April Peer-Reviewed Publications from MedStar Health

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

  1. Pertuzumab, Trastuzumab, and Docetaxel for HER2-positive Metastatic Breast Cancer (CLEOPATRA): End-Of-Study Results From a Double-Blind, Randomised, Placebo-Controlled, Phase 3 Study
    The Lancet Oncology, 2020. DOI: 1016/j.ajem.2020.04.035
    Swain SM, Miles D, Kim SB, Im YH, Im SA, Semiglazov V, Ciruelos E, Schneeweiss A, Loi S, Monturus E, Clark E, Knott A, Restuccia E, Benyunes MC, Cortés J; CLEOPATRA study group.
  1. Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Proximal Scaphoid Reconstruction
    Journal of Hand Surgery, 2020. DOI: 10.1016/j.jhsa.2019.08.008
    Pet MA, Assi PE, Yousaf IS, Giladi AM, Higgins JP.
  1. MitraClip 30-day Readmissions and Impact of Early Discharge: An Analysis From the Nationwide Readmissions Database 2016
    Cardiovascular Revascularization Medicine, 2020. DOI: 1016/j.carrev.2020.04.004
    Case BC, Yerasi C, Forrestal BJ, Wang Y, Musallam A, Hahm J, Torguson R, Ben-Dor I, Satler LF, Rogers T, Waksman R.
  1. A Philosophical Approach to the Rehabilitation of the Patient with Persistent Pain
    American Journal of Hypnosis, 2020. DOI: 1080/00029157.2019.1709152
    Appel PR.
  1. Timing of Intervention May Influence Outcomes in Blunt Injury to the Carotid Artery
    Journal of Vascular Surgery, 2020. DOI: 1016/j.jvs.2019.05.059
    Blitzer DN, Ottochian M, O’Connor JV, Feliciano DV, Morrison JJ, DuBose JJ, Scalea TM.

MedStar Investigators Identify Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication

Researchers at MedStar Health sought to understand how communication between emergency medicine (EM) providers plays a critical role in delivering safe and effective care to patients. “Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication” led by A. Zachary Hettinger, MD, MS, from the MedStar Health National Center for Human Factors in Healthcare was published in The Journal of Emergency Medicine. This study identified communication needs of emergency medicine nurses and physicians, in particular, what information should be conveyed, by whom and the most appropriate time to convey the information based on the clinical scenario.

The research used semi-structured focus groups and interviews to identify communication strategies and barriers associated with information sharing in emergency medicine. Nine EM nurses, eight EM attending physicians, and four EM resident physicians participated in five focus groups and one interview to address questions regarding how EM personnel use and share information about patients and clinical work, what information tends to be exchanged, and what additional information would be helpful to share.

The interview sessions were audio recorded and transcripts were analyzed using a concept mapping approach. Eleven maps were developed to describe the role communication plays in patient outcomes comprised of: categories of information physicians needed from nurses and vice versa; methods of communication that could be utilized; barriers or obstacles to effective communication; strategies to enhance or ensure effective communication; and environmental or situational factors that impact communication.

Participants described several communication-enhancing strategies and the research team produced ten strategies to help support effective nurse-physician communication. These strategies include:

  1. Communicate diagnostic assessment, plan of care and, especially, disposition plan to other team members as early as possible. Update the team of any changes to the plan.
  2. Communicate pending tasks/steps in the patient’s care as well as information regarding changes or holdups to tasks or orders.
  3. Communicate details regarding proactive diagnostic testing and therapeutic interventions.
  4. Don’t assume everyone has a shared understanding: recognized that you might have unique access to information and make sure that it is shared in a timely manner.
  5. Notify providers of any critical or unexpected changes in vital signs or patient status.
  6. Do not assume electronic orders substitute for verbal communication
  7. Use asynchronous communication for lower priority items to aid in prioritization.
  8. Adapt communication strategies based on team members’ experience level and existing relationships.
  9. Adapt communication strategies to the physical layout of the ED, especially in those facilities where nurses and physicians may have workstations out of sight from one another or where it is not obvious which staff members are on different care teams
  10. Use strategies that exploit provider experience level regardless of role hierarchy.

The key findings of this study help provide insight on how to improve communication and patient care within the EM department. While the information needed by physicians and nurses was similar, discrepancies in knowledge occurred from timing of when a patient or family member was spoken to; differential access times to the EHR; complexities in information sharing among trainees, nurses, and physicians; or because each role may have had unique opportunities to access information.

This research was supported by the Agency for Healthcare Research and Quality, United States (R01HS022542).

The research team included A. Zachary Hettinger, MD, MS; Natalie Benda, PhD; Daniel Hoffman, BS; Akhila Iyer, MS; Ella Franklin, MSN, RN; R. J. Fairbanks, MD, MS from MedStar Health National Center for Human Factors in Healthcare in collaboration with researchers from Roth Cognitive Engineering; Department of Emergency Medicine, University of Florida, Jacksonville Medical Center; Department of Emergency Medicine, Georgetown University School of Medicine; and the Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York.

The Journal of Emergency Medicine, 2019. DOI: 10.1016/j.jemermed.2019.10.035






Operational Measurement of Diagnostic Safety: An AHRQ Issue Brief from a MedStar Health Collaborative Team

A new issue brief was released by the Agency for Health Research and Quality (AHRQ) as part of their contract with MedStar Health and partners, focused on developing additional capacity related to understanding and improving diagnostic safety.

Operational Measurement of Diagnostic Safety: State of the Science is an issue brief from AHRQ’s Patient Safety Program, reports that although few healthcare organizations have implemented systematic measurement of diagnostic errors, nearly all can use existing resources to monitor diagnostic safety for learning and improvement. Diagnostic errors affect approximately 1 in 20 U.S. adults each year, and reducing their incidence is an AHRQ priority. The issue brief includes a “call to action” for healthcare organizations to begin measurement efforts using data sources currently available to them to identify and learn from diagnostic errors.

This issue brief was authored by Hardeep Singh, M.D., M.P.H. and Andrea Bradford, Ph. D from the Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX. and Christine Goeschel, Sc.D., RN, FAAN, MedStar Health Institute for Quality and Safety, AHRQ Patient Safety Learning Lab Grantee, and AHRQ National Advisory Council member. Dr. Goeschel is also a Professor of Medicine at Georgetown University.

“Measurement of diagnostic performance is necessary for any systematic effort to improve diagnostic quality and safety, yet the development of diagnostic safety measures remains in its infancy. Our intent is to provide pragmatic and feasible ways for organizations to start using measurement to identify, prioritize, and address local diagnostic safety opportunities.” said Dr. Goeschel.

The issue brief has been accepted for publication in the peer-reviewed journal Diagnosis.

This work is part of a multi-year MedStar AHRQ ACTION contract that funds work and expertise related to building capacity to improve diagnostic safety and clinical quality. MedStar Health has partnered with Dr. Singh and his team to develop novel resources, tools and programs aimed at reducing diagnostic errors and related patient harm. Read the press release on the contract here.

Honoring SPIRIT at MHRI: First Quarter 2020

Theresa Moriarty was awarded the SPIRIT of Excellence Award for the first quarter of 2020 during MHRI's April virtual town hall meeting.

Theresa, known as Terry, is a Research Nurse Coordinator for MedStar Clinical Research Center at MedStar Health Research Institute. She was selected by our Executive Committee, based on KUDOS submissions during the first quarter (January through March) of 2020. 

Ron Migues, Executive Director for MedStar Medical and Surgical Research Network said “Terry knows the protocols inside and out, back and forth. You truly are a role model associate and are someone any member of the team can look up to and for guidance.” 

Terry was recognized for her excellent work in support of the many clinical trials she puts her all into and for always being a true team player and making herself available to assist where needed.  There were a number of KUDOS submitted that spoke highly of Terry and make this award well deserved:

  • “Terry, I truly want to thank you for all the time and work spent on teaching me to become a research nurse. There is not a better mentor/ teacher/ preceptor that I could have worked with.”
  • “Terry I cannot thank you enough for your dedication and guidance during this very difficult time.  I really don't know how we could have pulled it off without you.”
  • “Terry, you are a great help, and prompt to reply back. You are an awesome team player. I can always count on you. MHRI should be very proud of you.”
  • "Terry, you deserve all the kudos for leading the charge getting the Regeneron-sponsored COVID-19 clinical trial going, on the ground. You have made MedStar proud being counted amongst the top enrolling sites for the study, all because of your tireless commitment to seeing to the success of this study at MWHC/MHRI. This has been an example for the rest of us on the team to follow, and we will work as diligently as you have shown to make sure your outstanding contribution is not in vain."
  • “Theresa, thank you for all of your assistance with pre-screening patients for SELECT. You are appreciated”
  • “Thanks, Terry, for your continued excellent work in support of the Sarilumab study and your consideration for co-workers and patients.  You consistently display the highest level of compassion and professionalism in all that you do.  Your willingness to do whatever is required to ensure that studies you are involved with are conducted in accordance with the highest ethical and professional standards is a model for us all.”

The SPIRIT Award is given to recognize and reward one associate (management or non-management) each quarter, who excels in Service, Patient First, Integrity, Respect, Innovation, and Teamwork. 

Terry, thank you for your dedication  to advancing health and your commitment to MedStar Health's SPIRIT values. You are part of what makes MedStar Health great!

 

Celebrating Nurses at MedStar Health and the Research Institute

Join MedStar Health in recognizing the work of our nurses during National Nurses Week, from May 6 to 12, 2020. As our nurses continue to care for patients in the new world with COVID-19, MedStar Health will be featuring some of our nurses’ stories on our social media accounts, as a way to highlight their above-and-beyond care and show our gratitude. Stories will be shared from all over the MedStar Health system.

Because one week is not enough, the American Nurses Association will celebrate nurses for the entire month of May. In honor of the 200th anniversary of Florence Nightingale’s birthday, commonly considered the founder of modern nursing research, the World Health Organization has declared 2020 the International Year of the Nurse and Midwife. We want to celebrate and thank nurses throughout our system for their commitment to patient and associate care and wellness.

Joan K. Bardsley, MBA, RN, assistant vice president at MHRI, serves as MHRI’s representative to MedStar’s Chief Nursing Council and the Nursing Research Council. Ms. Bardsley says, “Nursing needs are met from multiple perspectives. Our MHRI nurses have shown incredible flexibility and tenacity to ensure our research participants are safe. Our nurses are supporting COVID-19 projects that will help us learn more about this pandemic in the future. In addition, many have volunteered for projects to call associates with testing results and advising on follow up. It is gratifying that so many are having the opportunity to learn about what our nurses do in general and how they contribute to research.”

During National Nurses Week, we would like to extend a special thanks to all our clinical research nurses, and all nurses in the MedStar Health system, as they continue to provide the highest level of quality care to our patients. They are critical in helping provide the best care to our community and are dedicated to advancing health. We appreciate you for what you do.

Successful Delivery of Baby to COVID-19 Positive Mother: A Case Report from MedStar Health

Researchers from MedStar Washington Hospital Center and MedStar Georgetown University Hospital successfully delivered a healthy baby to a mom and dad who both tested positive for COVID-19. The case report, “An Uncomplicated Delivery in a Patient with COVID-19 in the United States” was published in the April 1 edition of The New England Journal of Medicine.

This case describes uncomplicated labor and delivery in a 34-year old woman, at 39 weeks of gestation who was tested positive for COVID-19.  When presenting to the hospital, the mother had experienced a 3-day history of fever, chills, dry cough, and myalgia. She also reported decreased fetal movements over the previous day. The patient had not recently traveled, and her husband shared similar symptoms.

The appropriate measures for care were initiated and she was transferred to the emergency department after no obstetrical intervention was determined to be needed.  The patient’s history and findings on the chest radiography were consistent with COVID-19.  On day two of her hospitalization, the patient began to experience irregular contractions and oxytocin was provided to initiate labor. Prior to delivery, neonatal intensive care physicians consulted with the patient to review hospital protocol for mother and baby separation in setting of COVID-19.  During her labor, the patient’s test results confirmed a positive result for COVID-19.

Personal Protective Equipment (PPE) of hospital staff included gown, gloves, bouffant disposable surgical cap, knee high shoe covers, eye protection, and N95 mask. The patient always wore a facemask and was able to have a vaginal delivery without complications.

The infant’s first COVID-19 test was performed at 24 hours of age, with a negative result and the second test at 48 hours is currently pending. The mother showed no subsequent fevers or increased symptoms and the infant was allowed home with parents after clearance given by the infectious disease service. The husband relocated to a hotel nearby to complete his quarantine period.

The pediatric team followed up with the family and confirmed the baby is doing well and remains asymptomatic. The patient has a mild dry cough without fever or shortness of breath. The father of the infant is also doing well.  7 days after delivery, no caregivers appeared to be infected.

The team included Sara N. Iqbal, M.D.; Rachael Overcash, M.D.; Neggin Mokhtari, M.D.; Haleema Saeed, M.D.; Stacey Gold, M.D.; Tamika Auguste, M.D.; Muhammad-Usman Mirza, M.D.; Maria-Elena Ruiz, M.D.; Masashi Waga, M.S.; Glenn Wortmann, M.D.; and Joeffrey J. Chahine, M.S.

Congratulations to the team on the successful patient outcome, successful provider precautions, and on publication of this case report.

The New England Journal of Medicine, DOI: 10.1056/NEJMc2007605

Comparing Treatment and Outcomes for Patients with ACE-Inhibitor Induced Angioedema across MedStar Health

Recently published research from a collaborative team from across MedStar Health hospitals sought to compare patient demographics, treatment, and outcomes for Angiotensin-converting enzyme (ACE) inhibitor-induced angioedema to outcomes for patients with angioedema from other causes in our regional health-care system. ACE angioedema has not been characterized in comparison with angioedema from other causes in acute hospitalized patients.

Angioedema is the rapid or swelling of the area beneath the skin. It is normally an allergic reaction, but it can also be hereditary It tends to affect areas with loose areas of tissue, especially the face and throat, as well as the limbs and genitals.

The study “ACE inhibitor angioedema: characterization and treatment versus non-ACE angioedema in acute hospitalized patients” retrospectively compared patients admitted from the emergency department with angioedema or developed angioedema during the hospital course.   The electronic medical record data abstraction tool included demographics, etiology of angioedema, treatments, clinical outcomes, and intensive care unit (ICU) admission and intubation.

A total of 855 patient records were screened and 575 cases met the inclusion criteria of angioedema diagnosis. Of these, 297 had ACE angioedema and 278 had angioedema from other causes. Epinephrine was prescribed in 21% of ACE angioedema cases. One-third of patients in all groups were admitted to the ICU, and about 25% required intubation. Previous history of ACE inhibitor-induced angioedema was found in 63 of 278 non-ACE cause angioedema patients (23%) and in 23 (8%) in the ACE cause group. Age was significantly higher in the ACE cause group. At least 80% of cases in all groups were African American.  The current data suggest that angioedema poses a significant risk to patients regardless of the etiology, as 25% of patients required airway protection in the form of intubation.

The research concluded that ACE inhibitor-induced angioedema represented half of angioedema admissions over the study period.  The study found that physicians often prescribed medications that are known not to be effective for treating ACE-induced angioedema. This finding may be to the difficulty of making a definitive diagnosis. The study also identified that over 95% of the documented indications for ACE inhibitors were for hypertension. This finding supports consideration of alternate medications such as angiotensin receptor blockers to avoid the potential for angioedema from ACE inhibitors, especially in high-risk patients.

The study team included David S. Weisman, MD, DO; Nelly Arnouk, MD; M. Bilal Ashar, MD; Raheel Qureshi, MD; Anagha Kumar, Sameer Desale , Lyn Camire and Stephen Pineda  from MedStar Good Samaritan Hosptial, MedStar Union Memorial Hospital and MHRI.

Journal of Community Hospital Internal Medicine Perspectives, DOI:10.1080/20009666.2020.1711641






MedStar Investigator Evaluates Medicaid-funded Tenancy Support Services for Homeless Adults

Under the Affordable Care Act, large numbers of homeless adults gained Medicaid coverage and policymakers began to identify strategies to improve care and reduce avoidable hospital costs for homeless populations. “Medicaid Utilization and Spending among Homeless Adults in New Jersey: Implications for Medicaid‐Funded Tenancy Support Services” was published in The Milbank Quarterly by MedStar investigator Dr. Derek Delia, Director of Health Economics Research at MHRI. The study sought to examine data that would suggest tenancy support services (TSS) can reduce avoidable health care spending.

The study utilized linked data from the Homeless Management Information System and Medicaid claims to identify homeless adults who could be eligible for Medicaid TSS in New Jersey.  The data compares their Medicaid utilization and spending patterns to matched non-homeless beneficiaries. Homeless adult beneficiaries have higher levels of health care needs compared to non-homeless adult Medicaid beneficiaries. 

In 2016, more than 8,400 adults in New Jersey were estimated to be eligible for Medicaid TSS. Approximately 4,000 adults were living in permanent supportive housing, 800 formally designated as chronically homeless and 1,300 who were likely eligible for the chronically homeless designation, and over 2,000 who were at risk of becoming chronically homeless. In this study, the homeless adults tended to have substantial difficulties with mental health and substance abuse disorders and are more inclined to visit the emergency department or require inpatient admission. The results showed that Medicaid spending for a homeless beneficiary eligible for TSS ranged from 10% to 27% ($1,362 - $5,727) over what was spent on a non-homeless Medicaid beneficiary.

The study found emergency care and inpatient admissions can possibly be avoided when individuals have access to high-quality, community-based care.  Providing tenancy support services to homeless adults may help the population achieve stable housing and other healthy living conditions.  In conclusion, Medicaid funding for TSS could reduce avoidable Medicaid utilization and spending.

The research team included Derek DeLia, PhD, from MedStar Health Research Institute in collaboration with researchers from the Rutgers Center for State Health Policy, Monarch Housing Associates, and Rutgers School of Social Work.

The Milibank Quarterly, DOI: 10.1111/1468-0009.12446

RFA Now Available for Pilot Awards for Clinical Translational Studies through GHUCCTS

Applications are now being accepted for the Pilot Awards for Clinical Translational Studies (PTCS) through GHUCCTS.  Applications Submissions are online at PTCS Applications. The completed application and signed forms (institutional support forms) are due by Monday, May 4th, 2020 at 11:59 pm.

Funding Priorities

  • Research that addresses the transmission, course, and consequences of COVID virus infection
  • Investigations of environmental determinants of health, particularly those involving clinical and/or public health databases and geospatial mapping, and have potential to point toward solutions through surveillance or policy. 
  • Innovative community engagement methods and technologies including research aimed at engaging minority, vulnerable, or other understudied populations;
  • Research that brings together a new type of team;
  • Research that expands a translational research focus across the lifespan including to pediatric and/or geriatric populations;
  • Innovative approaches to the implementation of precision medicine;
  • Engaging individuals with Opioid Use Disorders in research and clinical care while developing effective models of care delivered within medical settings of interest;
  • Research to address health disparities and the significant burden of conditions that disproportionately affect rural, minority, and other underserved populations.

Eligibility

Applicants must have a full-time faculty appointment at one of the GHUCCTS institutions (Howard, Georgetown, DCVA, MedStar, ORNL). Each application should identify a Contact PI that will be responsible for coordinating and submitting the application. Research teams can include collaborators who are not GHUCCTS affiliated.

Funding Opportunity Details

  • Award Amount: up to $40,000 (includes Institutional cost share)
  • Duration: Funds must be spent by March 31st, 2021.
  • A 50% cost-share with the applicant institution is required. (In most cases this has previously been negotiated with the participating institutions.)

Applications Submissions are online at PTCS Applications. The completed application and signed forms (institutional support forms) are due by Monday, May 4th, 2020 at 11:59 pm

About GHUCCTS

The missions of Georgetown-Howard University Center for Clinical and Translational Science (GHUCCTS) and the national Clinical Translational Science Award (CTSA) programs highlight promotion of interdisciplinary research that translates basic research findings into clinical applications and clinical research into community practice, and improving the process of research. It is also our goal to implement research that will benefit underserved populations, including minorities, people with disabilities, and older adults. Additional priorities recently indicated by the agency that administers CTSAs, the National Center for Advancing Translational Science (NCATS) (see https://ncats.nih.gov/ctsa), further emphasize interaction and collaboration of the 62 CTSA hubs spread throughout the United States (see https://ctsacentral.org).