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This week’s topics include best therapy for Marfan syndrome, food at school, high potassium treatment, and chronic cough treatment.

Program notes:

0:31 Breakfast and lunch at school
1:30 Hundreds of schools participated
2:31 Lunch from home had more sodium and less fruits and vegetables
3:30 Sliding scale for families
4:01 Chronic cough treatment
5:01 Receptor antagonist for cough
6:01 Caused unusual taste
6:26 Marfan syndrome management
7:24 Beta blockers or losartan?
8:24 Dual therapy future studies
8:28 Elevated potassium treatment
9:26 75% responded to medications
10:40 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/11/28/dining-at-school/

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Anchor lead: Primary care physicians must help identify and manage mental health problems, Elizabeth Tracey reports

Mental health problems are a big problem that just keeps getting bigger, large studies demonstrate.  Constantine Lyketsos, chair of psychiatry at Johns Hopkins Bayview, says mental health professionals agree that the only way to get help to those who need it is to engage primary care physicians in the process.

Lyketsos: Right now one of the biggest unmet needs in primary care is for the detection and effective management of the increasingly common mental health problems.  Behaviors that are out of control, like obesity, common addictions like smoking, or alcoholism but now more and more prescription drug uses, chronic depression, as well as more severe mental illness.  And we don’t have a model right now where we can provide care for these conditions within the setting of primary care.   :32

Lyketsos proposes a model to facilitate mental health management in primary care, and notes that people shouldn’t be surprised at mental health questions in this setting.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Can a program to help caregivers reduce the stress of caring for someone with Alzheimer’s disease? Elizabeth Tracey reports

Mind at Home is a program developed by Constantine Lyketsos, an Alzheimer’s disease expert at Johns Hopkins, and colleagues, to enable people with the disease to remain at home as long as possible.  The program takes a multipronged approach to caregiving, with a recent study looking at how caregivers benefited.

Lyketsos: If you compare the intervention to the control, there are about 10-12 fewer hours per week that the caregiver is spending primarily in supervision.  There’s also a not quite statistically significant, but almost, improvement on the experience of burden.  So our view is that right now, caregivers are probably feeling more confident, they develop more specific skills, and so they feel able to spend less time with the person and at the same time, experience burden a little bit less.  :29

Absolute hours and the feeling of burden both contribute to caregiver burnout and negatively affect the Alzheimer’s patient. Lyketsos is optimistic that as the program is studied further even better outcomes are possible.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Do we finally have a laboratory model for Alzheimer’s disease that is practical? Elizabeth Tracey reports

Researchers have succeeded in developing a human model for Alzheimer’s disease by growing layers of nerve cells in a dish and having two materials that accumulate in the brains of people with disease, called amyloid and tau, also accumulate in the culture.  Constantine Lyketsos, an Alzheimer’s disease expert at Johns Hopkins, is cautiously optimistic.

Lyketsos: For the last two decades we have cured Alzheimer’s disease in mice dozens of times.  The therapies when they have come into humans have not been effective or promising.  So colleagues have created basically a three dimensional neuronal cell model that has all the features of Alzheimer’s disease. And that’s a very cool possibility because that might be a setting where testing drugs has a better chance of bringing drugs to humans that will be effective.   :28

Lyketsos says at the very least the model should help verify or disprove the process by which Alzheimer’s is thought to develop. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How will stratospheric generic drug prices affect you? Elizabeth Tracey reports

The federal government has finally made it official: they’re asking purveyors of generic drugs to explain the almost unfathomable increase in many of their prices.  Landon King, executive vice dean of medicine at Johns Hopkins, says it’s not a moment too soon.

King: That it’s now happening in the generic drug market, hundreds and thousands of percent increase in prices in drugs that have been known and used for decades in some cases is really putting a different level of strain on the ability of patients to get those drugs, and hospitals and health systems to provide those drugs.   :23

King says no one can account for this increase in any believable way.

King: The rationale for that is not at all evident, the need for that in a real business sense is not at all evident, the implications of that for access, for affordability, is immediately evident.   :13

For now, King recommends that anyone who is struggling to buy generics talk to their provider.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: There are a few things you should keep in mind if you’re shopping for health insurance, Elizabeth Tracey reports

You’ve just gotten the unwelcome news that your employer will no longer provide group health insurance. The health insurance marketplace can be a bit confusing, so what do you need to know to make an informed choice?  Landon King, executive vice dean of medicine at Johns Hopkins, comments.

King: I think that there are several components in the decision about how to take steps to provide for your healthcare. Certainly price is one of those, there’s no way around that. In addition, value is something different than just price. Access and some level of confidence that when you have a complicated problem you’re going to have access to people and organizations that can manage that with you.    :26

King says you might have to look pretty hard to find out everything.

King: I think it’s variable the extent to which the information is available. But I think people need to know for themselves that they need to be looking for that information.   :09

King says it’s always appropriate to make a phone call if information is hard to find.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include manual versus mechanical CPR, duration of dual therapy after stent placement, sudden cardiac death among policemen, and HDL efflux versus level.

Program notes:

0:54 Mechanical versus manual CPR
1:52 Mechanical in an ambulance better?
2:50 Expensive device and training needed
3:42 Sudden cardiac death in police officers
4:40 Happen during emergency situations
5:40 HDL cholesterol fine points
6:40 Cholesterol transport
7:41 Ability to transport cholesterol for excretion
8:25 How long to stay on drugs after stenting
9:30 Fewer heart attacks but not stroke or death
10:30 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/11/21/hands-down-manual-is-better/

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