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NEWS STORIES IN THIS ISSUE:
JOHNS HOPKINS MEDICINE RESEARCHERS SHOW HOW AIR POLLUTION MAY CONTRIBUTE TO LOSS OF SMELL
The lack of odor, a situation generally known as anosmia, can severely affect an individual’s high quality of life, making it extraordinarily troublesome to style meals, detect airborne hazards within the surroundings and perform different features depending on the sense. These with anosmia might expertise weight considerations, decreased social interplay, despair and basic nervousness. In some instances, lack of odor has been linked to demise in older adults. Now, Johns Hopkins Drugs researchers have studied one of many identified causes of anosmia — long-term publicity to air air pollution — to raised perceive the way it can rob somebody of the flexibility to odor and style.
“We included members from a wide range of areas in our research; nevertheless, most lived in city areas the place air pollution ranges are highest,” says lead writer Murugappan “Murray” Ramanathan, M.D., rhinologist and affiliate professor of otolaryngology–head and neck surgical procedure on the Johns Hopkins College Faculty of Drugs. “We wished to evaluate how their publicity to PM2.5 air air pollution — inhalable, particulate matter lower than 2.5 micrometers in measurement or about 30 occasions smaller than the diameter of a human hair — may trigger them to lose their sense of odor.”
In accordance with the U.S. Environmental Safety Company (EPA), PM2.5 (the PM stands for “particulate matter”) is the time period for a mix of strong particles and liquid droplets discovered within the air. Relying on location, PM2.5 can include many supplies, incuding mud, dust, soot, smoke, natural compounds and metals. It has been linked to heart problems, lung most cancers, decline in cognitive considering skill, persistent obstructive pulmonary illness, bronchial asthma and untimely demise. Earlier analysis has related PM2.5 as a possible perpetrator in lack of odor — a connection that Ramanathan and his group determined to discover in larger element.
Of their research, the researchers checked out 2,690 folks, age 18 and older, who had been evaluated by otolaryngologists between January 2013 and December 2016. Of those, 538 had been identified with anosmia, with a mean age of 54 and with males making up the bulk (339 or 63%).
Air air pollution information for the research got here from the EPA’s Air High quality System. The researchers fed the info into a posh laptop mannequin — incorporating meteorological and satellite-based environmental measurements, land-use info and simulations of airborne chemical motion — to estimate the PM2.5 air pollution ranges throughout the members’ residential ZIP codes. The mannequin was created by Zhenyu Zhang, a Johns Hopkins Drugs otolaryngology postdoctoral fellow.
The researchers discovered long-term airborne publicity to PM2.5 will increase the danger of dropping one’s odor by practically twice (a 1.6- to 1.7-fold enhance). They consider this may occasionally happen as a result of the placement of the olfactory nerve — which incorporates the sensory nerve fibers regarding the sense of odor — locations it immediately within the path of inhaled PM2.5 supplies.
“Based mostly on this outcome, we really feel that long-term publicity to excessive ranges of PM2.5 represents a standard danger issue for the lack of sense of odor, particularly in susceptible populations akin to older folks — but in addition one that’s probably modifiable if sources of PM2.5 parts will be higher managed,” says Ramanathan.
Subsequent, the researchers plan to check socioeconomic components amongst sufferers with anosmia to find out in the event that they affect the probabilities of publicity to PM2.5 air air pollution. Additionally they hope to judge different air air pollution parts that will contribute to lack of odor, akin to ozone.
Ramanathan is out there for interviews.
EXPERTS SAY CICADA SOUNDS COULD BE PROBLEMATIC FOR THOSE WITH EAR-RINGING PROBLEM
With this yr’s return of cicadas, many will view the principally innocent bugs as an annoyance. Nevertheless, the bugs’ high-pitched buzzing sound — which will be loud sufficient to drown out a jet airplane flying overhead — may probably worsen an ear-ringing situation generally known as tinnitus.
Tinnitus, a ringing sound contained in the ears, has numerous causes together with listening to loss, harm to the nerve ending within the internal ear, thyroid issues or publicity to loud noises. Greater than 45 million Individuals wrestle with the dysfunction.
In accordance with the U.S. Facilities for Illness Management and Prevention (CDC), publicity to sounds of cicada buzzing, which may attain 100 decibels, for 15 minutes will be sufficient to trigger noise-related listening to loss. The CDC says 100 decibels is roughly the noise degree of a motorbike revving or a jackhammer in operation.
“For these with tinnitus or any listening to challenges, you will need to deal with the extent of noise publicity that may happen throughout the cicada season,” says Rachel Hisim, M.S.N., C.R.N.P., an otolaryngology nurse practitioner who treats sufferers with tinnitus at Johns Hopkins Drugs. “Although we are able to’t all the time take away the sound irritant from our surroundings, we are able to take away ourselves from sure environments to lower noise publicity and the opportunity of worsening ear ringing.”
When open air throughout the cicada season, Hisim says it’s cheap to guard listening to with headphones or ear plugs. Or, she says, folks can decide to remain indoors to restrict their publicity throughout the intervals when cicadas are noisiest (afternoons via nightfall, if the climate is sizzling and sunny).
A sound meter app accessible from the Nationwide Institute for Occupational Security and Well being will help measure sound ranges, says Hisim. The app could also be accessed at www.cdc.gov/niosh/topics/noise/app.html.
Hisim is out there for interviews.
SIMPLE PROTOCOL CAN IMPROVE USE OF PROVEN MEDICINAL TREATMENT FOR OPIOID DEPENDENCE
Unintentional overdoses are the main reason for demise for Individuals below 50, with many individuals understanding not less than one one that has struggled with drug dependence. In a latest research, Johns Hopkins Drugs researchers discovered that efficient therapies for opioid dependancy are underutilized and provide a possible answer to the issue — rising entry to medical assist via a top quality enchancment undertaking.
The study, published May 18, 2021, in the Journal of Hospital Medicine, particulars how a group led by Ashish Thakrar, an dependancy medication fellow on the Johns Hopkins College Faculty of Drugs, suggest a easy, but efficient consciousness and academic program. The protocol will increase using evidence-based medicine — that’s, therapeutic medicine proven by scientific proof to be helpful at treating opioid dependence. There are at present solely three evidence-based drugs to deal with opioid dependence, and Thakrar says they’re all underutilized. Thakrar’s group targeted on rising using one among these medicine — buprenorphine — in sufferers admitted to The Johns Hopkins Hospital, many with substance use-related points.
Buprenorphine is a drug accepted by the U.S. Meals and Drug Administration to deal with opioid dependence. Consultants say that buprenorphine — which is also an opioid — will be prescribed alone or as a part of a complete remedy plan that features counseling and different behavioral therapies to offer sufferers with a whole-person method.
“Altering observe is difficult,” Thakrar says. “There are dozens of well-conducted potential and retrospective research exhibiting that buprenorphine works. It reduces mortality by 50%, reduces the speed at which sufferers use opioids, improves the affected person’s high quality of life and helps retain sufferers in different kinds of medical and dependence care.”
Earlier than the undertaking was applied for the research, Thakrar says solely 10% of eligible sufferers acquired accepted drugs for treating opioid dependence. After the undertaking, discharge prescriptions greater than doubled to 24%. Thakrar says the rise was on account of using a one-page, easy-to-use protocol posted in frequent areas of the hospital; the presentation of the protocol at a convention with a profitable affected person case research; and the institution of a novel, resident-led buprenorphine bridge group.
The bridge group consists of a gaggle of residents and attendees who’re legally permitted to prescribe buprenorphine prescriptions. This facilitates using the drug for treating opioid dependence — as a result of whereas any supplier can administer it inside a hospital, prescriptions require a particular waiver from the federal Drug Enforcement Administration.
As a part of the standard enchancment undertaking examined throughout the research, 140 inside medication residents and 16 mixed medicine-pediatrics residents acquired one hour of formal training about opioid use dysfunction. Moreover, 28 residents who had been specializing in city well being major care spent one month in a medical rotation targeted on dependence medication. Throughout that rotation, they accomplished the eight-hour coaching required to obtain the DEA waiver. The coaching included steering on choosing sufferers, shared decision-making round remedy, avoiding precipitated withdrawal, dosing buprenorphine and establishing follow-up.
After studying and implementing the protocol, nearly all of residents reported feeling extra snug and extra educated utilizing the buprenorphine remedy.
“Suppliers need to give excellent care to sufferers with opioid dependence, and are longing for instruments that may assist them accomplish that,” says Thakrar. “Most of the limitations for offering the very best care are structural and logistical, so we’d like multidisciplinary approaches that embody nurses and social employees. Collaboration is essential.”
Thakrar says the buprenorphine bridge group continues to be energetic at The Johns Hopkins Hospital. Because the group was established in 2019, the hospital additionally has began a full dependence medication seek the advice of service.
“I hope that different hospitals can see that there are protocols that may enhance the standard of care,” Thakrar says. “Small modifications could make a giant distinction for sufferers with opioid dependence.”
Thakrar is out there for interviews.
STUDY SHOWS HOSTILE WORK ENVIRONMENTS ARE GLOBAL HEARTACHE FOR CARDIOLOGISTS
In a world survey of practically 6,000 cardiologists carried out by Johns Hopkins Drugs and the American School of Cardiology, researchers discovered that as many as 44% of these polled report experiencing a hostile work surroundings (HWE) sooner or later of their careers. Based mostly on this discovering and others reported in a latest research assessing the survey responses, the researchers counsel that HWE — characterised by emotional harassment, discrimination, sexual harassment or any mixture of the three — has an adversarial impact on skilled and affected person interactions and relationships, raises considerations concerning the well-being of these impacted and will threaten the standard of affected person care supplied.
“Sadly, we found that the issue of HWE could be very widespread, with practically half of the world’s cardiologists experiencing some type of it at one time or one other,” says lead research writer Garima Sharma, M.D., assistant professor of drugs on the Johns Hopkins College Faculty of Drugs. “We discovered HWE in cardiology prevalent throughout areas, races and ethnicities, and each sexes and all gender identifications.”
The 50-item survey within the research was given between September and October 2019 to five,931 cardiologists in Africa, Asia, the Caribbean, Europe, the Center East, Oceania, and North, Central and South America. Individuals had been queried about their demographics, observe surroundings, tutorial rank and experiences with discrimination and harassment. Seventy-seven p.c of the respondents had been males, 54% had been white (adopted by 17% Asians, 17% Hispanics and three% Blacks), 73% had been age 54 or older and 75% had been married.
Cardiologists from the European Union made up the largest block of respondents (32%), adopted by cardiologists from South America (18%); the Center East, Jap Europe and Asia (all 9%); Africa (eight%); North America (7%); Central America (6%) and Oceania (2%).
“Based mostly on the responses from the survey, we discovered incidences of HWE had been mostly reported by girls [68%], Blacks [53%] and North Individuals [54%],” says Roger Blumenthal, M.D., director of the Johns Hopkins Ciccarone Heart for the Prevention of Cardiovascular Illness and professor of drugs on the Johns Hopkins College Faculty of Drugs. “Gender was probably the most frequent reason for discrimination [44%], adopted by age [37%], race [24%], faith [15%] and sexual orientation [5%].”
Seventy-five p.c of survey respondents mentioned HWE adversely affected skilled actions with colleagues, whereas 53% reported a adverse affect on relationships with their sufferers.
Taking a look at every subset of HWE studied, Sharma says that emotional harassment was skilled by practically one-third of cardiologists, 30% reported not less than one type of discrimination, and ladies endured extra incidences of sexual harassment — with 44% stating they’d skilled a number of varieties.
“These information come at a vital time when harassment and the tradition of discrimination in medication are being brazenly challenged,” the research states. “These findings assist the necessity to enhance the tradition inside medication tremendously and lift a name to motion to deal with harassment and discrimination.”
Sharma and Blumenthal can be found for interviews.
TO CULTURE OR NOT TO CULTURE: NEW TOOL HELPS DECIDE — AND LOWER ANTIBIOTIC USE IN THE PICU
The dictionary defines stewardship as “the job of correctly and responsibly caring for issues in order that they can be utilized successfully.” Nowhere is that idea — and the accountability connected to it — taken extra severely than in a pediatric intensive care unit (PICU), particularly when it entails stewarding the suitable use of antibiotics. Now, Johns Hopkins Drugs researchers hope to make that high-value well being care activity less complicated and simpler with a brand new bedside instrument that helps clinicians higher decide when to check for micro organism in endotracheal tubes getting used for critically unwell pediatric sufferers.
To diagnose probably critical bacterial respiratory infections in a PICU affected person receiving invasive mechanical air flow with an endotracheal tube, physicians and nurses usually acquire secretions from contained in the tube (generally known as an endotracheal aspirate) and tradition it within the laboratory. The issue with these endotracheal aspirate cultures (EACs) is they could result in a case of mistaken identification that would do the affected person extra hurt than good, says research lead writer Anna Sick-Samuels, M.D., M.P.H., a pediatric infectious illness specialist at Johns Hopkins Youngsters’s Heart and assistant professor of pediatrics on the Johns Hopkins College Faculty of Drugs.
“The human respiratory tract is much from a sterile surroundings, so micro organism cultured from aspirated samples could be a part of the physique’s regular microflora and never be inflicting an an infection that wants antibiotics,” says Sick-Samuels. “Nevertheless, the detection of any micro organism in these cultures is usually misinterpreted as an indication of a ventilator-associated an infection, which then might end in pointless — and probably dangerous — antibiotic remedy.”
To handle the issue, Sick-Samuels and her colleagues developed a medical determination assist algorithm to be used within the PICU. The algorithm is an easy move chart of progressively extra definitive, “sure or no” standards by which clinicians could make an knowledgeable, relatively than speculative, determination about whether or not or not an EAC is required.
“The algorithm standardizes the thought course of and makes the clinician rigorously take into account whether or not or to not name for an EAC, which in flip, prevents a ‘knee-jerk’ response to micro organism and the inappropriate use of antibiotics,” says Sick-Samuels. “It additionally helps cut back the issue of clinicians ordering repeated EACs from the identical affected person, although the identical micro organism usually develop once more in repeated cultures.”
For a PICU affected person with a tracheostomy (a surgically created airway immediately into the trachea) or an endotracheal tube in place for greater than 48 hours, Sick-Samuels explains that the algorithm asks clinicians to think about acquiring an EAC provided that:
- The affected person has an elevated amount of secretions within the tracheostomy or endotracheal tube over time.
- There may be not less than one further supporting signal of an infection, akin to fever larger than 38 levels Celsius (100.four levels Fahrenheit), a rise in white blood cell counts or a chest X-ray that signifies a creating pneumonia.
- The affected person has not had one other EAC throughout the previous three days.
To check the effectiveness of their algorithm, Sick-Samuels and her analysis group put it to work as a part of a 12-month high quality enchancment program on the Youngsters’s Heart PICU. Within the yr earlier than the instrument was applied, the researchers documented 557 EACs obtained over 5,092 days of sufferers on mechanical air flow (tracheostomy or endotracheal tube). This was equal to 10.9 EACs for each 100 ventilator-days.
Within the yr after the algorithm grew to become a part of the common medical observe on the Youngsters’s Heart PICU, the variety of EACs dropped to 234 over three,654 ventilator-days, or 6.5 per 100 ventilator-days — a 40% discount. The researchers say using the algorithm and the ensuing sustained decline in EACs didn’t change the variety of deaths, readmissions or lengths of keep for sufferers within the PICU. Additionally they estimate that the direct price financial savings from acquiring fewer EACs can be roughly $26,000 per yr.
What makes this stewardship completely different from different applications looking for to stop the inappropriate use or overuse of antibiotics, says Sick-Samuels, is that the “determination tree” course of goes to work earlier within the thought course of earlier than antibiotics is perhaps began.
“The algorithm makes the early determination for or in opposition to microbiological testing the pivotal level, not the selection of whether or not or to not prescribe antibiotics,” she says. “At JHCC, it actually did make our workers extra conscious and conscious of their actions, and it led to a shift in observe that was sustained even via the COVID-19 pandemic.”
Subsequent, the researchers plan to introduce diagnostic stewardship of EACs at 15 pediatric facilities throughout america, validate its effectiveness and present that the stewardship program will be tailored to be used in different PICUs. Additionally they hope their efforts will function a mannequin for EAC decision-making instruments that can be utilized in different medical settings.
Sick-Samuels is out there for interviews.