Anchor lead: Universal testing for HIV is just the beginning, Elizabeth Tracey reports

Less than 40% of US adults nationally have ever been tested for HIV, a recent CDC analysis revealed, and even in at risk areas of the country that number was less than 50%. Joseph Cofrancesco, an HIV expert at Johns Hopkins, says to improve that number, barriers to care must also be eliminated.

Cofrancesco: Everyone that is tested should be able to be suppressed and treated. That includes having access to care, lack of stigma, affordable drugs without expensive copays, and the ability to get to clinics. And for those who are negative, to stay negative by using appropriate protections including PrEP, and if you’re at relatively higher risk definitely PrEP. You have to be able to get to providers who know how to do PrEP and it has to be affordable.   :27

Cofrancesco notes that those deemed at risk for HIV infection should be tested at least annually to assess their status and initiate treatment if needed. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: The majority of US adults haven’t been tested for HIV, Elizabeth Tracey reports

All adults should be tested for HIV at least once, the CDC has recommended for several years. Yet their own recent analysis found that nationally, less than 40% of adults have been tested. Even in areas known to be at risk for acquiring HIV, the number still remains below 50% on average. Joseph Cofrancesco, an HIV expert at Johns Hopkins, says we must move the needle on testing to achieve our goals.

Cofrancesco: Let’s take a few steps back. What this is really about is trying to end the AIDS epidemic by eliminating new infections. We have the power to do that today. If everyone was tested and everyone tested got treated, and those who were negative who were at risk used protection and/or PrEP, we could eliminate the infection. The problem along the way with each of those and what this report demonstrated is we’re not even getting to that first step of testing everyone.  :29

Cofrancesco says universal testing would also remove stigma, a major barrier at this point. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Why do some parents object to vaccinating their children? Elizabeth Tracey reports

California’s recently reported experience with eliminating personal belief exceptions and tightening school policies has resulted in substantially more kindergartners coming to school with up to date vaccines. But about 5% still aren’t. Amber D’Souza, an epidemiology and vaccine expert at Johns Hopkins, believes parents try to act in their child’s best interests.

D’Souza: It’s so hard to speculate about why there’s differences by group. We have so much information and advocating for your children is really important. Before, when we had infectious diseases all around and people saw this it was so obvious – I don’t want to have my child exposed to this, I need to protect them. Because people don’t see these diseases anymore, they want to protect their children, but they’re acting to actually withhold from the child this vaccine that can help them, just out of a lack of understanding of the harm vs. benefit. :32

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: California laws prove that vaccine rates in kids can be boosted, Elizabeth Tracey reports

Removing personal belief exemptions and tightening the required vaccines for school entry have resulted in a substantial increase in the number of kindergartners in California who come to school up to date on immunizations, a recent study reported. Amber D’Souza, an epidemiology and immunization expert at Johns Hopkins, comments.

D’Souza: The reason to mandate a vaccine is for communicable diseases where the risk is not just to your self but you get an infection, you can spread to others, it’s really important that we act as a society and say, this goes beyond free will and personal protection. These are diseases we want to protect our society from, so mandating these school-based vaccines, which means making sure that all kids get them before they enter school, we know that’s a great way to protect the kids and protect everybody.  :30

California has had a number of outbreaks of vaccine-preventable diseases in recent years, and these often impact people who can’t get vaccinated or are immunocompromised. At Johns Hopkins, I’m Elizabeth Tracey.

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This month’s Pulse with Kevin Sowers focuses on the Johns Hopkins civility initiative. Civility has an impact on healthcare quality, safety and overall outcomes, and a team has been assembled to identify expected behaviors in the workplace to which all will be held accountable. The initiative also will develop interventions that are appropriate, with the aim of creating a culture where all at Johns Hopkins can thrive.


Program notes:

0:20 Civility in the workplace

1:20 Peer to peer conflict at times

2:20 What are the expected behaviors?

3:20 More embedded in who they are

4:24 Documented well in the healthcare workplace

5:24 Patient interactions

6:30 Manage our emotions to have a fact-based conversation

7:53 End


Full Transcript:

00:00 Elizabeth Tracey: Welcome to this month's Pulse, I'm Elizabeth Tracey..

00:02 Kevin Sowers: Thank you. I'm Kevin Sowers, it's a pleasure to be with you today.

00:06 ET: It's wonderful to be with you. Talk to me about civility. We have a new institutional initiative going forward that is really emphasizing that in the workplace.

00:16 KS: You know, when you think about civility in the workplace, it really is an opportunity for us to step back and understand how, not just the outcomes that we achieve every day make this organization successful, but how we treat each other in getting there and civility has been shown multiple times to have an impact in the workplace on quality and safety and just overall outcomes. And so creating an environment where we feel supported for who we are and what we bring to the table and respected is incredibly important.

00:49 ET: In fact, I just saw a study, it was looking at surgeon behavior and the OR and it showed that when a surgeon acted out during a procedure, it had a deleterious effect, not just on the staff, but also on a patient.

01:02 KS: That's correct. And it's not just in the OR. It's in the ICUs, it's in any type of unit where there may be work culture issues and behavior issues between individuals and it's not always just physician related. In nursing, there is peer to peer conflict at times and so we need to think about how we treat each other when we come to work each day.

01:23 ET: It seems like common sense, doesn't it?

01:26 KS: It does, but for some managing your emotions in the midst of a chaotic or a stressful day can sometimes be difficult and so understanding when it's important to step back to, to take a couple of deep breaths and really think through what you're going to do next instead of reacting. Be more proactive in learning how to manage yourself.

01:48 ET: Well. That sounds like a short prescription then for how to do this. Do we have a plan in place institutionally to make this happen?

01:55 KS: Actually, there's a group that we've accounted that's being led by Inez Stewart, who is our chief human resource officer of Johns Hopkins Medicine, and also Jennifer Nichols, who is our chief of staff. Jen and Inez are working on a group and the first step, if you've looked at how most organizations have dealt with this, is really sit back and really think through what are the expected behaviors that we expect from everybody when they come to work and then how do we hold people and evaluate people to those behaviors on an ongoing basis?

02:27 ET: Are there specific tools that right now you would say to folks, "Hey, here's what I think I need you to do if you're feeling like there's a situation developing that might result in this incivility."

02:39 KS: The sensibility thing is a little bit more complex than just a tool. I'll share with you in my experience.

Sometimes people have these moments in the workplace where they're stressed on that particular day and they just can't hold it together. On that situation, you sit down with the person and say, "Here's what I saw you do. Here's what I heard you say. I need you to know that that wasn't appropriate and here's how I'd like to see you to manage it the next time."

At times that's the only intervention you need to do and that person will change their behavior. In others situations, people have had things that have happened in their personal lives that have led to the behavior that you might see in the workplace. That's a lot more embedded in who they are. That sometimes takes a different level of intervention. Sometimes it's a coach, an ongoing coach, to look at what are the things that trigger the behavior in the workplace. Sometimes it's someone sitting down with the counselor because there's a lot of either grief or anger that's built in from life experiences that they have to work through to deal with that.

And then the last piece is really in some instances there are situations where people have substance abuse issues, have had difficult marital situations, a lot more complex social type experiences that require a different level of intervention.

So for me, as I've gone through this in my career, it's not one tool that will help everyone. You have to sit and understand to make sure you understand the complexities of what's driving the behavior in the workplace.

04:15 ET: Would you say see that the healthcare environment is peculiarly prone to this?

04:20 KS: I would say that it's documented well in the healthcare workplace. Do I think that it's only healthcare? Absolutely not. It's human behavior. So I think this exists in other disciplines and other types of organizations, but I would say the thing that's unique about healthcare is it's still based upon human interactions. Both from a patient perspective but from care coordination perspective of a plan of care.

And it's in those delicate interactions of where we can't lose sight of what those interactions mean in the lives of the people we're serving. And so that's why civility becomes really important because if I'm a provider and I just had a bad interaction with somebody, there's now research to show that that impacts the rest of my day and how I feel about myself and how I question myself for the rest of the day. So it does have an impact.

05:16 ET: Some of the examples that you cited, having borne witness, and I know you have abundant experience with this also, interactions with patients and caring for patients can be incredibly emotionally charged. How can we deal with that aspect of the healthcare environment so that it doesn't bleed then into our interactions with our colleagues?

05:35 KS: So, I think having the ability to have peer conversations are critically important.

As a nurse, I've been in situations before where I as a nurse may differ in my view of what should happen to a patient than a provider may feel. But in those situations, I've also found that I may not understand completely everything that providers thinking. What they're seeing, I might not be seeing. But the ability to not become immediately emotional, but to be able to have a fact based conversation with the provider to say, "Here's what I see. Here's what I understand. Obviously you're thinking something different. Can you help me understand?"

That's not always where we start. We start with the emotion of can you believe this? Look what they're doing. And so how do we make sure that we are able to manage our emotions in a way that allow us to have a fact-based conversation to learn someone else's perspective? That becomes incredibly important as we learn to partner together around civility.

And so we need to make sure that we have all the vehicles in place in our institution to support people through what's going on with them personally, what's going on with them in their work environment, and then also having programs that if they do have problems, that they need psychological support for a variety of different reasons that we have those programs in place to support them.

07:04 ET: It sounds like the common denominator in all of this is something that you identified about really listening and then compassionately saying, "How can I help?"

07:15 KS: That's correct. I think I would say to anyone working in an organization, if you see a colleague that you think is acting differently than they have been before, you should sit down with them to make sure that they're okay. We owe that to each other because it's not just about caring for our patients or loved ones, but it really is about us caring for each other too. That will make us a better organization.

07:41 ET: Thank you so very much.

07:41 KS: Thank you for having me today.

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Anchor lead: People may now consider the HPV vaccine up to the age of 45, Elizabeth Tracey reports

Certain human papilloma viruses, or HPV, cause cancer. Now a Centers for Disease Control and Prevention panel recommends the HPV vaccine for everyone through age 26 and for some adults up to age 45. Amber D’Souza, an epidemiologist and HPV expert at Johns Hopkins, explains.

D’Souza: People in their 30s or 40s very likely haven’t been exposed to all nine types of HPV that are in the HPV vaccine and so there’s still some benefit. That doesn’t mean that everyone needs to run out and get the HPV vaccine because the chances that it will protect you decrease as you’re older because you’re more likely to have already been exposed to more types and you’re not as likely honestly to have as many new partners so you’re not likely to have as much future risk but there are some older individuals who would benefit  and should get the HPV vaccine.   :32

So if you’re over 26, talk with your doctor about receiving the HPV vaccine. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new device may make treating a common eye disease much easier, Elizabeth Tracey reports

Macular degeneration or AMD is an eye disease that is a leading cause of blindness in people older than fifty. One form of the disease can be treated by injecting the eye with a drug known as an anti-VEGF, but this must be done fairly often. Now a new study by Peter Campochiaro, an ophthalmologist at Johns Hopkins, and colleagues, shows an implanted drug delivery system safely reduces the need for frequent injections.

Campochiaro: Vision gets worse, then they get an injection it gets better, a much better system is to have sustained delivery of an anti-VEGF. Patients who received the highest concentration went an average of 18 months before they needed a refill. So we don’t have to have them come in every few months but rather every six months to get a refill. This could greatly improve compliance and improve outcomes in patients with wet AMD.    :30

Campochiaro says a much larger study will need to be completed to confirm these results. At Johns Hopkins, I’m Elizabeth Tracey.

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