Raj Ratwani Appointed to Newly Created Vice President of Scientific Affairs Position

As part of our continued progress toward becoming a world-class academic health system, and advancing health through research and innovation, we are pleased to announce the appointment of Raj Ratwani, PhD, as Vice President of Scientific Affairs for MedStar Health Research Institute (MHRI). In this new position for MedStar, Raj will play a pivotal role in connecting the scientific activities of MHRI, MedStar Institute for Innovation (MI2), and the MedStar Institute for Quality and Safety (MIQS). He will join the MHRI executive leadership team to provide additional scientific perspectives that support research activities and their interaction with clinical operations.

In his new role on the MHRI executive team, Dr. Ratwani will contribute to the strategy, growth, and administration of research across MedStar, with a focus on working closely with organizational leaders and investigators to translate research results into practice. He will supervise and mentor investigators to support research activities, identify new areas of research funding and enhance MHRI’s reputation as a leading research organization. Furthermore, Dr. Ratwani will lead strategy development for MHRI to support the effective dissemination of research outputs. Dr. Ratwani will remain director of the MedStar Health National Center for Human Factors in Healthcare.

Please join us in congratulating Dr. Ratwani on his promotion as we continue to advance health for our patients and community.

MedStar Investigators Examine Patient Safety Issues from the EHR Surveillance Program

Researchers from MedStar Health National Center for Human Factors in Healthcare and Georgetown University School of Medicine analyzed electronic health records (EHR) surveillance data collected by The Office of the National Coordinator (ONC) for safety issues that could lead to patient harm.  The ONC collects data to determine whether EHR systems, which were certified as meeting specific design, functionality, and security standards set forth by the ONC, still meet those standards when implemented and used. 

The research team included Raj Ratwani, PhD and Aaron Z. Hettinger, MD from MedStar Health National Center for Human Factors in Healthcare; and Thomas B. Pacheco, BS from Georgetown University School of Medicine, Washington, DC.  

The ONC may perform surveillance on EHR vendor products in response to a reported issue (reactive) or by randomly selecting products for investigation (randomized). The researchers examined the surveillance data from January 2016 through June 2019 to determine whether identified issues had the potential for patient harm, and the frequency of these issues. The research focused on nonconformity issues that may have patient safety implications.

The analysis surveilled 697 EHR systems and 358 of all vendor products examined had a certified capability nonconformity issue. The study found that close to 4% (275 EHR systems), had an issue with the potential for patient harm. Most surveillance was reactive, with 352 product IDs having a certified capability nonconformity issue and 273 were coded as being associated with possible patient harm. With most issues being identified through reactive surveillance, 41.8% of product IDs were classified as having a possible patient harm issue.

The study concluded the need for an EHR safety reporting program.  To date, the health information technology industry does not have a method for clinicians or patients to openly report safety issues with EHR software. “This research highlights the need for proactive safety surveillance. We need to develop algorithms to identify safety issues before the issues reach patients, “ said Raj Ratwani, Ph.D.

Dr. Ratwani is supported by AHRQ grants R01HS023701 and R01HS025136. Dr. Hettinger is supported by Agency for Healthcare Research and Quality (AHRQ) grant R01HS025136. Mr. Pacheco is supported by the Frank S. Pellegrini, MD Medical Student Research Scholarship Endowment.

JAMA, 2019. DOI: 10.1001/jama.2019.17242  

December Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in December 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. Combined Vascular Brachytherapy and Stenting for the Treatment of In-Stent Restenosis.
    The American Journal of Cariology, DOI: 10.1016/j.amjcard.2019.11.035
    Chen Y, Buchanan KD, Chan RC, Zhang C, Torguson R, Satler LF, Waksman R.

  2. Frequency of Advanced Cardiac Life Support Medication Use and Association with Survival During In-Hospital Cardiac Arrest.
    Clinical Therapeutics, 2019. DOI: 1016/j.clinthera.2019.11.001
    Benz P, Chong S, Woo S, Brenner N, Wilson M, Dubin J, Heinrichs D, Titus S, Ahn J, Goyal M.

  3. Adherence among post-partum women living with HIV.
    The Lancet HIV, DOI: 10.1016/S2352-3018(19)30403-5
    Scott RK.

  4. Microbiologic Failure Despite Clinical Cure in Pneumonia: Cum Hoc and Post Hoc Ergo Propter Hoc.
    Clinical Infectious Diseases, DOI:10.1093/cid/ciz1191
    Shorr AF, Spellberg B, Zilberberg MD, Kollef MH.

  5. Creating a Care for the Caregiver Program in a Ten-Hospital Health System.
    Critical Care Nursing Clinics of North America, 2019. DOI:10.1177/1078390319878781
    Morales CL, Brown MM.

November Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in November 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. Silent Myocardial Infarction and Sudden Cardiac Death—Finding the Culprit
    Jama Cardiology, 2019. DOI: https://doi.org/10.1001/jamacardio.2019.4377
    Kuku KO, Olatunji-Bello T, Garcia-Garcia HM.
  1. Neurogenic Stunned Myocardium in Severe Neurological Injury
    Current Neurology and Neuroscience Reports, DOI:10.1007/s11910-019-0999-7
    Kenigsberg BB, Barnett CF, Mai JC, Chang JJ.
  1. Evaluation of Risk-Assessment Tools for Severe Postpartum Hemorrhage in Women Undergoing Cesarean Delivery.
    Obstetrics & Gynecology, 2019. DOI: 10.1097/AOG.0000000000003574
    Kawakita T, Mokhtari N, Huang JC, Landy HJ.
  1. Bariatric Surgery Among Vulnerable Populations: The Effect of the Affordable Care Act's Medicaid Expansion
    Surgery: Official Journal of the Society of University Surgeons, Central Surgical Association, and the American Association of Endocrine Surgeons, 2019. DOI: 10.1016/j.surg.2019.05.005
    Gould KM, Zeymo A, Chan KS, DeLeire T, Shara N, Shope TR, Al-Refaie WB.
  1. Does a Care Bundle Reduce Racial Disparities in Postcesarean Surgical Site Infections?
    American Journal of Perinatology, 2019. DOI: 10.1055/s-0039-1688822
    Kawakita T, Umans JG.

Implementation Science: Time and Motion Research to Improve Inpatient Diabetes Education at MedStar

Recently published research evaluated nurse and patient care technician workflow to identify opportunities for providing education to patients during care. The study sought to examine the feasibility of implementing a diabetes education program on a tablet computer in the hospital setting within existing nursing workflow with existing staff.

“Understanding Nursing Workflow for Inpatient Education Delivery: Time and Motion Study” was published in the Journal of Nursing Care Quality. The collaborative research team included Kelley M. Baker, MA and Kelly M. Smith, MSc, PhD from the MedStar Institute for Quality and Safety and MedStar Health Research Institute; and Michelle Magee, MD from the MedStar Diabetes Institute, MedStar Health Research Institute and the School of Medicine and Healthcare Sciences at Georgetown University.

The researchers conducted a time and motion study of nurses and patient care technicians on three medical-surgical units within a 912-bed tertiary care medical center. Two units were standard medical-surgical units and the third unit was a cardiac care unit. Five trained observers conducted observations in 2-hour blocks. During the observation block, one observer shadowed a nurse and one observer shadowed a patient care technician and recorded tasks, locations, and their durations using a web-based time and motion data collection tool.

The results of this observation study show that nurses spent approximately one-third of their time in direct patient care and 60% on the unit but not in a patient room. Patient care technicians spent 42% of their time in direct patient care, compared with nurses. Patient care technicians averaged 18.2 tasks per hour, while nurses averaged 16.2. On average, the amount of time spent for a direct patient care session was 3:42 minutes for nurses and 3:02 minutes for patient care technicians. For nurses, 56% of task durations were 2 minutes or less and 38% were 1 minute or less. For patient care technicians, 62% of task durations were 2 minutes or less and 44% were 1 minutes or less. Nurses visited 5.3 patient rooms per hour, while patient care technicians visited 9.4 patient rooms per hour.

The research team concluded that within the existing workflow of nurses and patient care technicians, constantly in and out of patient rooms, it is possible to deliver a tablet to the patient to provide diabetes education. However, the short duration of direct patient care sessions could potentially limit the ability of the nurses and patient care technicians to spend much time with each patient on instruction for use of the technology platform or in answering questions about the content. Diabetes self-management education and support is beneficial for persons living with diabetes. Future research should identify ways to implement technology to support education delivery in the hospital within the existing workflow for nurses and patient care technicians.

This research was funded by the National Institutes of Diabetes and Digestive and Kidney Diseases (R34DK109503). Dr. Smith also received funding from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001409.

JMIR Nursing, 2019. DOI: 10.2196/15658

KL2 Junior Faculty Scholars Program: Now Accepting Applications

Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS) is now accepting applications for its KL2 Junior Faculty Scholars Program. Projects that are novel, inter- or multi-disciplinary and collaborative will be favored. The KL2 scholars will be awarded up to $90, 000 salary support and $40,000 project support per year (for up to three years).

Who is eligible: Junior Faculty with a full-time or equivalent appointment at a GHUCCTS institution (Georgetown University, Howard University, or MedStar Health) at the time of award activation. Scholars must devote 75% effort to the program for three yearsscholars must be US Citizens, Non-citizen Nationals, or Permanent Residents. Individuals who were, or currently are Principal Investigator of NIH R01, P01 or P50 subprojects, or individual K (e.g., K01, K08, K22, K23) grant ARE NOT eligible; current/former PIs of non-NIH peer reviewed research grants >$100k annual direct costs are ineligible.

Learn more about the program and applicatation requirements on the GHUCCTS website.

Pre-Applications are due DECEMBER 13, 2019
Final Applications are due FEBRUARY 19, 2020

Online Informational Sessions:
November 22nd - 2:00PM
November 25th - 5:30PM
December 2nd – 3:00PM
December 4th- 2:00PM

To register for the sessions, e-mail [email protected]

ZOOM LINK: https://georgetown.zoom.us/j/784424793
Learn more on the GHUCCTS website

QUESTIONS? Contact the Executive Committee:
Jason G. Umans, MD, PhD [email protected]
Dexter L. Lee, PhD [email protected]
Kathryn Sandberg, PhD [email protected]

MedStar Investigator Receives the ‘Women Advancing Thyroid Research’ Award

Join us in congratulating Cristiane Gomes-Lima, MD, on her 2019 Women Advancing Thyroid Research (WATR) award from the American Thyroid Association (ATA). The WATR is a new award from the American Thyroid Association that recognizes and celebrates the work of women that are leading outstanding thyroid research. The WATR Award is sponsored by Mary Ann Liebert, Inc. through the Rosalind Franklin Society.

Dr. Gomes-Lima presented her award-winning work, “Do Molecular Profiles of Primary versus Metastatic Radioiodine Refractory Differentiated Thyroid Cancer Differ?” as a highlighted oral presentation at the ATA conference in late October. Her work was recognized at the Women in Thyroid meeting of the ATA.

The research focused on patients with advanced differentiated thyroid cancer. The research team sought to understand the molecular biology of the primary tumor and its metastases. They leveraged a bioinformatics approach to explore the interconnections of abnormal cancer genes in the context of thyroid physiology. In the era of precision medicine, this knowledge is essential to offer optimal treatment choices for our patients. “This award reassures my commitment to advance health through research,” said Dr. Gomes-Lima.

Dr. Cristiane Gomes-Lima graduated in Medicine from the University of Brasilia, Brazil. She completed her Internal Medicine residency, followed by Endocrinology fellowship and a master’s degree in Health Sciences. After working in clinical practice, she pursued a post-graduate research fellowship in thyroid cancer. She is currently a research fellow at MedStar Health Research Institute, in Washington, DC, and a guest researcher at the National Institutes of Health in Bethesda, Maryland.

In addition to Dr. Gomes-Lima, there were three other recipients of the award: Drs. Mariella Tutter, Silvia Ippolito, and Rosa Falcone. The ATA press release can be viewed here.

MedStar Researchers Evaluate Coffee and Tea Consumption in Relation to Risk of Rheumatoid Arthritis

Recently published collaborative research evaluated whether tea or coffee consumption is associated with an increased risk of incident rheumatoid arthritis using the Women’s Health Initiative Observational Study. The research team included members from MedStar Washington Hospital Center, National Institute of Nursing Research, Fred Hutchinson Cancer Research Center, National Institute of Environmental Health Science, MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Sciences.

The Women’s Health Initiative was a long-term national health study which MedStar Health Research Institute joined as a collaborating center in 1994, under the direction of Barbara Howard, PhD. The observational study includes a cohort of 93,676 postmenopausal women, age 50 to 79, whom were enrolled from 1993 to 1998. In the study, 76,853 women completed a self-administered questionnaire at baseline providing information on their daily consumption of tea and coffee.

During analysis, the study team found that previous studies have shown an increased risk of rheumatoid arthritis associated with consumption of decaffeinated coffee, but no such association with caffeinated coffee intake. Many teas such as green tea, black tea, and oolong tea have been considered as antioxidants and perhaps reducing the risk of rheumatoid arthritis. However, several studies have suggested no relationship between tea consumption and rheumatoid arthritis. Other risk factors such as age, race/ethnicity, cigarette smoking, medical history, medication use, and other lifestyle behaviors may also be associated with an increased risk of rheumatoid arthritis.

There were 185 women who self-reported incident cases of rheumatoid arthritis. The results show that women with a history of nonherbal, nondecaffeinated tea consumption of any amount had an increased risk of developing rheumatoid arthritis during the first 3 years of observation in the Women’s Health Initiative Observation Study. The study results do not show any association between coffee intake and rheumatoid arthritis but there is a minimal increased risk of incident rheumatoid arthritis with caffeinated tea consumption.

The study authors are Diman Lamichlane, MD; Christopher Collins, MD; Florina Constantinescu, MD, PhD; Brian Walitt, MD; Mary Pettinger, MS; Christine Parks, PhD, MSPH; and Barbara Howard, PhD.

Journal of Clinical Rheumatology, 2019. DOI: 10.1097/RHU.0000000000000788

Now Open: AcademyHealth Delivery System Science Fellowship

The Delivery System Science Fellowship application cycle for the 2020 cohort is NOW OPEN! The Academy Health Delivery System Science Fellowship (DSSF) provides a year-long professional development opportunity for highly qualified, doctorally-prepared individuals to gain more applied experience in a delivery system setting. MedStar Health Research Institute is one of six participating host sites. We are pleased to welcome Jason Brown, PhD, RN as our Academy Health Delivery System Science Fellow for this year. Dr. Jason Brown’s research interest include patient and provider decision support, behavioral economics, data science, clinical informatics, and healthcare disparities. Read his full bio here.

The goal of the fellowship is to provide hands-on training and professional opportunities for highly qualified researchers with a background in health services research (HSR) or related fields to enhance analytic skills and ultimately increase the capacity of the HSR workforce. Applications are now being accepted for 2020. The deadline to apply is January 1, 2020.

Submit an Intent to Apply
Once applicants submit a brief Intent to Apply form, they will receive a link to the full application.

Application Deadline: Wednesday, January 1, 2020, at 5:00 p.m. ET
Questions? Please contact DSSF staff at [email protected]

October Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in October 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. Second-generation drug-eluting resorbable magnesium scaffold: Review of the clinical evidence
    Cardiovascular Revascularization Medicine, 2019. DOI:10.1016/j.carrev.2019.10.012
    Ozaki Y, Garcia-Garcia HM, Shlofmitz E, Hideo-Kajita A, Waksman R.
  2. Virtual reality for pain management in patients with heart failure: Study rationale and design.
    Contemporary Clinical Trials Communications, 2019. DOI:10.1016/j.conctc.2019.100470     
    Stewart D, Mete M, Groninger H.

  3. Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Proximal Scaphoid Reconstruction.
    Journal of Hand Surgery, 2019. DOI: 10.1016/j.jhsa.2019.08.008 
    Pet MA, Assi PE, Yousaf IS, Giladi AM, Higgins JP.

  4. Diabetes Education for Behavioral Health Inpatients: Challenges and Opportunities.
    Journal of the American Psychiatric Nurses Association, 2019. DOI:10.1177/1078390319878781
    Bardsley JK, Baker KM, Smith KM, Magee MF.