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Showing posts from November, 2016

The Role of Cranberries in Preventing Urinary Tract Infections

Just in time for Thanksgiving, we are having a GeriPal podcast episode dedicated to the humble cranberry (click here to listen).

We discuss the use of cranberries to preventing urinary tract infections with Dr. Manisha Juthani-Mehta.  In addition to hearing about something called proanthocyanidin, we discuss her recent publication in JAMA on whether cranberry capsules decrease the presence of bacteriuria plus pyuria in older women living in nursing homes (spoiler alert - they don't).

If you want to read more about the paper, as well as a Cochrane review summarizing the evidence for cranberries to prevent urinary tract infections, please check out the following:
Juthani-Mehta M, et al. Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing HomesA Randomized Clinical Trial. JAMA. 2016;316(18):1879-1887. Jepson RG, et al. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321.
by: Eric Widera (@ewidera)
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Ger…

Palliative Care as the Standard of Care for Stem Cell Transplants

Today was a big day for palliative care.  Really big.  Why?   Because today we have the strongest evidence to date that integrating specialized palliative care into usual care not only helps those individuals with life-liming diseases like metastatic lung cancer, but also those undergoing potentially curative therapies.

In todays JAMA, El-Jawahri and colleagues describe a single-center randomized clinical trial of 160 adults hospitalized for hematopoietic stem cell transplantation.   These individuals either received specialist palliative care integrated along with usual transplant care or just usual transplant care.  Those assigned to palliative were seen by palliative care clinicians at least twice per week during hospitalization, with the focus primarily on addressing physical and psychological symptoms.

The usual course of stem cell transplant is one that includes worsened quality of life, increased symptom burden, and worsening mood, all of which were seen in the usual care grou…

Hallelujah: Integrating Primary Palliative Care In The ICU

There are a lot of ways one can imagine on how to integrate palliative care into the intensive care unit (ICU).   Some of these ideas don't work so well, like in a recent JAMA article that we discussed in a GeriPal post titled "Fast food-style palliative care consults found inneffective, may cause PTSD."

In todays GeriPal podcast, we talk with ICU doctor and researcher, Bill Ehlenback, about some ways that may work, including a discussion of his recent study looking at a proactive palliative care rounding intervention.   Along the way, Alex takes us on trivia journey celebrating the work of Leonard Cohen.




For those who want a little deeper dive, here are some of the articles we discussed in the podcast:
Braus, N., Campbell, T.C., Kwekkeboom, K.L. et al. Intensive Care Med (2016) 42: 54.Curtis, R.  Randomized Trial of Communication Facilitators to Reduce Family Distress and Intensity of End-of-Life Care.  Am J Respir Crit Care Med. 2016 Jan 15;193(2):154-62
by: Eric Wide…

Honoring Veterans

This Veterans' Day, stop and think about the World War II Veteran. The average veteran of WWII is now over 85 years old.  Currently 500 WWII veterans die every day. The "Greatest Generation" is in need of geriatric palliative care.

The next WWII veteran that you care for, ask them if they have been on an Honor Flight. If you have not heard about Honor Flights, read more about this amazing program here.  I once had the pleasure to see an Honor Flight arrive to Reagan National Airport (DCA) and the entire airport stood in applause.  It was truly moving as the leader of the group asked the terminal to cheer for these heroes.

The Honor Flight takes veterans and flies them (with medical volunteer support) to DC to see the WWII memorial on the mall (the program has expanded to Korean and Vietnam Wars' veterans as well.)  The WW II memorial was not completed until 2004, and by the time it was finally dedicated, many veterans who had waited for decades hoping to travel to th…

Sweet Little Lies: Is it Ever Ok to Lie to Our Patients?

Truth telling is an ethical pillar of medicine. But, are there instances when it is ever ok to lie to a patient?  In this episode of the GeriPal podcast we explore the use of deception and lies in modern healthcare, from those sweet little “therapeutic lies” commonly used in dementia care to withholding a diagnosis like terminal cancer.




While we don't pretend to know all the answers, we do have some wonderful resources that have helped shape our thoughts on the use of lies and deception in medicine:
Tony McElveen. Lying to people with dementia: treacherous act or beneficial therapy?Schermer M. Nothing but the truth? On truth and deception in dementia care.  Bioethics. 2007.
by: Eric Widera (@ewidera)

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Transcript of the Podcast:


Eric: Welcome to the GeriPal podcast, this is Eric Widera.

Alex: This is Alex Smith.

Eric: Before we start, Alex, do you want to give us a little song?

Alex…