Investigation of COVID-19 Positive Test Prior to Elective Surgeries Published from MedStar Health Team

Researchers from MedStar Health Urgent Care/MedStar Ambulatory Services, MedStar Health Research Institute and Georgetown University recently published research to determine what percentage of preoperative asymptomatic patients tested positive for COVID-19 on a hospital-based polymerase chain reaction (PCR) testing platform.  The researchers also sought to determine if there were certain demographics (ie, gender, age) which led to a higher pretest probability of an asymptomatic positive test.   

"Incidence of SARS-CoV-2 in Preoperative Patients Tested in an Urgent Care Setting" was published in the Journal of Urgent Care Medicine. The emergence of COVID brought on unique challenges for healthcare professionals.  It was essential to have the capability to identify patients with COVID-19 before they undergo a surgical procedure to ensure safety to the patient, the surgical team, and postoperative staff. Given the fact that many patients with the virus never exhibit symptoms, proactive preoperative testing in the urgent care center may lower the risk of spread and help quantify the rate of asymptomatic infection.  

As COVID began to spread more rapidly, there was higher demand in healthcare services including availability of healthcare personnel, equipment and hospital beds. To aid in conserving hospital resources and minimize exposure to COVID-19, semi-elective and elective procedures were suspended.  

The research included a total of 1,262 patients scheduled to undergo elective or semi-elective procedure presenting to a MedStar Health Urgent Care facility or urgent care testing tent for a nasopharyngeal (NP) PCR test 1–5 days prior to their scheduled surgery. After testing, patients were advised to quarantine at home to minimize any new exposures to the virus prior to their surgical date.   

The study results show that 29 (2.30%) patients tested positive for COVID-19. Patients between 20-29 years of age had the highest rate of positive cases around 6%. Patients over 80 years old or under 10 years old had no positive cases. However, the difference was not statistically significant. The data collected shows that gender is not a factor in rate of asymptomatic COVID-19 cases. As with age, our study shows that gender is not a factor in rate of asymptomatic COVID-19 cases. While females had a higher rate of positive asymptomatic tests (2.89%) compared with males (1.65%), the difference is not statistically significant.     

The research team concluded the findings from this study support the continued practice of testing for SARS-CoV-2 in all preoperative patients, with a positivity rate of over 2% in asymptomatic patients.
 
Because asymptomatic transmission is an important factor in the spread of the virus, all individuals, regardless of age and gender, should remain diligent to decrease the potential of asymptomatic transmission of the virus. Urgent care providers should take precautions prior to all patient interactions, not just patients with COVID-19 symptoms. Furthermore, these safeguards should be upheld with all patients regardless of gender or age. Additionally, these data suggest there are variables independent of gender and age that influence expression of symptoms of COVID-19.  

Journal of Urgent Care Medicine, 2020. 15(4):33-36

 






MedStar Health Measures Goal-Based Outcomes Among Older Disabled Patients

Collaborative research from MedStar Health Research Institute’s Health Economics and Aging Research team along with other researchers sought to assess goal-based outcomes that allow individuals to set goals based on their own priorities and measure progress.  "Standardised approach to measuring goal-based outcomes among older disabled adults: results from a multisite pilot" was published in BMJ Quality and Safety.

The study used seven clinical practices, with 33 clinicians participating, that served an older adult, functionally disabled population and existing process for eliciting patient centered goals. Each of the seven sites were asked to identify potential participants from their existing cases who were over 50 years old with either activity of daily living (ADL) or instrumental ADL impairments along with caregivers. 

For individuals with cognitive impairment, clinicians were encouraged to set goals with the patient if possible and engage the caregiver. For individuals without cognitive impairment, clinicians were encouraged to set goals with the patient but set goals with the caregiver (alone or in tandem with the patient) if they were normally part of the clinical encounter. Participants    and    clinicians    used      existing    approaches for eliciting patient-centered goals and then used either the goal attainment scaling or prioritized patient-reported outcome measures approach to measure goal achievement.  

Across the seven sites that implemented the goal-setting intervention, there were 193 patients alone, 30 patient and caregiver dyads, and 6 caregivers alone for a total of 229 participants. All study participants set at least one goal and 31 participants had more than one goal for a total of 263 goals. Seventeen of the 33 participating clinicians responded to the usability questions (response rate 51%).  On a 10-point scale (1–10), clinicians rated usability of goal attainment scaling. as high on all three domains on average: determining which services and supports to provide, helping patients achieve their goals and helping patients track their progress. 

Among goal attainment scaling participants with follow-up data, 74% met at least one goal. 12% revised their goal, or expected outcome, over the 6-month period. Sometimes goal revision occurred when participants achieved a goal and set new ones; in other cases, participants decided to revise their goal because they were not making progress and wanted to set a more realistic goal, or they preferred to work on a different goal. 

Among the prioritized patient-reported outcome measures participants with follow-up data, 70% achieved their goal, with 5 participants revising their goal over the study period. The rate of goal achievement was not significantly different between the two approaches. In most cases (92%), the individual and clinicians’ rating of goal achievement matched; however, there was a minority of cases where individuals rated their goal attainment higher than the clinicians’ ratings and vice versa. 

The study team concludes that using structured approaches to goal-based outcomes for older adults with complex care needs could be feasible in clinical care and a promising approach for quality measurement that could lead to improvements in person-centered care delivery for this population.   

BMJ Quality and Safety. 2020. DOI: 10.1136/bmjqs-2020-012244






MedStar Plastic and Reconstructive Surgery Research 2020 Year in Review

We are MedStar Health Proud of the MedStar Plastic and Reconstructive Surgery (MPRS) department for their impressive effort in reaching over 100 publications and presentations in 2020. In 2020, MPRS published 79 papers and had another 24 accepted, up from 45 published in 2019.  

“This remarkable effort - well over 100 papers published or accepting in a year – shows the true nature of our academic health system and the continued commitment of MedStar Health teams to advancing health through research,” said Neil J. Weissman, MD, Chief Scientific Officer, MedStar Health, President, MedStar Health Research Institute, and Professor of Medicine, Georgetown University. “This incredible effort is what us proud to be part of our system.” 

“In spite of a tumultuous year, we have seen incredible research growth thanks to our outstanding research fellows, medical students, residents, and faculty,” said Kenneth L Fan, MD, Scientific Director, Plastic and Reconstructive SurgeryMedStar Health Research Institute. 

Here are a few of selected research publications. View the full list here

Does surgeon handedness or experience predict immediate complications after mastectomy? A critical examination of outcomes in a single health system.
The Breast Journal, 2020. DOI: 10.1111/tbj.13487
Luvisa K, Fan KL, Black CK, Wirth P, Won Lee D, Del Corral G, Willey SC, Song DH.

Incidence of Major Arterial Abnormality in Patients with Wound Dehiscence after Lower Extremity Orthopedic Procedures.
Plastic and Reconstructive Surgery, DOI: 10.1097/PRS.0000000000007361
Zolper EG, Kotha VS, Walters ET, Nigam M, Lakhiani CX, Fortman EC, Janhofer DE, Steinberg JS, Attinger CE, Evans KK.

Time for a Consensus? Considerations of Ethical Social Media Use by Pediatric Plastic Surgeons
Plastic and Reconstructive Surgery, 2020. DOI: 10.1097/PRS.0000000000007389.
Hetzler PT, Makar KG, Baker SB, Fan KL, Vercler CJ

The "Double hit": Free tissue transfer is optimal in comorbid population with irradiated wounds for successful limb salvage
The Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020. DOI: 10.1016/j.bjps.2020.10.054
Deldar R, Black CK, Zolper EG, Wirth P, Luvisa K, Fan KL, Evans KK.

Breast Surgery in the Time of Global Pandemic: Benefits of Same-Day Surgery for Breast Cancer Patients Undergoing Mastectomy with Immediate Reconstruction during COVID-19.
Plastic and Reconstructive Surgery, 2020. DOI: 10.1097/PRS.0000000000007269
Perez-Alvarez IM, Bartholomew AJ, King CA, Lovett BL, Greenwalt IT, Song DH, Fan KL, Tousimis EA.





January Peer-Reviewed Publications from MedStar Health

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

Selected research:

  1. National trends and 30-day readmission rates for next-day-discharge transcatheter aortic valve replacement: An analysis from the Nationwide Readmissions Database, 2012-2016
    American Heart Journal, 2021.DOI: 10.1016/j.ahj.2020.08.015
    Yerasi C, Tripathi B, Wang Y, Forrestal BJ, Case BC, Khan JM, Torguson R, Ben-Dor I, Satler LF, Garcia-Garcia HM, Weintraub WS, Rogers T, Waksman R.

  2. It Is Not Pneumonia! A Case of Unilateral Pulmonary Edema.
    The American Journal of Medicine, 2021. DOI: 10.1016/j.amjmed.2020.05.050
    Stingo FE, Sallam T, Govindu R, Ammar H.

  3. Opioid Education in Obstetrics and Gynecology Training Programs.
    Southern Medical Journal, 2021. DOI: 10.14423/SMJ.0000000000001194
    Dieter AA, Willis-Gray M, Carey ET. 

  4. Sociodemographic Disparities in Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease in the United States.
    JAMA Cardiology, 2021. DOI: 10.1001/jamacardio.2020.3978
    Grandhi GR, Mszar R, Vahidy F, Valero-Elizondo J, Blankstein R, Blaha MJ, Virani SS, Andrieni JD, Omer SB, Nasir K.





Department of Continuing Professional Education Spring Meeting Lineup

Organized by the Department of Continuing Professional Education, MedStar Health is offering a variety of CE conferences this spring that provide an opportunity to gain knowledge of new treatments and techniques and network with leaders in the field through interactive case studies and presentations. MedStar associates may earn CE credits and discounted registration is available. For more information and to stay up to date, please visit medstar.cloud-cme.com.

Spring 2021

Diabetic Limb Salvage (DLS 2021)
April 7 to 10 – An Interactive Virtual Experience
Conference Chairman: Christopher Attinger, MD; John Steinberg, DPM
Course Directors: Cameron M. Akbari, MD; Karen Kim Evans, MD; J.P. Hong, MD, PhD
MedStar Associates may attend complimentary using code: DLSMS

Abdominal Wall Reconstruction (AWR 2021)
June 9 to 12 – A Dynamic Virtual Conference with Expert Faculty
Conference Chair: Parag Bhanot, MD
Course Directors: Karen Kim Evans, MD; William W. Hope, MD; Jeffrey E. Janis, MD
MedStar Associates may attend for $100 using code: AWRMS

Save the Date!

40th Annual Cherry Blossom Seminar: An Update on Arthroscopy, Arthroplasty and Sports Medicine
April 23 to 24, 2021
A Virtual Conference
Course Chairman: M. Mike Malek, MD
Course Co-Chairmen: Jeffrey S. Abrams, MD; Steven J. Svoboda, MD, Colonel (retired), US Army

Esophageal Cancer Conference
April 24, 2021
A Virtual Conference
Course Directors: Puja G. Khaitan, MD; Shervin Shafa, MD

Frontline: Cardiovascular Care in the Community
May 1, 2021

A Virtual Conference
Course Directors: Carolina I. Valdiviezo, MD; Allen J. Taylor, MD; Sriram Padmanabhan, MD
Course Co-Director: James C. Welsh, MD, MBA, MPH

Advances in the Management of Prostate, Kidney, and Bladder Cancers
NEW Date Coming Soon!

A Virtual Conference
Course Directors: Michael B. Atkins, MD; Keith J. Kowalczyk, MD;
Ross E. Krasnow, MD, MPH; Young Kwok, MD; Paul D. Leger, MD, MPH;
George K. Philips, MBBS, MD, MPH; Suthee Rapisuwon, MD

For more information and to stay up to date, please visit medstar.cloud-cme.com

MedStar Health Researches Jockey Injuries at Maryland Racetracks

Researchers across MedStar Health recently published collaborative research which characterized jockey injuries at Maryland racetracks during thoroughbred racing activities over 4 years. This research study examines types and mechanisms of injury among jockeys at Maryland thoroughbred racetracks.  “Injuries Among Maryland Jockeys During Thoroughbred Racing: 2015-2019” was published in BMJ Open Sport & Exercise Medicine.

MedStar Health sports medicine physicians gathered injury data over 4 years to evaluate and treat injuries experienced by the jockeys. There were 670 jockeys that participated in the 4-year study across 590 races days, and nearly 5600 races and 45,000 mounts. Among these jockeys, there were 204 injuries involving 184 incidents and 131 falls. The vast majority of injuries (80%) was related to soft tissue, while 4% were concussions. Most injuries involved the lower extremity (31%) or upper extremity (26%) and typically resulted from a fall from the horse. Among all falls, 76.3% (n=100) resulted in an injury.

The results showed a significant proportion of injuries (41%) in and around the starting gate. Over a quarter of injuries required further medical care in a hospital or other medical facility, while surgery was required in only 2.5% of injuries.

The research team hopes that more sports medicine clinicians coordinate care with local racing tracks to improve injury data collection to benefit riders’ health and safety internationally.

Kelly D. Ryan, DO from the Family Health Center at MedStar Franklin Square Medical Center said, “This study is important because there is limited jockey injury data that has been reported or published in the United States over the past 20 years. Injury data is important to give us a better understanding of our athlete and the consequences of their sport. It also gives us insight into areas that we can focus on improving to try to decrease injuries. Our ability to collect and publish this data as well as manage all of these injuries shows the benefit of integrating a sport medicine team at the racetrack to improve the care and health of jockeys and other workers."

The research team included Kelly Ryan from MedStar Franklin Square Medical Center; Kezia Alexander from MedStar Sports Medicine Research Center; Andrew E. Lincoln from Rehabilitation Medicine, Georgetown University Medical Center and MedStar Sports Medicine Research Center; Gabrielle Garrruppo from Johns Hopkins University Bloomberg School of Public Health; and Christine M Hluchan from Johns Hopkins University School of Medicine.

BMJ Open Sport & Exercise Medicine, DOI: 10.1136/bmjsem-2020-000926






December Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in December 2020. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

View the full list of publications on PubMed.gov here.

Selected research:

 

  1. Offset in Reverse Shoulder Arthroplasty: Where, When, and How Much
    Journal of the American Academy of Orthopaedic Surgeons, 2020.
    DOI: 10.5435/JAAOS-D-20-00671
    Wright MA, Murthi AM.

  2. Comparison of Characteristics and Outcomes of Patients with Acute Myocardial Infarction with versus without Coronarvirus-19
    The American Journal of Cardiology, 2020. DOI: 10.1016/j.amjcard.2020.12.059
    Case BC, Yerasi C, Forrestal BJ, Shea C, Rappaport H, Medranda GA, Zhang C, Satler LF, Ben-Dor I, Hashim H, Rogers T, Waksman R.

  3. Race Differences in Reported Harmful Patient Safety Events in Healthcare System High Reliability Organizations
    Journal of Patient Safety, 2020. DOI: 10.1097/PTS.0000000000000563
    Thomas AD, Pandit C, Krevat SA.

  4. Inpatient and Outpatient Technologies to Assist in the Management of Insulin Dosing
    DOI: 10.2337/cd20-0054
    Cui L, Schroeder PR, Sack PA.

Maureen McNulty is Awarded MedStar Health Nursing Impact Award

Maureen McNulty, RN, Compliance Assurance Associate was awarded the MedStar Health Nursing Impact Award for MedStar Health for the second quarter of 2020. This award honors nurses who have led efforts at process improvement or practice development through their role as representatives to MedStar Health Nursing committees and councils at each entity.  Maureen was presented with the award at the quarterly nursing leadership meeting on behalf of the MedStar Health Nursing Leadership by Joan K. Bardsley, Assistant Vice President, Research and Nursing Integration, MedStar Health Research Institute.

The Impact Award recognizes a nurse who makes an effort to communicate and implement MedStar Health nursing goals at their entity, including reduction in unit or service line Hospital Acquired Pressure Injuries or Falls, achieving Magnet designation, contributing to or supporting research, focus on quality and safety or improvement in continuity of care index.

Maureen has been an expert resource in assessing and ensuring quality and safety for research and regulatory compliance in all areas of research with audits, trainings, and support of investigator-initiated trials during her time with the Research Institute. Throughout the pandemic, Maureen has volunteered to work with Occupational Health to support the need for screening, disposition of results and plan of care for associates affected by COVID-19. In this role, Maureen has identified areas of process improvement opportunities for Occupational Health and continues to ensure that the voices of the associates are heard, particularly in the area of quality improvement.

Joan Bardsley said, “I strongly believe Maureen has made a local and system wide impact on both quality of research and the health of our associates. Her knowledge, adaptability and approachability are attributes that support her effectiveness and contributions to MedStar Health.”

Congratulations to Maureen on receiving this important award for her continued dedication to MedStar Health, our patients, and our associates.






MedStar Health Policy and Procedure Updates

MedStar Health regularly updates, revises and creates new policies for the operational efficiency of the organization.

A new policy and associated procedure related to the application of Uniform Guidance or Federal Acquisition Regulations to grants and contracts awarded to MedStar Health Research Institute. The Research Institute Office of Contracts and Grants Management has been following the appropriate federal regulations; this policy brings the Research Institutes official policy in line with regulations.

The new procedure closes the gap between billing and payment for contracts and grants to ensure that accounting practices are in line with regulations. 

Please be advised, the following policies and procedures are now in effect.
OCG.O-004.01 Cash Management
OCG.O-004 Uniform Guidance and FAR

Any questions regarding the new policy and procedure should be directed to [email protected].

MedStar Health Research Evaluates Risk Factors for Emergency Department Visits After Upper Extremity Surgery

Recently published research evaluated pre-op and post-op patient questionnaires to identify if patient responses were related to subsequent emergency department visits 90-days after surgery. “Risk Factors for Emergency Department Visits After Upper Extremity Surgery” was published in Plastic and Reconstructive Surgery - Global Open. The research team included Pragna N. Shetty, MPH; Kavya K. Sanghavi, MPH; and Aviram M. Giladi, MD, MS, from The Curtis National Hand Center at MedStar Union Memorial Hospital.

The researchers reviewed more than 2,000 medical records and collected the patient’s presenting diagnosis, preoperative and postoperative questionnaires, pain scores, and postoperative satisfaction scores.  The results show that sixty-one (3.0%) patients presented to the emergency department with hand-related or surgery-related complaints within 90 days after surgery. Preoperative pain scores were higher in the group that presented to the ED compared to those that did not. Patients who presented to the emergency department had significantly worse preoperative questionnaire scores, and significantly lower postoperative satisfaction scores.

The research team concluded that those patients with worse preoperative questionnaire scores and lower postoperative satisfaction were associated with an increased likelihood of presenting to the emergency department for management of a hand or postoperative issue during the global period. These patients should be identified early and educated on their healthcare options in order to improve value-based care and decrease healthcare utilization.

This research abstract was awarded “Best Hand Abstract” at the 89th Annual Plastic Surgery The Meeting, attended virtually this year.

Plastic and Reconstructive Surgery – Global Open, 2020. DOI: 10.1097/01.GOX.0000720836.06040.bd