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Medical Rounds

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The Freeze Is On

Almost 10 years ago, Johns Hopkins physicians and researchers were among the pioneers of a therapy that uses freezing gas to zap the cell clusters that can lead to cancer of the esophagus. Today, they are taking this therapy one step further.

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Thinking Small

Of the 48,000 corneal transplants performed each year in the United States, 10 percent end up in rejection, largely due to poor medication compliance.

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Seeing the Light

Three years ago, when Dan Berkowitz moved to an updated lab in the Ross Research Building, he didn’t consider the potential benefits of gaining a lighting system activated by motion. Not only has it helped him and his team see their blood vessel experiments more clearly, but it also triggered an accidental discovery that may prove transformative in treating aneurysms and other vascular diseases.

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A Urine Test for Bladder Cancer

It’s not a substitute for surveillance cystoscopy and transurethral bladder biopsy, but a new urine test developed at Johns Hopkins may soon become part of the arsenal for detecting bladder cancer, picking up recurrent cancer and predicting aggressive tumors, says Trinity Bivalacqua, director of urologic oncology.

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Heart Failure Culprit Collared

Working with lab animals and human heart cells, a team from Johns Hopkins and other institutions has identified what they describe as “the long-sought culprit” in the mystery behind a cell-signaling breakdown that triggers heart failure.

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Asthma’s New Hot Zones

Challenging the long-standing belief that city dwellers suffer disproportionately from asthma, the results of a new Johns Hopkins Children’s Center study of more than 23,000 U.S. children reveal that income, race and ethnic origin may play far more potent roles in asthma risk than kids’ physical surroundings.

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ER or Urgent Care?

“Urgent care versus the ER versus your doctor’s office: Some situations are no-brainers, but many fall in a gray zone of uncertainty,” says Therese Canares, an emergency physician for the Johns Hopkins Children’s Center.

How is a parent to make the right call? Consider the five scenarios below. If you couldn’t get in to see your pediatrician within a day or two, would you head straight to the ER—or make a trip to the nearest urgent care center instead?

  1. Your child hits his head and appears to pass out or lose consciousness for a few seconds.
  2. Your child is less than 2 months old and has a fever (a temperature above 100.4 degrees Fahrenheit).
  3. Your child has had a few episodes of vomiting or diarrhea—without blood in the stool—but has no belly pain or signs of dehydration.
  4. You suspect your child has a broken bone, particularly if there is visible swelling or unevenness and bumps in the injured area—a sign that the broken bone is misaligned.
  5. Your child has a fever accompanied by cold symptoms, and you suspect it may be the flu.

(See below for guidelines—though Canares cautions that the first step should always be calling your pediatrician’s office or an after-hours answering service to discuss the symptoms with a triage nurse or a physician.)

1. ER; 2. ER; 3. Urgent care; 4. ER; 5. Urgent care

31.4% Increase

Increase in daily patient volume at the Johns Hopkins Kimmel Cancer Center’s outpatient pancreatic cancer clinic after implementation of a “workflow” system developed by the U.S. Air Force. “The care we were providing was great, but we were limited by the number of patients we could see,” says clinic director Joseph Herman.

Led by Johns Hopkins radiation oncology resident Shereef Elnahal, Herman and his colleagues identified six critical tasks that were reallocated to support staff—including the collection of pain assessment scores the morning of the clinic, assigning patients to specific doctors based on the patients’ stage and comorbidities, and ensuring patients came to the clinic with the most up-to-date medical imaging.

“This allowed physicians to make treatment decisions faster and more confidently on the day of the clinic, affording them more time to address patients’ symptoms and concerns,” says Elnahal. The team reported its findings in the March issue of Physician Leadership Journal.