Play

Anchor lead: When opioids are combined with another drug, the chances of overdose increase, Elizabeth Tracey reports

Opioid overdose is epidemic, and now a study in the British Medical Journal shows that when these drugs are taken with benzodiazapines such as Valium, the chance of overdose shoots up. Constantine Lyketsos, director of psychiatry at Johns Hopkins, comments.

Lyketsos: Opioids, even without concomitant use are not designed to be used chronically period end of story. It is very rare that its appropriate for someone to be on an opiate chronically. Combine them with these other medications that also act on the brain and yes, you have a greater likelihood of side effects and in some instances catastrophic side effects including death. :20

Lyketsos says the problem is especially acute for older folks.

Lyketsos: I challenge everybody, every older person and people who are in their family who are involved in caring for them, they should challenge their physician at every visit to clearly justify every medication they’re prescribing. And I think if you do that systematically you appreciate that many seniors need far fewer medicines than are being prescribed. :18

At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 5.0/5 (1 vote cast)
Play

Anchor lead: Taking too many medicines that affect the brain has consequences, Elizabeth Tracey reports

At least three medicines that impact the brain- the number of older Americans who are on such a regimen has doubled over a decade, a recent study finds. Constantine Lyketsos, director of psychiatry at Johns Hopkins, sounds a note of warning.

Lyketsos: Some of these medicines are risk factors for dementia whether they directly cause brain damage that leads to dementia or whether they affect the brain in such a way that they unmask a brain process and therefore lead to dementia is not clear. Also we know that these medicines or some of them are prescribed to patients or individuals with dementia that they seem to accelerate progression. So their increased use raises concerns both for an increased occurrence of dementia, in relationship to these and also for a worse outcome.  :33

Lyketsos says all medicines should only be taken for an appropriate period of time, and reassessment is continuously needed, as the effects may be cumulative or interactive. At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 5.0/5 (1 vote cast)
Play

Anchor lead: Many older Americans are taking three or more medicines that impact the brain, Elizabeth Tracey reports

Opioids, sleep medicines, medicines for psychiatric conditions.  The number of retired persons and older who are taking at least three such medicines has doubled over a decade, and these medicines directly affect the brain. Constantine Lyketsos, director of psychiatry at Johns Hopkins, identifies at least one contributing factor.

Lyketsos: I think to a great extent this reflects the reduction in access to specialty mental health services. And what’s happening is that individuals and our seniors especially are presenting to their primary care doctors with mental health complaints. Primary care doctors are busy, mental health complaints require more time, than say, a high blood pressure complaint, and so prescriptions are being written perhaps with less careful attention and are being maintained when perhaps they’re not needed anymore.   :31

Lyketsos says caution is needed here, as well as careful review of all medicines someone is taking. At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 5.0/5 (1 vote cast)
Play

Anchor lead: Can an internet-based intervention help manage knee pain? Elizabeth Tracey reports

Therapy for knee pain due to osteoarthritis was effectively delivered using a web-based approach, a recent study found. Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health, describes the results.

Klag: The intervention group reported significantly less pain, so their pain improved more, both groups their pain improved but it improved much more in the intervention group and they also had better physical functioning than the control group. They looked at three months, and there was improvement, and those differences were sustained at nine months. :16

Klag says since knee pain is universal, such a strategy has worldwide utility.

Klag: That’s the promise of this. As we age as a society for us in the US but especially in countries like Japan and China, how do we deal with these chronic conditions of aging? And so this is a way where you can do it very efficiently, and very cheaply and so it holds great promise. It’s a model for what we do as we deal with people with multiple conditions. :19

At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
Play

Anchor lead: The federal government is stepping into regulation of medical apps, Elizabeth Tracey reports

Do you have a medical app on your smart phone? Measuring how many steps you take, how you’re sleeping, what you’re eating? Now federal agencies are stepping into this space to regulate such apps.  Paul Rothman, dean and CEO of Johns Hopkins Medicine, applauds the strategy.

Rothman: As a new area of endeavor it probably needs some regulation because unlike some other apps people are going to utilize this information and perhaps act on it that might cause harm, so I think it’s really important for someone to go and regulate this space.   :16

Rothman notes that sometimes the device used to measure things like blood pressure isn’t very accurate and renders the app inaccurate.

Rothman: That happens. I don’t know all the apps. I was just working with someone on the EKG app and we did it to each other and it was fairly accurate but I’m not sure all the apps are that good and there’s a lot of things that can go wrong with the apps so it is the right space for the FDA. It’s a device.   :15

At Johns Hopkins, I’m Elizabeth Tracey.

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
Play

3D illustration of Lungs - Part of Human Organic.

This week’s topics include managing after DVT, anticoagulation in folks with a-fib, surviving with cystic fibrosis, and where to have rehabilitation after knee replacement

Program notes:

1:00 Folks with cystic fibrosis survive longer in Canada
2:00 Have transplant earlier
3:00 How can we address in the US?
3:32 Where to have rehabilitation after knee replacement
4:32 Followed for up to a year
5:35 Underutilization of anticoagulation in a-fib
6:32 About 40% inadequate dose
7:11 DVT and management afterward
8:10  Novel oral anticoagulants
9:10 Prolonged benefit with one of the newer agents
10:05 End

Related blog:https://podblog.blogs.hopkinsmedicine.org/2017/03/20/surviving-longer-with-cystic-fibrosis/

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)
Play

Happy Asian family

This week’s topics include how often women need pelvic exams, what we can learn from the oldest old, mouse allergens and asthma, and cardiometabolic death and diet.

Program notes:

0 :30 Learning from the oldest old
1:30 Physical performance and cognitive function
2:30 Living longer but more frail
2:50 Pelvic exam interval
3:52 Abandoning altogether
4:51 Routine screening every five years
5:28 Mouse allergen reduction and asthma
6:28 Professional cleaning versus self activity
7:29 Less cost
8:07 Cardiometabolic death and diet
9:07 Almost half due to diet
10:37 End

Related blog:https://podblog.blogs.hopkinsmedicine.org/2017/03/10/studying-the-oldest-old/

VN:F [1.9.17_1161]
Rating: 0.0/5 (0 votes cast)