Podcast: Download (Duration: 10:34 — 9.7MB)
This week’s topics include the effect of education on prenatal testing, Ebola estimates, varicose vein therapy, and PET scanning to diagnose lung cancer.
0:40 Ebola update
1:40 Numbers of cases doubling every 20-30 days
2:40 Body prepared by a relative
3:17 PET scanning for lung cancer
4:16 Generally very accurate
5:16 Only slightly better than 50:50
5:49 Education and uptake of prenatal testing
6:50 Looked at computerized interactive guide and free testing
7:51 Can be done effectively without direct involvement of healthcare person
8:13 Treatment of varicose veins
9:13 Laser appears best
Related blog: http://podblog.blogs.hopkinsmedicine.org/2014/09/26/full-disclosure/
Podcast: Download (Duration: 1:07 — 1.0MB)
Anchor lead: The CDC served up some surprises with a recent list of the most common causes of accidental poisonings in kids, Elizabeth Tracey reports
Narcotics and painkillers are tops on the list of 12 medications that send more than 70,000 kids, most of them younger than two, to the emergency department each year. That’s according to the most recent Centers for Disease Control and Prevention data. Tina Cheng, a pediatrics expert at Johns Hopkins, comments.
Cheng: I was a little bit surprised to see that list. That list has changed over time and I think it has to do with the availability of particular medications and poisonous substances to young kids, toddlers in particular that are getting poisoned. I think that if you look at abuse of medications opioids and pain medications are way up there on the list and as a result we’re also seeing that with young kids. :26
Cheng says this list reflects our national problem with prescription opioid abuse among adults, and expresses concern that with the skyrocketing use of electronic cigarettes nicotine might make the list next year, since it, too, it toxic for toddlers. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Informed parents make for healthier kids, Elizabeth Tracey reports
Getting parents up to speed on what their kids need in terms of preventive health care may help overcome conclusions reached in a recent study showing that many children don’t come close to getting all the prevention they need. Tina Cheng, a pediatrics expert at Johns Hopkins, says even with the best intentions, that can be quite a challenge.
Cheng: For parents, I think they should become as educated as they can be, on what services their kids need and what screenings their kids need. It’s pretty complicated these days. The immunization schedule is very complicated. It used to be when I first started practicing fairly simple. Now there’s many, many shots just to take immunizations as an example. So educating themselves as much as they can on what they’re supposed to get at the different visits they have and talking with their physician. :29
Cheng says parents also need to remember that prevention changes throughout their child’s lifetime, so continued vigilance is required. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Why don’t parents get as much preventive healthcare for their kids as they can? Elizabeth Tracey reports
If you’re a parent, have you had your child appropriately screened and vaccinated throughout their lifetime? A recent Journal of the American Medical Association study asserts the answer is quite often no, with many children not assessed for developmental milestones, having seen a dentist, or being up to date on immunizations. Tina Cheng, a pediatrics expert at Johns Hopkins, comments.
Cheng: Though most kids in this country have health insurance, there’s still some that don’t have health insurance. And then there’s many steps they have to go through to get the services. They have to be enrolled in insurance even if they’re eligible, they have to have a place to go, and a place that will provide the services that they need, they have to go, and then once they get to the pediatric provider they need to receive the services. So a lot of time we think it should be so simple, you just go and get these services and everybody should get their shots, but there’s actually a lot of steps and there’s a lot of barriers along the way. :31
Cheng says identifying those barriers is key to healthier kids. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Will the rising tide of diabetes worldwide sweep away gains made in tuberculosis control? Elizabeth Tracey reports
Multidrug resistant and extensively drug resistant tuberculosis are already worldwide concerns. Enter now the worldwide epidemic of diabetes, which a recent Lancet series identified as a risk factor for the development of TB, and conditions seem right for the perfect storm. Jonathan Golub, a TB and diabetes expert at Johns Hopkins, echoes these sentiments.
Golub: I think it could become huge. In these countries where tuberculosis has been out of control and in epidemic proportions for many years, we’ve started to see a slow decline in tuberculosis globally, which is wonderful. However if you start to think about diabetes as a risk factor for TB and if diabetes starts to increase in these settings, then you’ve got a whole lot more people who are at risk for developing TB. And therefore you might stem the tides that we’re seeing in declines of tuberculosis globally. :28
Golub reiterates that prevention of both TB and diabetes remains the best intervention. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead:Diabetes complicates tuberculosis, Elizabeth Tracey reports
Diabetes and tuberculosis, two worldwide health problems of epidemic proportion, work in synchrony to make things even worse. That’s according to a recent Lancet series. Jonathan Golub, a tuberculosis and diabetes expert at Johns Hopkins, comments.
Golub: People with diabetes have about a three-fold increased risk of developing tuberculosis. And patients with tuberculosis and diabetes end up having a much worse tuberculosis outcomes. They’re at greater risk of relapsing and they’re at greater risk of dying when they’re on TB treatment compared to patients who don’t have diabetes. :17
Golub says the exact nature of the compromise isn’t known.
Golub: Patients who have diabetes have a poor immune system which puts them at great risk of reactivation of latent tuberculosis infection to active disease. Patients who have diabetes who develop tuberculosis also end up having poorer glycemic control. :16
Golub says screening efforts should look for both conditions. At Johns Hopkins, I’m Elizabeth Tracey.
Podcast: Download (Duration: 1:07 — 1.0MB)
Anchor lead: Should you manage your own blood pressure medicines? Elizabeth Tracey reports
Many people with high blood pressure are capable of managing not just monitoring but also increasing or decreasing their medicines to keep blood pressure under control, a new study concludes. Howard Levy, an internal medicine expert at Johns Hopkins, says there is precedent for such a strategy.
Levy: I don’t yet have any clinical experience with self-titration of medications. I have some potential fears. I love the idea of self-monitoring and participating in one’s own healthcare. I’m also open to self-titration of medications, I do engage my patients with other types of self-titration. We have a long track record of training diabetics to titrate their insulin based on certain parameters. It comes down to making sure we have the resources to educate patients on how to do it properly and safely, and taking steps to minimize harm. :31
Levy says too much or too little medicine for blood pressure can result in falls or other bad outcomes, so care is needed. At Johns Hopkins, I’m Elizabeth Tracey.