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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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  • April 05, 2019

    By MedStar Health

    GHUCCTS is pleased to co-host the upcoming DC CTSA Consortium conference, "Spring Regulatory Update and Hot Topics in Clinical Research." The conference will be held on Monday, April 29, 2019 at The George Washington University Cloyd Heck Marvin Center, located at 800 21st NW in the 3rd Floor Ballroom.

     The full agenda will be posted here when it is finalized. The event is offered free of charge. Deadline for registration is April 24, 2019.  If you have already registered, your space is secured.  Please check the website periodically for the full agenda as it is finalized.

    RSVP by emailing resinteg@gwu.edu by noon on Wednesday, April 24, 2019.

  • April 04, 2019

    By MedStar Health

    Written by David Mayer, MD, Executive Director, MIQS

    Many of us know medical errors are the third leading cause of death in the United States. We are also aware that healthcare is a high-risk industry like aviation and nuclear energy. But unlike other high risk-industries, healthcare has been slow to adopt tools, techniques and behaviors proven to lower risk. As a result, errors made by well-intentioned caregivers continue to cause unintentional harm and even death to patients at alarming rates. 

    What comes next however, after a preventable medical error is discovered to be just as alarming. Largely driven out of fear, many times medical mistakes are “buried” by the hospital system. An approach, known as “delay, deny, and defend” has become common place in the healthcare industry.  When hospital leaders begin to hide or even lie about medical errors a second set of harm is occurring – to the afflicted patient, family and even caregivers. During my anesthesia residency, I was involved in a medical error…

    As the anesthesiologist, my job was to bring our patient into the operating room, put the required monitors on him, and then administer the general anesthetic that would keep him unconscious during his right-sided hernia surgery. Focused on my job, like others in the operating room, I didn’t notice that the senior surgical resident had taken the scalpel and made the surgical incision on the patient’s left-side by mistake. Two minutes later the attending surgeon, who had been detained with a question from another surgeon, came into the operating room, looked at the patient on the operating table and asked, “I thought this was a right-side hernia repair?” When the surgical resident realized the mistake, she passed out.

    Covering Up More than Incisions

    The surgeon closed the incision on the left side and then proceeded to fix the hernia on the right side. The patient now had two surgical bandages on their abdomen: one to cover the hernia repair, the other to cover our mistake. I dreaded having to discharge the patient from the recovery room after they fully woke up and explain my part in the medical error that harmed him. I had never been involved in a medical error before, and was very nervous about the anger he might feel towards me and our team. When I went to see the patient about an hour later, I noticed he had a big smile on his face as I approached his bed. Before I could say anything, he looked at me and said, “Today is my lucky day.” I was dumbstruck. He continued, “Yes, today is my lucky day because under anesthesia my surgeon told me he discovered I had two hernias, one on each side, and was able to repair both at one time so I don’t have to miss another day of work to get the second one repaired. It then hit me. The plan was to lie to the patient and cover up our mistake. I didn’t know what to say or how to react. After a very long pause, I responded, “Yes, today is your lucky day,” and I discharged the patient.

    Courage and Transparency: The Path Forward

    In defining professionalism in healthcare, we use words like altruism, honor, integrity, respect, caring, compassion, and accountability to name a few. In telling my patient “Yes, today is your lucky day”, I violated every one of those principles we take an oath to honor when becoming a caregiver. Not only was my lie morally and ethically wrong, our lack of honesty and transparency kept us from learning from our mistake and finding ways to prevent others from suffering similar harm. As a result, wrong-sided surgeries continued to occur far too frequently.

    It is said healthcare “buries” our medical mistakes. Fear of malpractice claims and multimillion dollar settlements, fear of losing our license, fear of admitting we are fallible and can make a mistake are just a few of the reasons caregivers and hospital leaders try to hide or even downright lie when medical errors cause patient harm. This approach, known as “delay, deny and defend”, is a common legal and malpractice insurance strategy, not only in healthcare but in other insurance-based industries.

    Historically, the role of hospital risk managers has been to protect the hospital at all cost, even if it meant lying to patients and families. Refusing to answer questions, denying patients access to their medical records, not returning phone calls, or referring patients to hospital lawyers has been routine practice for many health systems. Many patients and families wait years to have their calls returned, and still fail to receive truthful answers on what really happened when there is a conversation. As many plaintiff attorneys have shared through the years, “There’s a lot of lying going on out there.” The only option patients and families often have to get their questions answered, is to hire their own lawyer and file a lawsuit against the hospital and the physician. Once both sides “lawyer up”, the only thing that matters is to win the lawsuit, regardless of the financial cost or additional suffering incurred by all stakeholders. No one wins in a medical malpractice trial.

    Fortunately, some courageous health systems, hospitals and medical malpractice carriers are discovering there is a better way. They are embracing CANDOR – being fully open and honest when preventable harm occurs. We will talk more about this disruptive new approach to preventable harm in my next post.

     

  • April 04, 2019

    By Edward F. Aulisi, MD

    Imagine this scenario: You come to the hospital with a complex neurological condition, and your surgeon uses a device or instrument you’ve never seen before—a tool that is perfectly designed to approach your delicate or complicated surgical need. If it sounds futuristic, think again. This scene plays out daily in our neurosurgery department due to innovative creations from our Center for Image-Guided Neuro-Integrative Surgery, or CIGNIS.

    At CIGNIS, the brightest minds in neuroscience and engineering join forces to refine treatments and instruments to navigate neurological care. CIGNIS scientists not only improve existing tools but also design novel instruments and therapies to treat even the most complex conditions.

    Streamlined Scientific Solutions

    The CIGNIS spirit of collaboration often leads us to work alongside equipment manufacturers such as K2M, a company that designs and creates many of our surgical products. MedStar Washington Hospital Center is a K2M alpha site for innovation, which means we help them test and refine the most advanced equipment before it’s available to everyone else.

    For example, we are the first hospital in the Washington, D.C., area to have the Airo Mobile Intraoperative CT system, which lets us perform high-definition CT (computed tomography) scans in real time during neurosurgery. Our doctors worked closely with K2M and its partner, Brainlab, to provide input that influenced the Airo system’s design and software.

    Our collaboration with K2M is a two-way street. I might realize after a surgery that a procedure could be better or more efficient with a new or different tool. Next, I describe the need to an engineer, who determines whether it’s possible to create such a device and, if so, develops a prototype.

    Likewise, the engineers often watch us in surgery while we use the tools and get our feedback on improvements we’d like to see. For example, all our tools and software for intraoperative angiography, a procedure that lets us see inside the blood vessels of the brain during neurosurgery, have been revamped based on the feedback we gave the K2M engineers. We also collaborate to create unique solutions, such as implants designed for a single patient and constructed with a 3D printer to fit the patient’s anatomy exactly.

    Benefits for Patients and Neurosurgeons

    Refining the tools and techniques we use for neurosurgery pays huge dividends for patients and doctors alike. More of our surgeries are being done with a minimally invasive approach, which means smaller incisions and faster recoveries for patients. These procedures require extremely precise instruments, and we are constantly refining these instruments to improve patient care and surgical accuracy.

    Better surgical equipment means our surgeries also take less time. Some surgeries that used to take eight hours now only take four, which means patients can begin recovery sooner. Precise, minimally invasive surgeries offer our patients better outcomes and a lower risk of needing more surgeries down the road.

    Pushing the Boundaries of Neuroscience

    We have been developing CIGNIS here at MedStar Washington Hospital Center for a long time, and I’m not aware of another hospital that has a program quite like ours.

    However, we are spreading the word of our success to our colleagues. We regularly train doctors from around the world on how to use the cutting-edge tools and technologies we help create. I’m hopeful that they institute similar programs at their organizations to benefit more patients worldwide.

    A whole squadron of professionals is involved when we perform neurosurgery—even experts who never scrub up or put on surgical gowns. CIGNIS helps us bolster the talents of these amazing people and shape the course of neurosurgery for decades to come. I can’t wait to see where we go from here.

    Call 202-877-3627 or click below to make an appointment with a neurosurgeon.

    Request an Appointment

  • April 04, 2019

    By MedStar Health

    Informed Consent for Clinical Research

    The Informed Consent Form (ICF) template at MHRI was updated Spring 2018.  As of January 21, 2019 this template is required for all new submissions being reviewed by the MHRI IRB which require consent.  The new ICF template conforms to the revised common rule as well as institutional changes including:

    • Provision of a concise summary at the beginning of the consent form
    • Integration of HIPAA language into the body of the consent form, allowing for a combined HIPAA authorization/consent form
    • Revision to the signature block of the consent form, most notably removal of the requirement for an investigator signature

    This ICF template may be downloaded from the MHRI website here and is also available in the library in the new eIRB system. 

    ORI Operational Update

    In order to improve customer service and IRB communication, the Office of Research Integrity (ORI) has assigned ORI Administrators to assist specific departments and identified a dedicated coordinator for IRB reliance agreements (use of external IRBs).

    If you have a question/issue regarding a protocol or require pre-submission assistance, please contact the appropriate ORI administrator or coordinator listed below.  If you are unsure of who to contact, please email the Office of Research Integrity at MHRI-ORIHelpDesk@medstar.net.

    Amy Harchelroad
    ORI Administrator
    Amy.J.Harchelroad@medstar.net

    • Infectious Disease
    • Cardiology
    • Orthopedics
    • Emergency Medicine
    • Dermatology
    • Endocrinology
    • Hand Center
    • Infection Control
    • OB/GYN
    • Otolaryngology

    TJ Rodriguez
    ORI Administrator
    Timothy.J.Rodriguez@medstar.net

    • MI2/Health Services Research and Human Factors
    • Neurology
    • National Rehabilitation Network/PM&R
    • Biostatistics
    • Critical Care
    • Family Medicine/Medicine/Internal Medicine
    • Surgery/Burn Center
    • Gastroenterology
    • Imaging
    • Pharmacy
    • Oncology/Hematology
    • Ophthalmology
    • Rheumatology
    • Urology
    • Palliative Care

    Yessica Contreras
    ORI Coordinator
    Yessica.Contreras@medstar.net

    • IRB Reliance Agreements
    • Use of External IRBs
    • IRB Meeting Management
    • Human Subject Protection Training
  • April 02, 2019

    By Ravi Agarwal, DDS

    Patients often turn to corrective jaw surgery to correct irregularities in their jaw and teeth to improve chewing, speaking, and appearance. However, an additional condition that many people don’t realize corrective jaw surgery can improve is obstructive sleep apnea.

    Obstructive sleep apnea, or when people repeatedly stop breathing while asleep, can occur when jaw bones aren’t properly working in tandem with muscles around the face and neck to support the tongue and airway. This can cause symptoms such as:

    • Excessive fatigue
    • Loud snoring
    • Morning headache
    • Sleepiness

    Corrective jaw surgery can be a solution for patients with these problems. The surgery can realign the jaws and teeth, open up the airway, and relieve patients of their symptoms—so much so that some patients say their entire family sleeps better upon their snoring being corrected.

    LISTEN: Dr. Agarwal discusses corrective jaw surgery in the Medical Intel podcast.

    Candidates for Corrective Jaw Surgery

    Aside from people suffering from sleep apnea, individuals with jaw deformities, such as underbites, deep bites, and jaw asymmetries, are good candidates for corrective jaw surgery. Typically, we’ll determine if someone is a good candidate through a:

    • Conversation about their symptoms
    • Physical examination of their mouth, face shape, teeth, and jaw bones
    • X-ray to evaluate the size and dimensions of patients’ airways and jaws

    A significant number of our corrective jaw surgery patients are teenagers and young adults, but we are starting to see more people with obstructive sleep apnea in their 30s to 50s.

    How Corrective Jaw Surgery Works

    Corrective jaw surgery is done under general anesthesia. During surgery, the doctor:

    1. Makes incisions in the gums and around the jaws
    2. Accesses the bones and uses specialized tools to make cuts in them
    3. Repositions the bones to the desired position using splints
    4. Stabilizes the bones with small plates and screws (patients can’t feel these after surgery)
    5. Makes dissolvable stitches to close the gums

    Some patients undergoing corrective jaw surgery have had braces for one to two years prior to surgery. For these patients, we work closely with their orthodontist to ensure their braces are safe and used correctly prior to surgery.

    A Success Story

    One man came to his consultation with his family and his kids. While he explained how he struggled with sleeping and snoring, his young child interrupted and said, “Daddy snores really loud!” Then, he looked at me and said, “See? I really have a problem with sleeping.”

    He ended up having corrective jaw surgery. When I saw him a few weeks later, he was excited to say that his sleeping was better, he was more energetic, and the entire house was more peaceful, because the kids didn’t have to hear his snoring anymore.

    Corrective jaw surgery can cure obstructive #sleepapnea. In fact, some patients report results so drastic that their entire family started sleeping better. https://bit.ly/2UaUdMR via @MedStarWHC

    Click to Tweet

    What to Expect During Recovery

    Following corrective jaw surgery, patients typically stay in the hospital overnight. Then, they return home for the next two weeks while inflammation settles. Patients must be on a full liquid diet for six weeks after surgery to allow their jaws and mouths to heal.

    We ask that patients don’t exercise or do any heavy lifting for two weeks after surgery. Daily activities, however, such as washing the dishes, cleaning, and housework are fine. After two weeks, patients can begin doing light exercise, but heavy exercise usually is prohibited until six weeks after surgery, and even months if individuals play sports where facial injuries are common.

    How to Prevent Obstructive Sleep Apnea

    Many factors can lead to the development of obstructive sleep apnea but being overweight is one common risk factor. We suggest patients exercise at least 30 minutes a day, four days a week, and eat a healthy diet to keep their weight in check and reduce the risk of developing obstructive sleep apnea.

    There are nonsurgical treatments for obstructive sleep apnea that don’t prevent it but can limit symptoms, such as continuous positive airway pressure (CPAP) machines and oral appliances, which are devices made by dental providers that fit into the mouth and shift a patient’s bottom jaw forward while they’re sleeping to open up their airway. Most patients prefer the outcome of corrective jaw surgery, however, if they decide to go that route.

    MedStar Washington Hospital Center is one of the busiest medical centers in the region when it comes to corrective jaw surgery. We have advanced experience and skills because we see and treat many different types of jaw deformities every day. Furthermore, we use 3D CT scans to plan the surgery virtually beforehand so that we can pick up on any potential issues.

    Whether a patient wants to cure their sleep apnea or feel better about themselves by aligning their jaw, corrective jaw surgery is a proven treatment that people utilize every day.

    Call 202-877-3627 or click below to make an appointment with an oral surgeon.

    Request an Appointment

  • March 28, 2019

    By Allen J. Taylor, MD

    Drinking diet soda might seem like a good idea, as it contains zero calories. However, drinking two or more artificially sweetened drinks a day could significantly increase the risk of heart disease, stroke, and early death in women over 50, according to a 2019 study published in the Journal Stroke.

    The study, which is just the latest example of why it’s harmful to consume artificial sweeteners, found that women who were African-American, obese, and had no family history of heart disease or diabetes experienced the most heightened risk.

    Let’s further discuss the results of the study, how reliable it is, and how important it is for you to stop drinking artificially sweetened beverages.

    What the Study Found

    The study asked nearly 82,000 U.S. postmenopausal women how often they drank a 12-ounce diet drink over the past three months. Then their health outcomes were tracked for an average of nearly 12 years.

    The study found that when compared to women who drank diet beverages less than once a day or not at all, women who consumed two or more artificially sweetened drinks a day were:

    • 31 percent more likely to have a clot-based stroke
    • 29 percent more likely to have heart disease
    • 16 percent more likely to die from any cause
    Women over 50 who drink artificially sweetened drinks are about 30 percent more likely to have a clot-based #stroke and #heartdisease, a 2019 study found. https://bit.ly/2OytPGF via @MedStarWHC @TaylorMHVIcard

    Click to Tweet


    The study also found that women who had no family history of heart disease and diabetes—key risk factors for stroke—had a 50 percent higher stroke risk if they were obese (a body mass index above 30). African-American women with no previous history of heart disease or diabetes, meanwhile, were four times more likely to have a clot-based stroke.

    Naysayers of the study might point out that it’s observational, rather than a strictly controlled, double-blind, randomized study. However, a randomized trial isn’t possible in this scenario, as you can’t ask 80,000 women to drink set amounts of artificially sweetened drinks for a decade and observe what happens to their health. The study statistically controlled factors such as women’s ages and how often they exercised, so it’s exceptionally strong observational evidence.

    Why It’s Important to Stop Drinking Artificial Sweeteners

    Drinking beverages with artificial sweeteners provides no nutritional benefit. It just impairs the body’s ability to manage sugar, leads to no significant weight loss, and is associated with a higher risk of stroke and dementia. So what’s the reason to drink them? Plenty of other alternatives exist, such as coffee and tea, if people desire moderate amounts of caffeine or want to drink something other than water. Remember, though, that water is the healthiest drink you can have and is critical for your heart health.

    About 10 years ago, I drank diet soda practically every day. Once I quit, I couldn’t believe I drank so much of something that was bad for me—and didn’t even taste that good.

    You Tell Us: Did you quit drinking diet soda at one point? What kind of benefits did you experience? Tell us about your experience on our Facebook page.

    Observational studies for other serious health concerns such as secondhand smoke took years for some people to take seriously. However, as studies continually showed its implications, most of the population finally adopted the approach to avoid secondhand smoke. It’s my hope that we soon adopt the same ideology when it comes to consuming artificially sweetened beverages.

    Avoiding artificially sweetened beverages is an important part of your health. Make sure you attempt to swap out these drinks for more healthy alternatives, starting today.

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