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Anchor lead: Sending
a nurse to a person’s home helps manage heart failure, Elizabeth Tracey reports
People with heart failure often contend with complicated
self-care plans and are at high risk for repeated hospitalizations. Now a new
study shows that sending a nurse to the home of a patient with heart failure
improves both quality of life and the need for rehospitalization. Patricia
Davidson, dean of the Johns Hopkins School of Nursing, isn’t surprised.
Davidson: The first randomized controlled trial of
home-based visiting of people with heart failure was published in 1999. The
vast majority did not continue into usual care. I commend those authors for
continuing to demonstrate the evidence. We often hear this term it takes 17
years to get an innovation into usual care. It’s kind of heartbreaking because
if you think of the money that has been wasted, the suffering that has been
incurred because of what could be just a nurse going to the home. :32
Davidson says such programs are gaining traction, and people
with heart failure should ask about them. At Johns Hopkins, I’m Elizabeth
Tracey.
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Anchor lead: Can artificial intelligence improve
mammography? Elizabeth Tracey reports
Can the power of mammography to correctly identify breast
cancers be improved used artificial intelligence or machine learning? A recent
study finds it can. William Nelson, director of the Kimmel Cancer Center at
Johns Hopkins, describes the data.
Nelson: This was Google’s play to look at mammography. They
ended up having a dataset of 28,000 mammographic images. The upshot of it was
in the US the false positive rate was reduced from 5.7% to 1.2%, saying that
this looked like it could be breast cancer and it turned out not to be. The
false negative rate which was reduced by 9.4% down to 2.7% which is saying this
doesn’t look like breast cancer even though it was, if you look at the AI tool
it was roughly equivalent to having a second reader. :30
Nelson says images are among the most suitable for
interpretation by artificial intelligence, and he expects that to extend into
other forms of cancer, such as melanoma and other skin cancers. At Johns
Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Supplements known as antioxidants may be
harmful for women being treated for breast cancer, Elizabeth Tracey reports
If you’re being treated for breast cancer, taking
supplements that fall into a category known as ‘antioxidants’ may not be a good
idea, a recent study found. This includes vitamins such as C, E, and A, notes
William Nelson, director of the Kimmel Cancer Center at Johns Hopkins.
Nelson: There was a general worry that providing a lot of
antioxidants at a time when chemotherapy for instance might generate breast
cancer killing by oxidizing the breast cancer DNA maybe that’s not the time to
use an antioxidant. The people who took iron and B12 supplements had even worse
breast cancer recurrence and for death. Women who took a multivitamin they
didn’t appear to change their breast cancer risk in this trial so its enough to
pause and think about what you’re doing, particularly before and during
treatment. :31
Nelson says women should definitely talk with their
oncologist if they’re taking supplements at all. At Johns Hopkins, I’m
Elizabeth Tracey.
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Anchor lead: How many opioid overdoses may actually be
suicides? Elizabeth Tracey reports
Opioid overdose deaths may actually be suicides in a
sizeable number of cases, a recent study projects. Eric Strain, a drug
addiction expert at Johns Hopkins, says a look at changing social factors for
at risk groups is revealing.
Strain: What’s really striking is that if you look at other
developed countries over the last ten years mortality rates have been going
down, but in the US, especially for white men, mortality rates have plateaued
or even gone up slightly. Why is this demographic group more vulnerable to
using opioids and to dying from opioids? These are the populations that we’ve
seen decreases in employment for, less social capital, less community
engagement. :30
CDC data show that the US suicide rate is twice that of the
UK, and that the slight decrease in the number of fatal overdoses, which stood
at more than 67,000 in 2018, compared to more than 70,000 in 2017, may not
continue as numbers are tabulated for 2019. At Johns Hopkins, I’m Elizabeth
Tracey.
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Anchor lead: Adolescents experience opioid overdose and
need treatment, Elizabeth Tracey reports
Fewer than one in fifty adolescents who come to an emergency
department with opioid overdose and survive are offered recommended treatment
to help them avoid a recurrence, a study by Rachel Alinsky, an adolescent
medicine expert at Johns Hopkins, and colleagues has shown.
Alinsky: The American Academy of Pediatrics recommends that
adolescents with severe opioid use disorder should receive treatment that
includes medication and that’s consistent with what the standard of care is for
adults as well. It’s just that I think we talk a lot more about treatment in
adults and prevention in youth, and don’t spend as much time thinking about how
do we build a better treatment system and show that that treatment is available
for youth when it’s recommended.
:25We’re seeing that more youth are being diagnosed with opioid use
disorder and there’s definitely an increased use. :31
Alinsky notes that mortality due to opioids has increased
300% since 2000 in those 20 years of age or younger. At Johns Hopkins, I’m
Elizabeth Tracey.
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Anchor lead: How are adolescents who overdose on opioids
treated? Elizabeth Tracey reports
When people experience a non-fatal opioid overdose treatment
to curb addiction and help them avoid recurrence is indicated, yet only a very
few adolescents receive such treatment. That’s according to research by Rachel
Alinsky, an adolescent medicine expert at Johns Hopkins.
Alinsky: We were looking at adolescents who were having
opioid overdoses are they receiving the recommended treatment after overdose
and unfortunately what I found is that less than one in fifty are getting the
standard of care medication treatment after overdose. :14
Alinsky points to a need for greater awareness.
Alinsky: Youth are about one-tenth as likely to receive
treatment for opioid use disorder and when it comes to overdose specifically I
think there’s probably a lack of pediatric familiarity with how do we recognize
and treat opioid use disorder, it’s not typically thought of as a pediatric
disease although we’re seeing that it clearly does affect the pediatric
population. :20
At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Different
ethnicities have differing rates of diabetes, Elizabeth Tracey reports
Your risk of developing type 2 diabetes may depend in part
on your race or ethnicity, a recent study found. Rita Kalyani, a diabetes
expert at Johns Hopkins, explains.
Kalyani: This study really broke down what are the ethnic
subgroups that may have higher or lower prevalence of diabetes? In non-Hispanic
whites, the prevalence was 12.1%, in non-Hispanic blacks it was 20.4%, for
Hispanics it was 22.1%, and for non-Hispanic Asians it was 19.1%. So there was
wide variability, perhaps most strikingly is that about one-quarter to
one-third of the diabetes was undiagnosed.
:32
Of particular note, the study showed that those of Asian
descent were most likely to have diabetes even at what is considered to be a
normal body mass index, or BMI, so more intensive screening in this population
may be appropriate. At Johns Hopkins, I’m Elizabeth Tracey.
