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Anchor lead: Would you consider a clinical trial for your cancer care? Elizabeth Tracey reports

Only about 3% of people with cancer enroll in a clinical trial for care, with a recent large study attempting to assess people’s attitudes and beliefs regarding such trials. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: Ninety percent of the respondents thought that clinical trials were likely safe, the 10% that didn’t were really worried about adverse events associated with a new drug or a new treatment. Forty-five percent rarely considered clinical research as an option for their treatment. But as you drilled down on the folks that participated in clinical trials 93.4% said they’d participate again. The major criticism of those people was the burdensome aspect of multiple visits and the bureaucracy of having to participate in the trials.  :33

Nelson notes that clinical trials are widely available around the country and are likely to provide very comprehensive care. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Using several strategies helps people reduce the likelihood they will develop delirium while in the ICU, Elizabeth Tracey reports

Pain must be managed in those who are critically ill, a bundle of strategies called A-F for patient care in the ICU acknowledges. Dale Needham, a critical care expert and pioneer in early mobilization of patients at Johns Hopkins, says when a constellation of methods is employed, pain can be held at bay without sedation.

Needham: Where now we’ve got a patient that’s not in pain, that’s not sedated, is not delirious, and we can begin to have them engage in meaningful activity. And I always say the head bone is connected to the body bone.  When we manage sedation and delirium and have more clear thinking for our patients, then they’re able to engage in rehabilitation much more easily. There are also randomized controlled trials showing us that when patients get physical rehabilitation their duration of delirium decreases.  :32

Needham says avoidance of long term compromise because of an ICU stay is the desired outcome. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can delirium be avoided when someone has an ICU stay? Elizabeth Tracey reports

Can a bundle of strategies known as A to F help people in the ICU avoid developing delirium as well as other treatment related problems, as reported recently? Yes, says Dale Needham, an early mobilization pioneer in critical care medicine at Johns Hopkins.

Needham: What this talks to use about is the need to think carefully about patient’s pain, and often when we think about pain management we don’t actually need to give our patients sedation. Sedation is associated with delirium and if we can manage pain without adding sedating medications then our patients may have less delirium. And then the E part in the A to F bundle is early mobilization, early exercise, early rehabilitation.  :29

Needham says adequate pain relief can often be achieved with things like cold or heat, use of non-opioid pain relievers and other methods, allowing people to avoid using opioids, which are much more likely to produce delirium. He notes that physical activity is possible, even when someone is on a ventilator. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can we help people addicted to drugs without adequate numbers of providers? Elizabeth Tracey reports

The journal Science has just reported that our problem with drug overdose deaths actually began in 1979, and has been rising steadily since. Eric Strain, a drug abuse expert at Johns Hopkins, says this puts the onus on healthcare providers of all disciplines.

Strain: The healthcare system should be constantly screening people for potential substance use disorders. That’s critical just like we should be screening for hypertension or diabetes or any other medical condition. We need better tools for doing that, because right now most of them are self-report tools, but it should be part of our routine practice.  :20

Strain says treatment also must be widely available.

Strain: Most depression is not treated by psychiatrists it’s treated by primary care physicians. We just need to continue to push forward with all medical providers doing those sorts of services including treatment of substance use disorders.  :13

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Opioids are just the latest in a long trend of escalating drug overdoses, Elizabeth Tracey reports

Everyone knows opioids, including prescription drugs, heroin and fentanyl are the culprits when it comes to drug overdoses, right? Not so fast, a recent paper in the journal Science points out. Turns out drug overdoses have been rising exponentially since 1979. Eric Strain, a drug abuse expert at Johns Hopkins, comments.

Strain: We don’t have an opiate use disorder problem, we have a substance use disorder problem, and we play whack a mole addressing one category of substances and take our eyes off the ball with other categories, which inevitably then resurge.  :15

Strain notes that such data are very important in stemming the tide.

Strain: There’s this overall trend and then you can start to parse out what are the factors behind that? By geographical region, by drug class, by age, by race, by urban versus suburban, versus rural, and we need to start looking at the data in that kind of granular way.  :17

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Will a new, lower priced hearing aid encourage more people to use them? Elizabeth Tracey reports

Have you or someone you love experienced hearing loss? You may know that such loss is usually progressive, leads to social isolation and is associated with an increased risk for dementia. Now a newly FDA-approved hearing aid that people can both buy and fit themselves, developed by Bose, will soon be available. Nicholas Reed, an audiologist and researcher at Johns Hopkins, says if this helps more people to use the devices earlier, that’s all to the good.

Reed: A big problem is people wait, on average eight years, before doing anything about their hearing loss. When you wait that long you can imagine, you’re living with hearing loss every day, your brain changes, your perception of the world changes, so it’s much better for people to come in having used amplification over time, they’re going to adapt to hearing aids, it’s going to be a much easier process over time, it’s a good thing overall. :24

Reed notes that hearing aids are devices with FDA approval, while personal sound amplification devices are not, although they may be essentially the same. He counsels seeking expert advice if you’re considering such a purchase. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Will the new Bose hearing aid open the market and improve access? Elizabeth Tracey reports

Hearing loss is common as people age, and is associated with an increased risk of dementia. Research is ongoing on whether hearing aids can slow that trajectory, and now a newly approved device developed by Bose is poised to radically change the market and perhaps encourage more people to use the devices. That’s according to Nicolas Reed, an audiologist and researcher at Johns Hopkins.

Reed: It could open the floodgates to a lot of companies entering quicker, and this is a good thing for the consumer. The more companies involved in this space and the different tiers of hearing care that are out there – self-fitting, eventually over the counter, direct to consumer,  via the Internet, typical gold standard via an audiologist, this changes the price and it gives you more possible entryways, and to me that’s the name of the game, it’s a big part of why people aren’t adopting hearing aids cause they don’t have that chance right now.   :27

Reed welcomes Bose’s hearing aid as perhaps how people may more easily begin using the devices. At Johns Hopkins, I’m Elizabeth Tracey.

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