Play

Anchor lead:  Can CPR in hospitals be streamlined? Elizabeth Tracey reports

When people who are hospitalized have a heart attack, inserting instruments to assist their breathing is most often standard issue. But now a new study calls that practice into question, finding that those who were put on breathing machines died in greater numbers than those who were not. Seth Martin, a cardiologist at Johns Hopkins, says studies such as this one are important in improving patient care.

Martin: These are really fascinating results and I think it really speaks to the point that we need to constantly challenge ourselves, ask ourselves is what we do the right thing, just because we’ve done it for years or decades is this truly the right thing? If we have new data, bring those to bear, ask the question, can we do better? Challenge the conventional wisdom, ultimately this leads to better care. This is the promise of big data.   :27

Martin says gathering such information on practices that just seem to be the right thing are underway in every area of healthcare, and are likely to impact on many more standard operating practices in medicine. At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
Play

Anchor lead: A new approach to healthcare is helping those with complex needs, Elizabeth Tracey reports

Meeting patients where they are is one central tenet of a Johns Hopkins program designed to help patients avoid readmission to the hospital and reduce their need to visit an ED, with early results indicating the approach not only works, but staff and patients are much happier with it. Scott Berkowitz, senior director for accountable care, says the program required a paradigm shift.

Berkowitz: We have to continue to understand that a lot of care is not delivered within traditional settings, a lot of care is not delivered within our hospitals or even within our clinics. But to the extent that we can move care to the home, to the extent that we can move care to places where these patients are comfortable, and these patients sometimes have had long relationships of distrust with traditional healthcare settings, but it doesn’t mean that they can’t be engaged and participatory in their care, and we can get there by working as a team.  :25

Berkowitz believes lessons learned here are applicable around the country in healthcare improvement efforts. At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
Play

Anchor lead: Taking a comprehensive approach to complex patients helps everyone, Elizabeth Tracey reports

‘Super user’ is the term used to describe people who make frequent use of the emergency department and are often hospitalized and rehospitalized. Now a Johns Hopkins program headed by Scott Berkowitz, senior director for accountable care, has not only helped reduce ED use and readmissions to the hospital, it’s resulted in greater satisfaction all around.

Berkowitz: We’ve received really exciting feedback from patients who’ve participated in the program and found it to be quite beneficial.  We have stories that we have online on our J-Chip website. And we also have stories from our care team members who are community health workers or others who are sometimes brought into these positions from the community and had conditions previously where they were challenged and are now those who are helping to team up with us in terms of combating some of those conditions and understanding the local needs of the community.  :27

Berkowitz says the community health workers are part of the all-encompassing team who care for the patient, where the patient is at the center. At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
Play

Culture of Clostridium difficile, an anaerobic bacterium. This bacterium is in some cases able to cause severe diarrhoea leading to pseudomembranous colitis and death. Clostridium difficile has caused many nosocomial outbreaks in hospitals. Viable spores of the bacterium can survive months or years on surfaces. This culture is NAP1 or CD027, an epidemic subtype of toxigenic Clostridium difficile.

This week’s topics include at home sleep studies, an antibody for C.difficile infection, using big data to examine medical devices, and language concordance and type 2 diabetes control.

Program notes:

0:35 Treatment of C. difficile
1:35 Antitoxin antibody
2:32 Phase III trial
2:55 Post market surveillance data of devices
3:55 Vascular closure devices
4:50 Registry is voluntary
5:22 Language concordant providers
6:23 Compared with those who stayed had better control
7:27 Can sleep studies be done at home?
8:28 Can we use to guide CPAP?
9:28 Still requires education
10:11 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/01/27/treating-c-dif/

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
Play

Anchor lead:  How can we stem the tide of opioid addiction? Elizabeth Tracey reports

Prescription opioid drugs are useful and humane for those in extreme pain, but they are associated with predictable dependency and withdrawal issues, so physicians who prescribe them need to consider how to stop these drugs as well as start them.  That’s one assertion made by Travis Rieder, a bioethicist at the Berman Institute of Bioethics at Johns Hopkins and author of a recent essay in Health Affairs.

Rieder: We need physicians who prescribe this medication to either be better educated on how to use this medication. Some of them have never taken a course, never been formally mentored in how to use opioids long term, in how to manage them. Or we need them to know that that has to happen somewhere, and so to be able to reliably and predictably pass them on to someone who will able to give that sort of help, and that will require systematic sort of change.   :26

Rieder says his own self-managed withdrawal experience in the wake of several surgeries renders him passionate about the opioid epidemic. At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
Play

Anchor lead:  What can one bioethicist’s experience teach us about the opioid crisis? Elizabeth Tracey reports

A personal experience with being prescribed a plethora of opioid medications in the wake of several surgeries related to an accident has led Travis Rieder, a bioethicist at the Berman Institute of Bioethics at Johns Hopkins to come clean with his own story, in hopes of informing others. Rieder published his travail recently in the journal Health Affairs.

Rieder: I had a foot crushed in a motorcycle accident, I understand real, genuine, terrible traumatizing pain. In those moments opioids were a miracle, I feel like they saved my life. But it’s also the case that the doctors who saw me didn’t have a plan for how to treat me long term with opioids, a plan to get me off of opioids safely and comfortably, and as a result I went through a lot of suffering, and that’s not okay either. :24

Rieder says everyone, including the patient, has a role in the responsible use of opioids when they are clearly indicated, but also a clear path toward cessation. He says about half of those who currently use heroin describe their journey to addiction via prescription medicines. At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
Play

Anchor lead:  Cannabis poses a particular risk for children, Elizabeth Tracey reports

The National Academy of Sciences has just exhaustively reviewed the scientific literature related to marijuana, or cannabis use, and concluded that in states where the drug is legal, it poses an especial risk to kids.  That’s according to William Checkley, a member of the review panel from Johns Hopkins.

Checkley: In states where cannabis was legalized we’ve seen an increase in the number of pediatric overdose injuries. Hospitalizations of children who had an overdose reaction some of them also who may have required intensive care unit hospitalization and respiratory support. Part of it has to do with how cannabis is commercialized. Many of the products look like chocolates or gummy bears or candies that are attractive to children. That is one reason why we may have seen this uptick in cases in states where cannabis is legal.   :30

Checkley says there is movement toward standardizing the amount of THC, the active ingredient in cannabis, in products such as edibles to reduce the risk of overdose, which can also happen in adults. At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)