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UnknownThis week’s topics include diet quality and longevity, health and coffee, treating depression, and prostatectomy in early prostate cancer.

Program notes:

0:33 Coffee drinking and longevity
1:33 Over 185,000 people followed in one study
2:32 Can’t advocate for a type of coffee
3:01 Prostatectomy or not in early prostate cancer
4:01 Higher incidence of side effects
5:01 What kinds of means are used to monitor?
5:40 Treatment of refractory depression
6:40 Added atypical antipsychotic
7:40 Adding another agent that works differently
8:32 Quality diets and longevity
9:32 Substitute healthier foods
10:55 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/07/14/more-joy-for-coffee-drinkers/

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Anchor lead: How can more appropriate antibiotic use be implemented? Elizabeth Tracey reports

One in five hospitalized adults who received antibiotics experienced an adverse event related to their use, a recent study of nearly 1500 inpatients by Pranita Tamma, an antibiotic use expert at Johns Hopkins, and colleagues, has shown. Tamma says the study clearly points to the need for clinicians to carefully assess the risk/benefit ratio when deciding antibiotics are indicated.

Tamma: The first message we need to understand is for both patients and for clinicians we need to all be on the same page, antibiotics are important, they’re great when they’re necessary, but they’re not benign.  There is harm associated with them. On the patient side, we need to do a good job of educating patients and family members that if the physician feels comfortable that the likelihood of a bacterial infection is low they’re really weighing the risks and benefits making this decision and they’re really looking out for your best interests.  :30

Tamma says many people have become accustomed to the idea that there aren’t any harms associated with antibiotic use, but her study shows that’s not the case. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: About one in five people who take an antibiotic may have an adverse event, Elizabeth Tracey reports

Many people who are hospitalized receive antibiotics, but a new study by Pranita Tamma, an antibiotics use expert at Johns Hopkins, may ultimately change that. The study looked at adverse events among hospitalized patients who received antibiotics.

Tamma: Of all patients about 20% developed an antibiotic associated adverse event. Some common ones include gastrointestinal problems, low white cell count, anemia, etcetera, or kidney damage. We also had two clinicians decide whether the antibiotics were necessary or not because we wanted to get a sense of what percentage of adverse events could have been completely avoided. So looking at patients who really had no indication for antibiotics still in that group 20% went on to develop an adverse event.   :32

Tamma says this study supports the practice of not prescribing antibiotics until a need is clearly shown, and then using the most appropriate medicine for the shortest period of time. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Will personal sound amplification products change the way hearing loss is managed? Elizabeth Tracey reports

If you or a loved one has hearing loss, you may have seen ads for personal sound amplification products or PSAPs on the internet or elsewhere, and according to a study by Nicholas Reed and colleagues at Johns Hopkins and published in JAMA, many of them work very well. Reed says that points to the need to unbundle services of an audiologist from the sale of traditional hearing aids.

Reed: I think that these over the counter devices introduce the need for a la carte unbundled audiology services. what we just demonstrated in our study, you could buy something over the internet, bring it to us, and it only takes 15 minutes for us to get it working nicely for you, and then maybe another 15 minutes to show you how to use it. That’s not a lot of time on either side’s part and I think both sides could benefit from that relationship.   :23

Reed also supports federal legislation to regulate PSAPs.

Reid: If we have a regulated class, though, then those devices have to meet some standard. And at least people will be starting off on the right foot when they start with something over the counter.  :10

At Johns Hopkins, I’m Elizabeth Tracey.

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woman holds empty white plate on hand isolated on white background

This week’s topics include comparison of two types of insulin, reduced sudden cardiac death in heart failure, ADHD and educational achievement, and fasting versus consistent caloric restriction in weight loss and cholesterol.

Program notes:

0:37 Fasting and weight loss
1:40 Followed over twelve months
2:37 No evidence it reduces risk
2:54 ADHD and educational attainment
3:54 How well did they do in school?
4:54 The study clearly shows that kids with ADHD don’t do as well
5:37 Rate of sudden cardiac death and heart failure has declined
6:39 Evidence based guidelines
7:22 Two different types of long acting insulin
8:22 Reduced incidence of hypoglycemia
9:22 Does benefit outweigh cost?
10:15 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/07/07/the-benefits-of-fasting/

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Anchor lead: Should you consider an implanted cardiovascular defibrillator? Elizabeth Tracey reports

Implanted cardiovascular defibrillators, or ICDs, shock someone’s heart back into a regular heartbeat when it fails to beat regularly, and the devices save lives. Now a study in the New England Journal of Medicine affirms that for people at high risk but who’ve never had a cardiovascular event, implanting an ICD may make sense. Seth Martin, a cardiologist at Johns Hopkins, agrees.

Martin: It can make perfect sense that if this is someone at high risk this is someone who could benefit, and that’s the rationale for implanting a cardiovascular defibrillator in a person who’s at high risk for the condition. This could be a lifesaving device.  For someone who hasn’t had an event it’s a hard sell. This is about having a really engaged clinician and patient discussion about what the real risks are, and making an informed decision. Because this is something that is hard to appreciate when it hasn’t happened to you.    :30

Martin says the risk of sudden death is high when the heart fails to beat in a coordinated fashion, known as fibrillation. ICDs are designed to detect and correct this condition. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What might be the impact of changing the fats you eat? Elizabeth Tracey reports

Should you switch your fat consumption to vegetable oils, especially extra virgin olive oil? Yes, advocates a recent “Presidential Advisory” from the American Heart Association, citing abundant evidence that animal fats and butter are bad for your heart and aiming to eliminate confusion on this score. Seth Martin, a cardiologist at Johns Hopkins, says there’s another upside to making such a change.

Martin: It is very possible that making changes in your diet can lead to less medications, less blood pressure, less cholesterol medications, either going down on the dose or even stopping the medicine altogether, because you’ve become healthier, you’ve lost weight, you no longer require that medicine, and so this is I think amongst other one of the key incentives to making these changes.  :26

Martin notes that most people would rather not take medications on a daily basis and that they are expensive, have side effects that can be troublesome, and sometimes stop working so a new one needs to be tried or added. At Johns Hopkins, I’m Elizabeth Tracey.

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