Notes from Neil

Dear Friends and Colleagues,

This week marked the 2-year anniversary of our community’s first known case of COVID-19. As we start to reconnect with family and friends, we find ourselves reflecting on the experience. Some things will never be recaptured because of the pandemic, like my son’s senior year in high school or his final season on the baseball mound. On the other hand, the pandemic has helped us grow and become stronger. I proudly witness his, and others, enhanced ability to deal with unpredictability, greater accommodations for rapid change and a resilience that young people rarely possess. 

So, this morning I asked him what the best thing was to come out of the pandemic.  As a business major studying for exams, he immediately shared the stats on the skyrocketing number of startups in the last 2 years.  As a scientist, I can also attest that these have been banner years for science and for research at MedStar Health.

While our main priority is caring for our community while ensuring the safety of our associates, patients, and research participants, science has not slowed down. As an academic health system, we have stepped up to address the greatest challenges COVID-19 has presented. 
Our goal has always been to advance health through research to help our patients of today and tomorrow:

• We’ve grown our portfolio of research related to COVID-19 from 50 studies in May of 2020 to more than 200 current active clinical studies today.
   
• In the fall of 2020, MedStar Health was a leader in the national consortium for the COVID Community Research Project (CCRP), an at-home research study to help us better understand the best ways to treat and prevent COVID-19, enrolling more than 14,000 participants in our region.
   
• Researchers at MedStar Health led an international team that used artificial intelligence to evaluate cardiac images from patients across the globe who had COVID-19 to predict who is at greatest likelihood to die from COVID-19.  
   
• The Research Institute brings a community based, health equity lens to all of the work that we do, including disparities of COVID-19 care, vaccine hesitancy and accessibility.  As an example, MHRI researchers are applying artificial intelligence techniques to develop a tool in the emergency department that supports safe discharges of COVID-19 patients and can address disparities in care.

As we continue in our fight to end the pandemic, we remain committed to better understand this virus and improve our therapeutic approaches and its long-term consequences.  In this month’s newsletter, we highlight collaborative work we’re doing with NIH to improve COVID-19 research to better treat and care for our patients. In this edition, you’ll also see how we were able to gain knowledge to help others as we rapidly built-out two monoclonal infusion centers for outpatient management of COVID-19.

The rain has cleared and the sun came out to a glorious 75 degrees today! I am grateful for the hints of spring and the falling COVID-19 numbers.  However, I am even more grateful to work with such wonderful people, demonstrating their resilience to accomplish such meaningful and impactful work. As One MedStar, there’s nothing we can’t accomplish together. And for me, that is why its been a banner two years!

Thank you for your contributions to advancing health.

In my professional life, I wear many hats. One of my favorites is mentoring the next generation of investigators, scientists and medical leaders. Part of our collective effort as an academic health system is to create an environment where we are not only providing excellent care, but we’re also creating a healthier world tomorrow. We advance health through science and education.  In short, we invest in the next generation.

The MedStar Health Research Institute Early Stage Investigator Grant is a funding opportunity available to support early stage investigators at MedStar Health to help launch impactful research careers in any discipline or specialty that will advance health and create new knowledge. 

The goal of the grant is to support scientific research by a MedStar Health employed investigator that will advance health for patients in the communities we serve. Also, this opportunity provides seed funding that has a high likelihood of leading to external funding which ultimately contributes to the successful launch of a productive research career at MedStar Health.

I am pleased to announce the following MedStar Health early stage investigators to receive funding for their research.  This is the first round of funding with others likely to be funded later this year. 

We are MedStar Health Proud of our grantees and excited to see them take their research career to the next stage and support our mission to advance how we treat our patients today and tomorrow.

Investigator: Erica Coates, PhD

Research Project: Preschooler’s Adjustment to In-Person Learning Following COVID-19-Related School Closures in Black Families: A Mixed Methods Approach

The purpose of this study is to draw attention to the experiences of Black families with young children during the pandemic and identify parent and teacher protective factors associated with children’s adjustment during the return to in-person learning 2021-2022 school year. This is especially important given the public health, economic, educational, and racial injustices Black Americans have endured during the pandemic, and for hundreds of years.

The proposed study will provide valuable insight about the inequities experienced by Black children and caregivers and will lead to improved methods for addressing health disparities. This work will support the efforts of the MedStar Health Research Institute’s Health Equity Plan to promote justice for marginalized communities and to dismantle structural racism across the spectrum of bias and discrimination

Investigator: Charlotte Gamble, MD, MPH

Research Project: Racial Inequity in Endometrial Cancer Diagnosis, Treatment, and Outcomes in Washington, D.C.- A Mixed Methods Study

Endometrial cancer has the second widest Black/White racial disparity in 5 year mortality of all cancers affecting people in the United States at 20% -- second only to Melanoma at 26%. Rates of endometrial cancers are increasing, yet the mortality gap remains unchanged. In order to design successful multi-level interventions that eliminate the systematic inequity that culminates in this massive survival gap, it is essential that both the patient experience as well as community and local health system resources are leveraged appropriately.

The aims of this study are to: 1) determine experience of black patients during diagnosis and treatment, using semi-structured interviews; 2) quantify disparity in receipt of surgery, chemotherapy, or radiation therapy within a single healthcare system; and 3) map regional (DC area) disparity in diagnosis and treatment by patient neighborhood to assess role of racial segregation in determining referral patterns and access to cancer care.

This study will lay the necessary groundwork for designing tailored interventions that address inequity in diagnosis and treatment of Black women with endometrial cancer. It will also leverage the patient experience to prioritize identified gaps in provision of care that should be targeted.

Investigator: Joshua Reuss, MD

Research Project: Comprehensive Assessment of the Immunobiology of Immunotherapy-Refractory NSCLC Patients Treated on a Phase II Trial of Anti-PD-L1 Plus Anti-TIGIT Immunotherapy with VEGF Inhibition

Anti-PD(L)1 immune checkpoint blockade (ICB) has revolutionized the frontline management of patients with advanced non-small cell lung cancer (NSCLC) who lack actionable driver mutations. Despite this, the majority of patients develop resistance, at which point effective treatments are limited. The aims of this proposal are to analyze tumor and blood specimens collected from patients prior to and during study treatment in order to illuminate: (1) what factors in the pre-treatment tumor microenvironment (TME) and periphery promote immune checkpoint blockade resistance, and (2) how tiragolumab plus atezolizumab and bevacizumab (TAB) therapy acts on the TME and peripheral immune repertoire to enhance an effective antitumor immune response.

Not only would these analyses illuminate the underlying mechanisms of ICB resistance in advanced NSCLC, but they would also provide supporting data to evaluate potential biomarkers of response, as well as additional candidate treatment targets that further invigorate an effective anti-tumor immune response. Critically, pilot data generated from this proposal will serve as the backbone for career development proposals that incorporate additional innovative analyses which seek to explore the functional evolution of the anti-tumor immune response including: T-cell receptor sequencing, neoantigen prediction, and single-cell RNA sequencing.

MHRI Wellness Experience Program

The MHRI Wellness Committee launched the MHRI Wellness Experience Program for leaders and associates. This program provides funding from MedStar Corporate Wellness for onsite and remote teams throughout the MedStar Health system to create their own wellness experiences.

Here are a few examples that teams can take advantage of:

We encourage you, our leaders and associates to take time to identify ways that we can promote wellness for ourselves and our coworkers. For questions, email MHRIWellness@medstar.net

MedStar Health Center for Wellbeing

The MedStar Health Center for Wellbeing (MCW) was launched to further develop and promote an innovative and supportive wellbeing culture that prioritizes optimal health, professional fulfillment, and quality of life for MedStar Health associates and providers. MedStar Health formally established the Center in November 2021 after years of successful foundational wellbeing activities that earned Joy in Medicine™ recognition from the American Medical Association (AMA).

The MedStar Health Center for Wellbeing strives to make a positive impact by supporting individuals and creating a culture of wellbeing. The team wants to fundamentally transform how associates cope with the stresses of working in health care, and support those who help others do so. The Center works to overcome healthcare associates’ hesitancy to seek care for themselves by driving meaningful engagement in and expansion of wellbeing initiatives and resources.

Learn More Here.

Free Meditation and Mental Health Resources

• Smiling Mind offers mindfulness programs for adults, parents, healthcare workers and more
  
• Soothing meditations and sleep meditations from Calm
  
• Burnout and other support through the Medical Society of DC's Physician Health Program
  
• Peer Support Line
• COVID Coach: a government-developed, free mobile app, designed to provide resources and enhance emotional support during this pandemic. The app is private and secure, no email account or password is required, and user data are not collected. This app is intended for EVERYONE in the community and is available for iOS and Android.
  
• MedStar Mind Body Medicine Meditation Series (Please note: You must be logged into the MedStar Health Network to access this resource on Starport)
  
• Virtual wellness opportunities

A Checklist for Depression 

What's the difference between a bad case of the blues and the painful mental disorder known as depression? According to the experts, impaired functioning is usually a clear-cut indication of a major depression.

Here's a quick checklist of depression symptoms. If the list sounds familiar, you may want to see a counselor or a  psychiatrist.

• Depressive Mood: Do you suffer from feelings of gloom, helplessness or pessimism for days at a time?
• Sleep Disturbance: Do you have trouble falling asleep at night or trouble staying asleep, waking up in the middle of the night or too early in the morning? Are you sleeping too much?
• Chronically fatigued: Do you frequently  feel tired or lack energy?
• Isolation: Have you stopped meeting friends for lunch?  Increasing isolation and diminished interest or pleasure in activities  are a major signs of depression.
• Appetite Disturbance: Are you eating far less than usual -- or far more? Severe and continuing appetite disturbance is often an indication of depression.
• Inability to Concentrate: If you can't seem to focus on even routine tasks, it's probably time to get some help.
• Dependence on Mood-Altering Substances: If you depend on alcohol or other drugs to make it through the day, you may be suffering from depression. Often the substance abuse causes symptoms that mimic the appearance of clinical depression, but are in fact due wholly to the drug use.
• Feeling a sense of inappropriate guilt or worthlessness.
• Recurrent thoughts of death or suicidal ideation/attempt.

Expedited Mental Health Access

We recognize how important it is for you to take care of yourself, even as you are busy taking care of others. Through this initiative with the MedStar Georgetown University Hospital’s Department of Psychiatry, MedStar Health providers and associates can establish contact with a mental health clinician within 1-2 business days of the initial call. The mental health clinician will identify the issues and either provide individual support immediately, or, if deemed helpful, will refer the associate to a mental health provider within Georgetown Psychiatry. Providers with expertise in adult, child, adolescent, and family mental health are available.

To set up an appointment, call 202-944-5400 and choose option 2. For urgent needs related to mental health access, please contact BHS at 866-765-3277. (Note BHS is the MedStar Health employee assistance program.)

Care for the Caregiver

Did you know that Care for the Caregiver support is not just for clinicians? And it’s not just for concerns related to work! The team provides free confidential 24/7 care to all associates and physicians system-wide.

• Real time attention using a nonjudgmental presence, focusing on listening and  understanding
• Informal debriefings, exploring the meaning of events and offering resiliency-building techniques
• Information about additional services through the Employee Assistance Program (EAP) or crisis intervention services for larger scale stress reduction

Call: 866-674-9355 (866-MSH-WELL)
Email: c4c@medstar.net

Wellness Associate Support & Resources

There are many resources available from MedStar Health, all listed at medstarhealth.org/wellbeing. For questions or concerns, please email MHRIWellness@medstar.net.

This week, we have passed a sad milestone of 900,000 lives lost to COVID-19.  This deadly pandemic continues to kill approximately 3,000 people per day in the United States (equal to a 9/11 casualty event every day!).  It’s a staggering number.

While we continue to work to understand and fight the devastating COVID-19 virus, including more than 200 active research studies happening across the MedStar Health system, an even larger killer remains at large. Heart disease.  Despite all our medical advances, heart disease remains the top cause of death in the U.S, accounting for about 1 in every 4 deaths according to the latest data from the American Heart Association.  And while heart disease can impact anyone, regardless of gender or race, statistics show that people of color disproportionately shoulder the burden of the worst outcomes. For example, according to CDC data, Black people are 30% more likely to die from heart disease than white people.  In Washington D.C., the death rate due to heart disease is more than 4x higher in Ward 8 than Ward 3.

The intersecting need to improve heart health and reduce health disparities are far reaching, beyond just the cardiac care unit.  For example, pregnancy related deaths, which are significantly higher among women of color, are most often due to cardiovascular disease (and other cerebro-vascular disorders like hypertensive disorders of pregnancy, cardiomyopathy, thrombotic pulmonary embolism or stroke).

MedStar Health is committed to developing a nationally recognized academic health system that advances health through education and research.  Academics are vital to our ability to recruit and retain the best and brightest in healthcare, to achieve optimal quality and safety results for our patients, and to fulfill our vision as the trusted leader in caring for people and advancing health.  To help achieve our vision, MedStar Health has committed to funding $5M in academics over the next 3 years. The goal is to create the future of advancing health by supporting physicians and other clinical professionals’ education and research goals.

We are pleased to announce the initial call for applications to the MedStar Health Academic Investment fund. This initial call will focus on specific academic investments in People and Programs, including:

• MedStar (internal) “K-award” Research Grants.
• MedStar (internal) Educational Fellowships.
• Support for a Master’s Degree or professional certification in educational scholarship or research.
• Tail funding for those who have completed established academic/scholarly programs (such as Teaching or Research Scholars, etc.)
• Seed funding to create a new position that supports education or research.

A more detailed overview of these five categories and all application requirements can be found in the FAQs. This information should be read carefully so applicants can adequately prepare prior to entering the online application.

The application can be accessed through this link:  https://www.surveymonkey.com/r/5million.

 

Applications for this initial round of funding are due by February 1, 2022.  Funding decisions will be finalized by the MedStar Health Academic Investment Executive Oversight Committee in mid-February, with awards being announced as early as March 21, 2022.

 

We look forward to expanding MedStar Health’s Academic Investment.  A call for applications for the next category (Pilots) will be forthcoming to clinical departments and service lines in early 2022.

 
If you have any questions, please email  AcademicInvestment@medstar.net. Additional information is available on StarPort here.

Thank you for your partnership and support!

Below is my monthly message for the January 2022 edition of the MHRI newsletter, Focus. You can view Focus articles online at https://www.medstarhealth.org/blog.

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Dear Friends and Colleagues,

Happy New Year… I think!  
 
No one expected to start the new year with an explosive new variant of COVID-19 yet here we are. While I hope everyone had a chance to relax a little, enjoy time with family and friends and take stock in all the things we have to be grateful for over the holiday season, I also know that so many of us are dealing with the strain of navigating yet another COVID-19 surge.  With record number of cases for DC and Maryland, virtually all of us have been touched by COVID-19 in some way, not to mention the unprecedented, added stress this current surge is putting on our healthcare system and each of us personally.
 
In August 2020, I used this monthly newsletter to partner up with Dan Marchalik, MD (who serves as the Executive Director of the MedStar Health Center for Wellbeing), to tell the story of Michael Phelps' mental agony and how it is 'OK to not be OK.' We shared how this silent battle is taking place on healthcare workers and we all need to use the resources available to us from MedStar Health to take care of ourselves. This is important now more than ever as the battle against COVID-19 rages on with a renewed urgency for our community.

I am going to keep this message short because we all have a lot in front of us right now. If nothing else, I want those of you who are serving on the frontlines to know that as you work to get our patients healthy, your research colleagues at MedStar Health are working hard to find solutions for our patients tomorrow. In this issue of FOCUS you will learn about research looking at the benefits of co-delivering behavioral health services with other medical disorders, how health systems can use data to identify providers who may be on the verge of burnout, and how MedStar Health is dedicated to advancing health by investing in the next generation of investigators.  This is what an academic health system does - providing excellent care to each and every person in our community today while working to advance health to make this a better world for tomorrow. This is what you are all doing and I am eternally grateful and proud to be on your team throughout these challenging times.
 
Stay well, take care of yourself and your loved ones and recognize the difference our work is making in so many lives along the way. 

Neil

Read Focus online at MedStarHealth.org/blog.