End of Life

Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial

End of Life | Johns Hopkins Medicine

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Long shadow cast by psychiatrist on transgender issues finally recedes at Johns Hopkins

End of Life | Johns Hopkins Medicine
Paul McHugh, the former chief of psychiatry at Johns Hopkins Hospital, helped to end Johns Hopkins’s pathbreaking transgender surgery program nearly 40 years ago.

(Courtesy of Johns Hopkins Medicine)

Nearly four decades after he derailed a pioneering transgender program at Johns Hopkins Hospital with his views on “guilt-ridden homosexual men,” psychiatrist Paul McHugh is seeing his institution come full circle with the resumption of gender-reassignment surgeries.

McHugh, the hospital’s chief of psychiatry from 1975 to 2001, still believes that being transgender is largely a psychological problem, not a biological phenomenon. And with the title of university distinguished service professor at Johns Hopkins Medicine, he continues to wield enormous influence in certain circles and is quoted frequently on gender issues in conservative media.

“I’m not against transgender people,” he said recently, stressing that he is “anxious they get the help they need.” But such help should be psychiatric rather than surgical, he maintains.

Hopkins, however, is moving beyond McHugh. This summer, it will formally open a transgender health service and will resume, after a 38-year hiatus, an accompanying surgical program.

Once at the forefront of ­gender-identity science — and site of the nation’s first “change-of-sex operations,” as the headlines announced in 1966 — Hopkins abruptly halted those surgeries in 1979.

Johns Hopkins Hospital hopes to return to the forefront of transgender medicine with a new transgender health service formally opening this summer. (Bill O'Leary/The Washington Post)

The main trigger was a study by Jon Meyer, who ran the hospital’s Sexual Behaviors Consultation Unit. In the study, Meyer concluded that although “sex-change” surgery was “subjectively satisfying” for the small sample surveyed, the operations they underwent conferred “no objective advantage in terms of social rehabilitation.”

“With these facts in hand,” McHugh later wrote, “I concluded that Hopkins was fundamentally cooperating with a mental illness.”

Two months later, its gender-identity clinic was shut down.

Many scientists subsequently challenged the methodology behind Meyer’s study, as well as his interpretation of the results, but in the decade that followed, other academic hospitals often cited the research when they discontinued their own transgender surgical programs.

The decision to restart operations initially was made public in July and then repeated in October on the health system’s website in a letter titled “Johns Hopkins Medicine’s Commitment to the LGBT Community.

” The letter stressed “strong and unambiguous” support of the LGBT community and made clear that when “individuals associated with Johns Hopkins exercise the right of expression, they do not speak on behalf of the institution.”

At the same time, the letter emphasized a hallmark of American higher education: the freedom to express contrarian views. “Academic freedom is among our fundamental principles,” it said, “essential to the self-correcting nature of scientific inquiry, and a privilege that we safeguard.”

McHugh, many people assumed, was the unnamed impetus for both declarations.

Hopkins’s shift not only reflects the public’s far broader discussion about transgender rights and protections, but also the controversies that the discussion engenders.

In February, the Trump administration revoked federal guidelines put in place under President Barack Obama that had directed public schools to allow transgender students to use restrooms matching their gender identity.

And North Carolina passed its own restrictive “bathroom bill” for public spaces — legislation that drew such condemnation, especially from outside of the state, that lawmakers last week voted to repeal the law.

“Obviously there’s a lot of apprehension and anxiety in the transgender community, because we don’t know how health care is going to be impacted [by Trump’s agenda], especially for transgender youth,” said Paula Neira, clinical director of the new Hopkins program. “I think it shows that what we’re doing is timely.”

But as the plans for the transgender health service were coming together last fall, a 143-page report, titled “Sexuality and Gender,” appeared in the New Atlantis, a science and technology magazine published by the Ethics and Public Policy Center, a conservative Christian think tank. It was authored by McHugh and Lawrence S. Mayer, a professor of statistics and biostatistics at Arizona State University and, at the time of the publication, a scholar in residence at Hopkins.

The pair contended that neither sexual orientation nor gender identity is biologically determined. Although the New Atlantis is a small publication, the report dismayed many in the Hopkins medical community and beyond.

Those included Dean Hamer, a scientist at the National Institutes of Health for several decades and one of the first researchers to identify a genetic link to homosexuality.

Hamer termed some of the authors’ statements “pure balderdash.”

The paper gained traction with conservative media, however.

“People began citing the New Atlantis article as a reason to support legislation against transgender people,” said Tonia Poteat, a Hopkins epidemiologist who is an expert on transgender issues.

The result: In October, Poteat and a half-dozen colleagues at the university’s Bloomberg School of Public Health denounced the report, writing that it “mischaracterizes the current state of the science on sexuality and gender.” More than 600 students, faculty members, interns, alumni and others at the medical school also signed a petition calling on the university and hospital to disavow the paper.

“These are dated, now-discredited theories,” said Chris Beyrer, a professor at the public health school and part of the faculty group that denounced McHugh’s stance.

In an interview from his home in Baltimore, where he still sees patients, McHugh explained that the “duty of all doctors who propose a treatment is to know the nature of the problem they propose to treat. The issue of transgender [people] is, the vast majority coming for surgery now don’t have a biological reason but a psychosocial reason.”

While McHugh successfully lobbied for more than 30 years to keep gender-reassignment surgery from becoming a Medicare benefit, he supports the operation for those born with an intersex condition, which means having a reproductive or sexual anatomy that doesn’t fall into the typical definition of male or female.

Most recently his name was prominent on an amicus brief in opposition to the case of Virginia transgender student Gavin Grimm. The teen sued his school district to be allowed to use the bathroom of his gender identity — an issue that until last month was headed to the Supreme Court.

“People with abnormalities of development should be helped to find their place as they see it best,” McHugh said. “But they are a tiny number of the transgender population seeking and being given treatment.”

Those involved in Hopkins’s transgender health services disagree with his positions. But the 85-year-old doctor, who still teaches an occasional course, says he bears no animus toward them.

In fact, he appreciated a visit made last fall by W.P. Andrew Lee, the head of plastic and reconstructive surgery at Hopkins.

Lee wanted to tell the former psychiatry chief that the hospital would be resuming gender-affirmation surgeries, as they are called these days.

The visit was “a professional courtesy,” Lee said in an email to The Washington Post. He declined an interview request.

McHugh elaborated a bit on their conversation and how the two had disagreed: “When I said [surgery] reduced options, he said he was thinking about the people who were pleased about the treatment.”

Their stalemate, the psychiatrist knew, wasn’t going to affect the hospital’s decision.

So far, the new transgender health service involves 25 to 30 professionals across a number of departments, including plastic surgery, urology, endocrinology, nursing and social work. The surgeries will take place at Hopkins Hospital and possibly at some of the system’s satellite centers.

Despite important gender research the university maintained over the years, it has ground to recover. The long break in its surgical program, coupled with McHugh’s vocal positions on gay and transgender issues, caused Hopkins to lose standing within the LGBT community.

“It took an exceptionally long time,” Beyrer said. “Too long.”

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Source: https://www.washingtonpost.com/national/health-science/long-shadow-cast-by-psychiatrist-on-transgender-issues-finally-recedes-at-johns-hopkins/2017/04/05/e851e56e-0d85-11e7-ab07-07d9f521f6b5_story.html

AFL-CIO, RN Leaders to Headline Huge Johns Hopkins Rally to Demand JHH End Practice of Suing Patients with Medical Debt

End of Life | Johns Hopkins Medicine

AFL-CIO President Richard Trumka, Secretary-Treasurer Liz Shuler, and National Nurses United Executive Director Bonnie Castillo are headlining a major rally outside Johns Hopkins Hospital in Baltimore, Saturday, July 20 to press hospital officials to end their deplorable practice of suing low-income community patients and their families for medical debt.

 Hospital officials continue to hound patients even while hospitals in Virginia and Tennessee have suspended the practice. Labor, health care and community activists from across the region will be on hand as well as those who have been sued by Johns Hopkins Hospital for alleged medical debt.

 The July 20 rally will also press Johns Hopkins to respect the rights of its RNs to form a union. 

What: Major rally at Johns Hopkins HospitalWhen: Saturday, July 20, 2-3 p.m.

Where: Outside Johns Hopkins Hospital, North Broadway between Orleans and Monument Streets (in front of dome), Baltimore

 The AFL-CIO, National Nurses United, and the Coalition for a Humane Hopkins are sponsoring the rally. More details on the Johns Hopkins medical debt lawsuits is available in a research report by the three organizations at https://act.nationalnursesunited.org/page/-/files/graphics/Johns-Hopkins-Medical-Debt-report.pdf  Since 2009, Johns Hopkins Hospital has filed more than 2,400 lawsuits in Maryland courts seeking payment of alleged medical debt from former patients. In more than 400 cases, the hospital has won garnishments of wages or bank accounts. Many patients would ly qualify for reduced-fee or charity care, but were apparently not informed of that option by the hospital despite the obligation of Maryland’s charity care provisions. Hopkins’ medical debt practices also have a disproportionate impact on African American Baltimore residents. The area which contains the largest number of residents sued by Hopkins, for example, is 90 percent African American and has a poverty rate nearly triple the state average. Johns Hopkins has continued its egregious medical debt practices despite widespread community criticism, and the recent announcement that two other large hospitals, Mary Washington Healthcare in Fredericksburg, Va. and Methodist Le Bonheur in Memphis, Tenn. have suspended medical debt lawsuits after similar practices were brought to light. Rallygoers will call on Johns Hopkins to cancel all medical debt lawsuits filed against low-income patients, end the practice of garnishing wages, substantially increase the amount of charity care it provides, and guarantee all patients are informed of the opportunity to qualify for free or reduced medical care at Johns Hopkins facilities. Further, the rally will press Johns Hopkins to respect the right of RNs who are seeking to unionize with the National Nurses Organizing Committee/National Nurse United. In June, the hospital reached a settlement with the National Labor Relations Board to agree to stop violating federal labor law with such practices as unlawful surveillance and interrogation of RNs and barring off-duty RNs access to non-patient care areas to talk to their colleagues about the union. 

However, nurses report continued violation of their rights, and an aggressive union-busting campaign designed to silence the voice of nurses. The nurses and supporters are calling on Johns Hopkins to agree to stop all harassment and intimidation tactics related to the union organizing effort.

Source: https://www.nationalnursesunited.org/press/afl-cio-rn-leaders-headline-huge-johns-hopkins-rally-demand-jhh-end-practice-suing-patients

Student Health Plan

End of Life | Johns Hopkins Medicine

Home > Offices and Services > Student Affairs > Resources > Student Insurance > Student Health Plan

All full-time students are required to have health insurance coverage. 

Students will automatically be enrolled in the Student Health Plan, administered by EHP, without proof of comparable coverage provided at Orientation Activities.  Comparable coverage would need to provide a minimum of $250,000 USD in coverage for all medical costs and allow the student to use the insurance in the State of Maryland.  See insurance waiver information at bottom of page.

  • EHP Benefits-At-A-Glance
  • EHP Coverage Description
  • EHP Full Plan Description

University Health Services Clinic Fee

All full-time on-campus students are billed a $850.00 Health Clinic Fee for access to our on-campus health center.  (Effective July 1, 2020)

The University Health Services Fee (UHS) is not insurance and students are billed the fee on a per-term basis ($212.50 per term) until the $850.00 is paid in full (after 4 terms).

  This fee grants students unlimited access to Primary Care Services as well as Mental Health Services at the UHS Clinic and is billed to all full-time on-campus students regardless of whether they are enrolled in the Student Health Plan.

  • Summary of Benefits Offered by University Health Services Clinic

Monthly Insurance Premium Rates

Academic Year 2020-2021  (effective July 1, 2020):

  • Individual: $330.00
  • 2-Party: $820.00
  • Family: $1,100.00

Annual Deductibles (what you have to pay pocket before your insurance coverage pays anything):

  • Individual = $150.00
  • Two-Party, Parent-Child, Family, etc. = $450.00


Your monthly premiums are posted to your student account on a term basis.

  • July-August: Summer Term
  • September-October: 1st Term
  • November-December: 2nd Term
  • January-March: 3rd Term
  • April-June: 4th Term

Student Health Plan Insurance WAIVER Information

Students opting to waive health insurance via providing proof of comparable coverage will have their waiver in full force and effect throughout the duration of their academic program enrollment at JHSPH. However, students are allowed to enroll in the Student Health Plan in the future terms as needed.

It is the responsibility of each student to notify the Student Accounts Office if current coverage expires or changes while enrolled as a full-time student.

Termination of Coverage

Students are responsible for notifying Student Accounts and Business Services when they wish to terminate their coverage, regardless of the source of funding.

If a student is no longer enrolled in the School or has graduated, the student will be notified in writing that their coverage will be terminated.

Student Accounts and Business Services must be notified no later than 60 days from the date of your termination (coverage will be retroactive). You have the right to continue these benefits at your own expense for a period up to 18 months.

Extension of current insurance benefits to students who are separating permanently from the University is offered under the Consolidated Omnibus Budget Reconciliation Act (COBRA). If you elect to continue under COBRA, premiums will increase slightly and payment will be due the first of each month. Monthly rates for COBRA are as follows:

Academic Year 2020-2021 (effective July 1, 2020)

  • Individual: $340.00
  • Two-Party: $840.00
  • Family: $1,120.00 

You are responsible for 18 months of premiums unless you notify the Student Accounts Office in writing that you wish to terminate your coverage prior to the end of your 18 month period. 

Access to UHS services ceases on the date of the one year anniversary of the first payment of the Health Fee. JHSPH students should begin to make arrangements to establish with a non-UHS provider at least 90 days prior to the anniversary. Participants in COBRA Student Health Program are not eligible to use UHS services.

Source: https://www.jhsph.edu/offices-and-services/student-affairs/resources/student-insurance/student-health-plan.html

Johns Hopkins launches center for psychedelic research

End of Life | Johns Hopkins Medicine

A group of private donors has given $17 million to start the Center for Psychedelic and Consciousness Research at Johns Hopkins Medicine, making it what's believed to be the first such research center in the U.S. and the largest research center of its kind in the world.

Psychedelics are a class of drugs that produce unique and profound changes of consciousness over the course of several hours. The Center for Psychedelic and Consciousness Research will focus on how psychedelics affect behavior, brain function, learning and memory, the brain's biology, and mood.

“The center's establishment reflects a new era of research in therapeutics and the mind through studying this unique and remarkable class of pharmacological compounds.”

Roland Griffiths

Director, Center for Psychedelic and Consciousness Research

“The center's establishment reflects a new era of research in therapeutics and the mind through studying this unique and remarkable class of pharmacological compounds,” says Roland Griffiths, the center's director and professor of behavioral biology in the Department of Psychiatry and Behavioral Sciences and the Department of Neuroscience at the Johns Hopkins University School of Medicine. “In addition to studies on new therapeutics, we plan to investigate creativity and well-being in healthy volunteers that we hope will open up new ways to support human thriving.”

At Johns Hopkins, much of the early work with psychedelics has focused on psilocybin, the chemical found in so-called magic mushrooms.

Further studies will determine the chemical's effectiveness as a new therapy for opioid addiction, Alzheimer's disease, post-traumatic stress disorder, post-treatment Lyme disease syndrome (formerly known as chronic Lyme disease), anorexia nervosa, and alcohol use in people with major depression. Researchers hope to create precision medicine treatments tailored to individual patients' specific needs.

“Johns Hopkins is deeply committed to exploring innovative treatments for our patients,” says Paul B. Rothman, dean of the medical faculty at the Johns Hopkins University School of Medicine and CEO of Johns Hopkins Medicine. “Our scientists have shown that psychedelics have real potential as medicine, and this new center will help us explore that potential.”

The center will provide support for a team of six faculty neuroscientists, experimental psychologists, and clinicians with expertise in psychedelic science, as well as five postdoctoral scientists.

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“I am thrilled about this magnificent opportunity that has been provided by enlightened private funders,” says James Potash, a professor and director of the Department of Psychiatry and Behavioral Sciences. “This center will allow our enormously talented faculty to focus extensively on psychedelic research, where their passions lie and where promising new horizons beckon.”

In the absence of federal funding for such therapeutic research, the new center will rely on gifts from private donors.

The center's operational expenses for the first five years will be covered by private funding from the Steven & Alexandra Cohen Foundation and four philanthropists: Tim Ferriss, author and technology investor; Matt Mullenweg, co-founder of WordPress; Blake Mycoskie, founder of the shoe and accessory brand TOMS; and investor Craig Nerenberg.

“We have to take braver and bolder steps if we want to help those suffering from chronic illness, addiction, and mental health challenges,” says Alex Cohen, president of the Steven & Alexandra Cohen Foundation. “By investing in the Johns Hopkins center, we are investing in the hope that researchers will keep proving the benefits of psychedelics—and people will have new ways to heal.”

The center's faculty will train graduate and medical students who want to pursue careers in psychedelic science, where there have historically been few avenues for career advancement.

“This represents the largest investment to date in psychedelic research, as well as in training the next generation of psychedelic researchers,” says Ferriss, whose podcast occasionally explores topics related to psychedelics and their therapeutics properties. “I sincerely hope this ambitious Johns Hopkins center will inspire others to think big and establish more psychedelic research centers in the U.S. and overseas, as there's never been a better time to support such important work.”

In 2000, the psychedelic research group at Johns Hopkins was the first to achieve regulatory approval in the U.S. to reinitiate research with psychedelics in healthy volunteers who had never used a psychedelic. Their 2006 publication on the safety and enduring positive effects of a single dose of psilocybin sparked a renewal of psychedelic research worldwide.

Since then, the researchers have published studies in more than 60 peer-reviewed journal articles. Their research has demonstrated therapeutic benefits for people who suffer from conditions including nicotine addiction and depression and anxiety caused by life-threatening diseases such as cancer.

It has paved the way for current studies on treatment of major depressive disorder.

These researchers have also expanded the field of psychedelic research by publishing safety guidelines that have helped gain approval for psychedelic studies at other universities around the world and by developing new ways of measuring mystical, emotional, and meditative experiences while under the influence of psychedelics.

The group's findings on both the promise and the risks of psilocybin in particular helped create a path forward for the chemical's potential medical approval and reclassification from a Schedule I drug, the most restrictive federal government category, to a more appropriate level. Psilocybin was classified as Schedule I during the Nixon administration, but the team's research over the last decade has shown psilocybin to have low toxicity and abuse potential.

“This very substantial level of funding should enable a quantum leap in psychedelic-focused research,” adds Potash. “It will accelerate the process of sorting out what works and what doesn't.”

The Center staff members will include:

  • Griffiths, who initiated the psilocybin research program at Johns Hopkins almost 20 years ago, leading the first studies investigating the effects of its use by healthy volunteers. His pioneering work led to the consideration of psilocybin as a therapy for serious health conditions. Griffiths recruited and trained the center faculty in psychedelic research as well.
  • Matthew Johnson, an associate professor of psychiatry and behavioral science. He has expertise in drug addictions and behavioral economic decision-making, and has conducted psychedelic research at Johns Hopkins since 2004. He led studies showing psilocybin can treat nicotine addiction. Johnson will lead two new clinical trials and will be associate director of the new center.
  • Frederick Barrett, an assistant professor of psychiatry and behavioral sciences who has expertise in cognitive and affective neuroscience, as well as psychological assessment. The focus of his past and ongoing research is the impact of psychedelics on emotional and brain functioning. Barrett will be the center's director of neurophysiological mechanism and biomarker assessment, overseeing a project that looks at how psychedelics change brain function and blood biomarkers that may predict response to psychedelics.
  • Albert Garcia-Romeu, an instructor of psychiatry and behavioral sciences with expertise in assessing the psychological and subjective effects of psychedelics and addiction treatment with psychedelics. At the new center, Garcia-Romeu will lead several clinical trials and will supervise key elements of participant recruitment and care.
  • Natalie Gukasyan, a Johns Hopkins trained psychiatrist and a study team member for the ongoing psilocybin depression study. Gukasyan will lead the study on psilocybin treatment for anorexia nervosa and serve as the new center's medical director.
  • Alan Davis, an adjunct assistant professor of psychiatry and behavioral sciences, is one of the lead psilocybin session therapists on the ongoing psilocybin depression study and lead investigator of several past and ongoing survey studies exploring the effects of psychedelics in real-world and clinical settings. At the new center, he will provide clinical supervision and consultation across clinical trials.
  • Mary Cosimano, who has been a member of the Johns Hopkins psychedelic research team since its inception and has served as a study guide for hundreds of psychedelic sessions. Cosimano will be the director of clinical services for the new center, with responsibility for training and supervising center staff members who prepare, support and provide after care for study participants.
  • William Richards, a clinical psychologist who conducted research with psychedelics in the 1960s. He has been a member of the Johns Hopkins psychedelic research team since its inception.

Posted in Health, University News

psychedelics, roland griffiths

Source: https://hub.jhu.edu/2019/09/04/hopkins-launches-psychedelic-center/

The American Nurse Project

End of Life | Johns Hopkins Medicine

Meet the nurses from this location:

AMY BROWNThe Johns Hopkins Hospital Baltimore, MDGynecologic Oncology


AMY BROWN, BSN, RN, OCN : Women are the Caregivers of the World>AMY BROWN, BSN, RN, OCN : Overwhelmed and Overworked vs. Being Present>AMY BROWN, BSN, RN, OCN : On Being a Camp Nurse>AMY BROWN, BSN, RN, OCN : I’m Proud to be a Bedside Nurse>PAM DODGEThe Johns Hopkins Hospital Baltimore, MDPediatric Intensive Care


PAM DODGE, RN : This Is My Family>PAM DODGE, RN : Doing What Needs to Be Done>BRIAN FOWLER
The Johns Hopkins Hospital Baltimore, MD Emergency Nurse  


BRIAN FOWLER, RN, NCIIM — Save lives first, ask questions later>BRIAN FOWLER, RN, NCIIM — Reflections on my oncology experiences>BRIAN FOWLER, RN, NCIIM — What trauma really looks >BRIAN FOWLER, RN, NCIIM — The harsh reality of gun violence>KAREN FRANKThe Johns Hopkins Hospital Baltimore, MDNeonatal Intensive Care


KAREN FRANK, RNC, MS, CNS : Back to Basics>KAREN FRANK, RNC, MS, CNS : When One Twin Survives>KAREN FRANK, RNC, MS, CNS : Death in the N.I.C.U>MELISSA MASONThe Johns Hopkins Hospital Baltimore, MDEmergency Department


MELISSA MASON, BSN, RN : Disaster Triage in the E.D.>AMANDA OWENThe Johns Hopkins Hospital Baltimore, MDWound Nursing


AMANDA OWEN, BSN, RN, CWCN : Holding onto False Hope>AMANDA OWEN, BSN, RN, CWCN : Dying on Their Own Terms>AMANDA OWEN, BSN, RN, CWCN : On Being Merciful>MICHELLE PATCHThe Johns Hopkins Hospital Baltimore, MDPatient/Staff Safety


MICHELLE PATCH, MSN, RN, ACNS-BC : Healthcare Workers as Second Victims>MICHELLE PATCH, MSN, RN, ACNS-BC : Patients with a History of Violence>ALLISYN PLETCHThe Johns Hopkins Hospital Baltimore, MDPsychiatryEating Disorders


ALLISYN PLETCH, MSN, RN, NCIII: Obesity and Learning Portion Control>ALLISYN PLETCH, MSN, RN NCIII : Nursing Machines vs. Nursing Patients>ALLISYN PLETCH, MSN, RN NCIII : Learning From Patients>ALLISYN PLETCH, MS, RN, NCIII : A History of Eating Disorders>TRAVIS SIMONETTIThe Johns Hopkins Hospital Baltimore, MDGeneral Medicine


RANIMARIA TOLEDOThe Johns Hopkins Hospital Baltimore, MDEmergency Department


RHONDA WYSKIELThe Johns Hopkins Hospital Baltimore, MDSurgical Intensive Care



For more than a century, The Johns Hopkins Hospital has had a tradition and mission of striving to lead the world in the diagnosis and treatment of disease and to train tomorrow’s great physicians, nurses and scientists.

Above all, we aim to provide the highest quality health care and service to all of our patients. The Charlotte R. Bloomberg Children’s Center Tower and the Sheik Zayed Adult Tower opened May 1, 2012, adding approximately 1.6 million square feet of state-of the-art medical facilities.

The 12-story towers mark a new era for The Johns Hopkins Hospital. Nationally and Internationally recognized Specialty Care,  The Johns Hopkins Hospital is globally acclaimed for its exceptional services and programs. For 21 consecutive years, it has topped U.S.

News & World Report’s “Honor Roll” in the magazine’s annual ranking of America’s Best Hospitals.

Part of a Premier Integrated System

The Johns Hopkins Hospital, founded in 1889, and the Johns Hopkins School of Medicine, created in 1893, form the nucleus of Johns Hopkins Medicine.

This is one of the world’s premier, integrated health systems, with six hospitals, four community-based health care and surgery centers, more than 30 primary health care sites throughout Maryland, managed care and home care services, and numerous strategic collaboration, affiliate and management agreements overseas, and multiple short-term consulting projects.

Source: https://americannurseproject.com/locations/the-johns-hopkins-hospital/