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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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  • June 11, 2019

    By Erin A. Felger, MD

    The adrenal glands, located right above the kidneys, produce hormones that are critical to your health and well-being. Everyone is familiar with adrenaline, and it is one of the main hormones that the adrenal gland produces.

    The adrenal glands respond to signals from the nervous system and secrete hormones—including cortisol, metanephrines, and aldosterone—that regulate stress, help maintain metabolism, and distinguish male and female physical and sexual characteristics.

    Adrenal surgery often is necessary when you’re either producing too many or not enough adrenal hormones. This can be because of a growth on the adrenal gland. Read on to learn about adrenal gland tumors so you can spot the signs and seek the treatment you need.

    LISTEN: Dr. Felger discusses adrenal surgery in the Medical Intel podcast.

    Diagnosing Adrenal Tumors

    Most growths on the adrenal glands are not cancerous but may produce hormones that can influence the patient’s blood pressure or response to stress.

    An adrenal tumor is considered a functional tumor if it’s producing too many hormones. You may be experiencing:

    If the adrenal tumor is not producing hormone, you likely won’t have any symptoms at all. Functional tumors are very treatable. Adrenal tumors that are cancerous are rare and usually grow from a cancer that started in a different organ.

    There are several methods used to diagnose your adrenal tumor, including:

    • Blood and urine tests: Show levels of hormones that may signal the presence of a functional adrenal tumor.
    • Imaging: A CT scan or MRI scan can show whether a tumor exists and determine location and size.
    • Metaiodobenzylguanidine scan: This is administered over two days. On the first day, a patient gets an injection of a radioisotope that attaches to tumor cells and a scan is taken. We repeat the scan the following day.
    • Gallium Dotatate Scan: This scan is done in one visit and involves a newer radioisotope to identify some adrenal tumors.
    • Adrenal vein sampling: This helps determine which of the adrenal glands is overproducing hormones.

    After the diagnosis, you’ll have a consultation with your surgeon and complete necessary steps prior to surgery, which usually include labs, electrocardiogram (ECG or EKG), physical, extra imaging, and any clearances that need to be made by other physicians.

    Treating Adrenal Tumors

    Treatment is based on where the adrenal tumor is located, its size, and whether it is functional or not. Some patients will be treated with open surgery, which is traditionally used for larger adrenal tumors or tumors that are attached to other nearby organs.

    We also offer two minimally invasive procedures: laparoscopic and retroperitoneal approaches. Laparoscopic adrenal surgery is done from the patient’s belly side, and it includes using a camera, small instruments, and small incisions to remove the adrenal gland and the tumor. Retroperitoneal adrenal surgery also uses a camera, small instruments, and small incisions, but we perform this procedure from the patient’s back.

    Recovery is very straightforward for adrenal procedures that are done laparoscopically or retroperitoneally. You’ll be able to eat, walk, and take part in most regular activities shortly after surgery except for heavy lifting.

    Depending on the type of adrenal tumor you have, you may need to follow up with your endocrinologist to adjust medications. You also may need further imaging studies and potentially treatment if cancer is involved.

    Our adrenal patients benefit from the team approach we use at MedStar Washington Hospital Center. They can see our endocrinologists and have their nuclear medicine studies done, then follow up with the surgical team. We have a high volume of adrenal surgeries with many successful outcomes.

    An Adrenal Surgery Success Story

    I treated one young man who had excessively high blood pressure and was taking multiple medications. His symptoms were affecting his daily life. His doctor did a full workup and found an adrenal tumor on one side. The patient’s doctor referred him to me.

    After I examined this young man, we had a good discussion about the operation to remove the adrenal tumor. I explained to him that it would hopefully help his high blood pressure, but it might not completely cure it.

    He had the operation and did very well during the surgery and afterward. At his post-operative visit, he was off all his blood pressure medications. He was thrilled to be back to the usual activities that he’d been unable to take part in prior to surgery.

    The adrenal gland is critical to your body’s normal function. Through our team-based approach to identification and treatment, we can help more patients overcome these tumors and get back to their healthy lives.

    To request an appointment with an endocrine surgeon, click below or call 202-877-3627.

    Request an Appointment

  • June 07, 2019

    By MedStar Health

    There are all kinds of reasons to pursue a career in medicine. For Victoria Lai, MD, MS, the motivation was relatively simple: “I just wanted to help people,” the New York City native says.

    But Dr. Lai’s discipline, endocrine surgery, is among the newest and most specialized in the overall field of surgery. Applying a variety of conventional and minimally invasive techniques, Dr. Lai treats benign and malignant disorders of the thyroid, parathyroid, and adrenal glands, as well as neuroendocrine tumors. The advent of transoral procedures allows many patients to be treated with no visible post-op scar.

    After Dr. Lai completed her undergraduate degree at Yale, she went to the Albert Einstein College of Medicine in New York, where she earned her medical degree and subsequently completed residency training in general surgery. Dr. Lai then went to the Medical College of Wisconsin for a fellowship in endocrine surgery.

    Endocrine Surgery’s Status as a Specialty

    Dr. Lai explains that for a relatively new specialty, endocrine surgery has become firmly established in a relatively short time.

    "We are getting more focused and versed in treatments, including those involving complex pathologies,” she says.

    In addition to using the latest surgical techniques to treat endocrine disorders, Dr. Lai also enjoys the field’s academic research aspects. To facilitate her pursuit of endocrine surgery research, Dr. Lai earned a Master of Science in Clinical and Translational Research from the Georgetown-Howard Universities Center for Clinical and Translational Science. The program seeks to speed the evolution and delivery of new scientific advances to health care.

    Dr. Lai hopes to make her own contributions to advancing the discipline, as she has a particular interest in outcomes and disparities research.

    “I’m particularly interested in researching disparities in surgical care and outcomes, and how they are influenced by various demographic factors,” Dr. Lai says. “Of course, better outcomes and other things that will benefit patients are always our top priorities.”

    Outside of Work

    The learning doesn’t end away from work. A voracious reader, Dr. Lai is particularly fond of non-fiction works, including the Alexander Hamilton biography by Ron Chernow, which inspired the hit Broadway musical, and former First Lady Michelle Obama’s recently published autobiography. She’s also taken a strong interest in the origins of creativity. Recent reads include Daily Rituals: How Artists Make Time, Find Inspiration and Get to Work by Mason Currey, and Bird by Bird: Some Instructions on Writing and Life by Anne Lamott.

  • June 06, 2019

    By Nicholas Paivanas,MD

    We often see patients who aren’t the type of people you’d expect to see in a cardiologist’s office. They’re not older folks with obvious risk factors for heart disease, such as obesity or diabetes. These are young, physically fit adults—often young men—who have been referred to us after having high blood pressure or other heart-related trouble with no apparent reason for their symptoms.

    Along with the usual tests, we’ve gotten into the habit of asking these patients if they’re currently taking any workout or pre-workout supplements, as patients often don’t think to note these items on their lists of current medications. Many times, they tell me they are taking one or more of these supplements.

    It’s important to note that not all supplements are bad; in fact, some can provide a powerful edge in workout routines. But due to the nature of supplements, it’s sometimes difficult to know exactly what you’re putting into your body, and very easy to suffer heart-related side effects from them if you’re not careful.

    Caffeine’s Effects on the Heart

    Almost invariably, if one of my patients is taking a pre-workout supplement, its ingredients will include caffeine or some other stimulant. Caffeine is included in many supplements taken before exercise because it makes you feel good, gives a slight sense of euphoria, and gives you a burst of energy during your workout.

    In moderation, caffeine is safe for your heart. Studies have found that it’s safe for adults to consume about 400 milligrams of caffeine per day. That’s the equivalent of the amount of caffeine in just over four 8-ounce cups of coffee, according to the U.S. Department of Agriculture (USDA).

    The problem with supplements, energy drinks, and other workout-related products, however, is that they often contain huge amounts of caffeine—far more than the USDA’s recommended daily limit in one concentrated serving. Some popular pre-workout supplements contain more than the USDA’s maximum dose of caffeine in just one serving.

    Consuming high doses of caffeine from pre-workout supplements, on top of your normal daily intake of caffeine in coffee, soda, or other sources, can lead to a number of heart-related side effects, including increased blood pressure (hypertension), which can raise your risk of a heart attack. It can also lead to palpitations and other heart rhythm problems. These effects can vary from person to person, which is why it’s important to discuss your pre-workout and workout regimen on an individual basis with your primary care doctor or a cardiologist.

    One dose of some #workout #supplements exceed the daily limit of #caffeine recommended by the @USDA, which can lead to high #bloodpressure #arrhythmia and other #heart-related side effects. Fuel your workout with natural foods from a healthy diet. https://bit.ly/31dQ36T via @MedStarWHC

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    Related Reading: How much caffeine is safe for you and your child

    What Else Is in Your Supplement?

    Unfortunately, supplements aren’t controlled or regulated by the Food and Drug Administration (FDA) as strictly as medications are, so we often don’t know exactly what they contain. This often makes it easier for supplements to cause harmful side effects that are challenging to track down due to hard-to-identify ingredients.

    When patients who are taking workout supplements come see me, I do a search of pharmacology references and medical literature to look for side effects other people may have experienced as a result of that specific supplement. For example, I had one patient who was experiencing vasospasms, a sudden contraction of the blood vessels that can reduce blood flow. As we talked about what medications and supplements the patient was taking, to our surprise we found that the patient was taking a number of supplements that are marketed as being heart healthy, but can also cause vasospasms. By eliminating the supplements that could lead to vasospasm, we were able to improve the patient’s symptoms.

    I’ve seen patients who have noticed many symptoms, whether heart-related or affecting other areas of the body, that ended up being related to their intake of workout supplements, such as:

    Replace Workout Supplements with Real Food

    I wish I could say there was a “magic bullet” out there—a single supplement you could take or one thing you could do to protect yourself from heart-related supplement side effects. But it takes patience and discipline to live a healthy lifestyle that complements your fitness routine.

    I believe that a natural approach is best, but I'm talking about real, wholesome foods, not supplements that often are ground up; concentrated; and sold to you in pill, powder, or drink form. If you can look at something on the shelf at your grocery store and know it’s a tomato, a carrot, or some other fruit or vegetable, that’s a natural product. If it’s hard to identify what ingredients originally went into the product because it’s in a pill bottle, I would treat that as a potentially powerful medicine, and check with your doctor before taking it.

    Another thing I tell patients is that moderation is key. Too much of any one thing is dangerous. It’s important to get a wide variety of vegetables, fruits, and other foods to boost your energy naturally and fuel a productive workout. When I was growing up, our parents and teachers used to tell us to “eat the rainbow.” That refers to having a plate that’s full of many colors of fruits and veggies, which means you’re getting a good balance of nutrients.

    If you find yourself craving a snack or wanting a little extra energy for your workout, reach for some nuts, especially almonds. Healthy, low-sodium nuts can boost your energy levels while cutting your cholesterol and lowering your blood pressure, and they’re pretty light on calories.

    Some of my patients take protein supplements for weightlifting because they want to build muscle. However, my advice is to put away the protein shake and increase the amount of natural protein in your diet. Good dietary protein sources include:

    • Chicken
    • Chickpeas
    • Eggs
    • Fish
    • Lentils
    • Milk
    • Peas

    Of course, many people take their supplements because they feel good from the energy boost they get to power through their workouts. However, if you’re doing a high-intensity, calorie-burning workout, carbohydrates are an excellent source of long-lasting energy. I know many fitness enthusiasts avoid carbs at all costs, but consider incorporating some healthy sources of unprocessed carbohydrates, such as:

    • Beans
    • Oatmeal
    • Starchy vegetables, such as potatoes, carrots, and squash
    • Whole-wheat bread

    Keep Yourself and Your Heart Safe While You Exercise

    As our country faces an ongoing obesity epidemic, which affects nearly 40 percent of the U.S. population, exercising and living a healthy, active lifestyle is essential. Just recognize that, when you incorporate supplements into your fitness routine, you are taking medications that have side effects. And because supplements aren’t as well-regulated as pharmaceutical drugs are, we often can’t say for sure what effects those supplements are having on your heart.

    Whenever possible, stick to natural foods as part of your overall wellness regimen, and ask your primary care doctor or cardiologist if you have concerns about how your workout routine might be affecting your heart.

    To request an appointment with a cardiologist, click below or call 202-877-3627.

    Request an Appointment

  • June 04, 2019

    By Cesar A. Torres, MD

    Have you noticed times when your loved one forgets about their typical television program or suddenly does not remember to pay their bills after years of doing so successfully? These can be common signs of dementia—a neurological condition that affects about 50 million people worldwide.

    Dementia develops when a neurotoxic protein called beta-amyloid accumulates as we age, which causes nerve cells in the memory centers of the brain (such as the hippocampus and temporal lobe) to die. As a result, people begin experiencing symptoms including:

    • Confusion
    • Difficulty reasoning or problem-solving
    • Limited social skills
    • Memory loss

    The most common risk factor for dementia is age, as dementia becomes more common as we get older. While it’s very rare to have the disease before the age of 60, seven percent of adults older than 60 do, and nearly 30 percent of those 85 and older do. Genetics also plays a role in the risk of developing dementia. Understanding its symptoms so your loved one can receive a diagnosis early can help protect them.

    LISTEN: Dr. Torres discusses dementia in the Medical Intel podcast.

    What Are the Types of Dementia?

    Dementia is mostly made up of four different types, which include:

    • Alzheimer’s disease: This is a neurodegenerative disease, meaning it occurs when brain cells continuously die over time. This is the most common type, making up about 60 to 80 percent of all cases.
    • Vascular dementia: This is when people have a blockage tin blood flow to the brain, which deprives the brain of the vital oxygen and nutrients it needs. This occurs mostly in people at higher risk of stroke because of diabetes and hypertension. This is the second most common type, making up about 15 to 20 percent of all cases we see.
    • Parkinson’s disease: This is a progressive central nervous system disorder that affects movement as well as cognition
    • Lewy body dementia: This occurs when protein deposits, called Lewy bodies, develop in nerve cells in the brain that affect memory, thinking, behavior, and movement.

    We’re also beginning to learn that brain trauma can predispose people to dementia later in life. In fact, we have seen chronic traumatic encephalopathy (CTE), a progressive degenerative disease of the brain that’s caused by concussions, in many individuals who play professional, high-contact sports.

    To diagnose dementia, geriatric or primary care doctors typically do initial screenings that include blood tests and neurological imaging via a computed tomography (CT) or magnetic resonance imaging (MRI) scan. If further screening is needed, they will refer you to a neurologist.

    Geriatric or primary care doctors usually diagnose #dementia through basic tests, which can lead to medication that slows down how quickly it affects your loved one. https://bit.ly/2QGTsGD via @MedStarWHC.

    Click to Tweet

    Is Dementia Treatable?

    Dementia unfortunately is irreversible at this time. Numerous researchers have attempted to identify treatments, but none have been successful. Medications are available, however, to slow down the progression of the disease. The most famous are donepezil, commonly known under the brand name Aricept; and memantine, commonly known under the brand name Namenda. Although these medications can work, people don’t automatically use them upon a dementia diagnosis. It is best to have a conversation with a doctor to decide whether the patient has reached the stage in which they would benefit from medication.

    Some people benefit greatly from medication, while others see less of a benefit. But regardless, the effect of medication diminishes, and dementia begins to progress again. The biggest benefit from taking these medications is the ability to buy time.

    Diagnosing dementia early on is important, as medications can slow it down, and there are even a few conditions that have dementia-like symptoms but are treatable. The most common is depression, as it can cause memory impairment and a loss of concentration.

    While many theories and stories abound that substances such as herbal medications, anti-inflammatories, and vitamin supplements can help prevent the development of dementia, they have never been proven true scientifically. Two things that I recommend, however, are daily exercise and a healthy diet that prioritizes plant-based foods.

    How We Can Help

    We help educate caregivers and assist them in meeting the needs of their loved one through personalized, expert care at MedStar Washington Hospital Center. We sometimes see frustration and sadness in a caregiver and their loved one with dementia. We often implement behavioral techniques that prioritize patience to help ease this tension. Additionally, we can suggest home health care when it’s necessary to help individuals with dementia avoid unnecessary trips to the hospital or emergency department.

    Dementia is a common disease among the elderly. If you notice your loved one experiencing symptoms, please consider scheduling an appointment with a geriatric or primary care doctor so they can undergo testing in order to receive treatment early on.

    To request an appointment with a geriatric or primary care doctor, click below or call 202-877-3627.

    Request an Appointment

  • May 31, 2019

    By MedStar Health

    Congratulations to all MedStar researchers who had articles published in May 2019. 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. Safety of Thyroid Surgery in the Elderly: A Propensity Score Matched Cohort Study
      Journal of Surgical Research, 2019. DOI: 10.1016/j.jss.2019.04.012
      Papoian V, Marji FP, Rosen JE, Carroll NM, Felger EA.

    2. Cardiovascular Emergencies in Pregnancy
      Emergency Medicine Clinics of North America, 2019. DOI: 1016/j.emc.2019.01.010
      Borhart J, Palmer J.

    3. Reproducibility of Semi-automated Three-dimensional Volumetric Analysis using Cardiac Computed Tomography in Patients With Left Ventricular Assist Device
      Cardiovascular Revascularization Medicine, 2019. DOI: 10.1016/j.carrev.2019.01.024
      Gill GS, Weissman G, Meirovich YF, Medvedofsky D, Mohammed SF, Waksman R, Garcia-Garcia HM.

    4. Left Bundle Branch Block After TAVR: Bubble or Trouble?
      JACC: Cardiovascular Interventions, 2019. DOI: 1016/j.jcin.2019.04.008
      Waksman R, Khan JM.

    5. Leveraging the electronic health record to eliminate hepatitis C: Screening in a large integrated healthcare system
      PLoS One, 2019. DOI: 10.1371/journal.pone.0216459
      Geboy AG, Nichols WL, Fernandez SJ, Desale S, Basch P, Fishbein DA.
  • May 31, 2019

    By MedStar Health

    At the 2019 MedStar Health-Georgetown University Research Symposium, three abstracts were recognized as outstanding abstracts from among all of our submissions. These research studies were the three highest scored out of the over 450 submissions to the Research Symposium by the Scientific Review committee and exemplifies the caliber of work presented by the MedStar-Georgetown research community.

    "Multi-Modal Sepsis Performance Improvement Initiative Improves Early and Appropriate Treatment, Reduces Sepsis-Related Readmissions, and Reduces Overall Mortality" analyzed patient outcomes before and after implementation of the Centers for Medicare and Medicaid Services (CMS) SEP-1 Core Measure. The SEP-1 Core Measure mandates that hospitals implement quality improvement initiatives to improve sepsis outcomes. The team looked at data before and after the implementation of the multi-modal sepsis performance initiative launched in 2016 at MedStar Washington Hospital Center (MWHC).

    Led by Seife Yohannes, MD, the research team included Sean Huang, PhD, Andrea Ryan, and Muhtadi Alnababteh.

    The multi-modal sepsis performance initiative at MWHC had multiple components as part of the process, including:

    • a hospital-wide educational campaign about sepsis
    • 24-7 electronic warning system (EWS) of patients at risk for sepsis
    • a rapid response nursing team that monitors the EWS and implements bundled treatments
    • 24-7 mid-level provider team that evaluates patients identified by the EWS
    • quality improvement initiatives in sepsis documentation and coding.

    The study used coding data for over 4,00 patients with a diagnosis of sepsis as reported to CMS. The study compared patient outcomes six months before the launch of the initiative and 13 months after full implementation.

    The study found that based on an average of 2000 sepsis cases at our hospital, this amounted to 90 lives saved per year. Post-intervention, hospital length of stay was reduced by 1.8 days and re-admission rate was reduced by 1.6%.

    Regression analysis showed age, admission through the emergency department, and severity of illness as independent risk factors for increased mortality. Adjusted for these risk factors, the incidence of severe sepsis and septicemia was reduced by 5.3% and 6.9% in the post-intervention period, while the incidence of simple sepsis increased by 12%.

    The study concluded that the “multi-modal sepsis performance improvement initiative improved quality of care and patient outcomes.”

    Congratulations to the research team for their outstanding research! You can read about the other winners here and here.