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Showing posts from 2018

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.

Dementia Specific Advance Directive: Podcast with Barak Gaster

In this weeks GeriPal podcast, we interview Dr. Barak Gaster, Professor of Medicine and General Internist at the University of Washington in Seattle. Dr. Gaster felt like there was hole in the advance directives landscape around future planning for people with dementia. People with dementia experience a fairly common set of complications and decisions around feeding, loss of independence, and loss of ability to make complex decisions. His dementia specific advance directive has specific sections for care preferences for persons who progress through stages of dementia, including descriptions of mild, moderate, or severe dementia.

A Social Worker Led Palliative Care Intervention in Heart Failure: A Podcast with Arden O'Donnell

Can routine initiation of goals of care discussions by a palliative care social worker improve prognostic understanding, elicit advanced care preferences, and influence care plans for high-risk patients discharged after a heart failure hospitalization? That is the question we attempt to answer with this weeks podcast guest, Arden E. O’Donnell.

NEJM Family-Support Intervention Trial, Breakthrough or Bust? Podcast with Doug White

by: Alex Smith, @AlexSmithMD

This week's guest is Doug White, Professor of Critical Care Medicine at the University of Pittsburgh and lead author of a randomized controlled study of a nurse-led intervention to provide emotional support to families of seriously ill patients in the ICU and improve the quality of communication, published in the NEJM.

Nurses trained in standard palliative care communication techniques (think NURSE statements) provided the intervention, which included regular family meetings with family members and daily check ins for emotional support.

The primary outcome, difference between the intervention and control groups in anxiety or depressive symptoms at 6 months, was negative.  There was just nothing going on.  Zilch.  So was it a bust?

Well...multiple secondary outcomes were positive, including improved quality of communication, greater perception of patient-centered care, and 28% costs in the intervention group compared to control.  Well, that sounds gre…

Top 5 Resources for Studying for the Hospice and Palliative Medicine Board Exams

We have started to get a lot of questions about how best to study for the 2018 Hospice and Palliative Medicine Board Exam.  Yes, that one that many of us took a little less than 10 years ago and now it’s coming due.  Or the one that you need to take after completing your fellowship this year.  

So, to help answer these question, we at Pallimed and GeriPal have created a quick guide of the top 5 resources we use to prep for the boards:
AAHPM's Intensive Board Review Course: the ultimate live in-person prep that includes a pretty stellar cast of speakers including Mary Lynn McPherson, Kim Curseen, Sandra Sanchez-Reilly, Joe Shega, Drew Rosielle, Michelle Weckman, Scott Schwantes, Janet Bull, Jeff Spiess, and Gregg VandeKieft.   The course takes place this August 9-11, 2018 in Minneapolis, MN, and will include both lecture based content plus lots of exam-type questions to help you pass the test (and brush up on your hospice and palliative care knowledge).  Plus you get to hang out wi…

How do patients decide whether or not to initiate dialysis? An Interview with Keren Ladin

How do patients come to the decision regarding whether or not to initiate dialysis?   Well, that is the question that we talk about with Keren Ladin on this week's podcast.  Keren is a social science researcher, bioethicist, and assistant professor in the department of Occupational Therapy at Tufts.  


What becomes clear when you look at Keren's research is the for many patients, there isn't a decision that is made.  As Keren said in our podcast:
We had asked people all these what we thought were thoughtful questions about, "Can you tell us more about what were the factors that were involved and how did you come to this decision"... and eventually we just got back two different options. One was that it wasn't really a decision at all, that they had felt that they needed to start it or that they would kind of die immediately, or that it wasn't their choice, it was more of their physician's choice, which we thought was also really interesting. To read mo…