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Anchor lead:  Are recent successes with CPR sustainable? Elizabeth Tracey reports

When bystanders initiate CPR during apparent heart attacks, more of those folks survive, recent studies show.  While these results are very encouraging, Gordon Tomaselli, director of cardiology at Johns Hopkins, says the changing nature of heart disease may slow down the ability of CPR to sustain folks who have an out of hospital cardiac arrest.

Tomaselli: We have made a lot of progress in reducing cardiovascular mortality, cardiovascular disease incidence over the last twenty to thirty years. We’re now seeing kind of a resurgence, a lot of this has to do with rising rates of obesity, earlier onset of diabetes, and this may create a different form of heart disease.  What we’re seeing is more heart failure as opposed to acute coronary disease, relatively speaking.  Acute coronary disease still very prominent more than a million heart attacks a year, on top of that we’re seeing other forms of heart muscle weakness.   :30

Tomaselli says public health efforts to prevent heart disease remain paramount.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Learning CPR is simple and can save lives, Elizabeth Tracey reports

CPR works to save lives, two more recent studies in the Journal of the American Medical Association conclude.  In Japan and North Carolina, where public education efforts were undertaken to improve rates of bystander-initiated CPR, almost twice as many people who had heart attacks survived to be discharged from the hospital. Gordon Tomaselli, director of cardiology at Johns Hopkins, says the message is clear.

Tomaselli: I would say learn CPR.  Everybody should know CPR.  It’s easy to learn it’s easy to keep proficient at, you may never need to use it but I think if you ever do need to use it you can save a life.  That’s really the simple public health message.  And I would also advocate for making sure there’s wide distribution of AEDs and that CPR is a requirement for graduation across all schools in this country. I think most people who can use a cell phone can use an AED.  :25

Tomaselli adds that if you’re the sole responder to an apparent heart attack, make sure to call 911 before doing anything else. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: When more bystanders perform CPR more people survive, Elizabeth Tracey reports

Greater numbers of people are performing CPR when they witness a heart attack, with the result that almost twice as many heart attack victims are surviving to be discharged from the hospital, two recent studies in the Journal of the American Medical Association report. Gordon Tomaselli, director of cardiology at Johns Hopkins, comments.

Tomaselli: The survival for out of hospital cardiac arrest has been abysmal. What we know is that if you can support the circulation with good CPR until more advanced rescue gets there, chances of survival improves dramatically.  One of the key things the AHA and others have done recently is to go to this philosophy of hands only CPR.  Here we know that even if you just provide chest compressions that will move air in and out of the lungs but more importantly it will support the circulation until you can correct the abnormal cardiac rhythm.  :32

So learn CPR, Tomaselli says.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Identifying someone to make your healthcare decisions if needed is just the first step, Elizabeth Tracey reports

Many interventions such as chemotherapy that can erode quality of life are still employed in people with advanced cancer within weeks of death, a Johns Hopkins study led by Amol Narang has shown.  Narang says even though the majority had a power of attorney additional steps must also be taken.

Narang: I think the important piece of advice for patients is that their caregivers really have to be involved in the process.  Making sure that there is another person who is knowledgeable about your values and your preferences for the care that you would like to receive I think is essential. And that doesn’t just mean assigning a durable power of attorney, it means assigning an informed durable power of attorney, with whom you’ve had the appropriate level of discussion.   :30

Advance directives and discussions with your physician will help make sure your wishes for end of life care are known, Narang says.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Many cancer patients receive futile care at the end of life, Elizabeth Tracey reports

Even though more people are identifying someone to make healthcare decisions for them at the end of life, that hasn’t reduced the use of chemotherapy or other interventions in the last weeks of life, a Johns Hopkins study led by Amol Narang has found.  There was also no relationship with how long someone knew they had cancer.

Narang: These were mostly patients above the age of 70.  We did look at when the cancer was diagnosed, and that actually did not seem to have a relationship with either the frequency with which advanced care planning was happening or the intensity of end of life care that was provided. That argues that even in these situations where there’s ample opportunity to have these conversations we’re just not doing a good job at having them.   :29

Narang says physicians need to be trained to have these conversations, for everyone’s benefit.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include a balloon for middle ear infections, depression screening, antisense RNA for high triglycerides, and hypothermia for kidney donation.

Program notes:

0:42 Balloon for middle ear infections
1:40 Negative pressure causes eardrum to retract
2:40 See expansion
3:07 Screening for depression
4:07 When combined with treatment helps
5:06 Draft recommendations
5:40 Cooling and kidney donation
6:41 Kidney function at 7 days after implantation
7:42 Short term failure
8:24 Hypertriglyceridemia treatment
9:24 Antisense experimental medication
10:40 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2015/08/02/balloons-in-the-noses-of-kids/

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Johns Hopkins Kimmel Cancer Director William Nelson discusses top cancer news during July 2015.

Program Notes:

0:14 A blood test for pancreas cancer
1:14 Biomarker potential
2:22 Five day fast and cancer risk
3:23 About 3% weight reduction
4:23 One that gets the results that you want
5:12 Guideline for physicians to talk about cost/benefit of cancer treatment
6:12 Effectiveness of treatment, toxicity, and quality of life, and what was the cost
7:14 Out of pocket costs most important for patients
8:14 Try to inform patients fully
8:52 End

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