STUDY EXAMINES WHY SKIN LACERATIONS MAY BE SLOW TO HEAL, EVEN WITH TOPICAL ANTIBIOTICS
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When you get a cut, scrape or other minor skin laceration, doctors recommend that you take measures to ensure that the wound doesn't get infected and heals properly. Many people opt to use over-the-counter medications, such as topical antibiotic ointments and liquids, to aid the repair process -- and as commonly believed, promote healthy skin healing.
Aiming to put this theory to the test, Johns Hopkins Medicine researchers recently examined whether or not skin regeneration is affected when topical ointments are introduced to a wound site.
In their study -- which appeared April 1, 2021, in the journal Cell Host & Microbe -- the researchers suggest that such over-the-counter medications may not be the healers we believe them to be.
The natural environmental factors that enhance skin regeneration are largely unknown. Although our immune systems and the nonpathogenic microorganisms living within our bodies play critical roles in repairing and regenerating our skin's structure, the precise interaction between the two has been unclear.
In a small trial following six adults over a 10-month period, the researchers wanted to see if bacteria made a difference in wound healing. The participants either applied or didn't apply a topical broad-spectrum antibiotic following every skin wound they received. To the surprise of the researchers, the majority of the antibiotic users experienced slower healing. Furthermore, in a concurrent study in mice, the antibiotics prevented the regeneration of hair follicles after wounding.
"We tested many conditions where there were fewer or more bacteria present during wound healing, for example after antibiotic use. We found that generally speaking, normal levels of bacteria -- and even bacterial infections that the body could fight off -- would actually improve healing," says study senior author Luis Garza, M.D., Ph.D., associate professor of dermatology at the Johns Hopkins University School of Medicine.
"If further research confirms the finding of this study -- that common over-the-counter antibiotic treatments are slowing the healing process -- then perhaps people may need to reconsider their use of these products," Garza says.
Garza is available for interviews.
FOR DEPRESCRIBING MEDICATIONS, WHAT THE DOCTOR SAYS IS KEY
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When an older patient no longer needs a medication or requires less dosage, doctors may consider "deprescribing" the medicine. Deprescribing enables clinicians to stop or reduce medications that are no longer beneficial or may even be harmful for a patient.
However, getting people to change their habits -- especially the regimens for taking medications -- may require doctors and other health care providers to think carefully about how they communicate deprescribing.
In a recent study, Johns Hopkins Medicine researchers examined the ways older patients prefer to get this communication, finding that "how it's said" can determine the success or failure of the process.
A report on the findings was published April 5, 2021, in JAMA Network Open.
"We tested targeted language that providers could use when suggesting patients stop potentially harmful medications," says study lead author and geriatrician Ariel Green M.D., M.P.H., Ph.D., assistant professor of geriatric medicine at the Johns Hopkins University School of Medicine.
Green and the research team say medicines that were helpful at one stage of life may be harmful or unnecessary at another stage of life. The language used by providers when reducing or stopping medications can help patients and their loved ones make better-informed decisions.
In the study, the researchers shared two scenarios with 835 adults age 65 and older related to medication regimens. One scenario involved a patient taking a statin or a cholesterol-lowering medication to prevent problems such as heart attacks or strokes, and the other scenario involved a sleeping pill being taken for the bothersome, but not life-threatening, symptom of insomnia.
The findings showed that patients were more likely to agree to stop taking the statin medication and the sleeping pill when doctors mentioned that the risk of side effects increased as a result of aging and co-existing health problems. In contrast, patients were less likely to agree to stop taking the statin when doctors used a phrase such as, "I think we should focus on how you feel now rather than thinking about things that might happen years down the road." They also were more hesitant to stopping the sleeping pill when told, "This medicine is unlikely to help you function better."
The study was conducted between March and April 2020. The average age of survey participants was 73 years old; 50% of participants were women; and 80% identified as white. Of the participants surveyed, 59% had personally taken a statin and 15% had taken a sleeping pill. Study participants were asked to choose from seven different phrases that a clinician could use to explain a recommendation for deprescribing.
The research team is currently developing and testing several interventions to improve prescribing -- and deprescribing -- medications for older adults in primary care, especially people living with memory problems or dementia. The current study shows that these interventions incorporate key language and rationales that improve the effectiveness of communication about medication use and deprescribing among older adults, their families and doctors.
Green is available for interviews.
WELL-CARE VISITS PROMOTE BETTER HEALTH DURING TRANSITION FROM CHILDHOOD TO ADOLESCENCE
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During well-care visits, children are seen by their primary care physician to address health needs. Maintaining these visits can have a positive impact on a child's current and future health. To determine how adolescents use well-care services over time, a research team at Johns Hopkins Medicine and the Kennedy Krieger Institute recently reviewed use patterns for nearly 7,000 adolescents based on their age and sex.
In their study -- one of the first to look at individual well-care use patterns throughout the transition from childhood to adolescence rather than just the cumulative number of visits over time -- the researchers discovered that well-care visits often declined during the transition, especially among boys, who were more likely to become disengaged after age 5 well-care visits.
A report on the team's findings was published in the May 2021 issue of the American Journal of Preventive Medicine (first posted online Feb. 27, 2021).
"We concluded how it is important to use a life course approach to understand which adolescents are getting or not getting well-care visits over time, since these type of visits are so important to promote positive health outcomes for children of all ages, including boys," says Arik Marcell, M.D., M.P.H., associate professor of pediatrics at the Johns Hopkins University School of Medicine and a physician at Johns Hopkins Children's Center.
The study assessed data from a survey of 6,872 children who were born between 1980 and 1997 and had at least one well-care visit between the ages of 5 (age reached during 1986-2000) and 17 (age reached during 1998-2015). The children were selected from the Child/Young Adult component of the 1979 National Longitudinal Survey of Youth.
Among the data factors for the children were race, ethnicity, mother's education and health insurance. Well-care use data were collected every two years from all study participants to assess the last time they were seen for a health checkup.
The study population was 50% female, 49% white, 30% Black and 21% Hispanic. More than three-quarters (78%) lived in an urban setting, 76% had a mother with at least a high school education and 89% had health insurance.
Participants were assessed on how engaged they were with their well-care visits over time -- specifically, from age 5 through age 17. Among girls, 37% were engaged in well care over the studied time frame, 39% were moderately engaged, 14% became gradually reengaged after initially dropping off after the age 5 visit (with visits resumed after age 7), and 10% became disengaged after the age 5 visit (with visits resumed after age 13).
For boys, 48% showed they were persistently disengaged from well care after their age 5 visit, 34% were engaged over the studied time frame, and 18% became gradually reengaged after initially dropping off at the age 5 visit (with visits resumed after age 7).
Well-care use for boys and girls decreased when the child transitioned into adolescence, with significantly greater drop-off for boys than girls. The researchers say this suggests health care providers should implement sex-specific measures to encourage more frequent well-care visits for both sexes during the middle childhood and adolescent years.
To continue their research, the Johns Hopkins Medicine and Kennedy Krieger investigators plan to examine the impact that regular well-care use has on establishing positive health promotion behavior and practices in children and adolescents over time.
Marcell is available for interviews.
GRANT FOCUSES ON PHYSICIAN USE OF PRESCRIPTION DRUG PRICING TOOLS DURING PATIENT CARE
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Researchers at the Johns Hopkins University School of Medicine have received $400,000 from the Patrick and Catherine Weldon Donaghue Medical Research Foundation to analyze the use of real-time prescription pricing tools that automatically calculate the out-of-pocket cost of medications and appropriate alternatives for doctors to review with their patients during their visit.
"Our long-term goal is to facilitate the adoption of and measure the effectiveness of these real-time health benefit tools nationwide," says Fasika Woreta, M.D., M.P.H., assistant professor of ophthalmology at the Johns Hopkins University School of Medicine.
The Johns Hopkins Medicine researchers will use the grant to study how physicians use the real-time prescription benefit tools in their ambulatory clinic visits over a two-year period. The tools -- including the Surescripts Real-Time Prescription Benefit -- were integrated into electronic health records in 2019. They will now be evaluated at the Johns Hopkins Health System, Yale School of Medicine and the Froedtert & Medical College of Wisconsin health network.
The United States ranks higher in spending on prescription drugs than any other country in the world, with half of patients reporting that they have not taken a medication because it was too expensive. This year, the Centers for Medicare and Medicaid Services has mandated that providers seeing patients with Medicare Advantage and stand-alone Part D plans use real-time prescription benefit tools in electronic health records during every visit in which the provider orders a prescription in an effort to bring down these costs.
Because these pricing tools are so new, data are lacking on how they are used by health care providers. To help remedy this, the research team plans to study:
- How and when providers are using the electronic system.
- Whether this use is associated with prescribers choosing a different drug type or brand for their patients.
- How the prescribing tool impacts patient spending at the pharmacy and decreases unused prescriptions.
- How to identify barriers or facilitating factors that enable use of the tools among providers.
Preliminary work by Johns Hopkins investigators has confirmed that the real-time prescription benefit tools provide accurate drug pricing information.
"Our hope is that these tools will enable physicians and patients to engage in conversations regarding medication cost based on their individual prescription benefits at the point of prescribing," says Woreta. "We believe this will lead to selection of more affordable medications, and thus, increased medication adherence by patients."
The researchers will focus their analysis on some of the most commonly prescribed drugs in the U.S., including eye drops, statins and diabetes medications.
Woreta is available for interviews.
Cell Host & Microbe