MedStar Investigators Evaluate Validity and Reliability of Diabetes Survival Skills Knowledge Test

MedStar Health investigators examined the validity and reliability of the KNOW Diabetes test, a survival skill knowledge test used to evaluate the impact of diabetes education and research interventions in their study “Validity and Reliability of a (Brief) Diabetes ‘Survival Skills’ Knowledge Test.” Diabetes self-management education support (DSMES) may be defined as essential education that facilitates the knowledge, skills, and abilities necessary for safe and effective sort-term diabetes self-care.

In the United States, there is a low rate of participation in diabetes self-management education support and lack of availability of short, easy-to-administer diabetes knowledge tests. This presents a need for a tool that can easily identify knowledge deficits to ensure the safety and effectiveness of diabetes self-care management among adults with type 2 diabetes mellitus where traditional diabetes self-management education support is not available. Managing diabetes is an important part of positive patient outcomes. The KNOW Diabetes knowledge test was developed with input from endocrinologists, certified diabetes educators, and patients in a US regional health care system. The test consists of questions from seven domains: nutrition and meal plan basics, blood glucose monitoring, glycemic targets, taking medications as prescribed, hyper- and hypoglycemia recognition and treatment, and when to seek medical help.

This study recruited 280 adults with T2DM for a two-phase research study. In phase one, the 19-question diabetes knowledge test was administered to assess feasibility. Following analysis of phase one data, three questions were removed from the knowledge test due to high difficulty and two questions on insulin storage were combined into a single question. The revised KNOW Diabetes survey contained 15 questions and was completed by 227 participants. Most participants were older than 65 years, and 65% reported having diabetes for more than five years. 70% of participants were African American.

The study results showed that patients who are older and have a lower level of education, have Medicaid or Medicare, and are without pain or numbness in the feet, scored significantly lower on the KNOW Diabetes test.  Test scores were higher among those who were younger, had a higher education level had a longer duration of diabetes and were non-Medicare or Medicaid insured.

The KNOW Diabetes knowledge test is intended to identify knowledge deficits in diabetes self-management survival skills and the study results prove the validity and reliability of the test for use in a variety of nondiabetic specialty care settings as well as in the clinical care setting.

The collaborative research team included Gretchen Youssef, MS, RD, CDE; Edward H. Ip, PhD; Michelle Magee, MD, MBBCh, BAO, LRCPSI; Shyh-Huei Chen, PhD; Amisha Wallia, MD, MS; Teresa Pollack, MS; Emilie Touma; Clayton Bourges, MS; Lynne Brecker, BSN, RN, CDE from the MedStar Diabetes Institute.

The Diabetes Educator, DOI: 10.1177/0145721719828064






Collaborative Research from MedStar Investigators Evaluates Early Laser Treatment in Surgical Scar Minimization

Recently published research from MedStar Washington Hospital Center, MedStar Health Research Institute, Firefighters’ Burn and Surgical Research Laboratory, MedStar Georgetown University Hospital, and Georgetown University School of Medicine investigated the efficacy of lasers to minimize surgical scars when applied less than one month after operation. Laser scar therapies aim to treat undesirable results post operation. Prevention of visible scars is preferred over treatment, and studies examining the use of lase scar therapies at earlier stages have shown improved results.

The study “Effectiveness of Early Laser Treatment in Surgical Scar Minimization: A Systematic Review and Meta-analysis” examined previously published literature in order to evaluate the efficacy of laser modalities in minimizing the undesirable characteristics of primary closed full-thickness surgical scars less than one month after operation. The literature review encompassed 8 articles in the systematic review and 4 in the meta-analysis.

The primary outcome of the study was the quantitative statistical review of the available data generated from randomized controlled trials determining the efficacy of early laser therapies applied less than 1 month after operation to minimize surgical scars. Based on the data, the analysis showed statistically significant therapeutic effect (p < .05). Due to the nature of the research included in this analysis (a diverse set of applications and usage), this statistical finding can offer evidence for the use of laser modalities as a whole under this indication.

The secondary outcome was a qualitative review where the validity of most individual studies included were determined to be “fair”. However, half of the studies included in the statistical review received “good” ratings.

Within the analyzed studies, there were inconsistent conclusions of studies using pulsed-dye laser systems. This observation was based on the varied use of purpuric versus non-purpuric laser settings. Only non-purpuric settings have been found to be reliably effective, whereas purpuric settings have failed to show efficacy. The research team recommends the use of non-pupuric settings when treating early scars, as this method is also desirable to patients.

In summary, the ability of lasers to achieve significant improvement after one session is ideal, alleviating the burden of repeat visits and providing a cost-effective means of minimizing scars. However, multiple scar treatments are often recommended for optimal results. Most patients prefer early treatment, as the scars are more amendable to treatment instead of waiting until they are hard, thick, and difficult to penetrate. The outcome supports the efficacy of lasers in minimizing primarily closed surgical scars when treated less than one month after surgery.

The study team included Rhett A. Kent, MD, Jeffrey Shupp, MD, Stephen Fernandez, MPH, Nick Prindeze, BS; and Cynthia M.C. DeKlotz, MD.

Dermatologic Surgery, DOI: 10.1097/DSS.0000000000001887






MedStar Health Teaching and Research Scholars: Now Accepting Applications

Applications open for the 12th class of Teaching Scholars at MedStar Health

The heart of the MedStar Teaching Scholars program is raising clinician educators to scholars of medical education by teaching educators from across MedStar Health how to apply research principles to medical education; become informed consumers of the medical education research literature; to be effective collaborators in medical education research; and to develop as a leader in academic medicine. GME program directors, core clinical teaching faculty, clerkship directors and other clinician educators (with limited research training or experience) in all specialties and professions are encouraged to apply.

Applications are due on Friday, October 18.
Learn more about the program at www.MedStarHealth.org/TeachingScholars.

Apply Today

Applications open for the 7th class of Research Scholars at MedStar Health

The MedStar Health Research Scholars programs aids in the development of a cadre of future academic leaders from disciplines across the entire system. Ideal Research Scholar applicants are early career MedStar clinicians seeking to develop significant personal scholarship in clinical or translational research, but with limited research experience, or with research experience in another field. A commitment to conducting mentored clinical or translational research with the ultimate goal of progressing to scholarly independence is the cornerstone of this program. 

Applications are due on Friday, November 15.
Learn more about the program at http://www.medstarhealth.org/education/faculty-development/research-scholars.

Apply Today





September Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in September 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. Future technology-enabled care for diabetes and hyperglycemia in the hospital setting.
    World Journal of Diabetes, 2019. DOI: 10.4239/wjd.v10.i9.473
    Montero AR, Dubin JS, Sack P, Magee MF.
  1. Advancements in Reconstructive Surgery Broaden Opportunities for Salvage of the Injured Lower Extremity.
    Annals of Plastic Surgery, 2019. DOI: 10.1097/SAP.0000000000001977
    Assi PE, Giladi AM.
  1. Clinical, Pathological, and Molecular Profiling of Radioactive Iodine Refractory Differentiated Thyroid Cancer.
    Thyroid, 2019. DOI:10.1089/thy.2019.0075
    Shobab L, Gomes-Lima C, Zeymo A, Feldman R, Jonklaas J, Wartofsky L, Burman KD.
  1. Lateral Transfer of the Flexor Digitorum Longus for Peroneal Tendinopathy.
    Foot & Ankle International, 2019. DOI:10.1177/1071100719853297
    Sherman TI, Koury K, Orapin J, Schon LC.





MedStar Health Investigates Utility of Teaching Kitchens to Improve Lifestyle Skills

Research from MedStar Institute for Innovation and the MedStar Lafayette Centre Internal Medicine used three Teaching Kitchen (TK) Shared Medical Appointment (SMA) programs to improve patients culinary and lifestyle skills in an effort to improve health habits. In 2017, Fresh and Savory, a Culinary and Lifestyle Medicine Teaching Kitchen program was implemented at MedStar Health as a Shared Medical Appointment. Alongside the portable Teaching Kitchen were physician consultations, interactive didactic presentations, nutritious cooking, and mind-body exercises.

The research was published in The Journal of Alternative and Complementary Medicine. The research team was led by Renee Kakareka, BS, and included Theresa A. Stone, MD, FACP; Paul Plsek, MS; Anthony Imamura, BEnvD, AOS-Culinary Arts; and Ellie Hwang, MHA.

In the United States, 100 million people are overweight or obese. The study referenced that “about 80% of coronary heart disease, 90% of type 2 diabetes, and 33% of cancers, can be reversed or prevented with healthy lifestyle interventions (exercise, healthful eating habits, and smoking cessation).” MedStar researchers saw an opportunity to test the use of culinary and lifestyle medicine program to teach patients evidence-based lifestyle skills to determine if they reduce primary and secondary cardiovascular disease risk.

Two cohorts were recruited from Internal Medicine and Cardiology and completed an 8-week program. One sports performance cohort was recruited which included young, elite athletes completing a 4-week program. The Internal Medicine and Cardiology program included eight, two-hour sessions consisting of mind-body exercise and both didactic presentations and hands-on activities. The Sports Performance program consisted of four, two-hour sessions following a similar format as Internal Medicine/Cardiology but focused on an athlete’s nutrition and lifestyle.

Each week vitals (blood pressure, weight, heart rate) were collected. The physician and patient would then discuss the patient’s goals, progress, medications, and other medically relevant information during the two-hour session. One of the Internal Medicine/Cardiology cohorts were emailed electronic surveys which inquired about lifestyle behaviors over the past month at baseline and 7 days each week. The other Internal Medicine/Cardiology cohort and Sports Performance group filled out paper booklets, “Passports”, each week recording their goals, program feedback, and lecture notes.

There were 53 patients that participated in the three Teaching Kitchen SMA programs. During the program, the research team noted that change in patient vitals were statically insignificant, yet habit changes showed clinical significance. Patients noted increased knowledge of plant-based meals, importance of sleep, and adding mindfulness and exercise to their weekly routine.

In conclusion, the research proved patient demand for opportunities to develop healthy behaviors. Although, vital signs may not significantly improve, small habit changes may improve long-term health outcomes. Future studies will seek to correlate the influence of Teaching Kitchen Shared Medical Appointment programs and long-term behavior changes.

The Journal of Alternative and Complementary Medicine, 2019. DOI: 10.1089/acm.2019.009






MedStar Investigators Evaluate the Effects of Medicaid Expansion on Trauma Triage

Recently published research from the team at the Curtis Hand Center explored whether the 2014 expansion of Medicaid in Maryland under the Affordable Care Act decreased the number of uninsured upper-extremity trauma patients and the volume of unnecessary emergency trauma visits at the hand center.

“The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma” was published in the Journal of Hand Surgery. The research team was led by Charles A. Daly, MD and included Brian H. Cho, MD; Sameer Desale, MS; Oluseyi Aliu, MD, MS; Mihriye Mete, PhD; and Aviram M. Giladi, MD, MS.

In the United States, 17% of total trauma-related costs are associated with hand and wrist injuries. In addition, care for hand trauma is often complex and time sensitive which creates a burden for patients sometimes being transferred long distances for treatment. The Affordable Care Act was passed in March 2010 with an intent of expanding health insurance coverage and health care access nationwide. Currently, only 32 states and the District of Columbia have elected to expand coverage.

The availability of trauma centers that specialize in upper-extremity care is critical to treating patients. However, there’s an overuse of referrals and transfers which creates additional financial burden for these centers. The study team hypothesized that by decreasing the number of uninsured trauma patients, Medicaid expansion would decrease unwarranted transfers because the patients may be able to find care closer to home.

This retrospective study looked at patients with isolated hand and upper-extremity trauma between 2010 and 2017 at the Curtis Hand Center. Demographic data was collected and the intensity of each patient’s injury was classified using the Hand Trauma Severity Matrix. The Severity Matrix assists with indicating the need for acute specialized hand trauma management. Patients were classified as appropriate/inappropriate, transfer/non-transfer, and pre-expansion or post Medicaid expansion in Maryland.

The research team studied 12,009 acute upper-extremity trauma patients. In total, 20% had Medicaid and 27% had no insurance. Thirty percent of patients traveled over 25 miles to obtain treatment and 25% of all patients were transferred to the hand center from other health care facilities. After Medicaid expansion, the percentage of trauma patients with Medicaid coverage increased from 15% to 24%, with a decrease in uninsured from 31% to 24%. After Medicaid expansion, non-transfer patient appropriateness decreased and appropriateness of transfers remained steady. Transfer patients were required to travel significantly farther for care than were non-transfer patients but the distance all groups traveled on average did not change significantly from before to after expansion.

The results show that Medicaid expansion significantly decreased the proportion of uninsured upper-extremity trauma patients. However, the study team did not find a significant change in the appropriateness of transferred patients after expansion, whereas appropriateness of non-transferred patients declined after Medicaid expansion. There is still a high percentage of uninsured patients that remain in the hand trauma population, which continues to place a financial burden on regional referral centers. Future research should focus on how to lessen the burden of unnecessary urgent referrals and improving resource use.

Dr. Avi Giladi recently had an interview with Dr. Brent Graham, Hand surgeon, Editor-in-Chief of the Journal of Hand Surgery (JHS) regarding “The Effects of Medicaid Expansion on Triage and Regional Transfer After Upper-Extremity Trauma” on the JHS monthly podcast. You may listen to Episode 42 here.  

 Journal of Hand Surgery, 2019. DOI: 10.1016/j.jhsa.2019.05.020






MedStar Health’s Raj Ratwani Receives American Psychological Association Award for Early Career Achievement

Congratulations to Raj Ratwani, PhD, director of the MedStar Health National Center for Human Factors in Healthcare and associate professor of the Georgetown University School of Medicine, for receiving the American Psychological Association’s (APA) Earl Alluisi Award for Early Career Achievement. The award is given annually to psychologists who, within 10 years of receiving their PhD, have made remarkable contributions to the field through research and publications, novel technology or techniques, theoretical advancements, and more. It is sponsored by APA’s Division 21, whose members work to advance the field of applied experimental and engineering psychology. The MedStar Health Human Factors Center is part of the MedStar Institute for Innovation and works in partnership with MedStar Health Research Institute and others throughout MedStar Health.

In the seven years he has been with MedStar Health, Dr. Ratwani has been awarded more than 25 grants and contracts, published more than 30 articles, and delivered more than 27 invited international, national, and regional presentations—all in collaboration with his growing team. 

The award, which emphasizes the translation of research into practice, recognizes Dr. Ratwani’s success in utilizing human factors science to impact healthcare operations and policy. His research on health information technology usability—and related work to advance patient safety and provider well-being—has been published in top-tier journals and was recently shared in a national campaign. Additionally, Dr. Ratwani’s research on interruptions and task resumption has informed innovative models that show the time cost of interruptions on physician workflow processes. These theoretical contributions lay the foundation for interventions that can prevent or mitigate interruption-related errors in health care.

In addition to his research efforts, Dr. Ratwani spearheads the continued growth of the MedStar Health Human Factors Center and has served as its leader since 2018. Currently, the Center has four active Research Project Grant (R01) awards from the U.S. Department of Health and Human Services, provides usability consultation and safety advisement to clients in and beyond MedStar Health, and works to expand the footprint of human factors through diverse education and outreach initiatives. Learn more about the Center’s latest work here






Save the Date | 2020 MedStar Health Research Symposium

Mark your calendars now for Monday, April 6, 2020 for the 2020 MedStar Health-Georgetown University Research Symposium. Join investigators, residents, and associates from across our community at the Bethesda North Marriott Hotel and Conference Center. This annual event supports our continuous effort to become a leading academic health system, while celebrating innovation, inspiration and investment in research and academics.

The Research Symposium showcases the diverse and wide-ranging research activities of across the MedStar-Georgetown community. More than 1,000 guests attended this year’s event, which featured 400 abstracts and highlighted our unique partnership with Georgetown University in building a collaborative academic community.

The 2020 Research Symposium is a full-day event, beginning with presentations from educators in the health professions, followed by educational sessions hosted by experts from MedStar and Georgetown University. Resident oral presentations, scientific poster presentations and speakers take place from 3 p.m. to 6 p.m. in the main ballroom.

From bench to bedside and into the community, our research and education efforts provide valuable insight into how we move forward in healthcare and provide better and more effective treatments.

Details on abstract submissions and registration are coming soon. To learn more, visit MedStarHealth.org/Symposium.

August Peer-Reviewed Publications from MedStar Health

Congratulations to all MedStar researchers who had articles published in August 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. Qualitative Findings From a Pilot Stage Implementation of a Novel Organizational Learning Tool Toward Operationalizing the Safety-II Paradigm in Health Care
    Applied Ergonomics, 2019. DOI: 10.1016/j.apergo.2019.102913
    Hegde S, Hettinger AZ, Fairbanks RJ, Wreathall J, Krevat SA, Jackson CD, Bisantz AM.
  1. Utilization of Left Ventricular Assist Devices in Vulnerable Adults Across Medicaid Expansion
    Journal of Surgical Research, 2019. DOI: 10.1016/j.jss.2019.05.015
    Ehsan A, Zeymo A, McDermott J, Shara NM, Sellke FW, Yousefzai R, Al-Refaie WB.
  1. Assessing the Impact of Serious Illness on Patient Intimacy and Sexuality in Palliative Care
    Journal of Pain and Symptom Management, 2019. DOI: 10.1016/j.jpainsymman.2019.04.015
    Kelemen A, Cagle J, Chung J, Groninger H.
  1. The Relationship Between Hemihamate Graft Size and Proximal Interphalangeal Joint Flexion for Reconstruction of Fracture-Dislocations: A Biomechanical Study
    Journal of Hand Surgery, 2019. DOI: 10.1016/j.jhsa.2018.09.017
    Elliott RM, Nayar SK, Giladi AM, Forthman CL, Parks BG, Means KR Jr.
  1. Respiratory and Hemodynamic Changes in Neonates with Hypoxic-Ischemic Encephalopathy during and after Whole-Body Hypothermia
    American Journal of Perinatology, 2019. DOI: 10.1055/s-0039-1694730
    Sheppard SR, Desale S, Abubakar K.





MedStar Educators Investigate the Impact of Training Statement on Cardiology Fellowships

Recent research from MedStar Health investigators and educators sought to understand the impact and perception of a newly implemented training statement for cardiovascular education. The research was the first to collect data from program directors in cardiology fellowships on how they understand and implement the new training guidelines.

The research as published in Journal of the American College of Cardiology. The research team was led by Gaby Weissman, MD, and included Alex J. Auseon, DO; James A. Arrighi, MD; Lisa A. Mendes, MD; Paul Theriot, BSBA; Marty C. Tam, MD; and Julie B. Damp, MD.

American College of Cardiology wanted to address the rapid advancement of knowledge for treating cardiovascular disease. Initially developed in 1995, the Core Cardiovascular Training Statement (COCATS), provided a uniform set of curricular recommendations for training in cardiovascular disease. The most recent iteration, COCATS4, differs from previous versions in that it added elements of competency-based medical education as well as adding new domains of knowledge such as critical care cardiology and it changed the duration of training that needed to be devoted to gaining clinical skills and knowledge. 

Of the 229 cardiovascular disease training programs based in the United States, 130 (57%) responded to the survey over a month-long period. Each program self-reported their size based on fellows (small to large, one through 18+) and program type (university hospital-based, community hospital/university-affiliated, community-based, or military hospital).

Half of the program directors found the guidelines to be helpful in assessing competency, with an additional 30% finding it somewhat useful. Many program directors (57%) found the COCATS4 guidelines to be extremely useful, with an additional 35% finding it somewhat useful. The majority of program directors (69%) found that the COCATS4 guidelines are better aligned with the needs of today’s job market.

Despite the new guidelines, almost one-half (45%) of programs had made no significant changes since the release of COCATS4, however 22% of programs increased the number of clinical months, 8% decreased the number of clinical months, and 11% increased the number of required echocardiography months. 57% of responding programs indicated that resource limitations impacted the lack of direct clinical experience. This included lack of subspecialty programs within their institutions. Another important finding was that over half of programs reported that they lacked the ability to deliver direct clinical experience in at least one domain of cardiovascular care. 

This research helped to identify gaps in training programs based on the guidelines, finding that programs may need to utilize alternative educational experiences to ensure that their fellows are meeting the guidelines. This data can be used as a comparison for future research, as it can create a benchmark of training programs. Importantly, it should serve as a call for national organizations to help fill in the educational gaps that cardiology training programs may have.

Journal of the American College of Cardiology, 2019. DOI: 10.1016/j.jacc.2019.03.488