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This week’s topics include fecal transplant capsules, stem cells for macular degeneration, exercise and depression in teens, and Ebola predictions.

Program notes:

0:59 Ebola update from WHO
1:50 Case fatality of 70%
2:48 Domestic concerns
3:50 Public health message re:Ebola
4:50 Capsules for fecal transplant
5:50 Previously direct infusion
6:51 Fairly clean packaging
7:20 Stem cells and retinal disease
8:20 No evidence of adverse proliferation
9:01 Exercise and depression prevention in teens
10:01 No association seen
11:02 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/10/17/a-capsule-for-a-scourge/

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Anchor lead:  There are strategies to employ to avoid enterovirus infection, Elizabeth Tracey reports

Two toddlers have died so far as enterovirus 68 sweeps the US.  Even as concerns about Ebola virus escalate domestically, parents especially are concerned about enterovirus infecting their children. Anna Minta, a pediatric infectious disease expert at Johns Hopkins, says simple strategies to avoid infection work.

Minta: The main thing is prevention, so this virus is spread by respiratory droplets so you should make sure to wash your hands  frequently, if you feel sick stay away from other people, make sure to cough into your sleeve, teach children about the importance of handwashing, and if your child is sick keep him away from other children.  :17

Minta says it’s worth remembering that severe symptoms and even death are seen every year with the flu and other illnesses.

Minta: All viruses can cause a variety of symptoms from very mild to up to and including mortality.  We see a spectrum of illness from every virus that we see every year.   :10

Minta reminds parents that if their child develops wheezing or has trouble breathing, or becomes lethargic or unresponsive, seeking medical attention promptly is best.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Children around the US are becoming infected with an enterovirus, Elizabeth Tracey reports

While the world’s attention is focused on Ebola virus, another viral illness, enterovirus 68, has spread across the US, killing two young children so far, and possibly producing a type of paralysis in several others.  Anna Minta, a pediatric infectious disease expert at Johns Hopkins, describes what is known about this bug.

Minta: Enterovirus is part of a group of viruses that typically cause the common cold in the summer and the fall.  This year there have been an increase in cases of severe respiratory disease that’s associated with enterovirus. And the children that appear to be most at risk are children with asthma or other underlying respiratory problems. So for parents the important thing to know is that most children will be perfectly fine, but if their child has asthma or any other breathing problems they should be on alert to any signs of trouble breathing or wheezing.  And that would be a reason to take their child to seek medical attention.   :31

Minta says prompt attention if such problems develop is always best.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  While many would rather not face end-of-life issues, that’s not usually the best strategy, Elizabeth Tracey reports

Death and taxes are commonly identified as the only things we can’t avoid.  Why then, don’t we think more about what we would like our final days to look like?  In the wake of a report on end of life care by the Institute of Medicine, Thomas Smith, director of palliative care at Johns Hopkins, hopes more people will stop thinking magically.

Smith: For the rest of us who accept that life is finite, and medical science can’t fix everything, it really helps to do some planning.  It helps to be able to sit with your loved ones and say, I love you.  Statements of love, statements of forgiveness, are really important as people are dying. Just as important are intentional acts to create your legacy.  I’m reasonably optimistic that the winds have changed.  We’re not providing the care that people want.  We have the capacity to fix that.   :30

Smith says having conversations with all concerned and documenting one’s wishes removes burdens from loved ones and caregivers.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Americans need to think about end-of-life care, Elizabeth Tracey reports

Do you have advance directives for your medical care at the end of life? Although most Americans don’t, that may soon change now that the Institute of Medicine has weighed in on the issues.  Thomas Smith, director of palliative care at Johns Hopkins, says death for the majority of us does not come suddenly, so planning is possible.

Smith: For most people, critical life-ending illness these days is not a surprise.  It is pancreas cancer.  It is lung cancer. Progressive congestive heart failure, progressive COPD, and those things all have an average survival but we don’t think of many of those diseases in that way.  What this report tried to do is emphasize that it’s okay to have these conversations. It’s okay to plan, that there’s a lot of good coming out of the planning process.    :29

Medical insurers and Medicare may soon facilitate matters by reimbursing physicians to take on these issues with their patients, with an eye toward providing both humane and desired medical treatments at the end of life.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: The Institute of Medicine met recently to look at the issue of end of life care, Elizabeth Tracey reports

Most Americans don’t think much about death, much less about their own preferences regarding dying.  Now the Institute of Medicine has released a report that may change that, as it likely paves the way to reimburse healthcare providers for talking about the issues.  Thomas Smith, director of palliative care at Johns Hopkins, is pleased the landscape is changing.

Smith:  What’s new is I think there is a coming to terms with the fact that most of us will eventually die. That the way it happens now is not what most people want. Around the world around 85% of people would really prefer to be at home. And in the US it’s about a third of people end up dying at home. That’s 40 to 50% who end up dying someplace other than where they would like to be.   :25

Smith is happy that the ‘death panel’ idea has dropped out of the lexicon and enabled everyone to be more open.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include transplanting a uterus, transfusions in those with septic shock, quality of life in teens with cerebral palsy, and decision fatigue and antibiotic prescription.

Program notes:

0:37 Transplanted uterus and birth
1:36 35 year old born without a uterus
2:35 A donor?
3:32 Fatigued physicians and antibiotic prescription
4:34 Explains overprescribing?
5:33 Transfusions in those with septic shock
6:37 Transfused at two different hemoglobin levels
7:34 Now we know it’s not only not helpful but may be harmful
7:50 Quality of life for teenagers with cerebral palsy
8:50 Ten different measures
9:40 When you ask them they have high quality of life
10:36 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2014/10/10/transplanted-uteri/

 

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