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Anchor lead: Who really needs to have their gall bladder removed? Elizabeth Tracey reports

When people have gallstones they may cause blockages that result in a very painful and sometimes dangerous condition known as pancreatitis. Guidelines for managing this call for removing the gallbladder in an operation known as a cholecystectomy. Now research by Susan Huffless and colleagues at Johns Hopkins has followed a large group of people with this condition and turned up a surprising result.

Hufless: When we then looked at the people who didn’t undergo a cholecystectomy they ended up going to the hospital more, but the majority of them never required a cholecystectomy. So now that we have personalized medicine that could help us identify who should be receiving care when, there may be an opportunity to say this person should be receiving a cholecystectomy now, perhaps this person we’ll wait and see what happens, and maybe they’ll undergo a cholecystectomy later and maybe they won’t.   :30

Hufless notes that the majority of patients in this study were treated according to the guidelines and had their gallbladder removed. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Steroid medications can cause of host of negative side effects, even with a single use, Elizabeth Tracey reports

Blood clots, fractures, and infections in the blood- those are three of the complications that can arise when someone takes even a single, short course of steroid medications, the British Medical Journal reported recently. Alicia Arbaje, a geriatrics expert at Johns Hopkins, says the problem can be magnified for older people.

Arbaje: Steroids in particular can have a side effect of blurring the processing of the brain and blurring our sensations putting older adults at high risk for delirium. We know that delirium carries a high risk for mortality because it represents something going on in the brain showing that the brain doesn’t have enough physiologic reserve to handle whatever is going on at any particular time. Steroids are very dangerous in older adults, obviously if you have an indication and you need it you should be on the lowest possible to manage your condition. :31

Arbaje says both liver and kidneys don’t process medications as quickly in older folks as they do earlier in life, so drugs stay around longer and may have more pronounced effects, so dose modification may be necessary. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Could scrutiny of prescription medicines help people take them appropriately? Elizabeth Tracey reports

125,000 people die each year because they haven’t taken their prescribed medications correctly, a recent study asserts. Alicia Arbaje, a geriatrics expert at Johns Hopkins, says primary care docs can help, by carefully evaluating every medicine a person is taking a minimum of two times each year.

Arbaje: I recommend that older adults reevaluate and revise their healthcare goals at least twice a year. So I say choose your birthday and then pick one other day during the year in which you go to your healthcare provider and reevaluate your medications. For every medication they should ask themselves and their healthcare provider do I still need this medication, do I still need it at the same dose, and is there an alternative to this medication such as making a change to my diet, my exercise regimen, my sleep habits, my lifestyle? :31

Arbaje says barriers to correct medication adherence must be identified for each individual so that solutions can be created, noting that one in ten hospitalizations is thought to be due to failure to take prescriptions as written. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Not taking medicines correctly is a big source of healthcare costs, Elizabeth Tracey reports

Almost half of all medicines prescribed for chronic problems such as diabetes and high blood pressure aren’t taken correctly, a recent study found. Alicia Arbaje, a geriatrics expert at Johns Hopkins, isn’t surprised.

Arbaje: Some people take their medications incorrectly because they just don’t know. That’s certainly something we can modify in the health care system. But some people are not taking medications correctly because of beliefs around what that medication is doing for them or a misunderstanding over why they’re supposed to be taking it or because they have concerns about taking medications they don’t believe in them or they feel it somehow reflects poorly on them in some way. So I as a physician always first ask what are your beliefs and concerns about the medications that you’re taking right now? :31

Arbaje says her own clinical experience with hospitalized adults affirms the idea that many of them could have avoided hospitalization if they had taken medications appropriately. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What’s the best exercise as you age? Elizabeth Tracey reports

All around us exercise is extolled as the fountain of youth. Alicia Arbaje, a geriatrics expert at Johns Hopkins, agrees, but in a recent article in the Washington Post, says one type of exercise is especially important as we age.

Arbaje: Everyone knows that exercise is good for you, but I think there’s a special piece that’s important as people get older. We’re used to thinking of exercise as like cardio and weights and those things are important, but really as we get older what’s very important is balance and flexibility. We know older people can fall, break their hip, and that these kinds of things can lead to continued decline. Balance and flexibility can help so much in preventing falls, and just being able to stay mobile and independent, which is what people really care about when they get older. :30

Arbaje says things like yoga and tai chi are especially good at improving and promoting balance, but says even simply lifting one foot while standing in line or raising one knee while washing the dishes are helpful and may be good places to start. At Johns Hopkins, I’m Elizabeth Tracey.

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Cagliari, Sardina, Italy cityscape.

This week’s topics include managing preeclampsia, diet soft drinks and stroke, autoimmune conditions and malaria, and fecal immunochemical testing and colorectal cancer.

Program notes:

0:36 Malaria, lupus and MS
1:36 B-cell activating factor or BAF
2:34 Sickle cell anemia also
3:16 Diet soft drinks and stroke
4:16 Three fold increased risk of stroke and Alzheimer’s
5:29 Guidelines on preeclampsia
6:29 All women have blood pressure measurement
7:29 Deliver baby
7:37 Fecal immunochemical testing and colorectal ca
8:38 No problem up to 7-9 months
9:35 Reduce number of screening colonoscopy
10:37 End

Related blog:

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Anchor lead: A new device helps screen people with head injuries for bleeding in the brain, Elizabeth Tracey reports

Brain bleeds after a head injury may now be more quickly identified with use of a hand held device tested at Johns Hopkins and several other centers. Called AHEAD 300, the device uses EEG type measurements and an algorithm to predict bleeding. Dan Hanley, lead investigator at Hopkins, says there may be other applications.

Hanley: Not only does this device find brain bleeding it also appears to have much potential in identifying who’s had a concussion, with substantial symptoms, with only mild symptoms, or in someone who’s had an event, that, to witnesses could be a concussion but that their EEG is completely normal, that in this group correlated with absence of symptoms of concussion. :24

Hanley says AHEAD 300 could be used for evaluation in places where no CT or other sophisticated imaging is available, with results used to determine if a patient should be transported. It may also have a role in reducing unnecessary CT scans for head injury, which are expensive and involve radiation. At Johns Hopkins, I’m Elizabeth Tracey.

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