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Anchor lead: If we find out who’s at risk for esophagus cancer we may be able to help, Elizabeth Tracey reports

Barrett’s esophagus is a condition that often precedes development of esophageal cancer, with its dismal survival statistics. Stephen Meltzer and colleagues at Johns Hopkins have developed a novel method to screen people for Barrett’s using biomarkers and a cell sampling technique. Meltzer hopes this test may soon help identify those at risk.

Meltzer: It’s known that the highest risk population is white, male, obese, you may or may not have reflux symptoms. There’s some anecdotal evidence that Barrett’s actually is an adaptive response. And may protect in some cases against symptoms. Sometimes you get the history from a patient that they had heartburn thirty years ago, and then it disappeared but more recently they had trouble swallowing. That’s a very ominous sign. Trouble swallowing in the context of heartburn a long time ago could mean that there’s a cancer.  :31

Meltzer notes that few of the millions of people with Barrett’s have actually been diagnosed. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a new method reduce the increasing numbers of cases of esophageal cancer? Elizabeth Tracey reports

Cancer of the esophagus is a killer, with only about one in five people surviving for five years after diagnosis, according to the American Cancer Society. Now a test combining biomarkers and a novel retrieval method developed by Stephen Meltzer and colleagues at Johns Hopkins may help diagnose a precursor condition called Barrett’s esophagus.

Meltzer: We’ve found that these four markers in our study were, if used in a combined panel, about 80% sensitive and 90% specific in diagnosing Barrett’s esophagus. It’s particularly good when viewed in the context of current screening. :15

Melzer says today, diagnosis comes too late.

Meltzer: People come in for symptoms, and some of those people get endoscopies. It’s a very small fraction of the people with Barrett’s. we estimate there’s somewhere between three and six million people in the United States walking around with Barrett’s. mostly undiagnosed. Only about 350,000 to 400,000 are diagnosed. And the cancers usually occur in the people who aren’t diagnosed with Barrett’s.  :20

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new method may predict who might develop esophageal cancer, Elizabeth Tracey reports

Cancer of the esophagus is on the rise, and it has a very poor prognosis. Now a new method of sampling cells from the esophagus developed by Stephen Meltzer and colleagues at Johns Hopkins may help diagnose a precancerous condition called Barrett’s esophagus and identify those at risk.

Meltzer: With the advent of the molecular biomarkers, it’s become a different ball game. And so now we have much higher sensitivities. So the approach is very simple. You just swallow this capsule, it’s about the size of a medicine capsule, and it has a string attached to it. And you wait three minutes for this capsule to dissolve in your stomach, and when that happens a sponge actually comes out, about two centimeters it diameter, and then you pull it out. And you retrieve about 400,000 cells, which you analyze for methylation.  :28

Meltzer says most people have no trouble swallowing the capsule, and although retrieval feels a little strange is not uncomfortable. He hopes to have the method available clinically soon. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can a program called CAPABLE help elders age in place? Elizabeth Tracey reports

CAPABLE is the name of an intervention that helps older people remain in their homes as they age, and it’s a win-win, a recent study found. Sarah Szanton, one of the program’s developers and authors of the study, describes CAPABLE.

Szanton: It’s just four months, and it’s a combination of a nurse, an occupational therapist and a handy person, a handy man. That means we pay attention to the home environment and the person themselves. In terms of resource intensive, it’s nothing compared to a hospitalization for example. So the program costs $3000 over four months, and it seems to save about 10 times that much per person, on average. And that’s mostly in reducing hospitalizations, so that’s also reducing harm, and suffering, and transitions as well. :32

Szanton says many states have already employed CAPABLE to both improve the lives of older people and reduce healthcare costs. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a program called CAPABLE help elders age in place? Elizabeth Tracey reports

Older people overwhelmingly say they want to remain in their own homes as they age, and a program called CAPABLE, developed by Sarah Szanton in the Johns Hopkins School of Nursing, and colleagues, helps them do just that. And Szanton has shown that CAPABLE is also cost effective in a recent study.

Szanton: That was a randomized controlled trial, the gold standard, where some people were randomized to get this program, CAPABLE, and others were randomized to get attention visits, which were also very powerful. But in the CAPABLE group we reduced disability by 30% compared to the control group. That’s pretty much unheard of in the disability literature. And the actually reduction was about 50% but because the control group also improved because they were getting some powerful treatment in essence, it was a win all around.  :26

The CAPABLE intervention uses a nurse, an occupational therapist and a repair person to modify the home environment to be easier and safer for an older person. Not only does the program save money, people who participate report greatly improved quality of life. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Compounded pain creams are no better than those available over the counter, Elizabeth Tracey reports

If you have pain due to arthritis or injury, pain creams that you apply to the skin may be one option. But don’t obtain a personalized, compounded pain cream. That’s according to Steven Cohen, a pain expert at Johns Hopkins, based on his recent study in Annals of Internal Medicine.

Cohen: The take home is that compounded pain creams don’t work better than topical creams that you can get over the counter. They seem to be less effective and that’s because the active substances are diluted. And they shouldn’t be routinely used.  :13

In fact, the military has been bilked out of millions of dollars for the creams by a couple of doctors.

Cohen: They’re incredibly expensive. I think that they targeted government organizations and that’s because of the conceptual appeal. So service members, you don’t want to give them drugs that could affect judgment. In the VA population it’s very similar. They’re also at high risk to be put on opioids and drugs that have cognitive effects. :18

Cohen advises using over the counter topical pain creams if you find them effective. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Would PET scans be helpful for people with post treatment Lyme disease syndrome? Elizabeth Tracey reports

PET scans may be helpful in assessing people who still complain of Lyme disease symptoms months or years after treatment, so-called post treatment Lyme disease syndrome, or PTLDS. That’s because PET scans can visualize a protein associated with brain inflammation, according to work by Jennifer Coughlin and colleagues at Johns Hopkins.

Coughlin: I can imagine that down the road, as we refine our imaging techniques, we could incorporate the imaging into our clinical diagnosis and potentially use it to really inform the right treatment for the right patient at the right time. A precision imaging approach to identify which patients with post treatment Lyme disease syndrome have that inflammatory process and might respond best to an immune modulating therapy.   :31

Coughlin notes that PET scanning may also be able to assess the effectiveness of treatments. At Johns Hopkins, I’m Elizabeth Tracey.

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