizes that developing and operationalizing the proposed COVID-19- emergency department return screening tool (CERST) can help emergency department clinicians avoid premature discharges and engage in evidence-based discussions with COVID-19 patients regarding discharge plans. It may also reduce strain on hospital capacity by identifying patients safe for discharge and reserving resources for higher-risk COVID-19 patients.

  • October 02, 2021

    By MedStar Team

    The MedStar Health Teaching Scholars Program and the MedStar Health Research Scholars Program are entering their 13th and 8th year, respectively. These programs provide multi-faceted educational support and mentorship to our clinical faculty as they develop their academic and research career pathways. Many of our alumni have successfully demonstrated their accomplishments through publications, national presentations, grant funding and more. All of their scholarly activities are highly influential on their professional well-being while also bringing well-deserved recognition to them individually, to MedStar Health, and to their home departments and institution/hospital.

    While we recognize the value of these programs, we also know the challenges of finding dedicated scholarly time in an environment that is often focused on clinical productivity. We are therefore very excited to share with you that we have secured funding for the programs to support 20% of scholars’ salaries to ensure they have the dedicated time to focus on their research/academic endeavors. This dedicated time will result in an actual amendment to their employment agreement.

    The next cohort of scholars will begin in January 2022. Of note, for this transitional year, scholars enrolled in either program will need to commit for approximately 2.4 years (as opposed to the 2.0 years) as we make schedule adjustments and use the extra time to ensure success and sustainability. Applications for this new cohort are due October 29, 2021.


    MedStar Health Teaching Scholars Program - Apply Here

    MedStar Health Research Scholars Program - Apply Here
  • October 02, 2021

    By MedStar Team

    Over the past year, our research team Dr. Thomas Fishbein, Dr. Khalid Khan and Dr. Alexander Kroemer from the MedStar Georgetown Transplant Institute has been working to develop a therapeutic to treat mild to moderate COVID-19 with the aim of reducing symptoms, eliminating disease progression, and preventing hospitalization.

    The research team were initially motivated by the vulnerability of their immunocompromised transplant patients to COVID-19. The team demonstrated that SARS-CoV-2 infection results in acute inflammasome and caspase-1 activation – which in patients with existing chronic disorders leads to inflammatory cell death and subsequently both hyperinflammation and adaptive immune dysfunction. The team was able to identify a compound that could inhibit caspase-1 activation and thereby potentially attenuate the devastating immune effects of COVID-19.

    With sponsorship from MedStar Health and in partnership with the MedStar Health Research Institute, the team has overseen the manufacturing of the drug, designed a clinical trial, and secured Investigational New Drug (IND) clearance from the FDA on September 24th.

    The Phase 2, double-blind, placebo controlled, randomized, proof of concept trial will investigate the safety and treatment effect of the caspase-1 inhibitor belnacasan. Starting in mid-October, high-risk outpatients who present to MedStar Washington Hospital Center and MedStar Franklin Square Hospital with mild to moderate COVID-19 symptoms will be offered the opportunity to enroll in the trial under principal investigators Drs. Glenn Wortmann and Christopher Haas at their respective institutions.

    This is the first time in MedStar Health history that the organization is serving as the sponsor in a commercial drug development program. If effective, the tablet being investigated would fill a key gap in the COVID-19 therapeutic arsenal as it can be taken orally and is more targeted than current, broad-based immunomodulatory treatments.

  • October 02, 2021

    By MedStar Team

    Congratulations to all MedStar researchers who had articles published in September 2021. 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.

    Effects of Maryland's global budget revenue model on emergency department utilization and revisits.
    Academic Emergency Medicine, 2021. DOI: 10.1111/acem.14351
    Galarraga JE, DeLia D, Huang J, Woodcock C, Fairbanks RJ, Pines JM.

    Beyond burnout: Understanding the well-being gender gap in general surgery by examining professional fulfillment and control over schedule
    The American Journal of Surgery, 2021. DOI:10.1016/j.amjsurg.2021.08.033
    Mete M, Dickman J, Rowe S, Trockel MT, Rotenstein L, Khludeney G, Marchalik D.

    Making Patient Safety Event Data Actionable: Understanding Patient Safety Analyst Needs
    Journal of  Patient Safety, 2021. DOI: 10.1097/PTS.0000000000000400
    Puthumana JS, Fong A, Blumenthal J, Ratwani RM. 

    Endocrine Surgery Patients' and Providers' Perceptions of Telemedicine in the COVID Era
    Journal of Surgical Research, 2021. DOI: 10.1016/j.jss.2021.07.018
    Zheng H, Rosen JE, Bader NA, Lai V.