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Anchor lead: A look at the development of resistance in cancer cells has already borne fruit, Elizabeth Tracey reports
Sophisticated mathematical modeling along with analysis of head and neck cancer cells as they acquired resistance over time has produced at least one surprise. That’s according to Elana Fertig, senior author of the study and associate professor of oncology at Johns Hopkins.
Fertig: What is regulating the resistance? We were expecting that one of the critical changes, the shape of DNA, was going to be the responsible driver for causing the resistance to therapy. And it turned out that that wasn’t the case. It turns out that what we observed in our system was that that critical shape of the DNA was associated with stabilization of the resistance, and it occurred later. :30
Fertig says this DNA shape shifting could potentially be used as a biomarker to assess changes in someone’s cancer that may necessitate a change in therapy. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Why should a promising treatment for sepsis be studied more? Elizabeth Tracey reports
Sepsis is a killer. This overwhelming infection is implicated in one in three deaths in the hospital, CDC data indicate, with one recent study touting the combination of vitamin C, thiamine, and steroids to reduce deaths by a third. So why is this treatment being tested so rigorously now, as the negative side effects seem negligible? Jeremiah Hinson, an emergency medicine physician at Johns Hopkins and one of the study’s leaders, explains.
Hinson: One of the main concerns that we would have is any small side effects that you’re getting from a drug that’s doing nothing is not good. And we want to be sure that we are doing right by our patients. The way that we do that is we investigate in the most rigorous way whether a treatment is actually effective. The other thing is that in sepsis there are very sick patients. So when they come in they’re often dehydrated, we’re giving them fluids, these are three simple drugs but they’re all given intravenously. In order to focus all of that energy on giving these medications every three hours and in very sick patients we want to know that those medications are actually helping. :31
At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Why would vitamin C be important in treating sepsis? Elizabeth Tracey reports
Sepsis, an overwhelming infection and inflammation that is the third leading cause of death, may respond to use of three drugs: vitamin C, thiamine, and steroids. That’s the hypothesis being tested in a randomized, prospective study underway now. Jeremiah Hinson, an emergency medicine physician at Johns Hopkins and one of the study’s leaders, explains why vitamin C is important.
Hinson: For vitamin C human beings and primates and guinea pigs are actually the only mammals that don’t make vitamin C and have difficulty storing vitamin C. and so during stress reactions for all other organisms they increase their levels of vitamin C and we’re unable to do that. If you take a look at patients who come into the hospital with sepsis and have higher mortality, they tend to have lower levels of vitamin C at the time of admission to the hospital and then a large proportion of the patients who have septic shock meet criteria for scurvy, which is severe depletion of vitamin C. :32
Hinson says all three drugs are administered intravenously and have shown impressive results in previous research. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Can a three drug combination treat sepsis? Elizabeth Tracey reports
Sepsis, where an infection spreads throughout the bloodstream, is the third leading cause of death. Now two new studies are examining whether a combination of vitamin C, a B vitamin called thiamine, and steroids can budge dismal mortality statistics relative to sepsis. Richard Rothman, a professor of emergency medicine at Johns Hopkins and a leader of one of the studies, explains.
Rothstein: There’s a lot of excitement about this new treatment because the results of this trial that was done suggest a very high impact. The excitement around that was based on a trial that was done about a year ago that showed upwards of about a 30% plus difference in mortality, so that’s very exciting for clinicians on the front lines in the emergency departments and the intensive care units in terms of a potential hopeful therapeutic but it has yet to be formally tested in a randomized controlled trial. :32
Randomized, prospective trials are the gold standard of proof, and Rothman notes all involved would celebrate a positive result. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Can a physician see anyone via telemedicine? Elizabeth Tracey reports
The Centers for Medicare and Medicaid Services has just released a proposed funding change that would help expand physician services delivered by telemedicine. Advocates hail this as a great boon for patients, who may struggle to come to in-office visits. Yet a big barrier remains. Redonda Miller, president of the Johns Hopkins Hospital, says the issue of physician licensure must be considered.
Miller: If you are a physician and treat a patient who lives in another state, you may not be licensed in that state. As a physician are you supposed to have 49 other licenses other than your home state? With this recent legislative session Maryland has agreed to be part of the interstate medical licensure compact. This is a compact among 23 states now that agree to recognize licensure amongst each other. If you are a physician licensed in one of the states that license is recognized in the other 22. :32
Miller looks forward to more progress in removing barriers to full telemedicine implementation. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Remote visits to doctors may soon be coming to you, Elizabeth Tracey reports
Telemedicine may soon get a big boost with proposed funding changes by the Centers for Medicare and Medicaid Services. Redonda Miller, president of the Johns Hopkins Hospital, says treatment for things like stroke could be much improved with telemedicine implementation.
Miller: Some of the therapies for stroke are highly technical and involve catheters into arteries in the brain, removing blood clots, so it’s very important for us to have specialized centers of excellence. If you are a patient at a community hospital, and you may be having a stroke, right there the doctors in the ED can conference in via telehealth, the experts at an academic medical center like Hopkins, make the diagnosis, confirm whether the patient needs transfer, get the patient immediately up here for whatever invasive procedure they may need that saves lives. :33
Miller notes that technology has enabled real time consults almost instantly in emergent situations like stroke, and that many more routine matters also lend themselves to telemedicine visits. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Can nurses help surrogate decision makers for people in the intensive care unit? Elizabeth Tracey reports
People who are making medical decisions for loved ones in the intensive care unit are called surrogates, and their task can be daunting. A new study looked at whether specially trained nurses could ease the burden of depression and anxiety of surrogates. Patricia Davidson, dean of the Johns Hopkins School of Nursing, describes the results.
Davidson: The intervention didn’t impact on psychosocial distress but it did improve decision making, or the satisfaction with decision making and also of great interest it decreased the stay in the ICU by nearly two days. I think what the PARTNER study shows is that these are complex interventions. So as well as the nurse who’s being trained in communication and facilitating the discussion, also noted that they actually had a change management consultant who was trying to make sure that these crucial conversations were instilled in the business processes of the ICU. :35
Davidson applauds efforts by nurses and administrators to ease suffering of both patients in the ICU and their loved ones. At Johns Hopkins, I’m Elizabeth Tracey.
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