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All the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson

On today's podcast we go deep into the mind of one of the most brilliant and respected palliative care pharmacists, Mary Lynn McPherson, to ask all the questions we've had about opioids but were too afraid to ask.   There isn't really a better person to do this with, as she also just released her second edition of her book:  Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing.  This is the go-to guide for not only learning how to calculate opioid conversions, but also gives great tips for those who have been doing this for a while (I learned a ton from it).

In today's podcast we talk about specific aspects of her book including questions about:

Whether is is time to update equianalgesic tablesThe usefulness of opioid conversion calculationsTips and tricks on methadone dosingFentanyl and cachexiaSublingual morphine - does it work?What to use in liver and renal failure (and why it may not be hydromorphone)Titrating PCAs and dripsand so much more... …
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Teaching Communication Skills: Podcast with Wendy Anderson

How do you teach communication in serious illness?  Can you?  Do you teach it the same way to doctors and nurses in training?  What level trainee do you target - medical students, interns, residents?  How do we know our teaching is working?

We discuss these and other bread and butter communication issues with Dr. Wendy Anderson, a palliative care physician at UCSF, director of the Bay Area Hub for Vitaltalk, and leader of IMPACT-ICU, a project to train ICU nurses in communication.  

Managing Behavioral Symptoms in Dementia: Podcast with Helen Kales

In this week's podcast we talk with Helen Kales, Professor of Psychiatry at the University of Michigan the VA Center for Clinical Management and Research. 

We've spent a great deal of effort in Geriatrics describing what we shouldn't do to address behavioral symptoms in dementia: physical restraints, antipsychotics, sedating antidepressants.  Helen Kales was lecturing around the country about all of these things we shouldn't do a few years back, and people would raise their hands and ask, "Well, what should we do?" She realized she needed to give caregivers tools to help.

Churning Patients Through the End of Life: A Podcast with Joan Teno

On this weeks podcast, we interview Dr. Joan Teno about her recently published study in JAMA titled "Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015."

In 2013, Dr. Teno published a study that showed how good our health care system in the US promotes patient churn. Despite positive signs of more hospice use and decreased deaths in the hospital, Dr. Teno found the from 2000 to 2009 we "churned" patients through more ICU visits, more hospitalizations, and more late transitions that are burdensome to dying persons in their family. Dr. Teno's latest study shows us how we are doing now, extending that work to 2015 and now including Medicare Advantage (MA) plans.

Number Needed to Tweet: Podcast with Charlie Wray

This week we talk with Charlie Wray, MD, Assistant Professor of Medicine at UCSF, about why clinicians should use social media in their professional lives. Charlie is a hospitalist and the Associate Social Media Editor for the Journal of Hospital Medicine. His arguments for using social media are germane to all clinicians, however. "Number Needed to Tweet" is the title of his recent grand rounds on this subject.

Nowhere Else to Be

The following story is by Jennifer Heidmann, MD, FACP. She is the Medical Director of Redwood Coast PACE in Eureka, CA, as well as a physician for Hospice of Humboldt and a hospitalist at St Joseph Hospital.

Hospice of Humboldt: Podcast with John Nelson

In this week's GeriPal podcast we talked with Dr. John Nelson, who has been Medical Director of Hospice of Humboldt for 17 years. Hospice of Humboldt serves the area around Eureka, a mix of town and very rural locations, and has several unique features, including:

How to Respond to an Inpatient Palliative Care Consult Request

Dilemmas in Aid in Dying: Podcast with Bernie Lo

In this week's podcast we talked with Dr. Bernard Lo (Bernie as he is known). Dr. Lo is President of the Greenwall Foundation, a foundation dedicated to improving Bioethics research nationally. Prior to Greenwall, Dr. Lo was Professor of Medicine at UCSF and head of the Bioethics Program. He still maintains a primary care practice at UCSF.

Geriatricizing the ICU

For today's GeriPal Podcast we talk with Drs. Nathan Brummel and Lauren Ferrante, both critical care physician-researchers, about integrating geriatrics principles in intensive care units.

Tramadon't: a podcast with David Juurlink about the dangers of Tramadol

Tramadol. Is it just a misunderstood opioid that is finally seeing its well deserved day in the sun, or is it, as our podcast guest David Juurlink put it, what would happen if "codeine and Prozac had a baby, and that baby grew into a sullen, unpredictable teenager who wore only black and sometimes kicked puppies and set fires"?

Well that's what we are going to be discussing today with none other than David Juurlink, an Internist and Clinical Pharmacologist at the University of Toronto who has written about Tramadon’t on both his twitter account and on the blog "Tox and Hound."

David walks us through the top reasons why we should question the rapid uptick in Tramadol prescriptions, including that its metabolism is hugely variable, so giving a dose of Tramadol is like giving venlafaxine and morphine in an unknown ratio. It also is associated with increased risks of hypoglycemia, seizures, serotonin syndrome and all the other usual stuff with opioids (including dep…

Destination Therapy: A Podcast about LVAD decision making with Dan Matlock and Larry Allen

On today's episode we talk to Larry Allen and Dan Matlock about decision making around destination therapy. No this has nothing to do with your summer vacation plans. Rather, we talk about how individuals with heart failure decide about whether or not to pursue "destination therapy" with an Left Ventricular Device, or LVAD.