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This week’s topics include PCSK9 inhibition, best choice for mitral valve replacement, gestational diabetes and autism, and preoperative testing before cataract surgery.

Program notes:

0:40 Gestational diabetes and autism
1:35 Before 26th week of pregnancy
2:37 Study doesn’t give us a lot of insight
3:25 Mitral valve replacement
4:26 All-cause mortality
5:30 Arm patient with information
6:11 Cataract surgery pre-op
7:10 Over half had additional testing pre-op
8:10 Are ophthalmologists reading the studies?
8:32 Novel cholesterol intervention
9:32 Injection every few weeks
10:40 End

Related blog:

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Anchor lead:  Can a new program ease transitions to home for people who’ve been hospitalized? Elizabeth Tracey reports

Caring for a loved one who’s been in the hospital doesn’t have to involve hands on care.  You can assist by acting as another pair of eyes and ears and managing details.  That’s the aim of a Johns Hopkins program called ‘Bridge to Home.’  Nurse educator Hannah Miller describes the role.

Miller: If someone doesn’t want to be a caregiver they can still be a health buddy. Really the health buddy is focusing on advocating for the patient while they’re in the hospital, asking the right questions of the care team, learning about the patient’s discharge plan and voicing concerns they might have about the discharge plan, helping patients to get their prescriptions when they get home, making sure their home is safe, also emphasizing maintaining mobility, also keeping a contact list in addition to a medication chart the patient and buddy can fill out.  :30

Miller says with early discharge, all too often people end up in urgent care or rehospitalized.  Bridge to Home hopes to help people stay home once they’re out of the hospital.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Helping people transition to home from the hospital gets a hand, Elizabeth Tracey reports

Bridge to Home is a new program underway at Johns Hopkins that is trying to help people who’ve been in the hospital manage the transition back home more easily.  Hannah Miller, nurse educator, describes the initiative.

Miller: We’re calling the whole program the ‘Bridge to Home’ program, so it’s all about helping patients prepare for their discharge.  The idea of the Bridge to Home program is to encourage patients to identify what we call a ‘health buddy.’ Someone within their natural support system, so their husband, their son, their daughter, but it can be a trusted neighbor, whoever the patient trusts to lend a hand while they’re in the hospital, and then through the transition home.  So they actually act as a second set of eyes and ears for the patient, as an advocate to be included in their education process as well.    :30

Miller says the health buddy is acknowledged as a part of a patient’s healthcare team and protects the patient’s interests when they often aren’t up to the task themselves.  The hope is to keep people from having to return to the hospital once they’re discharged.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Is comparing cancer versus noncancerous tissue a likely target for finding cancer early? Elizabeth Tracey reports.

Comparing normal and cancerous DNA from an individual reveals which mutations are unique to the cancer and may be used to guide treatment decisions, a Johns Hopkins study led by Victor Velculescu has found.  Could such an approach be used in early stage cancers or even for screening? Velculescu comments.

Velculescu: These types of genetic alterations are being right now primarily used in late stage cancers in order to identify therapeutic options in patients and also to identify the best clinical trials. We are seeing these types of tests being applied earlier and earlier in cancer as targeted therapies are being applied there. Of course there’s a whole other topic which is using these mutations as a possible tool for early diagnosis or actually classifying tumors.  :27

Velculescu says new approaches to identifying such mutations may even be possible with something as simple as a blood test rather than an invasive biopsy.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can comparing normal and tumor DNA become the new standard? Elizabeth Tracey reports

Almost half of people with cancer whose tumor DNA has been analyzed would likely have had different treatments if a comparison with their noncancerous DNA had been made, a study by Victor Velculescu and colleagues at Johns Hopkins has shown. Velculescu identifies barriers to utilizing such an approach.

Velculescu: There are some challenges in implementing these types of approaches, one is just the logistics of getting additional normal tissue or normal DNA from a patient.  That’s actually not that hard because you can use not only blood or saliva in additional to normal tissue from the time of surgery.  The second part of this is there is an additional cost to doing the sequencing of the normal, it’s not actually twice as much but at the present time insurance companies don’t fully cover the cost of that additional sequencing.  :29

Velculescu predicts that emerging technologies will drive the price down and hopes that creation of databases of cancer and noncancerous DNA will streamline the process. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Comparing tumor DNA to a person’s normal DNA may be critical, Elizabeth Tracey reports

Analyzing tumor DNA is becoming the norm in cancer treatment, but a study by Victor Velculescu and colleagues at Johns Hopkins shows that unless tumor mutations are compared to those seen in the same person’s non-cancerous tissues, mistakes in treatment decisions may result.

Velculescu: What we found out through this study is that many of the tests that are done today analyze only the tumor sample rather than matched normal tissue from the same patient, and when they do that these tests end up being inaccurate and provide information that may be misleading to the test requester and lead patients to inappropriate therapies.   :21

Velculescu estimates that almost half of all cancer patients whose tumor DNA is analyzed but not compared to non-cancerous tissues may not receive optimal treatment, since we all have variations in our DNA that may have been there since birth and are unrelated to the cancer. At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include open versus microsurgical laminectomy, PT versus surgery for lumbar issues, sudden cardiac death and exercise, benefits of leisure time, moderate or vigorous exercise on mortality, and height and coronary artery disease.

Program notes:

0:35 Height and coronary artery disease
1:35 There is an association between statue and heart disease
2:18 Sudden cardiac death and exercise
3:18 5% occurred during sports activity
4:18 What is level of concern?
5:20 Exercise of different types and mortality
6:25 Is a dose-response relationship
7:26 Moderate or vigorous?
8:01 Two studies on back interventions
9:02 PT prevented 50% of unnecessary surgery
10:40 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2015/04/10/your-heart-and-your-height/

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