In this next podcast, Elizabeth Scala and Maddie Whalen discuss a topic that’s specific to Evidence-Based Practice projects which is the difference between a background question and a foreground question. Maddie discusses a project that she helped staff with and their use of a background question in the PICO format. Finally, they wrap up the discussion encouraging people to reach out to CNI for support and to work on inquiry projects.  


Remote monitoring helps people undergoing treatment for cancer cope better with emerging symptoms, a new study concludes. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says this strategy may be even more important as new cancer treatments are developed.

Nelson: One of the things about chemotherapy is we sort of have a good sense when people get into trouble with nausea and vomiting, when people get into trouble with an increased risk for infection. When we look at some of the new immunotherapy agents people can get in trouble with activating the immune system attacking some normal part of the body. They’re a little bit less predictable but it’s very clear if the early symptoms are captured and it prompts an intervention that you can stop this autoimmune attack and not compromise the benefit of the immunotherapies.  :30

Nelson says data from remote monitoring can be integrated into electronic medical records so it is instantly available for care teams to respond. At Johns Hopkins, I’m Elizabeth Tracey.


People who used a remote monitoring tool to report daily symptoms as they underwent cancer treatment did better with regard to managing their treatment than those who did not, a new study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, isn’t surprised.

Nelson: What they were looking at were symptoms that people started with and symptoms that they would acquire as they are being treated with chemotherapy and radiation therapy and the like, is monitoring this basically at home 24 hour monitoring with one of these tools, can they identify symptoms and intercept them in some way so that they could be better managed. The answer was yes. When they did this kind of monitoring, when you looked at the folks who did the monitoring they didn’t get that much more and the more would have been related to the treatment and so managing the treatment associated symptoms with this monitoring tool seemed to be helpful.  :32

Nelson says people also like participating in their own care and felt more in partnership with their medical team. At Johns Hopkins, I’m Elizabeth Tracey.


People who are 75 and older and otherwise healthy reap benefits from continuing colorectal cancer screening, a new study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says that with new fecal screening tests, such a strategy makes even more sense.

Nelson: I think for the time being I think what is going to happen pretty quickly is that in this particular dataset they were not able to look back and make significant comments on the DNA containing stool tests. The Cologuard, that’s FDA approved, there’s other ones coming I think. And how often should you have that? Would that be a reasonable strategy to even more fine tune who gets colonoscopy who doesn’t when you get older. I think there’s going to be a lot more to be said about this and it’s going to be in the favor of there are people above the age of 75 who need to be screened.  :31

Nelson notes that this issue of age and cancer screening in general is actively being investigated by many, as is how best to treat older adults with cancer. At Johns Hopkins, I’m Elizabeth Tracey.


Colorectal cancer screening is recommended to begin at age 45, but at what age should it end? A new study finds that even in many over the age of 75, screening can still be beneficial. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: This study looks at what should we do with people when they get over the age of 75. They used data from the Nurses Health Study and the Health Professional Follow up Study and there was a clear advantage to screening after the age of 75. Whether you’d been screened before age 75 or not. The real reason you might think about not doing so much screening is related to the jargon term is competing causes of mortality, in other words if you have somebody who’s in an intensive care unit because their heart doesn’t work very well screening them for colorectal cancer not likely to be helpful.  :33

Nelson says that continuing screening or not should be a topic for discussion with your primary care physician. At Johns Hopkins, I’m Elizabeth Tracey.


Rates of diabetes are increasing, recent data indicate, and factors related to the pandemic seem likely to be related. Rita Kalyani, a diabetes expert at Johns Hopkins, describes some of them.

Kalyani: As we see less face to face interaction during the pandemic, less attention to healthy lifestyle behaviors, for good reason in many cases, fear of being outside, fear of going to the gym, all the things that we hear about. But we are going to see maybe a spike in the prevalence of these risk factors because during the pandemic people just weren’t able to follow the same routines as they were pre-pandemic. In some ways we might expect it’s going to take us back a little bit.  :29

The pandemic has also compromised how well clinicians can manage different aspects of diabetes care, which some are calling ‘treatment stagnation.’ For now, Kalyani says those with diabetes must redouble their efforts to keep the condition under control and become as educated as possible about the disease. At Johns Hopkins, I’m Elizabeth Tracey.


The number of people who have diabetes continues to increase but controlling it, along with other common health conditions that can make things worse, has stagnated, a recent study concludes. Rita Kalyani, a diabetes expert at Johns Hopkins, describes the data.

Kalyani: Diabetes prevalence increased from about 9.8% to about 14%. Discouragingly risk factor control really did not improve. Individualized A1c targets, they found out there really wasn’t much change at all. How many had achieved a blood pressure less than 130 over 80 they also found it had definitely not improved. When they looked at the percentage that had attained LDL less than 100 they also did not find find significant improvement. Only one in five achieved all three targets.  :32

Kalyani says keeping blood pressure, blood sugar and cholesterol in check is your best bet to avoid cardiovascular disease if you have diabetes, and even if you don’t. At Johns Hopkins, I’m Elizabeth Tracey.