MedStar Health Publishes Collaborative Research to Explore the Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection

Recently published collaborative research evaluated the prevalence of detectable inflammatory heart disease in professional athletes with prior COVID-19 infection, using current return-to-play screening recommendations. The major North American professional sports leagues were among the first to return to full-scale sport activity during the COVID-19 pandemic. Each of these professional sports leagues (MLS, MLB, NHL, NFL, and the men’s and women’s NBA) implemented a program for all players who had tested positive for COVID-19 prior to resumption of team-organized sports activities. “Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systemic Return-To-Play Cardiac Screening” was published in JAMA Cardiology.

The goal of the study is to assess the prevalence of clinically detectable and relevant cardiac injury in athletes testing positive for COVID-19 and the efficacy of consensus screening recommendations in achieving a safe return to competitive sports. This cross-sectional study reviewed return-to-play cardiac testing performed between May and October 2020 on professional athletes who had tested positive for COVID-19. Troponin testing, electrocardiography (ECG), and resting echocardiography were performed after a positive COVID-19 test result. Those with abnormal screening test results were referred for additional testing, including cardiac magnetic resonance imaging and/or stress echocardiography.

The study included 789 professional athletes. The results show a total of 460 athletes had prior symptomatic COVID-19 illness and 329 were asymptomatic or minimally symptomatic but had tested positive for the virus. Using the return-to-play cardiac screening algorithm, 6 athletes had an abnormal troponin level, 10 athletes had ECG abnormalities warranting further cardiac evaluation, and 20 athletes had an echocardiographic finding necessitating additional testing to exclude acute cardiac injury. No adverse cardiac events occurred in athletes who underwent cardiac screening and resumed professional sport participation.

The study team concluded “while long-term follow-up is ongoing, few cases of inflammatory heart disease have been detected, and a safe return to professional sports activity has thus far been achieved.” Further research is needed to understand whether there may be long-term cardiac effects among athletes infected with COVID-19, whether or not they were symptomatic.

This study was co-authored by Dr. Andrew Tucker, Medical Director of MedStar Union Memorial Hospital Sports Medicine and. Dr. Tucker also serves on the US National Football League General Medical Committee.

Jama Cardiology, 2021. DOI: 10.1001/jamacardio.2021.0565

MedStar Health Researchers Investigate the Effects of Headgear in High School Girls’ Lacrosse

A collaborative investigation was undertaken to evaluate potential differences in rates, extent, and game-play characteristics of impacts among players with and without headgear during high-school girl’s lacrosse competition. “The Effects of Headgear in High School Girls’ Lacrosse” was published in The Orthopaedic Journal of Sports Medicine. The research was completed in collaboration with the Sports Medicine Assessment, Research & Testing (SMART) Laboratory at George Mason University in Manassas, VA.

The goals of this study were to determine whether differences in the rates and magnitudes of impacts to the head and other areas of the body occurred in players with and without headgear during competition, along with determine if the distribution of impact mechanisms and penalties called for impacts were different with the introduction of headgear. With the growing popularity of girls’ lacrosse among high schools in the US, the reporting of head injuries has also increased. Recent studies have incorporated sensor technology and video surveillance to characterize head impacts and head injuries.

The study included a cohort of 49 girls from a single high school lacrosse team during the 2016 season (no headgear; 18 games) and 2017 (headgear; 15 games). In 2017, a performance standard (ASTM F3137) for girls’ lacrosse headgear became commercially available. Each participant was assigned a wearable sensor affixed behind their ear. All game-related impacts recorded by the sensors were verified on video. Data was collected to describe game-play characteristics among players with and without headgear.

The study recorded 649 sensor-instrumented player-games and 204 impacts ≥20g were verified as game-related impacts using video analysis. The results show that most impacts were imparted to the player’s body (74.5%), rather than to the player’s head (25.5%). Impact rates per player-game did not vary between the no headgear and headgear conditions. No game-related concussions were reported during this study.

The research team concluded that lacrosse headgear use was associated with a reduction in the magnitude of overall impacts but not a significant change in the rate of impacts, how they occur, or how penalties were administered for impacts sustained during competition. Further research is needed with a larger sample and different levels of play to evaluate the consequences of headgear use in girls’ lacrosse.

The Orthopaedic Journal of Sports Medicine., 2020. DOI: 10.1177/2325967120969685

March Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in March 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. Pharmacologic Treatments for PCOS Patients.
    Clinical Obstetrics and Gynecology, 2021. DOI: 10.1097/GRF.0000000000000597
    Kodama S, Torrealday S.

  2. Lessons Learned from Caring for Patients with COVID-19 at the End of Life.
    Journal of Palliative Medicine, 2021. DOI: 10.1089/jpm.2020.0251
    Rao A, Kelemen A.

  3. Evaluation of Maternal-Fetal Triage Index in a Tertiary Care Labor and Delivery Unit.
    American Journal of Obstetrics & Gynecology MFM, 2021. DOI: 10.1016/j.ajogmf.2021.100351
    Kodama S, Mokhtari NB, Iqbal SN, Kawakita T.

  4.  Assessing the Relationship Between Bone Density and Loss of Reduction in Nonsurgical Distal Radius Fracture Treatment.
    Journal of Hand Surgery, 2021. DOI: 10.1016/j.jhsa.2021.02.002
    Ghodasra JH, Yousaf IS, Sanghavi KK, Rozental TD, Means KR Jr, Giladi AM.

MedStar Health Researchers Assess Emergency Department Care Coordination Strategies Across Maryland’s Hospital System

Researchers from MedStar Health evaluated emergency department care coordination processes and their perceived effectiveness across Maryland’s hospital system, which were seeking to reduce hospital admissions due to financial considerations led by Maryland-state governance. “Emergency Department Care Coordination Strategies and Perceived Impact Under Maryland’s Hospital Payment Reforms” was published in the American Journal of Emergency Medicine. The goals of the study were to characterize the scope and variation of emergency department care coordination strategies in response to Maryland reforms and describe how physician leaders and care coordination staff perceive the effectiveness of specific strategies.

In 2014, Maryland expanded its all-payer hospital rate-setting model into a population-based global budget revenue model, which replaced fee-for-service hospital payments and introduced quality pay-for performance incentives for acute-care hospitals. The model has incentivized a shift towards non-hospital care and reduced hospital admissions. The research team conducted a total of 25 semi-structured interviews across 18 different hospital emergency departments with emergency department physician leadership (n = 14) and care coordination staff (n = 11) to examine emergency department care coordination processes and understand the focus of care coordination efforts. The interviews assessed the perceived efficacy of care coordination and identified barriers to success, as well as the influence of Maryland’s payment reform model on emergency department care coordination strategies.

The results showed that across all emergency departments, there was significant variation in the hours and types of care coordination staff coverage and the number of initiatives implemented to improve care coordination. Most participants perceived Maryland’s reform with global budgeting as having a mixed impact on emergency department care coordination and overall emergency department care. Participants perceived emergency department care coordination as effective in facilitating safer discharges, improving outpatient follow-up and addressing social determinants of health; however, adequate access to outpatient providers was a significant barrier. Emergency department physician leaders identified improved care transitions and patient care but experienced increased workloads to avoid admissions and support safe transitions among their discharged patients.

Although the observed care coordination initiatives were perceived to produce positive results, Maryland's global budgeting policies were also perceived to produce barriers to improving emergency department care. Further research is needed to determine the association of the different strategies to improve emergency department care coordination with patient outcomes to inform practice leaders and policymakers on the efficacy of the various approaches.  This research was led by Dr. Jessica Galarraga, a MedStar Health economics investigator and emergency medicine physician.

American Journal of Emergency Medicine, 2021. DOI: 1016/j.ajem.2020.12.048

MedStar Health Researchers Adapt Diabetes to Go-Inpatient Program to Implement Diabetes Survival Skills Education Within Nursing Unit Workflow

Diabetes researches from across MedStar Health sought to develop a strategy to enable hospital nursing unit staff to deliver diabetes survival skills education to adults with type 2 diabetes within their usual workflow using an adaptation of the Diabetes to Go (D2Go) program to fill the gap in education delivery on inpatient units.

Diabetes survival skills education (DSSE) focuses on core knowledge and skills necessary for safe, effective, short-term diabetes self-care. Inpatient diabetes survival skills education delivery approaches are needed. “Diabetes to Go-Inpatient: Pragmatic Lessons Learned from Implementation of Technology-Enabled Diabetes Survival Skills Education Within Nursing Unit Workflow in an Urban, Tertiary Care Hospital” was published in The Joint Commission Journal on Quality and Patient Safety. Diabetes to Go is an evidence-based diabetes survival skills education program originally designed for outpatients.

The Practical, Robust Implementation and Sustainability Model (PRISM) was used to help redesign D2Go for delivery and evaluate the feasibility of integrating a high-tech tablet computer-enabled DSSE program for hospital inpatients. The study team conducted interviews and focus groups with stakeholders to identify perceived barriers and facilitators for implementation; redesigned the D2Go program via stakeholder feedback and education and human factors principles; developed implementation design for tablet delivery and patient engagement by unit staff; and completed a prospective cohort implementation feasibility study on three medical/surgical units.

The results identified 596 adults with type 2 diabetes on three medical/surgical units, 415 (69.6%) were program eligible. Of those eligible, 59 (14.2%) received, accessed, and engaged with the platform; and among those, 43 (72.9%) completed the intervention, representing just 10.4% of those eligible. Multilevel implementation barriers were encountered: staff (receptivity, time, production pressures, culture); process (electronic health record [EHR] integration, patient identification, data tracking, bedside delivery); and patient (receptivity, acuity, availability, accessibility).

In conclusion, strategies are needed to enable effective delivery of diabetes survival skills education to inpatients with type 2 diabetes. System and staffing barriers coupled with patient and technology barriers limited successful implementation of the delivery of diabetes education at the bedside. As a result, adoption of a tablet-based diabetes survival skills e-learning program in a high-acuity care setting was limited.

The Joint Commission Journal on Quality and Patient Safety, 2021. DOI: 10.1016/j.jcjq.2020.10.007

February Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in February 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. "Innovations in Infection Prevention and Treatment"
    Surgical Infections, 2021. DOI: 10.1089/sur.2020.202
    Tejiram S, Shupp JW.

  2. "Understanding and Measuring Long-Term Outcomes of Fingertip and Nail Bed Injuries and Treatments"
    Hand Clinics. 2021.DOI: 10.1016/j.hcl.2020.09.011
    Means KR Jr, Saunders RJ.
  3. "Negative pressure wound therapy system in extremely obese women after cesarean delivery compared with standard dressing"
    The Journal of Maternal-Fetal & Neonatal Medicine, 2021. DOI: 10.1080/14767058.2019.1611774
    Kawakita T, Iqbal SN, Overcash RT. 

  4. "The STRIATE-G Technique for COVID-19 ST-Segment Elevation Myocardial Infarction"
    JACC Cardiovascular Interventions, 2021. DOI: 10.1016/j.jcin.2020.09.045
    Yerasi C, Khalid N, Khan JM, Hashim H, Waksman R, Bernardo N.

  5. Early mortality benefit with COVID-19 convalescent plasma: a matched control study"
    British Journal for Haematology, 2021. DOI: 10.1111/bjh.17272
    Shenoy AG, Hettinger AZ, Fernandez SJ, Blumenthal J, Baez V.

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.