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Anchor lead: An historic kidney transplant among two people with HIV has taken place at Johns Hopkins, Elizabeth Tracey reports

Transplanting a kidney from one person with HIV to another who is also infected has just taken place for the first time. Dorry Segev, a transplant surgeon at Johns Hopkins, says just like many others, people with HIV can develop conditions that put them on the transplant list.

Segev:  Having HIV today basically means you have to take a couple pills and your life expectancy is the same as everybody’s else’s life expectancy and the diseases you get are the same that everybody else gets. And so people with HIV are at risk of kidney disease because of hypertension and diabetes and the same reasons that other people get kidney disease. So we’re seeing more and more people with HIV living longer, developing these conditions, and then needing transplants.   :27

Segev notes that both donor and recipient are on antiretroviral therapy that keeps HIV at an undetectable level, so infection risk should be essentially zero, but he acknowledges that since such a transplant hasn’t been done before, close monitoring is planned. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Is use of e-cigarettes to quit smoking really helpful? Elizabeth Tracey reports

Harm reduction. That’s the health strategy of substituting one behavior for another that is less harmful, and that’s the idea behind using e-cigarettes to quit smoking. A recent study showed that use of e-cigarettes did help people quit, although the numbers were not impressive compared with other methods. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says she is sympathetic to smoking cessation challenges but isn’t a fan of e-cigarettes.

Davidson: Conceptually, we have to recognize that nicotine is addictive. Quitting smoking is really hard. The data tells us you need at least three, probably, three to four serious attempts using nicotine patches, you’re going to a counselor, so what concerns me just about that is that it’s a quick fix. Because we know that it’s a combination of lifestyle, and the people around you. It is a very addictive drug and you really have to tailor and target strategies                 :29

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What can the recent death of Luke Perry teach us about stroke? Elizabeth Tracey reports

Luke Perry’s recent death from a sudden stroke was shocking, especially in light of his age. At 52, Perry was not in a risk category for such an event. Patricia Davidson, dean of the Johns Hopkins School of Nursing and a cardiovascular disease expert, says there are some important legacies we can all learn from.

Davidson: Understanding warning signs is a very important part of any cardiovascular disease. We know from heart attack that the signs are not the same for every person, similarly for stroke. There are definitely warning signs for stroke, changes in vision, weakness in limbs, people sometimes talk about just this fogginess, it really comes to understanding your own body, how you feel, it’s really important thinking about what are the risk factors? :31

Davidson emphasizes that the vast majority of risk factors are modifiable, so assessing them for each individual is crucial, as is seeking immediate attention when stroke is suspected. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: When people have advanced cancers, a close look at preventive medicines is needed, Elizabeth Tracey reports

When people have advanced cancers, the average number of medicines they’re taking for things like cholesterol lowering and other preventive strategies actually increase in the last year of life, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says if this describes you, think carefully and talk with your provider.

Nelson: The number, some 80% of cancers are diagnosed above the age of 60, almost 30% above the age of 80, what people call polypharmacy, many medications, as you get older also carries a threat of what we call delirium, it affects cognitive abilities and promotes people falling, removing these medicines as people get older is already a reasonable approach to geriatric medicine and I think there should be a lot of thought as to why you’re taking each medicine you’re taking if you have a diagnosis of a metastatic cancer.  :30

Nelson says there’s also a significant financial cost to taking many medicines. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Removing lymph nodes may not help in advanced ovarian cancer, Elizabeth Tracey reports

Cancer cells can spread in the body by hitching a ride in lymph nodes, so removing them during surgery for cancer has always seemed like a good strategy. Now a new study looking at so called lymph node dissection in women with ovarian cancer shows the procedure isn’t helpful at all. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: Six hundred and forty-seven participants, so three hundred and some odd on either arm, and there was absolutely no difference in the ovarian cancer outcomes. No difference in overall survival, the propensity for the ovarian cancer to return, there were significant differences in complications following the operation including the need to be reoperated on, even stunningly 3.1% thirty day mortality following the operation, for those who receive the lymph node dissection versus 0.9% for those who did not. This suggests that this procedure should just plain be abandoned.  :34

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What are the barriers to clinical trial participation if you have cancer? Elizabeth Tracey reports

It can be really hard to participate in a clinical trial for cancer therapies, even if you want to. That’s according to a recent study examining barriers to such trials. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: Fifty-six percent of the time there was not a clinical trial available for the particular person and their cancer and its stage of progression. Twenty-two percent of the time the person wasn’t eligible for participation in the clinical trial, usually that ineligibility was they were at the wrong stage of disease or they had what is often called comorbidities,  there’s a heart problem or a kidney problem, something like this that rendered them ineligible for participating in the trial. That’s almost three-quarters of the people where there’s a structural barrier to participation.   :30

Nelson says many efforts to both expand entry criteria and engage community hospitals more in clinical trial research should improve access, and notes that very good clinical care also accompanies clinical trial participation. At Johns Hopkins, I’m Elizabeth Tracey.

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Program notes:

0:15 Surgery is the last bastion?
1:15 Joy in working with the team
2:16 Everyone expected to speak up
3:20 Culture of safety
4:17 Teaching in the OR
5:15 Grow together, learn together
6:15 Have everybody introduce themselves
7:15 Nurse felt patient was at risk
8:12 A very cool job
9:17 Wore their head and neck cancers
10:22 End

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