Skip to main content


Showing posts from October, 2017

Skin Failure: A New Paradigm

by Jeffrey M. Levine MD , AGSF, CWSP Skin failure is an emerging concept that deserves wider acceptance, particularly in the palliative care setting. Clinicians have long recognized that skin failure exists, but adoption of the name has been limited due to lack of a universally accepted definition. Terms such as Kennedy Terminal Ulcer (KTU), Skin Changes at Life’s End (SCALE), and the Trombley-Brennan Terminal Tissue Injury (TB-TTI) have been advocated to describe skin breakdown in patients who are dying. However this nomenclature does not fit into the clinical course of wounds that have similar characteristics in patients who recover from critical illness but have residual pressure injury. The term 'skin failure' assembles these phenomena into an easily understandable and more clinically accurate term. Pressure ulcers are often associated with lapses in quality of care.  However, there is growing recognition that pressure ulcers can occur in circumstances when risk is

Implicit Bias and Its Impact in Geriatrics, Hospice and Palliative Care

On this week's podcast , we have invited Dr. Kimberly Curseen to talk about how implicit bias influences us as providers in geriatrics, hospice, and palliative care, as well as the role of that cultural competence and cultural humility should play in our practice.  Kimberly Curseen, M.D. is an Associate Professor of Internal Medicine at Emory School of Medicine and Director of Outpatient Supportive/Palliative Care, Emory Healthcare. Here is Dr. Curseen introducing implicit bias in the podcast: "The way I like to think about it, implicit bias is the subconscious thoughts that we have that actually influence our behavior and we do this all the time. We're not completely conscious or behave in conscious ways about our environments. It's that first reaction, that first thought or assessment that we make of a situation or a person, that informs the way we behave. The explicit bias is when we're actually conscious of our assessment of a situation or of a person a

Gretchen Schwarze on Uncertainty, Scenario Planning, and American Pie

This week's GeriPal podcast features vascular surgeon, researcher, and bioethicist Gretchen Schwarze from the University of Wisconsin.  We talk with Gretchen about her recent NEJM paper titled, " Managing Uncertainty: Harnessing the power of scenario-planning ." What is scenario planning?  Does it sound like something a lawyer would talk to you about (a la "estate planning?") Here is Dr. Schwarze introducing scenario planning in the podcast: The idea behind scenario-planning, which is what our paper is about, is that it's not just about showing the limits of what's possible, but also the story that unfolds along the way. I agree with you, physicians hate this idea of uncertainty, because we don't want to be wrong, but we're not asking people to be certain. What we're asking people is to tell a story that's plausible and that shows that there are limits on what's possible to happen. It's not just where you end up, but