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This week’s topics include new hip and knee prostheses, cannabis use in adolescents, questionable use of medicines in people with dementia, and aspirin to prevent preeclampsia.

Program notes:

0:35 Cannabis use in teenagers
1:35 Frequency of use before age 17 and outcomes
2:35 Do metabolites compromise neurons?
3:36 Need to have efforts to reform legislation
3:58 Continuing medications in advanced dementia
4:58 Over half received medications of questionable benefit
5:58 Opportunity to decrease adverse events
6:22 Aspirin for preeclampsia
7:23 Risk reduction by about 10-20%
8:01 New hip and knee prostheses
9:01 Over 15,000 implants
10:05 Approval of devices needs registry
10:51 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/09/12/marijuana-and-the-teenage-brain/

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This week’s topics include a new drug for heart failure, ZMapp for Ebola, beta blockers in atrial fibrillation and heart failure, and flu vaccine in pregnant women with HIV.

Program notes:

0:33 ZMapp for Ebola
1:30 Mortality over 70%
2:32 Where medical care isn’t available
3:10 Flu vaccine in women who are pregnant and HIV positive
4:10 Group that was HIV infected and not
5:10 Pregnant women should get vaccinated
5:35 New class of medications for heart failure
6:35 In combination, a 20% reduction in death
7:14 Atrial fibrillation in heart failure and beta blockers
8:20 Beta blockers can be used but not preferentially
9:11 Weighing side effects per individual
9:47 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/09/06/zmapp-and-ebola/

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Anchor lead:  New models for laboratory research help understand infections and inflammation better, Elizabeth Tracey reports

Don’t be surprised if sometime soon your physician asks for a very small tissue sample from you to develop a laboratory model of one or more of your tissues.  Such a strategy, called a ‘human on a chip,’ is already in use in many areas of medicine.  Mark Donowitz, a gastroenterologist and researcher at Johns Hopkins, describes how his laboratory employs them.

Donowitz: These are spectacular models particularly for disease of the gut, particularly the infectious diarrheas.  They’re very important, they kill a lot of children.  We’ve already shown that you can use these models for rotovirus, the leading cause of death from acute diarrhea in the world, cholera, the main cause of traveler’s diarrhea, these are all easily, beautifully mimicked in these very simple cell systems, but that’s not where it stops.  If you biopsy it from a patient with celiac disease or colitis the mini-intestines continue mimicking their originators, so you can use them for disease models.   :32

Donowitz says such models will help bring the ideal of personalized medicine toward reality.  At Johns Hopkins, I’m Elizabeth Tracey.

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Headline:  Can a ‘human on a chip’ advance medical science faster than other models?  Elizabeth Tracey reports

Medical research is a billion dollar undertaking that may soon be accelerated with use of stem cell technology.  Mark Donowitz, a gastroenterologist and researcher at Johns Hopkins, describes a new type of system using stem cells that some are calling a ‘human on a chip.’

Donowitz: Humans are different than their cancers and rodent models. If you can develop a human model you might be able to develop interventions more effectively. Hence the concept of the human on a chip.  To use stem cells to develop the different organs.  It’s quite easy to get human stem cells, either you can take very simple cells and convert them molecularly into all kinds of tissues, or you can actually get the stem cells from the individual organs and create the organs on a chip, this is the concept that we’ve been working on.   :31

Donowitz and colleagues are particularly interested in intestine models, and especially salt transport within them, but he says such models are in place for virtually all human organs as well as some systems.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Would reading your own medical chart result in a little too much information? Elizabeth Tracey reports

Open Notes may be coming soon to your physician’s office, allowing you to read your own chart and what your physician has to say about you.  Howard Levy, an internal medicine physician and advocate for the project at Johns Hopkins, says some physicians identify one concern as primary.

Levy: I’m enthusiastic.  Any time a patient has asked for my notes I’ve had no qualms about sharing.  Sometimes there are technical barriers that make it hard to do but I’m not at all concerned about letting my patients read what I say about them.  Some of my colleagues are worried about if my note says my patient is obese, or the patient was ornery, or I think the patient is abusing drugs, or I’m concerned the patient might have cancer.  Those are scary things for a patient to hear, but if I think that, patients aren’t dumb.  Most of them suspect that I think that, and when it’s there in black and white it’s actually there in the open.  And that actually forwards the discussion.   :31

Levy believes disclosure and open dialog about observations the physician has made will ultimately improve the doctor/patient relationship and partnership to manage medical problems.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Do you want to read what your doctor writes about you?  Elizabeth Tracey reports

Open Notes is a project that’s been underway for several years allowing patients to read their own medical charts, including their physician’s notes.  Howard Levy, an internal medicine physician and leader of a group evaluating such a strategy at Johns Hopkins, says studies have shown that people can help correct errors in their charts but don’t barrage the doctor.

Levy: One of the nice reassuring things in the Open Notes project is that they tracked messaging of patients to their providers.  One would theorize that if there were a lot of error correction going on there would be an increase in the messages from patients.  That didn’t materialize.  At the same time however patients were feeling more empowered and more energized, and when they did find mistakes in the chart they were notifying their provider, and the truth is most of us in medicine are trying to do good by our patients and if we’ve made a mistake we’d much rather fix it.   :30

Levy says the hope for Open Notes is to further engage people in their own medical decision making and care.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How do academic medical centers benefit those around them? Elizabeth Tracey reports

Moody’s, a bond credit rating business, recently touted academic medical centers in the northeast as helping to bolster bond ratings in various cities, Baltimore among them, in an effect they called ‘eds and meds.’  Landon King, Johns Hopkins executive vice dean of medicine, says the benefits are a good deal more personal.

King: We do a lot of research. We frequently ask questions in partnership with the community, oriented towards problems the community faces.  Asthma. An enormous urban problem.  Investigators in the school of medicine and the school of public health are trying to understand what the factors are that either cause or that increase the severity of asthma.  Similarly for hypertension, for a variety of other conditions, we have an opportunity to partner with people in the community and try to come up with ways not just to better understand it but ideally to address it.   :33

King says effectively tackling these issues is also exportable nationally and internationally.  At Johns Hopkins, I’m Elizabeth Tracey.

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