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Program notes:
0:12 Rankings of all types relative to healthcare
1:12 Only a very few ratings per physician
2:09 To help patients make informed decisions
3:10 Administrative or billing data
4:10 Physicians managing own reputation
5:12 Being proactive as a provider
6:12 Care that ratings can't capture
7:10 Recent oncology patient
8:04 End
Podcast: Download (Duration: 1:04 — 1.5MB)
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Anchor lead: Can resistant viruses undo all the HIV containment efforts worldwide? Elizabeth Tracey reports
In some countries, up to ten percent of HIV infections are resistant to medication, a study reported at the recent international HIV meeting reported. The WHO has responded with alarm and a call for increased vigilance, in an attempt to keep these viral strains in check. Adriana Andrade, an HIV expert at Johns Hopkins, agrees.
Andrade: It’s a public health issue that not only has repercussions for treatment success and keeping a patient healthy, but public health issues that are much larger and could lead to transmission of resistant virus. :14
Andrade notes that spread of a resistant viral strain could threaten all the progress made against HIV internationally.
Andrade: Globalization, there is so much travel everywhere so everybody is exposed to everything. And being exposed to a virus that is already resistant to a number of medications when you haven’t taken anything yourself in some areas will limit options for treatment and prevention. :19
Prevention remains the best strategy with regard to HIV, Andrade says. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: HIV medicines given by injection work, Elizabeth Tracey reports
Vigilant medication use is key when it comes to keeping HIV infection in check, and now a new formulation of of medicines used for this purpose that’s given as an injection – known as IM for intramuscular- has proven efficacious in a new study. Adriana Andrade, an HIV expert at Johns Hopkins, says there are people who would find such an injection helpful.
Andrade: There is a group of individuals who are HIV infected who struggle with the need to take, even if it’s one pill once a day for HIV care. When you’re treating HIV compliance has to be very high, because if it’s not the virus becomes resistant. With IM, these individuals will come to clinic to have medications injected every four weeks instead of having to take it every day, instead of having to carry medications with them every day, instead of having to call the pharmacy to get their medications often. :30
Andrade notes that in limited resource settings such a strategy may also help. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Should obesity surgery be employed earlier? Elizabeth Tracey reports
The more obese someone is when they choose to have obesity, or bariatric surgery, the less likely they are to have a good outcome, defined as a BMI of less than 30, a year later, a recent study concluded. Kimberley Steele, a bariatric surgeon at Johns Hopkins, says what’s really important is how issues like diabetes, known as comorbidities, resolve after surgery.
Steele: We tell our patients that they may never get down to a normal weight, that they might hit a BMI of 25 to 30, which is classified as overweight. That’s not our goal. Our goal is resolution of the comorbidities that exist with obesity. That said, I think their point is very valid. Bariatric surgery is done over a wide range of BMI extremes. What they’re trying to say is that we need to intervene sooner, which makes sense. :31
Steele says that anyone with a BMI that’s over 25 and keeps rising should begin interventions to stop that trajectory. At Johns Hopkins, I’m Elizabeth Tracey.
Podcast: Download (Duration: 1:04 — 1.5MB)
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Anchor lead: Many people with a diagnosis of Alzheimer’s disease may not actually have it, Elizabeth Tracey reports
If you’ve been told you have Alzheimer’s disease and are taking medications that may help, it’s possible you really don’t have Alzheimer’s at all. That’s the rather startling conclusion of a study presented recently at the international Alzheimer’s meeting, where PET scanning failed to confirm the diagnosis in a large number of people. Constantine Lyketsos, an Alzheimer’s expert at Johns Hopkins, agrees that there’s a lot of controversy between the clinical picture and what’s going on in the brain.
Lyketsos: The brain state is where words like Alzheimer’s come into play, characterized by amyloid plaques and tau tangles and so forth. So what we’re struggling with to understand is how the two relate. We know that if you have dementia that’s bad, whether or not you have plaques and tangles. If you have dementia and you don’t have plaques and tangles yes, you do have something else bad we just don’t have the right PET scan to know what it is, or the right stain under the microscope to know what it is. :26
At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Can much of Alzheimer’s disease be prevented? Elizabeth Tracey reports
One-third of all cases of Alzheimer’s disease could be prevented if people exercised regularly, kept mentally engaged, didn’t smoke and controlled their blood pressure, a study presented at the recent Alzheimer’s disease meeting estimated. Constantine Lyketsos, an Alzheimer’s expert at Johns Hopkins, says some of that is age-dependent.
Lyketsos: If you’re talking about say age 75, it’s not unrealistic to think that you could have a huge effect on the risk of Alzheimer’s at 75 by what you do in these areas at age 50. But if you extend your horizon to age 80 or 90, where there’s much more biologic pressure to develop dementia I think the impact is going to be lower. But we’re already seeing effects, we’re already seeing reductions in the incidence of dementia in younger ages, which we believe is related to all these major changes. :28
Lyketsos encourages everyone to adopt these lifestyle habits to reduce their risk of many chronic diseases. At Johns Hopkins, I’m Elizabeth Tracey.
Podcast: Download (Duration: 10:23 — 14.3MB)
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This week’s topics include outcomes for payment, on- or off-pump CABG, cannabis for pain or PTSD, and the cognitive impact of a PCSK-9 inhibitor.
Program notes:
0:41 Cannabis and pain or PTSD
1:41 May alleviate neuropathic pain in some
2:44 Socially not good
3:04 Holding providers responsible for outcomes
4:04 Outcomes can’t be used for value or payment
5:04 How to properly incentivize
5:23 On or off-pump for CABG
6:23 Need a repeat procedure?
7:19 Cognitive function and evolucamab
8:19 Subgroup of 1200 patients
9:20 Doesn’t contribute to cognitive dysfunction
10:23 End
Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/08/18/is-cannabis-any-good-medically/
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