Health Newsfeed – Johns Hopkins Medicine Podcasts

The United States Preventive Services Task Force, or USPSTF, recently issued new guidelines on who should be screened for lung cancer. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the impact.

Nelson: What this study did is it used real world data. What they found was that rather that 34 and a half thousand that would have been eligible in 2013 an additional 18 and a half thousand would be eligible under the 2021 guidelines. What is most interesting is by the new guidelines with additional people being eligible for screening, you had more women who become eligible, and more minorities including Asians, Hispanics, and African Americans.  :29

The study found that an additional 30% of lung cancers were identified at an early stage, and in people who were younger and had fewer other illnesses. Nelson says this improves their chances of long term survival. At Johns Hopkins, I’m Elizabeth Tracey.

If you’re one of the vast number of people who are experiencing mental illness, a new book by Johns Hopkins psychiatrist Meg Chisholm may help. The title of the book is “From Survive to Thrive, Living Your Best Life With Mental Illness,” and Chisholm says it relies on a concept of flourishing in life to improve mental health over the long term.

Chisholm: The first step is getting the acute symptoms under control. Once the acute symptoms are under control where do we go from here? And I think a lot of people stop at just getting the acute symptoms under control, which doesn’t bode well in the long run for staying well. If you don’t have a lot of meaning and purpose in your life why would you continue taking your antidepressant? There’s so much more to life than just being disease free. Doctors traditionally haven’t asked about these aspects of a person’s life and they haven’t seen them as relevant to their health.  :33

Chisholm says people need to advocate for themselves to integrate flourishing into their treatment plan. At Johns Hopkins, I’m Elizabeth Tracey.

Mental health problems have spiked during the Covid-19 pandemic, and a new book by Johns Hopkins psychiatrist Meg Chisholm may help. Called “From Survive to Thrive, Living Your Best Life With Mental Illness,” the book aims to go beyond simply managing symptoms.

Chisholm: What the components are of a good life, what most people mean when they say that they’re leading their best life possible.  And that is happiness, life satisfaction, physical and mental health, close social relationships, character and virtue, and meaning and purpose, as well as financial and material security and stability. From these big epidemiologic longitudinal datasets, there seems to be a causal link between these four pathways and these outcomes of a flourishing life. And those are family, work, education and community.    :33

Chisholm says these must be integral to any plan for managing mental illness and moving beyond it. At Johns Hopkins, I’m Elizabeth Tracey.

For the majority of people with type 2 diabetes, weight loss of 15% of their body weight should be first among therapies to manage the condition, a recent study concludes. Rita Kalyani, a diabetes expert at Johns Hopkins, comments.

Kalyani: It’s not new to focus on obesity as a cornerstone of management in type 2 diabetes. The degree of weight loss they’re suggesting of 15% or more is what we usually see after bariatric surgery. It’s always been a challenge to maintain that degree of weight loss over time. Now that we have newer agents in the GLP1 agonist class that are given once weekly and at higher doses have been found to attain 15% or more weight loss in a substantial proportion of patients, now we have medical options.  :34

Kalyani says other medical options are also on the horizon and says that when weight loss of this magnitude is achieved, many of the abnormalities seen in type 2 diabetes disappear. At Johns Hopkins, I’m Elizabeth Tracey.

Intensive and personalized physical rehabilitation one to two months after a stroke helps people recover better, a recent study showed, but getting such services paid for remains a challenge. Steven Zeiler, a stroke expert at Johns Hopkins, says technology can help.

Zeiler: That’s why there is a lot of interest for example in some of the immersive environments, robotic assisted play areas, and creating virtual environments that would allow patients to do this with less occupational therapist input. Not to say completely independent, but perhaps less. We were excited to see this data; we’re not surprised. It fits right smack dab into the animal, and human model that we’ve built. It’s nice to see the confirmation and we intend to capitalize on it.  :29

Zeiler states that there’s no doubt of the benefit to society of more fully rehabilitated people who’ve had a stroke in addition to the individual’s quality of life. At Johns Hopkins, I’m Elizabeth Tracey.

Intensive physical therapy delivered to people one to two months after having a stroke and having already received usual rehabilitative services further improved their functioning, a recent study showed. Steven Zeiler, a stroke expert at Johns Hopkins, says this is an area that needs definition.

Zeiler: If we take a step back, what’s the dose of physical and occupational therapy? Nobody knows. We tend, after a stroke, in the right patients, to give a combined total of about three hours a day, and that’s physical, occupational and speech therapy combined. That’s based on what insurance companies will pay. And what emerging studies are showing us is that doing two things seem to be very beneficial. One providing more therapy, but two, providing an intense, tailored therapy. One that is supportive of a particular deficit of which the patient suffers.   :30

Zeiler says this study looked at muscle interactions, known as motor therapy, to help people with movement, and says other intensive strategies might also prove beneficial after a stroke. At Johns Hopkins, I’m Elizabeth Tracey.

People who’d had a stroke, got standard rehabilitation followed by more intensive physical therapy saw better recovery, if they got the additional therapy in the first two months after their stroke, a much awaited study finds. Steven Zeiler, a stroke expert at Johns Hopkins, explains.

Zeiler: Every patient that qualified for this study was then randomized into one of three arms: they were either exposed to twenty hours of intense motor therapy beginning less than 30 days after stroke, beginning at two months after stroke, or beginning at greater than six months after stroke. The end result was that the patients that received the extra 20 hours in that either early or middle time period did significantly better than patients who were exposed to the extra 20 hours at greater than six months.   :34

Zeiler says this study makes the case that rehabilitation that’s specific to someone’s deficits is beneficial for a longer period of time. At Johns Hopkins, I’m Elizabeth Tracey.

Specialized EMS units that only treat stroke improved stroke outcomes for people who were treated by them, a recent study found. Michele Johansen, a stroke expert at Johns Hopkins, says a few things about the study should be noted.

Johansen: If you’re going to really raise up these mobile stroke units it’s interesting that the mobile stroke units and the EMS trucks went together. Because most stroke units are going to be really really good at taking care of stroke and they probably have like critical care nurses who can manage other things, but you know EMS is good at kind of managing everything. And maybe they’re not expert at strokes, but they’re good enough at managing the emergency situation to get a stroke to the experts in the hospital. If you have a mobile stroke unit that’s used to just taking care of stroke, and they get there and it’s not a stroke, how are we going to manage that?  :30

Johansen says specialized stroke units also need CT and techs to do the studies to confirm or rule out a stroke, taking resources away from more centralized places like hospitals where more patients could be evaluated. At Johns Hopkin, I’m Elizabeth Tracey.

Mobile stroke units, much like emergency medical service trucks, enable  responders to evaluate and begin treatment for stroke in the field, with a recent study demonstrating they improve outcomes. Michele Johansen, a stroke expert at Johns Hopkins, says there are a few things to consider before a full scale investment in mobile stroke units.

Johansen: Stroke in general has done a great job training EMS personnel. They know how to screen stroke, they know what to do with a stroke, they know how to get stroke to an emergency room quickly. What the mobile stroke unit has that’s different from the EMS truck is advanced technology and advanced staffing. The advanced technology is a CT scanner. Unless the cost comes down that’s something to really think about before we start throwing out all these mobile stroke units. You’re going to need somebody like a tech for the CT to be in the mobile stroke unit to do the CT. That’s one of the key components of getting someone to the emergency room quickly, is making sure that they haven’t had a bleed.  :33

Johansen says she is concerned about personnel shortages in hospitals already, and assigning someone to a mobile stroke unit may make matters worse. At Johns Hopkins, I’m Elizabeth Tracey.

Children under twelve remain at risk for Covid infection, and even older children who can’t receive the vaccine or are immunocompromised are also at risk. Anna Durbin, an infectious disease expert at Johns Hopkins, says there are steps parents can take to protect their children.

Durbin: The family is the wall surrounding the children. So you want to make sure of course that you’re vaccinated, people they come in contact with are vaccinated. It’s really really difficult if you’re going to public spaces and you don’t know who’s vaccinated and who’s not vaccinated. I am cautiously optimistic, as kids under 12 get vaccinated, and we have vaccine mandates roll out that we are going to see decreases. And I think delta is slowing, I think that we’re starting to see that it’s peaked. It’s waning, but we still have I think probably six to eight weeks before we might feel safer.  :33

Durbin counsels patience as vaccines for younger children are evaluated. At Johns Hopkins, I’m Elizabeth Tracey.