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Anchor lead: What is ketamine’s role in treating depression? Elizabeth Tracey reports

Ketamine is in the news lately, with physicians opening clinics nationally to administer the drug to treat depression. Irving Reti, a depression expert at Johns Hopkins, says that right now, such use is so-called ‘off label,’ meaning the FDA has not yet approved it for this purpose.

Reti: The data is pretty good that some patients are going to benefit from ketamine. There’s an intranasal form of ketamine. Clinics typically offer intravenous ketamine rather than an intranasal formulation. How this will come out with the FDA is not yet known but it is certainly possible that in the next year or so there will be an approval by the FDA of ketamine in some form for the treatment of depression. :31

Reti says that clinics are using the IV form of the medication and patients must pay out of pocket for treatment. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How useful is transcranial magnetic stimulation for treating depression? Elizabeth Tracey reports

Transcranial magnetic stimulation, or TMS for short, utilizes magnetic waves to stimulate a specific area of the brain and may be helpful in treating depression, with a new coil design recently approved by the FDA. Irving Reti, a depression expert at Johns Hopkins, says for those how haven’t responded to other interventions, TMS may prove worthwhile.

Reti: There are now two coil designs that have been approved by the FDA for treating depression. We get a lot of patients coming to us who have failed medications and often been ill for a long time. TMS is something that is worth trying assuming that their insurance company will cover it and they have the time to come in every day for a treatment. The treatment course is typically six weeks daily followed by a taper down.  :31

Reti says TMS is somewhat uncomfortable for some and may require an acclimation period when treatment is initiated. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Education helps make sure people receive medicines to prevent blood clots, Elizabeth Tracey reports

Blood clot prevention is extremely important in hospitalized persons, but more than 10% of the time doses of medicines to prevent them are missed. Now a new education effort developed by Elliott Haut, a trauma surgeon at Johns Hopkins, and colleagues, is helping everyone understand the importance of prevention.

Haut: We asked patients and their families what did they want to learn and got the information, and then we created educational materials focused on the patient. It comes with a two page handout, it’s written in relatively simple language so everybody can understand it. Part two is a video. It has physicians and nurses and it has six patients telling their own story, and part three is a one on one conversation with a nurse educator about blood clot formation.  :28

Haut says the education team is alerted when the electronic health record detects that a dose of the medicine has been missed so intervention is targeted. He says rates of missed doses have declined by more than half since the program has been in place, and the materials are available online. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Why do patients in the hospital refuse blood clot prevention medicine? Elizabeth Tracey reports

Blood clots are a big problem for hospitalized patients, and can result in death. Yet in more than one in ten circumstances medicines to help prevent blood clot formation aren’t given. Elliott Haut, a trauma surgeon at Johns Hopkins, and colleagues decided to find out why.

Haut: A huge proportion of these patients don’t get every single dose of these medications. And the number one reason for that is patients refuse. About 12% of doses aren’t administered. So we went and talked to patients and talked to nurses, and there were two main reasons: patients didn’t realize how important it was and the nurses really didn’t realize how important it was, and the communication between the two often led to these doses not being administered. Missing those doses is associated with getting these bad blood clot events.  :32

Haut says education for physicians is already known to be effective, so now both nurses and patients are being educated as well. He says it’s early to say how well these efforts will work in preventing clots, but says missed doses are down. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can technology help support people to age as well as possible? Elizabeth Tracey reports

Can engineering technologies enable help older people age in place? That’s one hope of the Malone Center for Engineering in Healthcare at Johns Hopkins. Gregory Hager, director of the center, highlights one issue addressed at the recent ‘Engineering for an Aging Society’ symposium, utilizing a model that addresses many aspects of aging.

Hager: The question was can we start to take that model and say physical, cognitive and social/emotional, and think of how we could develop support tools, both for an older adult and for the care network that’s actually taking care of that older adult. A great example is falls.  They have a fall, suddenly they go from being at home to being in acute care, and then they’re going to go through a set of transitions as they rehab, move back home. We really have to think of this in a multidimensional way, not just in the immediate event and how to fix the immediate event but the broader individual and how to support that individual.  :32

Hager is confident that engineering solutions can develop tools to help. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: One of the biggest barriers for some people with chronic illness is access to care, Elizabeth Tracey reports

‘Social determinants of health’ is one of the most used buzz-phrases currently, identifying someone’s social factors as primary in determining health outcomes. Now a Johns Hopkins program called J-CHiP, led by Scott Berkowitz, provides more data regarding the importance of these factors.

Berkowitz: One of the components of our program for the community-based intervention was the performance of a barriers to care assessment, and it assessed what were the barriers that those patients were facing in terms of accessing care. Things like transportation, food, electricity, paying for the price of medicines and we found very elevated numbers with respect to those questions. Upwards of 40% for our Medicaid population and 20% for our Medicare population were having challenges in terms of meeting a transportation need, for example.  :30

Berkowitz says when these factors are addressed, people are able to manage their chronic medical conditions and improve outcomes. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What is the current state of being able to detect cancer with a so-called liquid biopsy? Elizabeth Tracey reports

When a cancer is suspected a biopsy, where a piece of the tumor is retrieved using a needle or another surgical technique, is frequently needed, and may have to be done again if the cancer recurs. Now techniques are able to find tumor DNA in other body fluids, a recent study reviewed. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains what’s known.

Nelson: One way to look at it is many people are familiar with the CSI franchises and have become amateur forensic pathologists and they recognize the one hair follicle at the crime scene, you can get DNA and you can figure out that person X was there and person Y was not. One question is if cancers have defects in genes that can be detected with the same technology can we find out if cancers is present or not in the bloodstream, in saliva, in urine, and the answer to that of course is yes, the question is what is the best information we have and how can we best use it?  :32

Nelson predicts the techniques will become more mainstream in the very near future, and will also be used to monitor response to treatment. At Johns Hopkins, I’m Elizabeth Tracey.

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