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Anchor lead: Just how much abuse do nurses endure? Elizabeth Tracey reports

Occupational Safety and Health Administration data tell us that healthcare workers are four times more likely than others to experience workplace violence, a statistic that may not be surprising in light of the recent handcuffing of a Utah emergency department nurse by a policeman. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says the problem is escalating.

Davidson: There is a torrent of inappropriate behaviors from patients when they’re attributable to a medical condition. We are seeing an increasing intensity and really frequency of these events. We have to have better interventions for managing delirium, for managing challenging behaviors, particularly in people who are mentally incapacitated. How do we use conversational skills or conversational skills to cool conversations down, rather than heating them up?  :32

Davidson affirms that developing new protocols and communications channels is also key to de-escalating violence against nurses. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What are the implications of the recent viral story on police handcuffing a nurse? Elizabeth Tracey reports

A policeman handcuffing an emergency department nurse for 20 minutes in late July went viral, and has precipitated a lot of responses. Patricia Davidson, dean of the Johns Hopkins School of Nursing, describes her reactions.

Davidson: Firstly, the importance of policies, procedures, and contact. The other amazing thing was the courage and tenacity of nurse Wubbels under these extenuating circumstances to maintain advocacy and protection of the patient. Really I’ve never been prouder to be a nurse, to see her actions. And the other thing that is really important, particularly in this increasingly complex times that we are all trained in situations of escalation.   :32

Davidson says she’s advocating for training that’s similar to negotiators for hostage release or those intervening in a threatened suicide as critical for nurses in potentially or frankly hostile situations, noting that such skills are an important part of a nurse’s toolkit. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can people with heart failure be safely managed outside of the hospital? Elizabeth Tracey reports

Heart failure rates domestically and internationally are soaring, with a recent study pointing to dietary salt consumption as one contributory factor. Nisha Gilotra, a cardiologist at Johns Hopkins, says a novel approach called a ‘bridge clinic’ can help people who’ve been hospitalized with heart failure avoid repeated hospitalizations.

Gilotra: In that clinic they’re able to have very close monitoring of whether the treatments that were initiated in the hospital are still working, if they need to be adjusted, they can even avoid coming back into the hospital by calling the clinic and saying I feel more short of breath, my weight is going up, my legs are swelling. And come in and get their pills adjusted, or even through an IV get medication that helps get the fluid off.  :25

Enrollment in the bridge clinic starts while people with heart failure are in the hospital and relies on abundant education to help them recognize when their condition is worsening and reach out for help. Giotra says people are really happy to be participants in their own care and avoid coming back to the hospital. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Should everyone be screened for type 1 diabetes? Elizabeth Tracey reports

Type 1 diabetes, where the body attacks its own insulin producing cells, seems to be increasing in incidence worldwide, pointing to the need to screen children for the condition. Now a need blood test developed by Dax Fu, a physiology expert at Johns Hopkins, and colleagues, may help.

Fu: If we could detect the disease earlier then we have a long time to find out ways to prevent or delay the occurrence of the type 1 diabetes.   :10

Fu says the test relies on the presence of proteins in the blood that point to type 1 diabetes, and that these may be present 10 years before the condition is actually manifest.

Fu: Right now the current screenings can only be used in the hospital for people who have a high risk of type 1 however in the past few years the percentage has increased by 1 or 2% every year.  :11

Fu hopes that combining existing technology with that developed for this test will enable screening to be 99 percent accurate in identifying type 1 diabetes. At Johns Hopkins, I’m Elizabeth Tracey.

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assorted medicine pills on black background with reflections

This week’s topics include hospital factors relative to readmission, hormone therapy, lymph node dissection in breast cancer, and the cost of bringing a new drug to market.

Program notes:

0:32 Cost of R and D versus profit in new drugs
1:32 Took 7.3 years
2:35 Reaping in sales far outstrips R and D
3:32 R and D with federal dollars
4:00 What is the long term impact of HRT
5:00 Should be reassuring for women
5:36 Lymph node dissection in breast cancer
6:36 Increases risk of complications
7:32 Least amount of therapy to be effective
7:48 Hospital factors in readmission
8:45 Patients readmitted to different hospitals
9:45 Need to correct poorly performing hospitals
10:31 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/09/18/drug-costs/

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Anchor lead: What is the best blood pressure? Elizabeth Tracey reports

What’s the best blood pressure to target in someone who has high blood pressure? That question has been avidly investigated for some time, and now a trial known by the acronym SPRINT may have provided an answer. Gregory Prokopowicz, a blood pressure expert at Johns Hopkins, explains.

Prokopowicz: The SPRINT trial looked a broad cross section of people, people with pre-existing hypertension, or high cardiovascular risk from across the country and Puerto Rico, and basically divided them into two groups, target of systolic blood pressure of 120 or a systolic blood pressure of 140. And the results were fairly dramatic and unexpected. The group randomized to a target systolic of 120 did significantly better than a target of 140, and this flew in the face of the existing trend in the field of blood pressure toward somewhat less aggressive goals. :31

Prokopowicz says there are some people in whom trying to lower blood pressure to 120 may come with too many side effects, so talk with your doctor. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Just how much blood thinning do you need? Elizabeth Tracey reports

If you have heart disease you may already be taking aspirin daily. Now a major new study known by the acronym COMPASS shows it might be wise for you to take another drug in addition to aspirin. Michael Blaha, a cardiologist at Johns Hopkins, explains the findings.

Blaha: Currently we treat these patients with aspirin alone. We always thought the addition of something like an antithrombotic drug would lead to unacceptable increases in bleeding. But this study showed that a low dose of an antithrombotic like rivaroxaban can reduce the risk of heart attack, stroke, or even death to a greater degree than a mild increase in bleeding. So we think now that there’s a net benefit in patients with stable coronary artery disease to actually thin the blood a little more than we had before.   :29

Blaha notes that previous drugs available for further blood thinning came with a constellation of issues, such as having to closely monitor drug levels to balance risks and benefits. Rivaroxaban is much easier to use, he says. At Johns Hopkins, I’m Elizabeth Tracey.

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