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This week’s topics include the impact of contraception on teen pregnancy, mechanical versus tissue heart valves, acupuncture for knee pain, and early gluten introduction and celiac disease.

Program notes:

0:36 Acupuncture and knee pain
1:35 Study designed to minimize bias
2:37 Celiac disease avoidance
3:36 During ‘gluten window’ no decrease
4:28 No cost contraception and outcomes
5:30 Rate of pregnancy very high
6:30 What about STIs?
7:12 Mechanical versus tissue heart valves
8:15 Aged 50-70 which is best?
9:15 Needed a heart valve to begin with
10:43 End

Related blog:

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Anchor lead: Just how low do you need to go if you have diabetes and high blood pressure? Elizabeth Tracey reports

People with diabetes who also keep blood pressure down reduce their risk of mortality, a recent study confirmed.  Yet other studies have shown that since blood pressure rises as we age, slightly higher levels are still acceptable.  What’s the best strategy?  Gregory Prokopowicz, a blood pressure expert at Johns Hopkins, reviews the data.

Prokopowicz: The guidelines have changed with respect to patients with type 2 diabetes. We don’t need to be quite as aggressive in that population we can accept a goal of 140/90. And I think that’s worth bearing in mind because a lot of people who have diabetes and high blood pressure are on a lot of meds.  To get their blood pressure down to 130/80 you may be having them on three, four, five antihypertensive medications in addition to perhaps two or three diabetes medications plus probably something for cholesterol.  Now you’ve got eight, ten, twelve medications.  It’s very difficult to manage all that.    :32

Prokopowicz says seeking a consult with someone with an interest in this field may allow the numbers of medicines to be reduced.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Two common health problems together are more than double trouble, Elizabeth Tracey reports

If you have diabetes you may think you have enough to manage, but you really need to keep your eye on your blood pressure, too.  That’s because a recent study demonstrates that good blood pressure control in those who have diabetes lengthens life.  Gregory Prokopowicz, a blood pressure expert at Johns Hopkins, explains.

Prokopowicz: I think anyone with diabetes has to take their blood pressure very seriously because you have both diabetes and high blood pressure the risk of the high blood pressure is greater than somebody who has high blood pressure without diabetes.  Whereas if somebody has mildly elevated blood pressure but no other problems going on, we might be comfortable watching them for six months a year maybe more without treatment but somebody with diabetes and high blood pressure we really want to get them under control quickly because the damage occurs more quickly and we really take that seriously.   :29

Prokopowicz says someone who is expert in this field can likely simplify regimens to manage both conditions together.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Four simple strategies can reduce your risk of heart attack, Elizabeth Tracey reports

Not smoking, eating a healthy diet, keeping a healthy weight, and exercising are the keys to avoiding heart attack and stroke, yet another study has confirmed.  Micheal Blaha, a preventive cardiologist at Johns Hopkins, applauds the study.

Blaha: I think this study is really important.  It really finds about the same things our study did. Which is that the adoption of four healthy lifestyle behaviors as early in life as possible, sustaining a healthy diet, exercise, not smoking and maintaining a healthy weight can largely eliminate heart attacks and strokes.  The key here is that this is a disease of lifestyle, and if we adopt lifestyles early in life and sustain them, most of the heart attack and stroke risk goes away.  First things first is smoking.  You have to quit smoking.  Then after that exercise comes out as really important.   :32

Blaha says that like so many things in medicine, prevention is much easier and has greater impact than treatment, so he encourages everyone to adopt these strategies.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Why haven’t there been any new antibiotics in recent years? Elizabeth Tracey reports

Antibiotic resistance is being tackled head on by the federal government with a new, comprehensive plan designed to address many aspects of the problem, from physician behavior to patient expectation.  But another facet also needs to be included.  Redonda Miller, an internal medicine expert at Johns Hopkins, says that’s encouraging the pharmaceutical industry to develop new drugs.

Miller: I think the R and D costs behind developing a new antibiotic are so large that we’ve created some impediment for pharmaceutical companies to embark upon this venture.  We’ll have to wrestle with how can we lower that burden so that they’re engaged and want to develop new antibiotics.  There has not been a true, groundbreaking antibiotic that’s come to market gosh, probably in five or ten years, so we need to take a look at our markets and what we’re doing that people don’t want to enter this market.   :30

Miller says price protections and other strategies may help. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: The federal government is now behind battling antibiotic resistant infections, Elizabeth Tracey reports

Antibiotic resistant organisms are big business, costing taxpayers millions in healthcare costs and accounting for many deaths annually.  Now the federal government has stepped in to combat the problem. Redonda Miller, an internal medicine expert at Johns Hopkins, describes the new initiative.

Miller: President Obama has mandated that there will be a special task force established, by 2015 they’re going to come back with an action plan, how we’re going to slow the development of resistant bacteria, strengthen the national surveillance efforts, advance the development and use of innovative diagnostic tests, and improve international collaboration.  Thrown in there is a $20 million prize for the development of a rapid point of care test to identify some of these superbugs that have become resistant.  Ambitious, but noble.    :31

Miller says consumers, too, must play their part by accepting that many infections are viral and therefore don’t require antibiotics.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include the effect of education on prenatal testing, Ebola estimates, varicose vein therapy, and PET scanning to diagnose lung cancer.

Program notes:

0:40 Ebola update
1:40 Numbers of cases doubling every 20-30 days
2:40 Body prepared by a relative
3:17 PET scanning for lung cancer
4:16 Generally very accurate
5:16 Only slightly better than 50:50
5:49 Education and uptake of prenatal testing
6:50 Looked at computerized interactive guide and free testing
7:51 Can be done effectively without direct involvement of healthcare person
8:13 Treatment of varicose veins
9:13 Laser appears best
10:34 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2014/09/26/full-disclosure/

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