Skip to main content

Welcome to #GeriCases


I want to welcome all GeriPal bloggers and readers to this new series of geriatric patient cases (#GeriCases) under the realm of Evidence-Based Medicine (EBM).

EBM is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

In fewer words, it can be explained by the model by Haynes, et al.


Even though patients would like to believe that clinicians have all the answers to their medical problems, clinicians often face questions and uncertainty when evaluating patients. EBM urges the clinicians to utilize best available evidence in light of their clinical expertise and patient preferences. This requires skill and time: to identify the question, look for evidence in the literature, evaluate the article for its validity and applicability and finally be able to apply it to the patient in front of the clinician.

These short blog posts are the work of significant evidence search and appraisal by geriatrics clinicians – fellows and faculty in the Department of Geriatrics and Palliative Medicine at Icahn School of Medicine at Mount Sinai. They will start with a short description of a geriatric patient case (without patient identifiers), followed by a clinical question. This question will be addressed in subsequent paragraphs by a systematic search of the literature and appraisal of the article/s, finally ending with how patient care was impacted by the practice of EBM. I hope you enjoy them and find them useful. Feel free to post your comments.

by: Ravishankar Ramaswamy, MD
@RavRamaswamy
Section Editor, #GeriCases

Comments

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…

Palliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den Block

Nursing homes are a tough place to do palliative care.  There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice.  So what can we do to improve the palliative care outlook in nursing homes?

On todays podcast we talk with Lieve Van den Block about her recent palliative care intervention that was published in JAMA IM this week.  Lieve led a multicomponent intervention to integrate basic nonspecialist palliative care in in 78 nursing homes located in 7 different European countries.  Just take a moment to grasp the size of this study - 7 counties, 78 nursing homes.  I struggle with just trying to improve palliative care in one site!

We discuss with Lieve the results of the study, her take on why they got…