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Anchor lead: How should opioids be used when someone has surgery? Elizabeth Tracey reports

Opioid medications are addictive. But they’re also effective for relieving severe pain. Now a study in the BMJ concludes that careful management of opioids in this setting may minimize risks. Eric Strain, an addiction expert at Johns Hopkins, comments.

Strain: We do know that duration of opioid use can lead to physical dependence. So if you’re on an opioid regularly for a period of time there’s a chance that you’ll become physically dependent upon that. And that’s a risk factor for then for continued opioid use. So it makes sense to be considering shorter duration of opioid use, even at higher doses perhaps.  :24

Strain says patients must get involved.

Strain: Patients should be very proactive about their management of pain. And all of their postsurgical care, and they should be asking questions and they should be thinking about what are the risks associated with using any medication that’s being prescribed, but especially opioids given the risk of their abuse.   :17

At Johns Hopkins, I’m Elizabeth Tracey.

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Program notes:

0:17 Jobs problems and health

1:17 Living in an impoverished area

2:11 Community health needs assessment

3:11 Hire locally

4:16 Over 400 interns from the city

5:11 Returning citizens program

6:50 End

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Anchor lead: Working nights may increase your risk of cancer, Elizabeth Tracey reports

Working nights has been associated with a range of deleterious health outcomes for some time now, with a new study adding cancer to the mix. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says the hormone melatonin gets out of whack, in addition to longer term issues.

Nelson: There are many other things that happen. Eating patterns become funny, a whole bunch of things that are disrupted in one’s life if you work at night. So they looked at 61 different studies from all over the world, 114,000 cancer cases, 3.9 million people, all of them women for this particular one, and they found 41% higher chance of skin cancer, 32% higher chance of breast cancer, 18% higher chance of digestive system cancer, for women who reported working night shifts.  :31

Nelson says since night work is likely here to stay, what’s really needed is an understanding of why its so disruptive so intervention may be possible. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: When it comes to combating cancer, are more mutations better? Elizabeth Tracey reports

Is having more mutations in your cancer better than having just a few? It may be, when the class of drugs known as checkpoint inhibitors is being used to treat it. That’s according to work done at Johns Hopkins and published recently in the New England Journal of Medicine. William Nelson, director of the Kimmel Cancer Center at Hopkins, comments.

Nelson: The group here looked at this across 27 different tumor types, people treated with any of the drugs targeting the PD1, PDL1, and what they found was that this hypothesis is more or less true. The cancers with greater numbers of mutations were far more likely to benefit from one of these immune checkpoint inhibitors than ones with few mutations. Fifty-five percent of the differences in the propensity to respond or not appeared to be related to the number of these mutations. :30

Nelson says more work needs to be done to discern why more mutations help when it comes to responding to this class of drugs. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can combining treatments lead to a win in lung cancer treatment? Elizabeth Tracey reports

Using drugs that target so-called epigenetic changes, where chemical groups are added to DNA, may help one of the newest types of cancer therapy, the checkpoint inhibitor, work better to combat cancer. That’s according to work by Stephen Baylin, a cancer expert, and colleagues at Johns Hopkins.

Baylin: What the trial seeks to do is to take our best bet with our work so far, to take two agents which contribute to what we call epigenetic therapy and pair them with immune checkpoint therapy, to improve the efficacy of the latter. And we will do it in patients with advanced non small cell lung cancer, which is our biggest killer. It’s our best hope for a theme that we’re had for several years going. We’ve made is more sophisticated by the work in this Cell paper and that’s what we brought to the trial.   :30

Baylin says the combination has worked well in both animal and human models of disease, and is now being used in patients. He says the strategy renders cancer cells more susceptible to therapy. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: It is practical to use ketamine to manage depression? Elizabeth Tracey reports

The anesthetic agent ketamine is proving useful in treating depression, as well as alleviating suicidal thoughts when they occur, a recent study showed. Irving Reti, a depression expert at Johns Hopkins, comments.

Reti: This is an exciting new treatment from an old drug that is now being offered to patients around the country. There are certainly patients who benefit from ketamine, say once a month, but are also on conventional antidepressant medications who do well with that combination.  :18

Ketamine does have a downside for some.

Reti: Some patients develop psychotic symptoms with ketamine. That is certainly one concern with the repeated use of this medication, as often as two to three times a week as it is sometimes administered.  :12

Reti advocates for more research on the drug to identify how it works, and perhaps develop drugs that mimic that mechanism of action without ketamine’s side effects. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can the drug ketamine help people with depression? Elizabeth Tracey reports

Ketamine is a drug that’s been around for quite a while, used for anesthesia. Now it’s proving its utility as a fast acting antidepressant, with the latest study showing it can reverse suicidal thinking very quickly. Irving Reti, a depression expert at Johns Hopkins, is cautiously optimistic.

Reti: Ketamine is a very interesting potential new antidepressant, that unlike our traditional conventional antidepressant medications has a rapid onset. And has the potential to reduce suicidality particularly in the emergency department. We still need to learn more about which patients respond best to ketamine. Something more needs to be learnt still about the durability of the response, and also the safety of repeated doses of ketamine.  :33

Ketamine requires intravenous infusion and does have what’s called ‘abuse potential,’ meaning that recreational use does take place, so many questions remain. At Johns Hopkins, I’m Elizabeth Tracey.

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