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This week’s topics include neonatal abstinence syndrome, early HPV vaccination, new vaccine for herpes zoster, and IVC filters for pulmonary embolism.

Program notes:

0:36 HPV vaccination
1:36 Reduced risk of dysplasia
2:30 Parents underestimate child’s sexual experience
3:01 New herpes zoster vaccine
4:01 Can’t give current vaccine to immunocompromised
5:01 Downside is mild reaction
6:01 Exposures during pregnancy and infant consequences
7:01 Increased rate 4 to 5x
8:01 Filters and pulmonary embolism recurrence
9:03 Does putting a filter in help?
10:35 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2015/05/01/neonatal-abstinence-syndrome/

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This week’s topics include autism and vaccines, oral insulin and diabetes prevention, management of first time seizures in adults, and long term effects of Ebola virus infection.

Program notes:

0:40 Vaccines and autism
1:44 Looked at over 95,000 children
2:45 When a parent has a child with autism
3:02 Insulin and prevention of diabetes type 1
4:02 Oral use of insulin in infants at risk
5:02 Sibling screening?
5:52 Sequelae of Ebola infection
6:58 Several chronic health problems
7:34 Management of first time seizures in adults
8:36 Should you start a drug immediately?
9:17 Mild and reversible medication side effects
10:15 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2015/04/24/insulin-to-protect/

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Anchor lead: Getting patients involved pays off, Elizabeth Tracey reports

Patients who had spinal surgery and engaged in a telephone intervention designed to help them stay on track with their postoperative physical therapy experienced less pain and improved functioning six months later, a Johns Hopkins study led by Richard Skolasky found.  Skolasky says the patient is really the key.

Skolasky: I think it’s important to find these low-cost, low-tech ways to engage patients in their care.  More and more, when we look at self-management and managing these long periods of recovery, patients are being asked to do a lot of the heavy lifting, but they’re, compared with the other members of the healthcare team, have much less experience and much less knowledge, and sometimes they don’t necessarily see the relationship between changing their behavior and getting better.  So I think we need to do a better job of educating patients, empowering them, and making them feel like they have some skin in the game.   :30

Skolasky sees expansion of the intervention to many more types of surgery as well as other outcomes, such as reducing the need for pain medicine.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  A simple telephone intervention may improve orthopedic surgery outcomes, Elizabeth Tracey reports

If you knew you could improve your outcome from spinal surgery with just a few phone calls, would you do it?  That was exactly the outcome found with such an intervention investigated by Richard Skolasky and colleagues at Johns Hopkins.

Skolasky: We did this in a one-hour, preoperative, telephone-based interview and then at six weeks and 12 weeks after surgery checked in with patients again over the phone, provided some additional there and compared how those people did compared to those who just went through standard care.  Patients who were in our intervention, Health Behavior Change Counseling, experienced greater engagement in their physical therapy, and they reported doing a higher percentage of their home exercise program compared to patients in the usual care group.  :30

Skolasky says people who participated in the telephone intervention reported much less pain and disability six months after surgery than those who did not.  They also saw improved scores on measures of physical functioning.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Could psychedelic drugs be used to treat depression? Elizabeth Tracey reports

Contrary to popular belief, psychedelic drugs not only don’t cause mood disorders, they are actually associated with a decreased risk of developing them.  That’s according to a study by Matthew Johnson and colleagues at Johns Hopkins, and Johnson says the finding may have much greater clinical implications.

Johnson: One of the exciting things is that in many areas of psychiatry we seem to have reached a plateau in the efficacy of our therapeutic agents, for example, in depression the SSRIs and related drugs have been effective but certainly there are many people who aren’t helped, so certainly there’s much room for improvement.  The therapeutic effects of psilocybin are exciting because they really represent not just a tweak to an existing therapeutic but a fundamentally novel mechanism.  :33

Johnson and colleagues are already engaged in research on psilocybin’s impact and are positioned to look at the drug in relation to depression.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Does use of psychedelic drugs case depression or other mood disorders? Elizabeth Tracey reports

Psilocybin and other hallucinogenic drugs have long been associated with the potential for causing depression or other mood disorders, but a study by Matthew Johnson and colleagues at Johns Hopkins actually shows that the contrary is found.

Johnson: What we found was the lifetime use of psychedelic substances was associated with a significant and rather large decrease in likelihood of recent psychiatric distress, suicidal thinking, suicidal planning, and suicide attempts.  This finding is interesting because there are a number of therapeutic applications being developed for psilocybin and related compounds, including the treatment of mood disorders.   :30

Johnson says the study, which looked at five years of data from a national survey on drug use and health, identified the inverse relationship between use of these non-addictive substances and mood.  While Johnson certainly isn’t advocating recreational use he does think a therapeutic use is possible.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How much medical testing is needed before cataract surgery? Elizabeth Tracey reports

Cataract surgery is very common, and so is medical testing beforehand, costing taxpayers millions of dollars although a study led by Johns Hopkins ophthalmologist Oliver Schein showed more than a decade ago that it doesn’t improve outcomes in this very safe procedure.  Now a new study in the New England Journal of Medicine supports that conclusion but finds that a lot of preoperative testing continues.  Schein comments.

Schein: I believe all those patients could arrive on the day of surgery and be screened by the anesthesia staff and the nursing staff to see if they were actively ill on the day of surgery. And if so, that small proportion would have their surgeries postponed.  The ones that screened positive with the questionnaire should go and see their physicians.  In order to do what I’m suggesting there has to be regulatory change because there currently is a requirement that there be a history and physical and a history and physical by the anesthesiologist on the day of surgery does not qualify as a preoperative history and physical.  :33

At Johns Hopkins, I’m Elizabeth Tracey.

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