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Anchor lead:  A new unit for deadly infectious disease containment is opening at Johns Hopkins, Elizabeth Tracey reports

Even as Ebola infection appears to be slowing and the number of infected people being transported to the US is just a handful, Johns Hopkins is about to open a new biocontainment unit.  Lisa Maragakis, director of infection control for the Johns Hopkins Hospital, says the unit may be useful for many more emerging diseases.

Maragakis: A unit like this is obviously important for a disease like Ebola but it will obviously be very useful for other emerging infectious diseases, some of which we haven’t even heard of.  This involves really preparing for diseases that can be transmitted by touching or also by the airborne route.  All of that has been taken into consideration in designing the unit.  So a disease for instance like coronavirus, such as we saw in SARS, or MERS-CoV, or a novel influenza virus, could be cared for here as well.   :32

Maragakis says the unit design may also prove useful for planning other biocontainment units in hospitals.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Caregiving for someone with cancer can put a lot of stress on your job, Elizabeth Tracey reports

If you’re in the workplace and you’re trying to care for a loved one with cancer, you know the meaning of stress.  Now a comprehensive resource developed at Johns Hopkins called ‘Cancer at Work’ may help.  Terry Langbaum, chief administrator in the Kimmel Cancer Center, says many of the resources are designed to help caregivers manage the burden.

Langbaum: I think that caregivers are really an ignored group of people.  They’re heroic. Absolutely heroic.  Once we launched this program we actually learned what our own employees are going through as caregivers. We’ve really learned what a stressor it is.  Many of our caregivers will say to us that being a caregiver is harder than being the cancer patient, because the patient knows what it’s like to get a bone marrow test, the caregiver only sits in the waiting room imagining what it’s like, and it’s always easier to actually do it than it is to think about it.   :31

Patients and employers can also benefit from using the Cancer at Work site, which is poised to roll out nationally.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Cancer at Work is a new program designed to help people manage the condition during their working years, Elizabeth Tracey reports

When cancer develops in someone who’s working, or an employee must manage a loved one with the disease, a new program developed at Johns Hopkins called ‘Cancer at Work’ can help.  Terry Langbaum, chief administrator in the Kimmel Cancer Center, describes the program.

Langbaum: The most important thing we can do with this program is to actually prevent cancer. And so we really tried to include all of it: cancer prevention, managing cancer at work, cancer survivorship, and cancer caregiving in one site.  We know of no other site that really addresses these issues for managers and supervisors. We help them with how to have that conversation when one of your employees is telling you they have a cancer diagnosis and they’re going to be out for a period of time or in and out for a period of time.  We know of no other comprehensive program like this one.   :30

Langbaum says the program is being tested at Johns Hopkins and then will be made available widely to employers who may need it.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Can finding a second pathway to heart failure help patients? Elizabeth Tracey reports

Congestive heart failure kills hundreds of thousands of people each year, largely by one of two aberrant cellular pathways.  While the first has been known for some time, David Kass, a cardiologist at Johns Hopkins and colleagues, have just identified the second, where an enzyme known as PDE9 is involved.

Kass: We’re excited by the theoretical possibly now that with a marked upregulation of expression of PDE 9 in the heart of HFPEF patients, about 6 fold a six hundred percent increase, that that suggests that it’s an important contributor to the disease cause what we’re showing in our paper is that we want to inhibit this.  The inhibitor remains to be obviously tested in people but we have drugs that are already through phase 1 safety tests.   :26

Kass’s group also delineated the first pathway and showed that sildenafil, marketed as Viagra, could help.  He hopes interfering with the second pathway will be as straightforward.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new pathway leading to heart failure has been identified, Elizabeth Tracey reports.

Heart failure is a leading cause of death worldwide, with more and more people affected by the condition as they age.  Now David Kass, a cardiologist at Johns Hopkins, and colleagues have shown that a novel pathway is involved in one type of heart failure.

Kass: There are two kinds of heart failure.  Heart failure where the heart looks big and flabby and just doesn’t contract well, and then there’s a kind of heart failure that’s been given a name, heart failure with a preserved ejection fraction or HFPEF, about half of all heart failure.  Everything that works in the big flabby weak heart has not really benefited people with HFPEF, so we’ve looked at PDE 9 in human hearts in this study.  What really struck everyone when we saw this is that it’s really upregulated in these patients who have HFPEF.    :32

Kass’s group identified the major pathway involved in the other type of heart failure several years ago and has also found drugs that help.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include stents versus CABG, screening people without symptoms for heart disease, agreement about breast biopsies, and imaging for low back pain in older folks.

Program notes:

0:47 CABG versus stents
1:49 Second generation drug-eluting stents
2:47 Stents have higher rate of restenosis
3:47 Stents and restenosis
4:22 Screening low risk people for cardiac disease
5:23 Not recommended
5:37 Imaging for low back pain in older folks
6:35 Early imaging not associated with better outcomes
7:04 Breast biopsies
8:04 Agreed well on invasive cancer
9:03 Middle range where problem occurs
10:20 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2015/03/20/cabg-versus-stents/

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Anchor lead:  How should you compare doctors and hospitals?  Elizabeth Tracey reports

Do physicians game the system when measures such as 30 day mortality are used to grade their performance, as a recent report suggests?  Joseph Califano, a head and neck surgeon at Johns Hopkins, says such an outcome is certainly possible.

Califano: There are a whole lot of measures out there right now including patient satisfaction, 30 day complication rates, 30 day mortality, and all of them together tell a lot about what happens in terms of quality. The article is interesting in that it makes the hypothesis that perhaps if we’re going to measure people in terms of a single measure, physicians may focus on that measure and adapt their care to have a good outcome in terms of that measure rather than really addressing quality globally.  :25

So how can quality be assessed? Califano comments.

Califano: I think you have to take all single measures with a grain of salt and take them in context. But I do think within the next ten years we are entering an era where we will have greater transparency of data, and the more transparency the better.  The more we look at ourselves critically the better we’re going to get.  :14

At Johns Hopkins, I’m Elizabeth Tracey.

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