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NEWS STORIES IN THIS ISSUE:
- Study Suggests VR Games May Help Children Better Cope with Painful Medical Procedures
- Johns Hopkins Medicine Experts Create Clinician Resource for Chronic Pain Treatments
- Johns Hopkins Medicine At-Home STI Test Kit Still Popular Even as Pandemic Demand Wanes
- How Should Predicted Life Expectancy Guide Cancer Screening Decisions for Older Adults?
STUDY SUGGESTS VR GAMES MAY HELP CHILDREN BETTER COPE WITH PAINFUL MEDICAL PROCEDURES
Dealing with a painful medical procedure is difficult for anyone, but often more so if the patient is a child. For example, a venipuncture — the penetrating of a vein for a procedure such as drawing blood or inserting an intravenous tube — may make a young patient anxious or uneasy. Many hospitals, including Johns Hopkins Children’s Center (JHCC), have a dedicated child life services team to help children cope with these procedures, while others depend on more traditional methods of diversions such as toys or books. Now, a recent study by Johns Hopkins Medicine researchers suggests that gameplaying using virtual reality (VR) headsets — if the games are appropriate and carefully chosen for pediatric clinical situations — may be an engaging and practical addition to the list of distraction therapy options.
Led by Therese Canares, M.D., director of pediatric emergency medicine digital health Innovation at JHCC and assistant professor of pediatrics at the Johns Hopkins University School of Medicine, the research team conducted a small-scale study to evaluate the therapeutic impact on pediatric patients of playing virtual reality games during a venipuncture procedure. Their findings were published online June 14, 2021, in the journal Hospital Pediatrics.
From June 2019 and March 2020, the researchers randomly assigned 55 patients — ranging in age from 7 to 22 and receiving venipuncture procedures in the JHCC pediatric emergency department — to three groups. The first group of 15 patients, played VR games in the presence of a child life specialist. The second group, consisting of 20 patients, did not use VR but was supported by a child life specialist. The remaining 20 patients in the third group did not have a child life specialist support or VR games.
Overall, the study found patients who played VR games during their venipuncture procedure benefitted from reduced pain and anxiety, and that the combination of VR and support from a child life specialist worked best. However, the researchers also found that children who used VR during venipunctures had significantly longer procedure times — by 4–6 minutes on average — than those who had only child life specialist support or no distraction therapy at all.
The most likely cause, say the researchers, was the nurse or technician having to repeatedly pause a game to correct a technical problem, provide guidance on game navigation or controller operation, or change a game.
“We feel that the extra time isn’t a huge detriment, because it is hard to put a value on reducing a child’s trauma during a venipuncture procedure,” says Canares. “Even if VR adds five minutes, making a child more comfortable is well worth it.”
Canares says the most surprising findings are how many adolescents needed help navigating the virtual reality games, and that a significant amount of “trial-and-error” was needed to determine which games were the best for distraction therapy.
“We found that games involving little movement of the head and arms, played without high anxiety scenarios — such as military battles or zombie attacks — and not requiring a controller or extensive menu options, worked best because they added the least amount of extra time to a venipuncture procedure,” she says. “Hospitals considering the use of VR as distraction therapy — especially those on a tight budget — may want to look first at such ‘clinically friendly games’ before making the investment.”
Canares says that although VR coupled with child life specialist support appears to be an excellent distraction therapy, “it isn’t meant to replace child life professionals since games cannot take the place of human touch and compassion.” However, she says, VR may be a solid option for community hospitals that don’t have a child life services team.
Canares is available for interviews.
This news story was researched and written by Johns Hopkins Medicine communications intern Rachel Hackam.
JOHNS HOPKINS MEDICINE EXPERTS CREATE CLINICIAN RESOURCE FOR CHRONIC PAIN TREATMENTS
Researchers at Johns Hopkins Medicine have authored a series of articles in the journal The Lancet as part of an effort by the publication to help clinicians navigate the complexities of treating chronic pain.
The three articles by the Johns Hopkins Medicine experts — part of a larger series in The Lancet published May 29, 2021 — describes new research and treatment advances that include an emerging news category of chronic pain; the psychological, biological and social factors that contribute to a person’s pain experience; and the potential risks and benefits of so-called neuromodulation therapies, which deliver electrical or chemical stimuli to the body’s neurological areas to suppress pain.
“Rather than a strictly physical, clinical categorization of pain, the appropriate definition of pain should be based on a patient’s psychological, biological and social factors,” says series lead author Steven E. Cohen, M.D., chief of pain medicine and professor of anesthesiology and critical care medicine, neurology, physical medicine and rehabilitation, and psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.
In the series, the Johns Hopkins Medicine experts advocate for personalized treatment plans that use a combination of therapies to manage a patient’s chronic pain. Accounting for a person’s age, medical history, and genetic and psychological factors when deciding on a treatment increases the likelihood of successful pain management and good health outcomes.
Additionally, the authors recommend that the invasiveness of procedures should be considered along with the patient factors.
Developing methods to identify patients that are likely to respond to a therapy, say the experts, is particularly important in invasive procedures, such as some neuromodulation therapies, the use of which has been on the rise in the last two decades. They emphasize that more high-quality research is needed to determine ideal patients for these therapies. However, this research often is difficult to perform due to practical limitations.
“We show that an interdisciplinary definition and approach — one that incorporates a patient’s individual experience and risk factors — is crucial to properly categorize and effective treat pain with neuromodulation,” says series co-author Eellan Sivanesan, M.D., director of neuromodulation and assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine.
Sivanesan and Cohen are available for interviews.
Watch a video covering the articles here:
This news story was researched and written by Johns Hopkins Medicine science writing intern Haley Wasserman.
JOHNS HOPKINS MEDICINE AT-HOME STI TEST KIT STILL POPULAR EVEN AS PANDEMIC DEMAND WANES
When many social and health care service organizations had to shut their doors during the first few months of the COVID-19 pandemic, the Baltimore City Health Department (BCHD) was among them. Fortunately, BCHD was still able to provide free, accurate and confidential screening for sexually transmitted infections (STIs) by referring its clients to a trusted, reliable partner — Johns Hopkins Medicine — and its I Want the Kit (IWTK) at-home testing program.
Now, as more of the population gets vaccinated against COVID-19 and access to STI-testing clinics has resumed, the people behind IWTK have documented a very interesting trend: The number of diagnostic kits requested has remained high even though the pandemic-driven need has lessened.
“IWTK offered a way to provide high quality testing, telemedicine follow-up and targeted treatment during BCHD’s COVID-19 shutdown, but we’ve found that the convenience, ease and privacy associated with an at-home test continues make our kit very popular on its own merits,” says Yukari Manabe, M.D., director of the Center for Innovative Diagnostics for Infectious Diseases in the Division of Infectious Diseases and professor of medicine at the Johns Hopkins University School of Medicine. “There’s been no drop off in demand to pre-COVID levels.”
Since its beginning in 2004, the IWTK program has conducted STI screenings for thousands of people in Maryland thanks to funding and support from its strong partnership with BCHD and the Maryland Department of Health. In 2011, the program expanded into Alaska through a contract with the state and a second partnership with the Alaska Native Tribal Health Consortium. More recently, a contract with the State of Arizona and a partnership with the Inter Tribal Council of Arizona broadened the program’s reach once more.
“The Alaska and Arizona programs are critically important to combat the disproportionally high numbers of STI cases among the indigenous American populations in both states,” says Gretchen Armington, M.A., project administrator for the Johns Hopkins Center for Point-of-Care Technologies Research for Sexually Transmitted Diseases and director of the IWTK program.
By requesting the discreetly packaged at-home testing kit — which contains sample collection swabs and transport tubes, instructions, a contact form, information on STIs, a biohazard bag and a pre-paid mailer — people be tested for chlamydia and gonorrhea by the Johns Hopkins Medicine laboratories.
Manabe says the trust people have in Johns Hopkins Medicine is a major reason that the IWTK test kits continue to be in demand.
“People feel that at-home testing eliminates the stigma attached with going to a clinic,” she explains. “And they come to us for that testing because, unlike other mail-in diagnostic services, we’re a free resource, we’re focused on STI reduction through easily accessed and user-friendly testing, and our quality is transparent.”
Armington adds that she and her colleagues are innovating the IWTK program to make it even more effective.
“For example, we are actively upgrading our website to be more than just a place to order an STI testing kit,” she says. “After requesting their kit, users can easily navigate our site to get current STI information, links to social services and counseling, options for treatment, and much more.”
Manabe and Armington are available for interviews.
HOW SHOULD PREDICTED LIFE EXPECTANCY GUIDE CANCER SCREENING DECISIONS FOR OLDER ADULTS?
Clinicians say timely and accurate screenings can facilitate early detection of and reduced death rates from cancer. However, for those age 65 and older, current guidelines for deciding if cancer screenings should be done are sometimes based on whether the person is likely to live 10 years — the time usually needed to accrue benefits from the procedure. In a recent study, Johns Hopkins Medicine researchers examined a large group of older Americans to better understand the relationship between cancer screening and a person’s likeliness of dying within a decade.
“Understanding the relationship between cancer screening and death can help inform how we should use a patient’s chance of dying within 10 years to make cancer screening decisions,” says study lead author Nancy Schoenborn, M.D., associate professor of medicine at the Johns Hopkins University School of Medicine.
For their study, Schoenborn and her colleagues used data from the Health and Retirement Study, an ongoing representative survey of more than 37,000 people over age 50 in 23,000 households in the United States. Included were 5,342 participants — 3,257 women and 2,085 men — age 65 and older who were eligible for a breast or prostate cancer screening. The average age for the women was 78 and for the men, 76.
The researchers used statistical methods to investigate the association between a person having a breast or prostate cancer screening, and whether that person either lived or died from any cause during the following 10 years. The researchers accounted for each person’s age, health status, ability to carry out daily functions, and other factors currently used to predict life expectancy.
The researchers found that women receiving a mammogram and men who had a prostate screening both had lower risks of death, even after adjusting for age and the other health factors.
This, the researchers say, is likely due to differences between the types of people who complete cancer screening and those who do not, as opposed to being caused by the cancer screenings themselves. The researchers say this suggests that for people who get cancer screenings as recommended, the algorithms used to predict life expectancies can underestimate the outcomes.
“Based on our findings, we feel that cancer screenings should be individualized and not only based on predicted life expectancy,” says Schoenborn. “The decision whether or not to screen should be made by the doctor and the patient working together in each individual situation.”
Schoenborn says it is hoped that her team’s future research in this precision medicine area will identify what is different about people who get cancer screenings from those who do not, and which differences may be associated with better survival.
“We can use that knowledge to improve how we predict life expectancy and, in turn, how those predictions are used in clinical decision making,” she says.
Schoenborn is available for interviews.