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This week’s topics include bystander CPR impact, Coumadin and an antibiotic, childhood poverty and brain development, and durable weight loss in obesity.

Program notes:

0:38 Kids raised in poverty and brain development
1:38 About a fourth lived near federal poverty level
2:38 Need early intervention
2:50 Bystander CPR impact
3:50 Combination almost doubled
4:50 We have covered additional studies on this
5:18 Can weight loss be achieved?
6:18 Estimated probability of obtaining normal weight
7:18 Community-based weight intervention not working
7:37 Coumadin and dicloxacillin
8:33 Makes Coumadin a less effective blood thinner
10:00 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2015/07/24/poverty-and-brain-development/

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Anchor lead:  How can you decide if a statin is for you? Elizabeth Tracey reports

If you’ve been told that you should take a statin medication simply because you’ve aged into a higher risk group but are otherwise in good health, what should you do? Roger Blumenthal, a preventive cardiology expert at Johns Hopkins, says the imaging technique known as coronary calcium scanning can help.

Blumenthal: A coronary calcium scan at this time is the best way to refine a person’s risk and that’s the go to test we often use.  The price has come down quite a bit, the radiation about the same as two mammograms, and women tend to get mammograms every year or two.  The drawback of a coronary calcium scan is about 5% of the time the radiologist may see a lung nodule and say probably good to repeat a CT scan in six to twelve months just to make sure that the nodule hasn’t gotten bigger.  :28

New data on the cost-effectiveness of people taking a generic statin medication supports the newest set of guidelines of who should be taking the drugs, Blumenthal says, but people can further assess their own risk with a coronary calcium scan.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  What’s the payoff when it comes to statin use? Elizabeth Tracey reports

Does the use of statin medications to control cholesterol really pay off in terms of healthcare dollars saved?  That was the question addressed recently by a study in the Journal of the American Medical Association.  Roger Blumenthal, a preventive cardiology expert at Johns Hopkins, interprets the findings.

Blumenthal: They concluded that if you use a generic statin, the potential long term benefits of decreasing heart attacks and strokes seemed to be very cost effective. With the new guidelines saying if someone had a 7.5% risk of heart attack or stroke or higher, then it seemed cost effective.  What they really didn’t focus in on though was one way to make it even more cost effective is quite a number of these people who were eligible for cholesterol lowering therapy actually had no or minimal coronary calcification.   :31

Blumenthal says if coronary calcium was assessed the people who would be recommended to take a statin would likely be fewer.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Are physician quality measurements really helpful? Elizabeth Tracey reports

A new surgeon rating system has just been announced by Pro Publica, an investigative journalism group.  The rating system is intended to inform consumers on how well their surgeon stacks up against others in the nation.  Robert Higgins, director of surgery at Johns Hopkins, says the shear number of these new rating systems is dizzying.

Higgins: I think it’s information overload.  I can’t keep track of many of these measures of quality.  The science of quality is still evolving while the intent is clear.  And if we can get the two to line up, the intent is to save pain, suffering and to save lives, and we can match up the methodology and the measurement, and then report it accurately then I think we’ll really raise the bar on patient performance and everybody will be happier.  :24

Higgins applauds efforts to provide safety data to patients to help inform their decisions, but cautions that another critical factor is the team that is providing care both during and after the operation.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Can a new rating system help people choose a surgeon? Elizabeth Tracey reports

Pro Publica, an investigative journalism group, has produced a quality rating system for surgeons based on outcomes, complications and other measures, with an eye toward informing anyone who might need a surgeon.  Robert Higgins, director of surgery at Johns Hopkins, comments.

Higgins: This is one of many of these report card functions that tries to separate the fact from the fiction, what’s the problem, where does it lie, who’s accountable, who’s responsible?  I don’t know that this is new ground yet this reinforces what we’ve known for some time, the Institute of Medicine report on To Err is Human.  Our responsibility as health care leaders is to try to make this the safest and the best environment knowing that there are complications that do occur, we learn from our complications.  Patient quality and safety is paramount.  :30

Higgins says for now, choosing a rating system that has a track record and has been validated independently is likely the best strategy for utilizing outcomes data, as well as checking more than one source and talking directly with your provider.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new device may help people with Parkinson’s, Elizabeth Tracey reports

A simple headset developed by Yousef Salimpour and colleagues at Johns Hopkins may help people with Parkinson’s disease cope with symptoms more easily. The headset stimulates certain parts of the brain.

Salimpour: It’s completely noninvasive and it’s not expensive. And even if it can do a small improvement in the symptoms it’s very valuable.  :08

Salimpour says people will simply wear the headset for a certain amount of time on a prescribed schedule, and although no one knows exactly how it works it may reduce both tremor and mood complications of Parkinson’s. It’s not yet available, but Salimpour hopes the device won’t take long to get to market.

Salimpour: By nature this device is very simple and the device is not very complicated. So when you put together these two characteristics and also since it’s noninvasive and up to now, without any side effects, it might facilitate its pathway through the market.   :16

At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include managing hypertension in those 80 and older, new cholesterol guidelines cost-effectiveness, a new agent to reduce potassium in the blood, and community-acquired pneumonia.

Program notes:

0:40 Community acquired pneumonia
1:37 2/3 of time couldn’t find an organism
2:35 Need vaccines for some of the other organisms
3:12 Hypertension in octagenarians
4:14 Over 3800 subjects
5:15 Limit to one or two medications
5:35 Cholesterol guidelines
6:37 How many more by new guidelines?
7:37 Very sensitive to price of the statin
8:01 Hyperkalemia treatment
9:01 It lowered to normal in 80-90%
10:11 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2015/07/17/managing-high-blood-pressure-in-octogenarians/

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