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MANY CHILDREN IN INTENSIVE CARE MAY NOT BE GETTING REHABILITATION THERAPY, STUDY SHOWS
Media Contact: Michael E. Newman
Adult patients in hospital intensive care units (ICUs) are often given rehabilitation therapy and urged to keep mobile from an early point in their hospital stays. This has been shown to improve muscle strength, physical functioning and cognitive health, along with reducing the risk of pressure ulcers (“bed sores”), blood clots and other short-term threats. However, the prevalence or lack of rehabilitation practices for critically ill children in pediatric intensive care units (PICUs) across the nation has been not been solidly researched.
Now, a multicenter study led by researchers at Johns Hopkins Medicine shows that 65% of the PICU patients examined did not get physical or occupational therapy, or adequate opportunities to be mobile, while hospitalized during the study period. Female patients and those with normal physical function prior to illness were the most likely to not receive this important care. The study team also found that 19% of critically ill PICU patients were completely immobile during the same time span.
The researchers reported their findings in the May 2020 issue of the journal Critical Care Medicine.
In the study, known as PARK-PICU (for “Prevalence of Acute Rehab for Kids in the PICU”), researchers gathered data on critically ill children in 82 PICUs in 65 hospitals across the United States. This represents one-third of all PICU beds in the country. There were 1,769 patient days in the PICUs reviewed, with the researchers also evaluating perceived barriers and potential safety events for patient mobility.
“Despite the evidence that early rehabilitative therapy and mobility provide benefits to adults in ICUs, and despite the fact that it is known to be safe and reliable for children, our findings reveal that patients in PICUs are not getting the rehabilitative care they need,” says Sapna Kudchadkar, M.D., Ph.D., associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and lead author of the study.
Kudchadkar and her colleagues also found that two-thirds of all children admitted to the PICU for three days or longer are under age 2.
“Pediatric survivors of critical illness commonly experience long-term physical, cognitive and psychological problems, and these issues are compounded by the fact that while children are in the PICU, they are undergoing intensive physical and mental development,” she says.
Based on their study findings, the researchers urge hospitals to “systematically design and evaluate PICU rehabilitation interventions for a vulnerable patient population.”
BETTER READING PROFICIENCY LINKED TO FEWER YOUTH HOMICIDES
Media Contact: Vanessa McMains, Ph.D.
A good education system has long been linked with providing opportunity for people to get better jobs and escape poverty. However, less is known about the impact of education on youth violence. By analyzing data about the residents of 55 Baltimore, Maryland, neighborhoods from the City Health Department’s 2017 Neighborhood Health Profile Reports, Johns Hopkins Medicine researchers recently showed that those urban areas with a larger number of third graders reading at grade level had lower rates of homicides among people age 25 or younger.
“Our findings fall in line with what we know about early childhood education, in that it helps form identities and a value system, and assists children with navigating dangerous situations more easily,” says lead author Michael Bray, M.Sc., a medical student at the Johns Hopkins University School of Medicine. “Investing in kids at the third grade or elementary school levels could have a positive impact that ripples up through the community and could reduce risk of violence.”
In the study, published online on June 8, 2020, in the journal Injury Epidemiology, the researchers found that for every 2% increase in the proportion of kids in a neighborhood who were proficient at reading in the third grade, there was one fewer homicide per 100,000 people a year in that area. On average overall, Baltimore has about 56 homicides per 100,000 people per year.
“Homicides are often the result of systemically inescapable poverty tied to a lack of options for upward mobility,” says Paul Nestadt, M.D., senior author and assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.
“Education has long been one of the few pathways out of this circular trap, fortified by racial and economic disparities,” he says. “It’s not surprising that when neighborhood schools are unable to provide comprehensive early education, the effects echo throughout the community imparting tragic outcomes.”
CHEMOTHERAPY/IMMUNOTHERAPY COMBO SHOWS PROMISE FOR FIRST-LINE TREATMENT OF MESOTHELIOMA
Media Contact: Valerie Mehl
Inoperable malignant pleural mesothelioma, is a rare and aggressive cancer of the protective lining of the lungs, or pleura, often caused by exposure to asbestos. At the annual meeting of the American Society of Clinical Oncology (ASCO), held virtually from May 29-31, 2020, a researcher from the Johns Hopkins Kimmel Cancer Center presented findings from a multicenter study that evaluated the efficacy of an immunotherapy-plus-chemotherapy combination for the disease.
According to Patrick Forde, M.B.B.Ch., associate professor of oncology at the Johns Hopkins University School of Medicine, director of the Kimmel Center’s thoracic cancer clinical research program and a Bloomberg~Kimmel Institute for Cancer Immunotherapy investigator, the study looked at 55 patients from 15 U.S. cancer centers who received the immunotherapy drug durvalumab in combination with two anticancer chemotherapies — cisplatin and pemetrexed — to create a novel first-line treatment.
Patients received six treatments of the combination therapy every three weeks, followed by treatment with durvalumab alone, for up to one year in total. The chemo-immunotherapy combination improved overall survival to 20.4 months from the historically expected survival of 12 months with chemotherapy alone. This is the first study to show survival times exceeding 20 months for patients with inoperable mesothelioma. The treatment was well-tolerated overall, with no unexpected side effects reported.
“Inflammation is key to the development of pleural mesothelioma and, as such, it represents a key target for immunotherapy. This, in addition to earlier studies that showed promising results using the same immunotherapy drug in previously treated cases, led us to study the combination,” says Forde. “Because of the promising results, we are in the process of starting a phase 3 study to confirm the benefit of this approach.” This study will begin accruing patients across the United States and Australia in late 2020.
The researchers studied tissue samples from patients who received the combination therapy and found that it prevented a protein called PD-L1 from forming a “protective armor” around cancer cells. The researchers say that’s because immunotherapies known as checkpoint blockers, such as durvalumab, act against PD-L1 and therefore, disrupt a cancer cell’s ability to avoid detection and destruction by immune cells.
Original post https://alertarticles.info
