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Anchor lead: Has bariatric surgery for teens come of age? Elizabeth Tracey reports

Bariatric surgery for obesity treatment is serious stuff, so especially for adolescents, many have resisted this option until more long term results were available.  Now two studies reported in the Lancet Diabetes and Endocrinology may help inform such a decision. Kimberley Steele, a bariatric surgeon at Johns Hopkins, comments.

Steele: In the past, the problem with adolescent bariatric surgery for primary care, for pediatricians is that there’s not enough evidence for long term results and the durability of weight loss in an adolescent patient. These studies now take it a step further and follow the adolescents who’ve had bariatric surgery out between five and in the other study 12 years. What it is demonstrating is there is durability of weight loss, also help with the conditions that go along with being obese.   :31

Steele says such things as lipid profiles and high blood pressure also improved for teens who had surgery. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Man’s impact on global health cannot be denied, Elizabeth Tracey reports

Carbon footprints, recyclables, renewable energy.  Perhaps you don’t usually think of these things as impacting health and healthcare, but they most certainly do, according to a recent report in the Lancet that chronicles man’s impact on our environment and the multitude of health consequences it engenders. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says all healthcare institutions must step up.

Davidson: The inspirational Lancet Rockefeller report really identified the Anthropocene era, how humankind are really impacting on the health and wellbeing of our planet. We know from auditable, verifiable resources that the planet is getting hotter. And so what we’re talking about is the impact of heat. We know that older people and infants are much more vulnerable to the climate. I’m really committed to the conversation on climate change in the everyday life of health professionals.  :33

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: If you don’t have a regular primary care doc maybe you should, Elizabeth Tracey reports

People who have a regular primary care physician visit the emergency department and are admitted less often to the hospital than those who don’t, a recent British Medical Journal study found. Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health, says there’s no question that solid primary care is of great benefit to both patients and the healthcare system.

Klag: Robust primary healthcare systems are associated with less use of resources and better outcomes, and lower mortality rates. Because if your doctor knows you and you have a relationship and knows that this is something where you don’t need to go to the emergency room because this happens and this is what I can do over the phone for you. That’s part of the reason why they got admitted less because when there’s uncertainty about what’s going on with the patient you often then send them to the emergency room or the hospital to get evaluated but if you know the patient well there’s less uncertainty.  :28

Klag says the role of primary care docs is even more critical when patients develop more than one medical problem and can be complicated to care for well. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Helping to improve heart valve replacement is one benefit of big data, Elizabeth Tracey reports

Discerning the differences between two types of devices used when someone has a valve in their heart replaced is now possible with the collection and analysis of a wealth of clinical parameters, often referred to as big data.  That’s as reported in a recent study in JAMA Cardiology. Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health, asserts that this is the future.

Klag: This is the future in many ways because we cannot do clinical trials for everything, they take too long, they’re very expensive and often by the time you’re done a big clinical trial the question may not be pertinent anymore, a new technology may have been developed, a new drug so in a sense clinical trials are always a bit behind so being able to use administrative data systems or from clinical care is going to be increasingly important because we have the ability to generate these data in real time.  :26

Klag says detecting even small differences in benefits of one treatment over another are now possible. At Johns Hopkins, I’m Elizabeth Tracey.

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Lung cancer in human body illustration

This week’s topics include heart problems and e-cigarettes, aortic valve replacement, the health impact of low socioeconomic status, and real life lung cancer screening data.

Program notes:

0:33 Risk for premature death
1:33 Low SES more important than most other risk factors
2:34 Strengthen local communities
2:57 e-cigarettes and cardiovascular risk factors
3:58 Measured sympathetic activity
4:48 Any comparison with traditional cigarettes?
5:32 Transcatheter aortic valve replacement
6:32 One-third didn’t survive or improve
7:19 Lung cancer screening in the VA population
8:19 Only 10 diagnosed among 1000 screened
9:21 Need a low false positive rate
10:32 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/02/03/real-life-screening-for-lung-cancer/

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Anchor lead: Can a coronary calcium scan help decide if you need blood pressure medicine? Elizabeth Tracey reports

Coronary calcium scans are looking for deposits on the inside of the heart’s arteries, and they can be helpful in determining someone’s risk for a cardiovascular problem. Now researchers at Johns Hopkins have shown the scans can also help in deciding whether someone needs to take blood pressure lowering medicine.  Seth Martin, a cardiologist at Hopkins who participated in the study, describes the findings.

Martin: What we find is that coronary calcium is a really powerful integrator of risk. The way I like to put it is it helps to put that blood pressure into context. We know that heart disease is caused not by one single factor in most cases but by a combination of risk factors. So it’s also the cholesterol level and in addition to that it’s blood pressure, whether they have diabetes or are smoking. These other factors really matter and so we want to put the single risk factor in the context of the overall risk.   :30

Martin says the scan is most helpful in helping those at intermediate risk for a cardiovascular event. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new smartphone app helps manage care for those who’ve had a heart attack, Elizabeth Tracey reports

If you’ve had a heart attack, an app developed at Johns Hopkins may be able to help streamline and integrate your care.  The app was developed by a trans-institutional team at Hopkins, including engineers, nurses, doctors and others. Seth Martin, a cardiologist at Johns Hopkins involved with the project, describes the app.

Martin: It is an app on your smart phone. It’s paired with an Apple watch and a blood pressure monitor. It really is your recovery at your fingertips, so you’ll be able to track your medications, track your physical activity, follow up appointments with your physicians, with cardiac rehabilitation, keeping track of your vital signs, your heart rate and your blood pressure, your mood, which we know is really critical after a heart attack, and it has really state of the art educational content.    :29

Martin says the hope is that soon, people will be able to upload data from the app to their electronic health record, enabling them to become even more participatory in their own care. At Johns Hopkins, I’m Elizabeth Tracey.

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