iStock_000022176290_MediumWho wouldn't want a chef to prepare their meals?  As Rick and I discuss on PodMed this week, I most certainly would, and I'm in agreement with denizens of public schools, who made healthy changes to their dietary choices when a chef got involved  in food preparation.  That's according to a study in JAMA Pediatrics, where a couple of thousand kids enrolled in 14 urban school districts were the beneficiaries of chef-inspired school lunches for a period of three months, or not. After this time period, an additional variable called 'food architecture' was also introduced, where strategic placement of food items to encourage purchase and consumption was attempted.  Lo and behold, after 7 months consumption of vegetables increased quite a bit, with the chef being the winning variable. Rick and I were both tickled to observe that the chef needed to be on board for a while before the students, and even teachers and administrators, adopted the new menu.

Other topics this week include treatment for macular edema and diabetic retinopathy in NEJM, stents versus medical therapy for prevention of recurrent stroke in JAMA, and exercise, vitamin D and falls in elderly women in JAMA Internal Medicine.  Until next week, y'all live well.

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iStock_000021636699_LargeIf you have blocked blood vessels in your heart, should you have them opened with stent placement or undergo coronary artery bypass grafting, abbreviated CABG, a much more lengthy and complicated process but which previous study has shown has more durable results than stent placement?  On PodMed this week, Rick and I examine that question again based on results of two studies in the New England Journal of Medicine with so-called 'second generation' drug-eluting stents that purportedly resist blockage formation and the need for additional procedures. Results indicate that there are risks and benefits to both treatments, with Rick of the opinion that these studies will assist caregivers and patients to make informed choices based on their personal preference, while I opine that the quest for the perfect stent continues.  No doubt there will be plenty more on this subject.

Other topics this week include cardiac screening in low risk patients in Annals of Internal Medicine, breast biopsy results in JAMA, and imaging for low back pain in older folks in the same journal.  Until next week, y'all live well.

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iStock_000017052299_LargeWhen an adult breaks a bone, 5 to 6% of the time it's the upper arm bone known as the humerus. Now a study in JAMA Rick and I discuss on PodMed this week shows that despite increasingly popular surgical management of the fracture, the good old-fashioned sling works just as well.  And that's in a group of people in whom the bone pieces are not in alignment, known as displacement, where the a priori hypothesis would be that getting those halves back in alignment would result in better outcomes.  Not so, by a variety of measures.  Including, perhaps most importantly, the patient's own assessment of treatment.

Other topics this week include liberal versus restrictive use of transfusions in patients undergoing cardiovascular surgery in NEJM, back to JAMA for transaortic valve replacement outcomes, and to JAMA Internal Medicine for the benefits of vegetarian diets on colorectal cancer risk.  Until next week, y'all live well.

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187541883Let's face it.  For most patients surgery is a nerve-wracking experience.  Enter then the practice of providing preoperative anti-anxiety medications to keep people calmed down before general anesthesia is employed.  But what of this practice?  Does it help or does it result in other outcomes that aren't desirable?  As Rick and I discuss on PodMed this week, that's the gist of a study in JAMA this week.  Basically the study shows that compared with either placebo or no medication, patients were no more satisfied with their experience when given lorazepam prior to surgery than either placebo or nothing.  They did however take longer to get off the ventilator and to recover cognitive function early.  Hmmm.  Sounds like the practice should be abandoned except perhaps in the very, very anxious, the only group who did seem to benefit in this study.  And as I comment in the podcast, this is a timely topic as factors that may end in delirium for elderly surgical patients are being scrutinized, and this may well contribute.

Other topics this week include improved air quality and growth of lungs in adolescents in NEJM, drugs to cope with shift work in JAMA, and the dangers of testosterone supplements per an FDA warning.  Until next week, y'all live well.

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GettyImages_464671264Should you begin exposing your infant to peanuts very early in life?  The answer may well be yes, even and especially if your baby is at risk to develop peanut allergy, a study Rick and I examine on PodMed this week  and published in the New England Journal of Medicine concludes.  How can babies at risk to develop peanut allergy be identified?  Turns out if they have the skin rash known as eczema, or have siblings or parents with the condition, this can be predictive.  Clearly parents will want to know about risk before exposing their infants, and skin testing may also help.  Finally, we conclude that peanut butter rather than whole peanuts may be the right vehicle, and Rick suggests that parents may want to attempt this in a physician's office so help is available if the baby has a reaction.  Since this is such a big and growing problem, seems like an 80% reduction in development of the condition is well worth attempting.

Other topics this week include pregnancy after bariatric surgery in the same journal, a report from the CDC and other federal agencies on common bugs and foods that cause food borne illness, and the risk of NSAIDs in those who've had a heart attack in JAMA.  Until next week, y'all live well.

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459903291Are electric fans any help in the prevention of overheating?  Rick and I consider that 'hot' topic this week on PodMed, and for me as well as my colleagues here in Baltimore, thinking of hot things is a welcome respite from the Arctic conditions outside!  The study is a small one published in JAMA, but shows that up to certain levels of humidity fans indeed help reduce increases in core temperature and sweating in subjects exposed to heat and humidity.  Surprisingly, this runs counter to the current public health notion that fans aren't helpful in these circumstances and may in fact be harmful.  Hmmm, as I opine in the podcast, good to have a cheaper alternative to AC or going to a shelter.

Other topics this week include steroid use in pneumonia and varenecline use in people who have doubts about quitting smoking, both in JAMA, and Fusobacterium as a common cause of sore throats in a group of teenagers and young adults, in Annals of Internal Medicine.  Until next week, y'all live well.

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200570995-001If you want to improve your health, even if you're an avid exerciser, you need to avoid sitting for prolonged periods of time, Rick and I discuss on PodMed this week.  That's according to a study in Annals of Internal Medicine, where irrespective of whether regular exercise was a part of the regimen, those who sat for prolonged periods experienced greater all-cause mortality as well as that from specific diseases.  Rick offers a number of practical ideas for getting moving in the workplace, which is, of course, where most of us spend a lot of time at the desk.

Other topics this week include a lack of benefit seen with bathing patients in the ICU with chlorhexidine daily, exciting results from an uncontrolled trial using stem cells in folks with multiple sclerosis, and lackluster results from intracytoplasmic sperm injection versus standard techniques for infertility. Until next week, y'all live well.

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When the whole community gets involved, people can reduce their risk factors for heart disease, reduce hospitalizations and live longer, Rick and I report on PodMed this week.  That's from a study published in JAMA.  Also in that journal, a look at breast cancer mortality as it relates to ethnicity, and in JAMA Internal Medicine, two studies: too much aspirin use and overtreatment of diabetes in older folks.  Until next week, y'all live well.

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thCAQZ6PWHWelcome to our annual Christmas spoof!  Happy listening, and a safe and healthy new year from us both! Three of four in the BMJ, with the fourth from the Journal of Economic Behavior And Organization.

http://podcasts.hopkinsmedicine.org/2014/12/19/podmed-week-of-december-22-2014/

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89468358PD-1 is a cancer pathway that's been known for some time to the cognoscenti.  On PodMed this week, Rick and I talk about a study in NEJM, which is incidentally where all the studies we talk about this week are published, that appears to bring manipulation of this pathway to fruition in folks with Hodgkin's lymphoma. Good news indeed, as well as proof of concept.  What did they do? First, a little background is appropriate.

PD-1, in that often inscrutable scientific fashion that is happily absent here when it comes to naming, stands for programmed death.  In this case it refers to a way our bodies use to damp down an immune response by T cells, one of the army of cells mobilized to protect us but which need to be called off when the deed is done. We can think of PD-1 as running up the surrender flag so T cells chill out.  Turns out cancer cells do the same, running up the surrender flag to call off T cells that might otherwise attack and kill them.  Oh so clever cancer cells!  This property partially explains why our immune systems fail to recognize these invaders and dispatch them, and it's also something researchers have been struggling to exploit for some time.  Indeed, antibodies to manipulate this pathway have been developed and used clinically, with this study reporting such an antibody for Hodgkin's.

Hodgkin's, of course, is rather a curiosity when it comes to immune system manipulation.  The problematic cells in the disease known as 'Reed-Sternberg cells' actually reside within a veritable army of immune cells, yet somehow evade detection and destruction. PD-1 utilization is alive and well in this type of cancer, and the authors reveal that host infection with Epstein-Barr virus also up-regulates this mechanism. Accordingly, 23 patients with Hodgkin's lymphoma who had either relapsed or had refractory disease were enrolled in this study to receive the monoclonal antibody 'nivolumab.' Previous treatment of these folks included some pretty heavy hitting therapy: stem cell transplantation and an antibody 'brentuximab vedotin.'

Here's the good news: "An objective response was reported in 20 patients (87%), including 17% with a complete response and 70% with a partial response; the remaining 3 patients (13%) had stable disease."  Wow!  That's very impressive.  Side effects could be problematic with nivolumab: "Overall, drug-related adverse events were reported in 18 patients (78%). The most common were rash (in 22%) and a decreased platelet count (in 17%). Drug-related grade 3 adverse events, which were reported in 5 patients (22%), included the myelodysplastic syndrome, pancreatitis, pneumonitis, stomatitis, colitis, gastrointestinal inflammation, thrombocytopenia, an increased lipase level, a decreased lymphocyte level, and leukopenia." These drug effects were manageable and the authors conclude that inhibition of the PD-1 pathway may be a very important therapeutic target in patients with this disease, and we agree.  Rick also opines that examination of additional tumor types will likely result in more applications for this strategy.

Other topics this week include the use of progesterone in traumatic brain injury, a new type of blood thinner, and US healthcare and equality, as mentioned before, all in NEJM.  Until next week, y'all live well.

 

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