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Showing posts from October, 2020

Palliative Care for non-cancer illness: Podcast with Kieran Quinn and Krista Harrison

In this week's podcast we talk with Kieran Quinn, author of a systematic review and meta-analysis of palliative care for non-cancer illness , published in JAMA.  We also talk with Krista Harrison, first author of an accompanying editorial .   JAMA editors cut out some of my favorite parts of Krista's editorial , possibly because they were more like a blog post than a JAMA editorial.  (I was senior author; go figure how it ended up reading like a blog post!) So here is the submitted introduction, unedited: "As with many people’s best ideas, inspiration struck in the shower. Dr. Balfour Mount, a urologic-cancer surgeon at the Royal Victoria Hospital in Quebec, Canada, needed a name to differentiate a new hospital-based service he created for people with serious life-threatening illness from Dr. Cicely Saunders’ English hospice programs. Dr. Mount coined the term “palliative care” to connote the core goals of the service: to improve quality of life and to mitigate sources of

State of Heart Failure & Palliative Care: Podcast with Haider Warraich

There are a lot of large numbers that involve heart failure, starting with the sheer number of patients diagnosed (6.5 million and counting), to the cost of their care (~$70 billion by 2030), to the amount of money invested by the NIH into research ($1 billion annually). But the smaller numbers deserve attention too - 50% of patients die within 5 years of their diagnosis, those older than 65 in the hospital die even sooner at ~2.1 years thereafter, the median survival on hospice since hospital discharge is 11 days, and <10% of patients with heart failure receive a palliative care consult. So what can we do to bridge the gap between heart failure and palliative care? As a current palliative care fellow and former hospitalist on UCSF's Advanced Heart Failure service, I have a strong interest in this question. This week I was lucky to have Alex and Eric let me join in interviewing Haider Warraich, Associate Director of Heart Failure at the Boston Veterans Affairs Hospital and Assoc

The Geriatric 5M Approach to Telemedicine Assessment: A Podcast with Lauren Moo

On todays podcast, we have Lauren Moo, a cognitive behavioral neurologist who has been doing video visits well before the COVID-19 pandemic to decrease the need for travel and to decrease the agitation in older adults with dementia that commonly occur when a clinic visits disrupts the usual routine.   Now with COVID among us, Lauren talks to us about her recently published JAGS article titled " Home Video Visits: 2‐D View of the Geriatric 5‐M s."   In the article and on the podcast, Lauren walks us through assessing the Geriatric 5M framework : mind, mobility, medications, multicomplexity, and what matters most.   Lauren gets very practical with us about how she does things like a cognitive assessments in this new medium of telemedicine.   One thing I'd like to note that we didn't talk about in our podcast, but Joe Ouslander wrote in the accompanying editors note to Lauren's article: "I recommend that you discourage patients and families from using the backgr

Advance Care Planning is So Right: Podcast with Rebecca Sudore and Ryan McMahan

Last month we published a podcast with Sean Morrison that garnered a great deal of attention, in which Sean Morrison argued that Advance Care Planning is an idea that is “clear, simple, and wrong.” This week, we have a fresh updated counterpoint from Rebecca Sudore and Ryan McMahan.  These two published a paper this week in the Journal of the American Geriatrics Society , or JAGS, that argues that the field of advance care planning has come a long way.  Early studies of advance care planning evaluated it with advance directives, and studies of advance directives showed little to no difference.  However, In their review they find recent (since 2010) high quality trials demonstrate the potential of advance care planning by using modern conceptions of advance care planning as a longitudinal conversation to help surrogates prepare for in the moment decision making.  These studies evaluated a broader (and more fitting) range of outcomes than prior work, including surrogate preparedness.

Why You Should Never Mix Miralax (PEG) with Starch Based Thickend Liquids

  By: Matthew Gonzales and Eric Widera Many of us in the GeriPal community are dubious about the benefits of using thickened liquids for dysphagia. If you haven’t read prior posts on this, head on over to see a great analysis illustrating the limited evidence . (Side note – if you need a pick me up for these days of 2020, be sure you revisit this video of the GeriPal team trying thickened liquids for the #ThickenedLiquidChallenge ).  Despite the lack of robust data, dysphagia-based diets with thickened liquids remain a standard of care. The hope is that it is easier for people to coordinate swallowing with a thick liquid versus a thin liquid and thus less aspiration events occur. To achieve the desired thickness, one adds a powdered thickener to any thin liquid (water, juice, coffee, etc.), stir, and voilĂ  you have a thickened version of that liquid. There are two types of powder typically used to thicken liquids. The original is starch based (i.e., cornstarch) while the newer

Brain Death: A Podcast with Robert Truog

In 1968 a committee at Harvard Medical School met to lay down the groundwork for a new definition of death, one that was no longer confined to the irreversible cessation of cardiopulmonary function but a new concept based on neurological criteria.  Over the next 50 years, the debate over the concept of brain death has never really gone away.  Rather cases like Jahi McMath have raised issues of the legitimacy of the neurologic criteria.   On today's podcast, we talk with one of the leading international thought leaders on Brain Death, Dr. Robert Truog.  Robert is the Glessner Lee Professor of Medical Ethics, Anaesthesiology & Pediatrics and Director of the Center for Bioethics at Harvard Medical School.  He has also authored multiple articles on this topic including the Hastings Center Brain Death at Fifty: Exploring Consensus, Controversy, and Contexts and these from JAMA: The 50-Year Legacy of the Harvard Report on Brain Death  Understanding Brain Death  Brain Death—Moving