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Showing posts from June, 2018

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

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