Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: Should you choose a hospital with a hospital at home program? Elizabeth Tracey reports

Hospital at home, where hospital level care is delivered to people in their own home, is burgeoning nationally. Bruce Leff, a gerontologist at Johns Hopkins and hospital at home expert, says the data are compelling.

Leff: In terms of patient and caregiver experience lots of data from studies we’ve done, randomized controlled trials done around the world, probably one of the best studies models out there consistently better patient and caregiver experience at home compared with hospital. Covid has changed a lot in healthcare delivery, so hospital A has it and hospital B doesn’t, and you have something that hospital A has hospital at home, and could probably put you in hospital at home for, and you have a favorable attitude towards getting that care at home, you should go to hospital A that has it.  :32

Leff predicts that as people become more aware of this option, more will choose hospital at home in lieu of admission to a bricks and mortar hospital. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Hospital level care at home is getting a boost across the country, Elizabeth Tracey reports

Let’s say you needed to be hospitalized but you were given the option to receive your care at home rather than a hospital. So-called ‘hospital at home’ programs are growing by leaps and bounds nationally. Bruce Leff, a gerontologist and expert in this area at Johns Hopkins, explains.

Leff: A lot of the patients that come into hospital at home are patients that are getting diverted from the emergency room and are going directly home. Covid created a strong incentive for hospital at home programs to start to transfer people out of the hospital early. They’re still going to need hospital level care so the hospital has to be a partner in this. The hospital really, truly has to not want to fill a bed, either because we’re in a capacity situation, and don’t want to invest more to build more beds because it costs about, depending on where you live in the United States, two to five million dollars to capitalize a hospital bed.  :33

Leff says as Medicare examines reimbursement he expects more and more such programs to open. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What do ALS and a common form of dementia have in common? Elizabeth Tracey reports

ALS and a common form of dementia known as ‘frontotemporal’ share a defect, research by Jeffrey Rothstein, an ALS expert at Johns Hopkins, and colleagues has shown. It’s a place inside cells where materials are transported into the cell’s center, or nucleus. They do so via an opening called a pore, Rothstein explains.

Rothstein: What we learned is that of these 30 different proteins that make up the pore we literally analyzed almost every single one of them and we said well which one is being screwed up? We learned that eight of them seemed to drop out of the pore, the pore is still there but they’re missing elements so think of a Lego complex with a hole here, a hole there. And that affects transport through it. So why are they missing? Turns out what we learn is that one of them is like the domino, you take that one away and the pore disassembles. And conversely if you put that one back in, it reassembles, which no one had done before.  :31

Rothstein says the proteins that make up the pore usually remain in the cell for years, so they are also of interest in aging. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should people with ALS ask about a new drug combination? Elizabeth Tracey reports

When a disease is always fatal, the bar for attempting new therapies is lower than that for more chronic conditions, and such is the case for ALS. A new trial has shown that the rate of decline in people with ALS using a two drug combination can be slowed. Jeffrey Rothstein, an ALS expert at Johns Hopkins, is all in.

Rothstein: There’s no question I would put patients on this drug. Absolutely. There is nothing negative I saw in terms of the side effect profile. There’s no reason not to. What gets complicated is one, they should be on this drug but they should be on previous drugs because for example riluzole, which is the first drug we studied back in 95, that drug has been repeatedly shown to be positive. Tiny effect. Way back then we did survival not this functional rating scale, so if patients say should I take this instead of riluzole the answer should be no, take both of them. Just like in cancer begin to combine these drugs.  :30

Rothstein says for now, the company is continuing to provide the drug combination to people who participated in the trial, and additional studies are ongoing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A drug combination slows progression of ALS, Elizabeth Tracey reports

A two drug combination tested in people with ALS, also called Lou Gehrig’s disease, has slowed their rate of decline compared with those who did not receive the drug, a study in the New England Journal of Medicine reports. Jeffrey Rothstein, an ALS expert at Johns Hopkins, comments.

Rothstein: The trial was successful. It’s based on the use of a reportable scale that rates how people are doing. The FDA often likes not just a biochemical marker they often want how do people function, and this is a functional rating scale. Previously in ALS especially in the 90s trials were based on survival with ALS being a fatal disease, but those are long trials, and in the end they don’t tell the patient have you done better or not? Have you slowed your disease down? So this trial used the ALSFRS and surprisingly, and excitingly found that it could slow down the disease. That’s very good.  :32

Rothstein says he’s heartened by the findings and is still on the hunt for even more efficacious drugs and possibly a cure. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Research nurses underpin the success of the RECOVERY trial, Elizabeth Tracey reports

RECOVERY is the acronym for a large randomized clinical trial taking place in the UK to evaluate treatments for Covid-19 quickly, and it has been credited with early identification of dexamethasone for helping those on ventilators. Now study leaders say among the critical factors for their success are research nurses. Patricia Davidson, dean of the Johns Hopkins School of Nursing, isn’t surprised.

Davidson: Not only do you as a nurse bring your clinical skills and attributes to the trial, the nurses have a big role in making sure that people are retained on the trial, that they are adherent with the medication, and also that data is collected on all the important endpoints for analysis. Because as we know a randomized controlled trial, if 30% of the people are lost to follow up, or other things, the data are pretty meaningless.  :32

Davidson says a research career is just one of the many options open to nurses. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should testing for Covid-19 occur more or less often? Elizabeth Tracey reports

Fewer people should be tested for Covid-19, federal officials stated recently. Aaron Milstone, an infectious disease expert at Johns Hopkins, says there really are two sides to this argument over testing.

Milstone: Some people believe that the sooner you identify someone that the more they’ll take it seriously. The other argument is if you’re exposed and we test you and you’re negative, then you’re not going to take it seriously and people will think I don’t have Covid and I can go to my friend’s house and they may ignore those quarantine recommendations. I do see that there are two clear sides to this. There may be value in recommending testing for people who are asymptomatic yet exposed to Covid but there may be an unintended harm in that in giving people false reassurance that they are clear and free.  :34

Milstone notes that the picture is further complicated by the fact that some tests are not very accurate so may give an untrustworthy result, and says over time, greater reliability will be developed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Allowing pharmacists to administer vaccines to kids will expand access, Elizabeth Tracey reports

Pharmacists are now allowed to give vaccines to most children, the federal government has mandated. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, says especially now, that should enable many more children to obtain needed vaccinations.

Milstone: Increasing access to vaccines is great for children. Doing it safely is also important. As long as pharmacists are prepared for reactions that either kids or adults can have, then I think increasing the access to vaccines is a positive thing. Any concern I have would be way overpowered by the benefits of increasing access to vaccination. I think having a vaccine registry really will facilitate good communication and record keeping about places like pharmacies giving vaccines. :32

Milstone notes that parents should likely keep their own record of their children’s vaccinations as well as assure that their child’s medical home is also informed. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Children may have very high levels of Sars-CoV2, Elizabeth Tracey reports

Some children have higher levels of Sars-CoV2 in their airways than even severely ill adults, a recent Pediatrics study found. Aaron Milstone, a pediatric infectious disease expert at Johns Hopkins, comments.

Milstone: None of us are surprised that kids are a potential reservoir for spreading respiratory viruses. We know that from flu, other studies have also shown increased viral loads in children. Having a high viral load doesn’t mean that you’re at risk of spreading than having a low viral load. When an adult coughs in your face they might do that with more force than a child, or they might be closer to your face than a child, so having that high viral load in a kid if they’re farther from you or generating lots of force may put you at less risk. But whether or not you’re more likely to get it from a kid or an adult still remains unclear.  :33

Milstone says as facts emerge about viral spread, one strategy is helpful: act as if everyone you come in contact with is infected, and make choices accordingly, including mask wearing, hand washing, and physical distancing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Where Sars-CoV2 enters the body should be covered by a mask, Elizabeth Tracey reports

Many more receptors for Sars-CoV2 are found in the part of the nose where smell takes place than elsewhere, research by Andrew Lane, an otolaryngologist at Johns Hopkins and colleagues has shown, and it may be that’s the primary place the virus infects us. Lane says that has clear implications for mask-wearing.

Lane: If the virus does in fact start in the nose or end up in the nose or that’s a place where even if you had no other symptoms that the virus might be located, it makes sense that when you breath out through your nose you maybe could potentially be spreading the virus. So therefore more for other people not necessarily for you you need to cover your nose and not just your mouth to prevent spread. And that’s the way to wear a mask anyway it’s not as though this is some new way to wear a mask. The proper way to wear a mask is to cover your nose and your mouth.    :25

So if you’re one of those people who sling your mask under your nose reconsidering this practice would most likely help others. Lane notes that with the plethora of masks of varying materials available, finding one that is comfortable and covers both nose and mouth should be straightforward. At Johns Hopkins, I’m Elizabeth Tracey.