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Anchor lead: A new term is being used to describe anguish on the job for medical professionals, Elizabeth Tracey reports

Moral injury. That’s the term some medical professionals are using to describe their mental state after prolonged exposures to situations where they feel compelled to make choices they wouldn’t if they were acting alone, and it is a major contributor to burnout. Cynda Rushton, a bioethics expert at Johns Hopkins, offers a definition.

Rushton: Moral injury to me is part of a continuum of moral suffering. What it points to is the anguish people feel when they feel like they’ve violated their core values, their sense of who they are and what they stand for. The continuum is that I think moral suffering can range from the sort of vague sense that something is wrong all the way to feeling like I have acted so contrary to my values that it really leaves me with a wound.   :32

Rushton says the term does help convey the depth of what people are feeling. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Expanding criteria for using kidneys for transplant is possible, Elizabeth Tracey reports

Kidneys that have sustained acute kidney injury, known as AKI, will most often recover and function well when transplanted, a study led by Chirag Parikh, director of nephrology at Johns Hopkins and colleagues has shown. Parikh says actually getting these kidneys into use will require some effort.

Parikh: We will need champions at each of the transplant centers who start expanding into their usual practice taking the AKI kidneys. There are a lot of oversight organizations like UNOS and Medicare, who can facilitate this process by encouraging the use of these kidneys. And giving people a waiver that they will not include this in their report card. This would allow surgeons to transplant these kidneys and gain experience.   :30

Parikh says using AKI kidneys will help some of the 95,000 or so people who are currently on the transplant list to receive a new kidney. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Would you accept a less than perfect kidney transplant? Elizabeth Tracey reports

When people are on kidney transplant lists, life is often a struggle. Frequent dialysis can define their lives, and each day brings worsening kidney disease. Now a new study shows that transplant centers often don’t tell patients that an offer of a kidney has been made to them if they think it’s not of sufficient quality, yet patients say they are willing to accept such an organ. Chirag Parikh, director of nephrology at Johns Hopkins, says patients should bring up this issue.

Parikh: Discussing this with the patients and patients expressing this preference that if it is a lower quality kidney and I’m lower on the list then that allows me to get a transplant faster I would be ready to take it, that would change the whole dynamic. The decision is being made on behalf of the patient and that patient is not fully in the loop. Not that anybody is trying to not give it to them but some patients would have gladly accepted those kidneys.  :28

Parikh says full disclosure on all sides would help. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: One way to make more kidneys available for transplant is to use those that may have some injury, Elizabeth Tracey reports

Kidneys are in short supply for transplant, with thousands of people on transplant lists in the US alone. Now new research by Chirag Parikh, director of nephrology at Johns Hopkins, and colleagues, has shown that using kidneys for transplant that may have acute kidney injury does not compromise their function or survival in the transplant recipient.

Parikh: In deceased donors when a person died if they had acute kidney injury the surgeons thought that the kidney was not of sufficient quality and should not be transplanted because it would have a shorter life. What happens when we compared kidneys that were transplanted with acute kidney injury versus kidneys that were the same in every other way but did not have acute kidney injury?  To our surprise we saw that the five years survival of the kidneys was not different.  :29

Parikh notes that acute kidney injury is often transient and the kidney will ultimately heal and function well, so using such organs could help the many people who are waiting on transplant lists. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Just a single dose of the HPV vaccine may be helpful, Elizabeth Tracey reports

Vaccines against human papilloma virus prevent cancer. Cancers of the cervix in women and cancers of the mouth and throat in both men and women. Now a new study shows that just a single dose of the vaccine in preteens prevented many abnormal Pap smears that did develop in those who didn’t get the shot. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says this study adds to others demonstrating the many benefits of the HPV vaccine.

Nelson: The other thing that we saw was some hint that vaccinating less than the full population had some benefit because then you’d be more likely to have a sexual activity with partners that may have been vaccinated and you suppress the transmission so I think what that means is that the more people you can get vaccinated the better and then many things will get better including you may not need so many vaccine courses or you may not ultimately need to get 100% of people vaccinated to already start to get benefit.  :28

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Women with triple negative breast cancer have a new treatment option, Elizabeth Tracey reports

Triple negative breast cancer, where the tumor lacks receptors for commonly used drugs, often has a poor prognosis. Now a treatment using chemotherapy and a drug called pembrolizumab before surgery saw tumors disappear more often than with chemo alone. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, is cautiously optimistic.

Nelson: How much did the cancer shrink? In particular in what fraction of the cases did the cancer completely disappear and what they saw in interim analysis for the 600 women who got far enough to ask this question, 65% has disappearance of all the cancer by the time they got out that far as opposed to 51.2% without the drug, so chemotherapy alone was pretty effective it got half of them to a pathologic complete response but the addition of pembrolizumab made more women get a pathologic complete response.  :33

Nelson believes this approach may be the new standard for treatment. At Johns Hopkins, I’m Elizabeth Tracey.

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Nurses are on the frontlines when it comes to managing infectious disease in the hospital, and COVID-19 is currently a big concern. Patricia Davidson, dean of the Johns Hopkins School of Nursing, has a message for them.

Davidson: The important message for nurses is to avoid workarounds and to be adequately staffed so that you are not taking risks. :09

Davidson says federal responses are also in need of shoring up.

Davidson: This is a time for reflection and calibration and recognition that this is not the first and it’s not going to be the last.  There has been a disinvestment if that’s a word in many of our preparatory services. We need much more investment in the CDC and in other infection control areas. :23

Davidson believes that the resources to manage COVID-19 are at hand for developed countries. At Johns Hopkins, I’m Elizabeth Tracey.