Brian H. Waters,
Dogs have been called man's best friend because of their loyalty and protection, but now, thanks to Johns Hopkins Medicine researchers and an international team of collaborators, canines may provide an even greater service for their human male companions: prostate cancer screening.
Prostate cancer is the second leading cause of cancer death in men in the developed world. Clinicians have been seeking accurate and reliable noninvasive diagnostic tools to differentiate early stage, less dangerous and more treatable stages of the disease from the aggressive, high-grade and likely-to-spread forms. Standard blood tests for early detection, such as the prostate specific antigen (PSA) test, often miss cancers in men whose PSA levels are within normal levels or overdiagnose men with clinically insignificant tumors or no cancer at all.
Recently, Alan Partin, M.D., Ph.D., urologist-in-chief at The Johns Hopkins Hospital and colleagues, along with collaborators from the United Kingdom, the Prostate Cancer Foundation and the Massachusetts Institute of Technology, have been researching a dog's extremely sensitive sense of smell as a novel way to improve testing for prostate cancer.
In a small study published Feb. 17, 2021, in the journal PLOS ONE, the researchers had two dogs sniff samples of urine from men diagnosed with high-grade prostate cancer and from men without cancer. The animals, Florin, a 4-year-old female Labrador, and Midas, a 7-year-old female wirehaired Hungarian vizsla, had been trained to respond to cancer-related chemicals -- known as volatile organic compounds (VOCs) -- added to urine samples and not respond to ones without them.
"Besides PSA, other methods to detect prostate cancer make use of a molecular analyzer called a gas chromatography-mass spectrometer [GC-MS] to find specific VOCs or profiling bacterial population in a urine sample looking for species associated with cancer, but these have limitations," says Partin. "We wondered if having the dogs detect the chemicals, combined with analysis by GC-MS, bacterial profiling and an artificial intelligence [AI] neural network trained to emulate the canine cancer detection ability, could significantly improve the diagnosis of high-grade prostate cancer."
Adding the AI analysis, says Partin, helped the researchers filter the more than 1,000 VOCs present in a typical urine sample down to those most beneficial for cancer diagnosis.
The dogs, says Partin, performed their cancer detection roles well. Both Florin and Midas identified five of seven urine samples from men with cancer, or 71.4% accuracy. Florin was able to correctly identify 16 of the 21 non-aggressive or no cancer samples (76.2%), while Midas was able to pick out 14 (66.7%).
When the canine olfactory (smell) results were combined with GC-MS, bacterial profiling and AI analysis, the multisystem approach proved a more sensitive and more specific means of detecting lethal prostate cancer than any of the methods alone.
Partin says that this recent study, and other prostate cancer research at Johns Hopkins Medicine, is only possible because of a long history of "biobanking" valuable patient samples. He says that "larger sample pools will be the key enabler of statistically powered, multi-institutional future studies seeking to fully integrate VOC and microbiota profiling."
Partin is available for interviews.
Some say the eyes are the windows to the soul, but new findings from researchers at the Johns Hopkins Wilmer Eye Institute suggest they may offer insight into the mind as well. Their new proof-of-principle study shows how an imaging technique that measures blood flow in the back of the eye may offer a noninvasive way to detect early-onset Alzheimer's disease.
"We set out to investigate the idea that changes in the retinal capillaries at the back of the eye can reveal changes in the brain that are otherwise undetectable and that occur before the disease is diagnosed ," says lead study author Amir Kashani, M.D., Ph.D., associate professor of ophthalmology at the Johns Hopkins University School of Medicine.
The study involved 13 people with a rare, genetically inherited form of early-onset Alzheimer's disease marked by mutations identified in three genes. This form of familial Alzheimer's disease affects approximately 1% of all patients with the condition.
Using an imaging technology called optical coherence tomography angiography (OCTA), the researchers took images of blood vessels in the back of the eyes of study participants with and without the mutation leading to the familial form of Alzheimer's disease. They also cataloged the disease stage for the people with Alzheimer's and the cognitive abilities of both groups.
Kashani and his team found that abnormal blood flow through the smallest vessels at the back of the eye correlated with the mutation status of subjects at risk for the familial form of Alzheimer's disease. Patients with the Alzheimer's-causing mutations who had no signs of disease had abnormally high and heterogeneous blood flow in their retinal capillaries. The researchers believe this may be a sign of the early inflammatory changes involved in the pathogenesis of Alzheimer's disease.
The researchers say these data support the belief that changes in the eye can demonstrate the earliest signs of brain disease before symptoms are present. With further evidence from larger studies over time, they believe that the method could offer clinicians a tool for earlier diagnosis and enable intervention to slow cognitive decline in patients.
Kashani is available for interviews.
Despite their existence for decades, electronic health records -- digitized patient information and medical histories available instantly and securely to authorized users -- are not commonly used by many addiction and substance use disorder treatment facilities in the United States. Now, a recent study by Johns Hopkins Medicine researchers suggests why this is happening. It also describes how not using this technology may hinder coordination between treatment programs and health care providers, leaving patients to flounder through the system on their own.
In their findings, published online on Jan. 9, 2021, in the journal Drug and Alcohol Dependence, the researchers conclude that electronic health records are less commonly used by substance use disorder programs compared with other mental health treatment facilities, and that this difference is significant. Overall, only 9.6% of substance use disorder treatment programs and 15% of mental health centers report exclusively using electronic health records. Even more troubling, they say, is that fewer than 25% of both these facility types are using electronic health records for core clinical activities, such as progress notes, laboratory monitoring and medication prescriptions.
Since their general acceptance by the medical community, electronic health records have provided a number of benefits, including increased storage capability and faster access to a patient's health information. They also enable the secure exchange of a patient's records between facilities and providers.
"This is key, because without electronic health records, patients may experience disjointedness in their care, and for the most part, these records have to be the link between the treatment facilities and care providers," says Stanislav Spivak, M.D., assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.
Compared with other settings, the researchers say that implementing electronic health records can be more difficult in addiction treatment facilities because these centers often face unique regulatory and funding challenges. The researchers also found that mental health facilities had more diverse sources of funding from insurance than addiction treatment centers.
"Traditionally, substance use disorder programs are smaller and may lack the resources and funding that other mental health treatment facilities might have," says Spivak.
According to Spivak, the initial hurdle to substance use disorder programs adopting electronic health records may be cost and technology.
"For example," Spivak explains, "if you need computers powerful enough to encrypt the data or special printers to access the information, the cost of electronic health records may be prohibitive to a low-funded substance use disorder facility."
Spivak is available for interviews.
Michael E. Newman,
The overuse of antibiotics in hospitals can lead to the emergence of drug-resistant strains of bacteria or outbreaks of infections by bacteria such as Clostridioides difficile. Over the past decade, efforts to combat the overuse problem have included antibiotic stewardship programs (ASPs) that ensure patients only receive antibiotics when needed, and then, only in the correct amounts and for the prescribed dosage period. However, ASPs have not been established in all medical facilities, particularly smaller and rural hospitals where access to experts in the use of antibiotics may not be available.
Researchers at Johns Hopkins Medicine and NORC at the University of Chicago developed a comprehensive stewardship intervention, the Safety Program for Improving Antibiotic Use, which is applicable for all types of hospitals and enables frontline clinicians to make informed and responsible decisions about prescribing antibiotics. In a recent study, the researchers evaluated the effectiveness of the program over a year's time at 402 hospitals across the nation -- the largest project of its kind to date. As a measure of success, they looked at overall antibiotic use and C. difficile infection rates in the hospitals during the study period.
According to the U.S. Centers for Disease Control and Prevention, C. difficile is a bacterium that causes severe diarrhea and colitis (an inflammation of the colon), and is estimated to cause nearly 500,000 infections in the United States each year. Most cases occur in people taking antibiotics during or just after hospitalization. This is because antibiotics may destroy some of the intestinal bacteria that normally keep C. difficile at bay.
"The Safety Program for Improving Antibiotic Use was designed to reduce the harm associated with antibiotic overuse by making stewardship part of the decision-making process for clinicians," says study lead author Pranita Tamma, M.D., M.H.S., director of the Pediatric Antimicrobial Stewardship Program at Johns Hopkins Children's Center and associate professor of pediatrics at the Johns Hopkins University School of Medicine. "We wanted to see how much of a difference an ASP could make in a one-year period," she says.
The ASP used in the study consisted of 17 webinars -- each repeated three times, as well as recorded for online viewing -- over a 12-month timespan (January to December 2018). Conducted by Tamma and her colleague, Sara Cosgrove, M.D., M.S., professor of medicine at the Johns Hopkins University School of Medicine, the webinars focused on how to establish and maintain an ASP at a hospital, methods for improving teamwork and communication, and best practices for diagnosing and managing infections without overusing antibiotics.
Participants in the program received additional coaching and tools to enhance their ASP activities.
The 402 hospitals that completed the one-year study program included 28 academic medical centers, 122 mid-level teaching hospitals, 167 community hospitals and 85 critical access hospitals. Compliance with the four key components of antibiotic stewardship (interventions before and after prescribing of antibiotics, availability of local antibiotic guidelines, ASP leads with dedicated salary support, and quarterly reporting of antibiotic use) improved from 8% to 74% overall during the 12 months. Antibiotic use (measured by days of antibiotic therapy per 1,000 patient days) decreased 30% and C. difficile infections decreased 20%.
"These results are particularly remarkable as a large proportion of the hospitals in the study were under-resourced and did not have access to infectious disease specialists," says Cosgrove. "They show that no matter their size, all hospitals can develop, establish and conduct good stewardship practices with the proper resources -- and remind us of the importance of organized strategies to assist hospitals and clinicians in implementing medical care best practices."
Hospitals wanting more information can access the "Toolkit Implementation Guide for Acute Care Antibiotic Stewardship Programs."
Tamma and Cosgrove are available for interviews.