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.

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






Introducing “Food and Friends” to the MedStar Health Research Community

Throughout the national health systems, social determinants of health are frequently present which negatively impact health-related outcomes despite excellent medical care.  Four of these determinants, namely food insecurity and access to housing, medications and transportation are prevalent in our region as cited by MedStar Health Community Health report. Because of the impact of these social determinates of health, Medstar Health is testing this new initiative. Food and Friends is a community-based NGO which provides nutrition consultation services and 3 medically tailored meals per day for several months to eligible clients with chronic complex medical conditions, including diabetes.

The Department of Emergency Medicine at MedStar Health Washington Hospital Center and the MedStar Health Diabetes Institute are partnering with Food & Friends on a pilot project to identify individuals with diabetes, hyperglycemia, and food insecurity, and link them to medically tailored meal delivery service for 6 months.

Food insecurity is defined as “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” Of tremendous concern, there are 700,000 people at risk of hunger in Washington, D.C. Those living with diabetes and food insecurity are at particularly high risk of adverse events, in part because of the high cost of medication and the subsequent struggle to decide whether to spend their limited financial resources on food or medication. Screening for food insecurity in patients is an important step towards finding solutions in the community. The MedStar group has described that 46% of hyperglycemic patients presenting to the MedStar Washington Hospital Center Emergency Department with a blood sugar greater than 250 g/dl screened positive for food insecurity, and that these food insecurity patients were 1.9 times more likely to be hospitalized than those without food insecurity.  Among the subset with a HgbA1c measured, the mean level was very high at 11.2% and 96% had a HgbA1c > 7.5, which would be considered a reasonable target for many of these persons.

In an emergency department study at MedStar Washington Hospital Center, senior Georgetown University medical students will enroll participants examining the impact of direct food referral for hyperglycemic patients.  The study is designed to determine the feasibility, adherence to, and impact of 6 months of no-cost, medically tailored meal delivery among diabetes patients experiencing Food insecurity directly linked from the emergency department..  

The study team members are: Munish Goyal, MD, PI, MedStar Emergency Physicians; Michelle Magee, MD, MedStar Health Diabetes Institute; Yumi Jarris, MD; Rebecca Breed, MD; Gavin Koenig; Katie Povey; Donya Enayati; Virginia Chan; Heng Nhoung and Christopher Wagner. In the attached picture, Drs Goyal and Magee are volunteering at Food and Friends to get first-hand experience!






KL2 Junior Faculty Scholars Program: Now Accepting Applications

The Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS) is now accepting applications for our 2021 KL2 Scholars Program. The pre-application is due December 31, 2020 with the final application due February 1, 2021. Funding is expected to begin in June 2021 pending the evolution of the COVID-19 pandemic.

During our first ten years, we have been privileged to award KL2 support to 18 junior faculty colleagues from Georgetown and Howard Universities and from MedStar Health, who have leveraged this opportunity in order to publish >500 peer-reviewed manuscripts, receive over 50 extramural grants and conduct 30 sponsored clinical trials.

This K-series career development award is nearly identical to our previous KL2 awards and analogous to individual K23, K08, or K01 awards, with a focus on developing early-career (MD or equivalent; doctorally-trained nurses, pharmacists or dentists; and clinically or translationally-oriented PhD) faculty investigators through an inter- or multi-disciplinary mentored research experience so that they can become independent, extramurally-funded investigators. Given the goals of the GHUCCTS, awards will favor those: 1) who propose novel trans-, inter-, or multi-disciplinary and collaborative/team research projects, 2) from the entire T1-T4 translational continuum, 3) which span departments, disciplines, and institutions, and 4) address significant health disparities.

After our 10th highly competitive application cycle, GHUCCTS recently announced the appointment of Dr. Haiyan He as a KL2 Scholar. Dr. He is an Assistant Professor in the Department of Biology at Georgetown University.

For more details, including application instructions, visit our KL2 Scholars page or download the RFA announcement.

QUESTIONS?
Inquiries to Ms. Cyndi Campbell [email protected], or to any member of the KL2 Executive Committee (Jason G. Umans, MD, PhD: [email protected] Kathryn Sandberg, PhD: [email protected]; Charles D. Howell, MD: [email protected])





November Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in November 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) COVID-19: associated morbidity and mitigation strategies
Infectious Diseases, 2020. DOI: 10.1080/23744235.2020.1799071
Mahmood SN, Woods CJ, Chan CM.

2) Development and validation of a simple risk score for diagnosing COVID-19 in the emergency room
Epidemiology & Infection, 2020. DOI: 10.1017/S0950268820002769
Sung J, Choudry N, Bachour R.

3) Evaluation and Treatment of Amiodarone-Induced Thyroid Disorders
The Journal of Clinical Endocrinology & Metabolism, 2020. DOI: 10.1210/clinem/dgaa686
Ylli D, Wartofsky L, Burman KD.

4) An unusual presentation of inhalation injury in a patient with high voltage electrical injury: A case report
International Journal of Surgery Case Reports, 2020. DOI: 10.1016/j.ijscr.2020.10.139
Keyloun JW, Travis TE, Johnson LS, Shupp JW.

 

 





MedStar NRH Study Finds that Innovative Devices Did Not Provide Better Outcomes for Knee Replacement Patients Undergoing Outpatient Rehabilitation

Researchers from MedStar National Rehabilitation Hospital and MedStar Health Physical Therapy were a part of a large multi-center randomized clinical trial that found that newer and more expensive devices, increasingly seen in outpatient physical therapy centers, did not enhance outcomes for patients following their knee replacement relative to conventional care.

Study findings appear in  a recent issue of the Journal of Arthroplasty, one of the nation’s three leading orthopedic surgery journals and in  JAMA Network Open, JAMA’s on-line journal.

In the U.S., upwards of 1.0 million people obtain a primary total knee arthroplasty (TKA) per year. Most go on to use outpatient physical therapy—soon after discharge or following a stay at home or another facility. As part of a typical outpatient visit, the patient will initially participate in a warm-up exercise using a recumbent bike designed to increase blood flow and tissue pliability.

The trial compared 4 exercise interventions: (1) a recumbent bike (which is usual care) compared to the three newer exercise interventions: (2) a bodyweight-adjustable treadmill, (3) a patterned electrical neurostimulation (PENS) devise used with a recumbent bike, and (4) a PENS device used with a bodyweight-adjustable treadmill.

The study compared intervention outcomes using (1) walking speed, a performance-based measure, and (2) the Knee Injury and Osteoarthritis Outcome Score or KOOS, the most common patient-report measure used to evaluate TKA outcomes.

The study enrolled 363 patients with more than 90 participants in each of the study’s four arms across 15 MedStar Physical Therapy outpatient rehabilitation centers. Altogether 19 MedStar orthopedic surgeons referred patients to the study.

Jean Hsieh, PhD, of MedStar NRH’s research program served as the study’s principal investigator. Dr. Hsieh was assisted by Gerben DeJong, PhD as co-principal investigator. Michele Vita, DPT served as the chief clinical services coordinator with able assistance from Linda Briggs, EdD, AVP for the MedStar National Rehabilitation Network. Biostatistical support for the study came from Alexander Zeymo and Sameer Desale of the MedStar Health Research Institute. The study could not have succeeded without the strong support of John Brickley, VP, MedStar National Rehabilitation Network and John Rockwood, its president.

The study was funded internally by the MedStar National Rehabilitation Network with support from several outside sources including the company’s whose devices were evaluated.

Journal of Arthroplasty, Vol. 35 (08), 2054-2065. DOI: 10.1016/j.arth.2020.03.048






MedStar Health Research Evaluates Diabetes Survival Skills Education for Behavioral Health Inpatients

Researchers from across MedStar Health sought to adapt Diabetes to Go (D2Go), a diabetes survival skills education (DSSE) program for delivery on inpatient behavioral health units (BHU) and to evaluate the feasibility of implementing D2Go-BHU within nursing unit workflow. “Diabetes Education for Behavioral Health Inpatients: Challenges and Opportunities” was published in the Journal of the American Psychiatric Nurses Association. The study assessed the need for diabetes survival skills education to help patients with self-care during their transition from the hospital.

The study team used the practical robust implementation and sustainability model implementation science framework to conduct the research. There were 1989 patient admissions observed, among which 264 were discharged with a diagnosis of type 2 diabetes. Interviews, focus groups and feedback were provided from support staff and nurses to design various adaptations for the D2Go-BHU program. Adaptions to the program included (a) delivering education through facilitated group learning sessions, (b) providing paper surveys and a hard copy D2Go survival skills education booklet, (c) and developing videos which were delivered using a secure DVD versus a tablet.

During the study period, two psychiatry behavioral health units conducted a total of 9 group sessions. The primary diagnosis at hospital discharge was obtained for 29 patients and included suicide attempt (n = 10; 35%), depression (n = 7; 24%), schizophrenia (n = 5; 17%), psychosis (n = 7; 17%), bipolar (n = 3; 10%), posttraumatic stress disorder (n = 1; 3%), delusion (n = 1; 3%), homicidal (n = 1;3%), and other (n = 2; 7%). After completing assessment surveys, the results showed that those with diabetes had lower ASK12 scores compared with those without diabetes. Persons with diabetes answered most items related to what to eat correctly, but less than 33% correctly answered items related to target blood glucose (BG) after a meal, need for checking BG, symptoms of high BG, and where to store oral medicines.

The study team identified multiple barriers to implementation including lack of standardization of education content by nurse facilitators and difficulty engaging patients for the time required for completion of surveys plus group education. Both nurses and patients preferred a book as it relates to educational materials.  Further research would be needed to determine if individual diabetes education alone or a model which combines individual and group sessions is preferable for this population.

The team included Joan K. Bardsley MBA, RN, CDE, FAADE, from MedStar Health Research Institute, Michelle F. Magee, MD, from MedStar Diabetes Institute and Georgetown University; Kelly M. Baker, MA, and Kelly M. Smith, Msc, PhD, from MedStar Institute for Quality and Safety.

The study was funded by the National Institutes of Health, National Institute for Diabetes, Digestive, and Kidney Diseases (Grant Number R34-DK-109503).

Journal of the American Psychiatric Nurses Association, DOI: 10.1177/1078390319878781






October Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in October 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. Pharmacologic Management of Gout in Patients with Cardiovascular Disease and Heart Failure
    American Journal of Cardiovascular Drugs, 2020. DOI: 10.1007/s40256-020-00400-6
    Mouradjian MT, Plazak ME, Gale SE, Noel ZR, Watson K, Devabhakthuni S

  2. Externally Validated Prediction Model of Vaginal Delivery After Preterm Induction With Unfavorable Cervix
    Obstetrics & Gynecology, 2020. DOI: 10.1097/AOG.0000000000004039
    Kawakita T, Reddy UM, Huang JC, Auguste TC, Bauer D, Overcash RT.

  3. Galectin-1 production is elevated in hypertrophic scar
    Wound Repair and Regeneration, 2020. DOI: 10.1111/wrr.12869
    Kirkpatrick LD, Shupp JW, Smith RD, Alkhalil A, Moffatt LT, Carney BC.

  4. Micropuncture technique for femoral access is associated with lower vascular complications compared to standard needleCatheter Cardiovasc Interv, 2020. DOI: 10.1002/ccd.29330
    Ben-Dor I, Sharma A, Rogers T, Yerasi C, Case BC, Chezar-Azerrad C, Musallam A, Forrestal BJ, Zhang C, Hashim H, Bernardo N, Satler LF, Waksman R.

  5. Management of recurrent granulosa cell tumor of the ovary: Contemporary literature review and a proposal of hyperthermic intraperitoneal chemotherapy as novel therapeutic option
    The Journal of Obsetrics and Gynaecology Research, 2020. DOI: 10.1111/jog.14494

       
       

      MedStar Investigators Examine Computed Tomography Pulmonary Angiography in the Emergency Department

      Recently published collaborative research examined utilization patterns and predictors of computed tomography pulmonary angiography (CTPA) results in the emergency department. “High Scan Volume with Low Positive Scan Rate in Highest Utilizers: Computed Tomography Pulmonary Angiography in the Emergency Department” was published in The Journal of Emergency Medicine. This publication was the result of the Summer Research Student program with MedStar Health investigators mentoring rising second-year medical students from the Georgetown University School of Medicine. The team included investigators from MedStar Good Samaritan Hospital, MedStar Union Memorial Hospital, MedStar Washington Hospital Center and Georgetown University.

      The overutilization of CTPA is a serious concern in the emergency department because the potential of increased risk for radiation exposure, cost, and over diagnosis bias may occur. This study reviewed all CTPA studies performed in one year across a multisite medical system and focused on data for emergency department attendings and positive CTPA scan rates (PSR). The team manually reviewed all applicable scans and classified them as positive, negative, or indeterminate.

      The results show there were 10,032 total scans from the emergency department and 6,168 of those were ordered by 153 emergency department attendings. Most attendings (123/153; 80%) ordered 60 or fewer scans, with relatively high PSR (259/2927, PSR 8.8%; 95% confidence interval 7.8–9.9%). Of the emergency department attendings, 13 (3%) ordered more than 100 scans each (1981 scans; 32% of all scans), with PSR of 5.5% (95% confidence interval 4.5–6.5%).

      Overall, the study found that most emergency department attendings were low-to mid-volume utilizers of CTPA and had a relatively high PSR. However, the small percentage of attendings who ordered more than 100 scans each accounted for a large percentage of the total number of scans and had a relatively low PSR. These findings suggest that mentoring and/or sharing of performance feedback and best practices in the highest utilizers could help to improve CTPA PSR in the emergency department. 

      Dr. David Weisman, a mentor for the Scholars program and senior author for the publication shared his thoughts on the students and the program.  “I’ve have been extremely fortunate to have had the opportunity to work with so many wonderful Georgetown medical students for the past 4 years. Each student brings to the table their individual uniqueness and talents. I’ve been thankful and impressed by the dedication of MedStar Health and Georgetown University leadership to support this program which is so vital to introduce students to research early in their career. I look forward too many more years of collaboration and mentorship.”

      The research team included Himanshu Rawal, MD; Oluwatoyosi Ipaye, MS; Amit D. Kalaria, MD; Radhika Vij, MD, FACP; Jeffrey S. Dubin, MD, MBA; Lyn Camire, MA, ELS; and David S. Weisman, DO, FACP.

      The Journal of Emergency Medicine, 2020. DOI: 10.1016/j.jemermed.2020.04.008