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This week’s topics include persistent banned substances in supplements, knowledge of central venous catheters among physicians, vitamin D levels and different types of milk, and MD versus hospital owned practices and costs.

Program notes:

0:44 Vitamin D levels and milk
1:37 High risk of having very low vitamin D level
2:40 Ricketts a possibility
3:13 Continued presence of FDA banned substances in supplements
4:11 2/3 had banned substances
5:23 MD and hospital owned practices
6:24 75% physician owned
7:24 ACOs are a medical fad
8:15 Central venous catheters and physician knowledge
9:15 21% of clinicians interviewed didn’t know it was there
10:37 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/10/24/cows-milk-wins-at-least-for-now/

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Anchor lead:  A novel vending machine helps nursing moms at Johns Hopkins, Elizabeth Tracey reports

Johns Hopkins is leading the way in helping support breastfeeding moms when they return to work.  Meg Stoltzfus, a work life expert at Johns Hopkins, developed a novel vending machine to make sure moms could easily obtain materials they need while on the job.

Stoltzfus:  We’ve been having a problem at Johns Hopkins where nursing moms would forget their pieces to their breast pump when they would come back to work. I couldn’t figure out how to solve that problem.  In this healthcare environment that’s 24 hours a day, our only option was to create and install a vending machine where moms could buy what they needed during their work shift.  We provide hospital grade breast pumps in all of our mother’s rooms at Johns Hopkins so moms just need to bring their accessory kit. They may forget something such as their bottles or the tubing that would connect to the breast pump.   :32

Stolzfus says to her knowledge, no other employer nationally has undertaken such a remedy, but she’s had plenty of interest from other employers since the machines have been developed.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Big data from electronic medical records may help medical trials, Elizabeth Tracey reports

Clinical trials are the gold standard by which much of medicine moves forward, but they’re expensive and often take years to complete.  Electronic medical records promise to step into the breach and facilitate answering many such questions, one of the reasons they were mandated under healthcare reform.  Dan Ford, Vice Dean of Clinical Investigation at Johns Hopkins, says we should see benefits soon.

Ford: I think you’re going to start seeing sorting out of patient subgroups by looking at these that say, patients with these lab tests, these symptom clusters are going to have a much worse outcome or a better outcome than others.  This is the drug or treatment that seems to be most appropriate.  You will have the ability to test more treatments for lower cost, which hopefully means they’ll be more randomized clinical trials.    :32

Ford hopes rare side effects of drugs or treatments will also be much easier to spot.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Has big data delivered on any of its promise in healthcare? Elizabeth Tracey reports

Electronic medical records have been deployed nationally, and many researchers are attempting to glean new insights about disease and treatments from these massive quantities of data.  Why haven’t we seen much insight so far?  Dan Ford, Vice Dean of Clinical Investigation at Johns Hopkins, says the data is much more unwieldy than anyone knew.

Ford: Randomized clinical trials are much, much easier. We know how everybody got in there, they all got one treatment or another, and the study is over. In electronic medical record data people are coming into our system disease free, early in the disease, end stage disease.  Some have been in the system for a year, some three, some twenty, to analyze that and get strong data that we all would have  confidence in, it takes a lot more time.   :31

Ford says new methods and tools for analysis are also necessary, but believes the promise of electronic health records will come to fruition.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  What can we learn from recent Ebola transmission domestically? Elizabeth Tracey reports

Everyone has 20/20 hindsight, the saying goes, and while that’s usually true, rigorous examination of recent cases of Ebola virus transmission here in the US is still ongoing to determine exactly what happened.  Karen Davis, director of medical nursing at Johns Hopkins Hospital, says there are many lessons to be learned.

Davis: I think it’s important that we don’t criticize what the healthcare providers did in Texas , that we look at where our systems might have failed, where our systems could be improved, where resources could have been offered in a different way, and that we really do a root cause analysis around this and say, now that we know more information how could we have done better?  What system fixes do we need that we can then take out as a best practice, so other organizations that need to figure out how can we protect our people better that we’re doing that.  We’re hungry for information from those transmission so we can figure out exactly how it happened so it doesn’t happen again.   :32

Davis reminds everyone that panic is never helpful when trying to keep an urgent situation under control.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Why have nurses contracted Ebola in the western world?  Elizabeth Tracey reports

Two in Texas and one in Spain- how is it that nurses are developing Ebola infection while other members of the Western healthcare teams remain uninfected? Karen Davis, director of medical nursing for Johns Hopkins Hospital, comments.

Davis: I think it’s because the bulk of the work in taking care of an Ebola patient falls into the practice of the scope of nursing. We’re in the room, we’re doing the things that patient needs, which is usually keeping them hydrated, keeping them clean and dry, providing emotional support.  Imagine how scary it would be to be that patient, alone in that room, you can have no visitors, you have one nurse coming in to take care of you, you feel terrible, you need the psychosocial piece of that as well, and that’s what we do, that’s what we’re trained for. So we want to be at the bedside of those patients, they need our support.    :28

Davis says many of the nurses she works with are more than willing to be on the front lines in caring for Ebola patients, having cared for many patients with other serious infections over the years.  She feels confident that such care can be delivered safely as protocols, procedures and drills are in place to prevent infection.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include fecal transplant capsules, stem cells for macular degeneration, exercise and depression in teens, and Ebola predictions.

Program notes:

0:59 Ebola update from WHO
1:50 Case fatality of 70%
2:48 Domestic concerns
3:50 Public health message re:Ebola
4:50 Capsules for fecal transplant
5:50 Previously direct infusion
6:51 Fairly clean packaging
7:20 Stem cells and retinal disease
8:20 No evidence of adverse proliferation
9:01 Exercise and depression prevention in teens
10:01 No association seen
11:02 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/10/17/a-capsule-for-a-scourge/

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