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Anchor lead: One of the biggest barriers for some people with chronic illness is access to care, Elizabeth Tracey reports

‘Social determinants of health’ is one of the most used buzz-phrases currently, identifying someone’s social factors as primary in determining health outcomes. Now a Johns Hopkins program called J-CHiP, led by Scott Berkowitz, provides more data regarding the importance of these factors.

Berkowitz: One of the components of our program for the community-based intervention was the performance of a barriers to care assessment, and it assessed what were the barriers that those patients were facing in terms of accessing care. Things like transportation, food, electricity, paying for the price of medicines and we found very elevated numbers with respect to those questions. Upwards of 40% for our Medicaid population and 20% for our Medicare population were having challenges in terms of meeting a transportation need, for example.  :30

Berkowitz says when these factors are addressed, people are able to manage their chronic medical conditions and improve outcomes. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What is the current state of being able to detect cancer with a so-called liquid biopsy? Elizabeth Tracey reports

When a cancer is suspected a biopsy, where a piece of the tumor is retrieved using a needle or another surgical technique, is frequently needed, and may have to be done again if the cancer recurs. Now techniques are able to find tumor DNA in other body fluids, a recent study reviewed. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains what’s known.

Nelson: One way to look at it is many people are familiar with the CSI franchises and have become amateur forensic pathologists and they recognize the one hair follicle at the crime scene, you can get DNA and you can figure out that person X was there and person Y was not. One question is if cancers have defects in genes that can be detected with the same technology can we find out if cancers is present or not in the bloodstream, in saliva, in urine, and the answer to that of course is yes, the question is what is the best information we have and how can we best use it?  :32

Nelson predicts the techniques will become more mainstream in the very near future, and will also be used to monitor response to treatment. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A comprehensive approach to healthcare benefits all, Elizabeth Tracey reports

A program known as J-ChiP, for Johns Hopkins Community Partnership, not only saves millions of dollars in healthcare costs for people with chronic illness, it creates an entire community of caring around them. That’s according to Scott Berkowitz, the study’s lead author.

Berkowitz: We were really excited about putting together a large team of people from Hopkins, community based organizations, hospitals, ambulatory clinics, skilled nursing facilities. We were able to improve the care for Medicaid and Medicare patients and also to reduce the cost of that care. What we were most excited about was our ability to bring on board a new generation of workforce team members, care managers, community health workers, neighborhood navigators, health behavior specialists, transition guides, patients and families, and work with them as they transitioned back to their community. :32

Berkowitz says the community health workers and others embedded in the neighborhood are pivotal to the success of the program. The study was published recently in JAMA Open. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Efforts to reduce ED crowding don’t seem to be helping, Elizabeth Tracey reports

Emergency departments are more crowded than ever, with some patients waiting many hours to be seen, a recent study concluded. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says for some, that’s the only way they know to obtain medical care.

Davidson: With the introduction of better access to care through the affordable care act they actually talked about having to talk to their workers about scheduling appointments, about planning ahead, as an international person coming to the US the healthcare system is pretty daunting as to how you access it, and for many how you pay for it. People know that if you turn up in an emergency department someone is going to take care of them.  :28

So far, things like urgent care centers don’t seem to be lightening the load, but Davidson notes that if more of them were positioned next to EDs, it might help. She says strategies like advising people of wait times may also prove beneficial. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Nurses are taking the lead in reducing violence against health care providers, Elizabeth Tracey reports

Violence against health care providers is a big problem that just keeps getting bigger, federal data indicate. Now nurses are taking the lead in trying to bring awareness to the issue as well as craft solutions. Patricia Davidson, dean of the Johns Hopkins School of Nursing, comments.

Davidson: This needs intervention at the level of the public when they come, skills for healthcare providers in how to de-escalate in challenging situations, as well as how do we configure the environment of emergency departments to somehow create calm and decrease that sense of anguish that goes when you walk into an emergency department.  :27

Davidson says training for everyone who comes into contact with patients is essential, and notes that other skills are routinely taught and assessed, so conflict resolution should be included. She says such training needs to start in high risk situations like the ED but should be employed throughout the hospital. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: New guidelines on screening for cervical cancer have been released, Elizabeth Tracey reports

Cervical cancer screening is a success story in the United States, with cancers detected early and more widespread disease largely avoided. Now the United States Preventive Services Task Force has updated the guidelines for screening. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes them.

Nelson: The United States Preventive Services Task Force has given an A rating to the idea of doing Pap smear screening between the ages of 21 and 65 or doing a combination of Pap smear screening and swabbing the cervix testing for human papilloma virus  between the ages of 30 and 65.  They’re biased a little bit against HPV  before that age as it’s suspicious because there’s a lot of infections that are ultimately cleared that you would detect. They’re a little down on testing above that age.  :29

Nelson notes that the majority of cervical cancer can be prevented with widespread use of the vaccine against human papilloma virus, which would eliminate the need for frequent screening, and would also curtail much mouth and throat cancer. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: When it comes to surgery for cervical cancer, traditional methods may be best, Elizabeth Tracey reports

Cervical cancer may be best treated with an open, traditional type surgery rather than more minimally invasive approaches, two recent studies in the New England Journal of Medicine seem to conclude. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes one of them.

Nelson: The randomized trial randomized women with early stage cervical cancer to an open procedure versus a minimally invasive approach. Some of those turn out to be robotic and some of those are laparoscopic and what they found was a significant difference. Women who had the minimally invasive surgery  were more likely to have their cervical cancer recur.  86% were free of disease with minimally invasive surgery  and 96-97 were free of disease  with the open procedure. That’s a significant concern. :30

A second study examined the same issue using a different approach but reached the same conclusion. Nelson says for now, women should likely choose the open approach to get the best outcome. At Johns Hopkins, I’m Elizabeth Tracey.

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