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BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. WHY YOU SHOULD NEVER MIX MIRALAX (PEG) WITH STARCH BASED 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 COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis INAPPROPRIATE MEDICATIONS IN THE HOSPICE SETTING Inappropriate Medications in the Hospice Setting. August 02, 2009. Supportive Care in Cancer recently published an article on the use of “futile” medications in patients with advanced and incurable cancer. It was a retrospective chart review of patients attending a palliative care clinic at the Princess Margaret Hospital in Torontobetween
GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.”. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE) A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH State of Heart Failure & Palliative Care: Podcast with Haider Warraich. October 22, 2020. 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 intoresearch ($1
BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. WHY YOU SHOULD NEVER MIX MIRALAX (PEG) WITH STARCH BASED 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 COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis INAPPROPRIATE MEDICATIONS IN THE HOSPICE SETTING Inappropriate Medications in the Hospice Setting. August 02, 2009. Supportive Care in Cancer recently published an article on the use of “futile” medications in patients with advanced and incurable cancer. It was a retrospective chart review of patients attending a palliative care clinic at the Princess Margaret Hospital in Torontobetween
BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. VIRTUAL RESOURCES FOR OLDER ADULTS DURING THE COVID19 PANDEMIC Virtual Resources for Older Adults during the COVID19 Pandemic. September 15, 2020. by: Kahli Zietlow, Serena P Wong, and Mitchell Heflin. In a recent telehealth visit, a patient presented alongside her husband, who was concerned that she had become a “shell of herself.”. She previously enjoyed reading, spending time withfamily, and
ALL ABOUT IMPLANTABLE CARDIAC DEFIBRILLATORS AND We had fun on this in-studio podcast with Dan Matlock, geriatrician and palliative care clinician researcher at the University of Colorado, and frequent guest and host on GeriPal. We most recently talked with Dan about Left Ventricular Assist Devices and Destination Therapy. Today we talked with Dan about Implantable Cardiac Defibrillators (ICD) - everything a geriatrician or palliative care TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. LENGTH OF STAY IN NURSING HOMES AT THE END OF LIFE the median length of stay in a nursing home before death was 5 months. the average length of stay was longer at 14 months due to a small number of study participants who had very long lengths of stay. 65% died within 1 year of nursing home admission. 53% died within 6 months of nursing home admission. The authors also found that length of stay SOMETIMES IT'S JUST A WAY TO DIE Sometimes It's Just a Way to Die. September 29, 2012. During my senior year of residency, I brought an elderly gentleman to the operating room with peritonitis and a benign-appearing CT scan only to find a belly full of black, necrotic bowel. We closed him up, told his family, and he died peacefully several hours later. WHEN TO STOP MEDICATIONS IN ADVANCED DEMENTIA Over half of nursing home residents with advanced dementia (53.9%) received at least one medication of questionable benefit. The most commonly prescribed were cholinesterase inhibitors (36.4%) and memantine hydrochloride (25.2%). Continuing these medications does not increase survival or alter the course of advanced disease, can causeside
GERIPAL TASTE TEST PART I: LIQUID BOWEL MEDICATIONS GeriPal has put together a taste test on "Liquid Bowel Medications" (see attached video) which was inspired from a great selection of comments from our previous posts on medications that should never be prescribed to hospice patients. We have a fine selection of medications including sorbitol, lactulose, and liquid (and crushed!)docusate.
INAPPROPRIATE MEDICATIONS IN THE HOSPICE SETTING Inappropriate Medications in the Hospice Setting. August 02, 2009. Supportive Care in Cancer recently published an article on the use of “futile” medications in patients with advanced and incurable cancer. It was a retrospective chart review of patients attending a palliative care clinic at the Princess Margaret Hospital in Torontobetween
GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.”. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE) A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
"PALLIATIVE" INOTROPES?!?: PODCAST WITH HAIDER WARRAICH Eric: Welcome to the GeriPal podcast. This is Eric Widera. Alex: This is Alex Smith. Eric: And Alex, who do we have with us today? Alex: Well today, we're welcoming back to the GeriPal Podcast Haider Warraich, who is a heart failure specialist, does research, writing, he's interested in palliative care. He's at the VA in Boston and the Brigham and Women's Hospital also in Boston. FRAILTY AND RESILIENCE: A PODCAST WITH LINDA FRIED On today’s podcast we talk to Linda Fried, Dean of Columbia University's Mailman School of Public Health and world renown frailty researcher about all things frailty. We talk to Dr. Fried about how she first got interested in frailty, how we define it including the difference between phenotypic frailty and a “deficit accumulationmodel
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. SOMETIMES IT'S JUST A WAY TO DIE Sometimes It's Just a Way to Die. September 29, 2012. During my senior year of residency, I brought an elderly gentleman to the operating room with peritonitis and a benign-appearing CT scan only to find a belly full of black, necrotic bowel. We closed him up, told his family, and he died peacefully several hours later. TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. "PALLIATIVE CHEMOTHERAPY" What is this term "palliative chemotherapy"? Are the words "palliative" and "chemotherapy" so incompatible that their combination is an oxymoron? Is this term a useful term? Who is it useful for? Doctors? Patients? Researchers?I think the term "palliative chemotherapy" is misused by doctors and confusing to patients. It muddies the waters of what "palliative" means. GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.”. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE) A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
"PALLIATIVE" INOTROPES?!?: PODCAST WITH HAIDER WARRAICH Eric: Welcome to the GeriPal podcast. This is Eric Widera. Alex: This is Alex Smith. Eric: And Alex, who do we have with us today? Alex: Well today, we're welcoming back to the GeriPal Podcast Haider Warraich, who is a heart failure specialist, does research, writing, he's interested in palliative care. He's at the VA in Boston and the Brigham and Women's Hospital also in Boston. FRAILTY AND RESILIENCE: A PODCAST WITH LINDA FRIED On today’s podcast we talk to Linda Fried, Dean of Columbia University's Mailman School of Public Health and world renown frailty researcher about all things frailty. We talk to Dr. Fried about how she first got interested in frailty, how we define it including the difference between phenotypic frailty and a “deficit accumulationmodel
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. SOMETIMES IT'S JUST A WAY TO DIE Sometimes It's Just a Way to Die. September 29, 2012. During my senior year of residency, I brought an elderly gentleman to the operating room with peritonitis and a benign-appearing CT scan only to find a belly full of black, necrotic bowel. We closed him up, told his family, and he died peacefully several hours later. TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. "PALLIATIVE CHEMOTHERAPY" What is this term "palliative chemotherapy"? Are the words "palliative" and "chemotherapy" so incompatible that their combination is an oxymoron? Is this term a useful term? Who is it useful for? Doctors? Patients? Researchers?I think the term "palliative chemotherapy" is misused by doctors and confusing to patients. It muddies the waters of what "palliative" means. "PALLIATIVE" INOTROPES?!?: PODCAST WITH HAIDER WARRAICH Eric: Welcome to the GeriPal podcast. This is Eric Widera. Alex: This is Alex Smith. Eric: And Alex, who do we have with us today? Alex: Well today, we're welcoming back to the GeriPal Podcast Haider Warraich, who is a heart failure specialist, does research, writing, he's interested in palliative care. He's at the VA in Boston and the Brigham and Women's Hospital also in Boston. STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH State of Heart Failure & Palliative Care: Podcast with Haider Warraich. October 22, 2020. 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 intoresearch ($1
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. VIRTUAL RESOURCES FOR OLDER ADULTS DURING THE COVID19 PANDEMIC Virtual Resources for Older Adults during the COVID19 Pandemic. September 15, 2020. by: Kahli Zietlow, Serena P Wong, and Mitchell Heflin. In a recent telehealth visit, a patient presented alongside her husband, who was concerned that she had become a “shell of herself.”. She previously enjoyed reading, spending time withfamily, and
"PALLIATIVE CHEMOTHERAPY" What is this term "palliative chemotherapy"? Are the words "palliative" and "chemotherapy" so incompatible that their combination is an oxymoron? Is this term a useful term? Who is it useful for? Doctors? Patients? Researchers?I think the term "palliative chemotherapy" is misused by doctors and confusing to patients. It muddies the waters of what "palliative" means. TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. GERIPAL TASTE TEST PART I: LIQUID BOWEL MEDICATIONS GeriPal has put together a taste test on "Liquid Bowel Medications" (see attached video) which was inspired from a great selection of comments from our previous posts on medications that should never be prescribed to hospice patients. We have a fine selection of medications including sorbitol, lactulose, and liquid (and crushed!)docusate.
WHEN TO STOP MEDICATIONS IN ADVANCED DEMENTIA Over half of nursing home residents with advanced dementia (53.9%) received at least one medication of questionable benefit. The most commonly prescribed were cholinesterase inhibitors (36.4%) and memantine hydrochloride (25.2%). Continuing these medications does not increase survival or alter the course of advanced disease, can causeside
THE DANGERS OF FLEET ENEMAS The Dangers of Fleet Enemas. February 23, 2012. The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counterpreparations of
DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.”. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE) A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. "PALLIATIVE" INOTROPES?!?: PODCAST WITH HAIDER WARRAICH Recall that in one of our earliest podcasts, we talked with Nate Goldstein who memorably proclaimed “the best palliative care for heart failure is treatment for heart failure.”. To unpack the issue of palliative inotropes, we welcome back Haider Warraich, acardiologist with a
BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
WHY YOU SHOULD NEVER MIX MIRALAX (PEG) WITH STARCH BASED 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 COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. SOMETIMES IT'S JUST A WAY TO DIE Sometimes It's Just a Way to Die. September 29, 2012. During my senior year of residency, I brought an elderly gentleman to the operating room with peritonitis and a benign-appearing CT scan only to find a belly full of black, necrotic bowel. We closed him up, told his family, and he died peacefully several hours later. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. THE DANGERS OF FLEET ENEMAS The Dangers of Fleet Enemas. February 23, 2012. The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counterpreparations of
GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.”. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE) A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. "PALLIATIVE" INOTROPES?!?: PODCAST WITH HAIDER WARRAICH Recall that in one of our earliest podcasts, we talked with Nate Goldstein who memorably proclaimed “the best palliative care for heart failure is treatment for heart failure.”. To unpack the issue of palliative inotropes, we welcome back Haider Warraich, acardiologist with a
BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
WHY YOU SHOULD NEVER MIX MIRALAX (PEG) WITH STARCH BASED 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 COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. SOMETIMES IT'S JUST A WAY TO DIE Sometimes It's Just a Way to Die. September 29, 2012. During my senior year of residency, I brought an elderly gentleman to the operating room with peritonitis and a benign-appearing CT scan only to find a belly full of black, necrotic bowel. We closed him up, told his family, and he died peacefully several hours later. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. THE DANGERS OF FLEET ENEMAS The Dangers of Fleet Enemas. February 23, 2012. The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counterpreparations of
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. VIRTUAL RESOURCES FOR OLDER ADULTS DURING THE COVID19 PANDEMIC Virtual Resources for Older Adults during the COVID19 Pandemic. September 15, 2020. by: Kahli Zietlow, Serena P Wong, and Mitchell Heflin. In a recent telehealth visit, a patient presented alongside her husband, who was concerned that she had become a “shell of herself.”. She previously enjoyed reading, spending time withfamily, and
STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH State of Heart Failure & Palliative Care: Podcast with Haider Warraich. October 22, 2020. 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 intoresearch ($1
LENGTH OF STAY IN NURSING HOMES AT THE END OF LIFE the median length of stay in a nursing home before death was 5 months. the average length of stay was longer at 14 months due to a small number of study participants who had very long lengths of stay. 65% died within 1 year of nursing home admission. 53% died within 6 months of nursing home admission. The authors also found that length of stay DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis GERIPAL TASTE TEST PART I: LIQUID BOWEL MEDICATIONS GeriPal has put together a taste test on "Liquid Bowel Medications" (see attached video) which was inspired from a great selection of comments from our previous posts on medications that should never be prescribed to hospice patients. We have a fine selection of medications including sorbitol, lactulose, and liquid (and crushed!)docusate.
THE DANGERS OF FLEET ENEMAS The Dangers of Fleet Enemas. February 23, 2012. The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counterpreparations of
WHAT TO DO WHEN YOUR PATIENT IS RACIST? Some tricks - change the gender, the setting, the disease, the relationship of the caregiver. (2) Stories are most helpful if you share how you responded and why . A final thought. I want to write a paper about how physicians should approach the racist patient. But my sense is that, despite the influx of foreign medical graduates andincreasing
WHEN TO STOP MEDICATIONS IN ADVANCED DEMENTIA Over half of nursing home residents with advanced dementia (53.9%) received at least one medication of questionable benefit. The most commonly prescribed were cholinesterase inhibitors (36.4%) and memantine hydrochloride (25.2%). Continuing these medications does not increase survival or alter the course of advanced disease, can causeside
TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.”. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE) A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. "PALLIATIVE" INOTROPES?!?: PODCAST WITH HAIDER WARRAICH Recall that in one of our earliest podcasts, we talked with Nate Goldstein who memorably proclaimed “the best palliative care for heart failure is treatment for heart failure.”. To unpack the issue of palliative inotropes, we welcome back Haider Warraich, acardiologist with a
STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH State of Heart Failure & Palliative Care: Podcast with Haider Warraich. October 22, 2020. 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 intoresearch ($1
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. SOMETIMES IT'S JUST A WAY TO DIE Sometimes It's Just a Way to Die. September 29, 2012. During my senior year of residency, I brought an elderly gentleman to the operating room with peritonitis and a benign-appearing CT scan only to find a belly full of black, necrotic bowel. We closed him up, told his family, and he died peacefully several hours later. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. INAPPROPRIATE MEDICATIONS IN THE HOSPICE SETTING Inappropriate Medications in the Hospice Setting. August 02, 2009. Supportive Care in Cancer recently published an article on the use of “futile” medications in patients with advanced and incurable cancer. It was a retrospective chart review of patients attending a palliative care clinic at the Princess Margaret Hospital in Torontobetween
GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.”. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE) A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. "PALLIATIVE" INOTROPES?!?: PODCAST WITH HAIDER WARRAICH Recall that in one of our earliest podcasts, we talked with Nate Goldstein who memorably proclaimed “the best palliative care for heart failure is treatment for heart failure.”. To unpack the issue of palliative inotropes, we welcome back Haider Warraich, acardiologist with a
STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH State of Heart Failure & Palliative Care: Podcast with Haider Warraich. October 22, 2020. 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 intoresearch ($1
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. SOMETIMES IT'S JUST A WAY TO DIE Sometimes It's Just a Way to Die. September 29, 2012. During my senior year of residency, I brought an elderly gentleman to the operating room with peritonitis and a benign-appearing CT scan only to find a belly full of black, necrotic bowel. We closed him up, told his family, and he died peacefully several hours later. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. INAPPROPRIATE MEDICATIONS IN THE HOSPICE SETTING Inappropriate Medications in the Hospice Setting. August 02, 2009. Supportive Care in Cancer recently published an article on the use of “futile” medications in patients with advanced and incurable cancer. It was a retrospective chart review of patients attending a palliative care clinic at the Princess Margaret Hospital in Torontobetween
"PALLIATIVE" INOTROPES?!?: PODCAST WITH HAIDER WARRAICH Recall that in one of our earliest podcasts, we talked with Nate Goldstein who memorably proclaimed “the best palliative care for heart failure is treatment for heart failure.”. To unpack the issue of palliative inotropes, we welcome back Haider Warraich, acardiologist with a
STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH State of Heart Failure & Palliative Care: Podcast with Haider Warraich. October 22, 2020. 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 intoresearch ($1
BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. IT'S TIME WE STARTED TALKING OPENLY ABOUT NEAR-DEATH Joe reported a decreased fear of death, reduced feelings of guilt about having survived a war in which so many of his friends had been killed, decreased fear of punishment and his intrusive memories ceased. Affirming that, for Joe, the experience was real “made death feel less violent, less harsh.”. Processing the after-deathcommunication
VIRTUAL RESOURCES FOR OLDER ADULTS DURING THE COVID19 PANDEMIC Virtual Resources for Older Adults during the COVID19 Pandemic. September 15, 2020. by: Kahli Zietlow, Serena P Wong, and Mitchell Heflin. In a recent telehealth visit, a patient presented alongside her husband, who was concerned that she had become a “shell of herself.”. She previously enjoyed reading, spending time withfamily, and
GERIPAL TASTE TEST PART I: LIQUID BOWEL MEDICATIONS GeriPal has put together a taste test on "Liquid Bowel Medications" (see attached video) which was inspired from a great selection of comments from our previous posts on medications that should never be prescribed to hospice patients. We have a fine selection of medications including sorbitol, lactulose, and liquid (and crushed!)docusate.
LENGTH OF STAY IN NURSING HOMES AT THE END OF LIFE the median length of stay in a nursing home before death was 5 months. the average length of stay was longer at 14 months due to a small number of study participants who had very long lengths of stay. 65% died within 1 year of nursing home admission. 53% died within 6 months of nursing home admission. The authors also found that length of stay WHEN TO STOP MEDICATIONS IN ADVANCED DEMENTIA Over half of nursing home residents with advanced dementia (53.9%) received at least one medication of questionable benefit. The most commonly prescribed were cholinesterase inhibitors (36.4%) and memantine hydrochloride (25.2%). Continuing these medications does not increase survival or alter the course of advanced disease, can causeside
TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.”. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE) A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH State of Heart Failure & Palliative Care: Podcast with Haider Warraich. October 22, 2020. 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 intoresearch ($1
BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis SOMETIMES IT'S JUST A WAY TO DIE Sometimes It's Just a Way to Die. September 29, 2012. During my senior year of residency, I brought an elderly gentleman to the operating room with peritonitis and a benign-appearing CT scan only to find a belly full of black, necrotic bowel. We closed him up, told his family, and he died peacefully several hours later. THE DANGERS OF FLEET ENEMAS The Dangers of Fleet Enemas. February 23, 2012. The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counterpreparations of
INAPPROPRIATE MEDICATIONS IN THE HOSPICE SETTING Inappropriate Medications in the Hospice Setting. August 02, 2009. Supportive Care in Cancer recently published an article on the use of “futile” medications in patients with advanced and incurable cancer. It was a retrospective chart review of patients attending a palliative care clinic at the Princess Margaret Hospital in Torontobetween
GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed “pump head.”. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE) A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH State of Heart Failure & Palliative Care: Podcast with Haider Warraich. October 22, 2020. 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 intoresearch ($1
BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis SOMETIMES IT'S JUST A WAY TO DIE Sometimes It's Just a Way to Die. September 29, 2012. During my senior year of residency, I brought an elderly gentleman to the operating room with peritonitis and a benign-appearing CT scan only to find a belly full of black, necrotic bowel. We closed him up, told his family, and he died peacefully several hours later. THE DANGERS OF FLEET ENEMAS The Dangers of Fleet Enemas. February 23, 2012. The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counterpreparations of
INAPPROPRIATE MEDICATIONS IN THE HOSPICE SETTING Inappropriate Medications in the Hospice Setting. August 02, 2009. Supportive Care in Cancer recently published an article on the use of “futile” medications in patients with advanced and incurable cancer. It was a retrospective chart review of patients attending a palliative care clinic at the Princess Margaret Hospital in Torontobetween
BRAIN DEATH: A PODCAST WITH ROBERT TRUOG 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 theHastings
PARENTERAL FLUIDS AT THE END OF LIFE Parenteral Fluids at the End of Life. It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV or subcutaneous) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH State of Heart Failure & Palliative Care: Podcast with Haider Warraich. October 22, 2020. 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 intoresearch ($1
ALL ABOUT IMPLANTABLE CARDIAC DEFIBRILLATORS AND We had fun on this in-studio podcast with Dan Matlock, geriatrician and palliative care clinician researcher at the University of Colorado, and frequent guest and host on GeriPal. We most recently talked with Dan about Left Ventricular Assist Devices and Destination Therapy. Today we talked with Dan about Implantable Cardiac Defibrillators (ICD) - everything a geriatrician or palliative care LENGTH OF STAY IN NURSING HOMES AT THE END OF LIFE the median length of stay in a nursing home before death was 5 months. the average length of stay was longer at 14 months due to a small number of study participants who had very long lengths of stay. 65% died within 1 year of nursing home admission. 53% died within 6 months of nursing home admission. The authors also found that length of stay A NEW TREATMENT FOR ATRIAL FIBRILLATION IN THE ELDERLY Atrial Fibrillation is a very common heart rhythm that substantially increases the risk for stroke. The likelihood of having atrial fibrillation increases markedly with age. WHEN TO STOP MEDICATIONS IN ADVANCED DEMENTIA Over half of nursing home residents with advanced dementia (53.9%) received at least one medication of questionable benefit. The most commonly prescribed were cholinesterase inhibitors (36.4%) and memantine hydrochloride (25.2%). Continuing these medications does not increase survival or alter the course of advanced disease, can causeside
DO THICKENED LIQUIDS BENEFIT PEOPLE WITH SWALLOWING There are a lot of people with swallowing difficulty who are currently getting thickened liquids. For instance, in one study published in 2004 in the Journal of the American Dietetic Association, one out of twelve nursing home residents in the U.S. were getting thickened liquids.Of these individuals getting thickened liquids, 30% were getting honey consistency thickened liquids and 60% were WHAT TO DO WHEN YOUR PATIENT IS RACIST? Some tricks - change the gender, the setting, the disease, the relationship of the caregiver. (2) Stories are most helpful if you share how you responded and why . A final thought. I want to write a paper about how physicians should approach the racist patient. But my sense is that, despite the influx of foreign medical graduates andincreasing
TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE David: All right, so Tramadol itself, the drug Tramadol isn't much of an opioid. It's an SNRI, more or less like Venlafaxine. It's converted by the liver into an opioid. It's actually got several metabolites but there's a key one, goes by the handle M1 or O-Desmethyltramadol and that metabolite is an opioid. GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE)GERIPAL PODCASTGERIPAL PODCAST TRAMADONT A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. BRAIN DEATH: A PODCAST WITH ROBERT TRUOG Listen to GeriPal Podcasts on: iTunes ; Google Play Music; Soundcloud; Stitcher; TRANSCRIPT. Eric: Welcome to the GeriPal podcast. This is Eric Widera. Alex: This is Alex Smith. Eric: And Alex, who do we have with us today? Alex: Today we are honored to be joined by Bob Truog, who is the Francis Gleeson Lead Endowed Professor of Legal Medicine and the Director of the Center for PARENTERAL FLUIDS AT THE END OF LIFE It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITHCHRONIC HEART FAILUREEARLY SIGNS OF HEART FAILUREHEART FAILURE MEDICATIONS 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 billionannually).
WHY YOU SHOULD NEVER MIX MIRALAX (PEG) WITH STARCH BASED 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 SOMETIMES IT'S JUST A WAY TO DIE for thirty years I have companioned the dying, young and old. For the elderly, the push for survival and longevity ("We want her to make it to her 100th birthday) too often results in pain and suffering that could be diverted to comfort and peace by intelligent, honest conversations between primary care physicians and their patients andsurrogates.
COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis THE DANGERS OF FLEET ENEMAS The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. GERIPALCOVID-19GERIPAL PODCASTABOUTVIDEOSBLOGS TO BOARDS A September 2000 New York Times article titled, “Sometimes Saving the Heart Can Mean Losing the Memory” describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. GERIPAL PODCASTABOUTGERIPAL GERI ATRICS AND PAL LIATIVE CARE)GERIPAL PODCASTGERIPAL PODCAST TRAMADONT A geriatrics and palliative care podcast for every health care professional. You'll laugh, learn, and maybe even sing a little. BRAIN DEATH: A PODCAST WITH ROBERT TRUOG Listen to GeriPal Podcasts on: iTunes ; Google Play Music; Soundcloud; Stitcher; TRANSCRIPT. Eric: Welcome to the GeriPal podcast. This is Eric Widera. Alex: This is Alex Smith. Eric: And Alex, who do we have with us today? Alex: Today we are honored to be joined by Bob Truog, who is the Francis Gleeson Lead Endowed Professor of Legal Medicine and the Director of the Center for PARENTERAL FLUIDS AT THE END OF LIFE It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITHCHRONIC HEART FAILUREEARLY SIGNS OF HEART FAILUREHEART FAILURE MEDICATIONS 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 billionannually).
WHY YOU SHOULD NEVER MIX MIRALAX (PEG) WITH STARCH BASED 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 SOMETIMES IT'S JUST A WAY TO DIE for thirty years I have companioned the dying, young and old. For the elderly, the push for survival and longevity ("We want her to make it to her 100th birthday) too often results in pain and suffering that could be diverted to comfort and peace by intelligent, honest conversations between primary care physicians and their patients andsurrogates.
COPYRIGHTS AND COPYLEFTS IN MEDICINE: THE CASE OF THE The Mini-Mental State Exam (MMSE) is the most widely used cognitive screening test. Many have attributed this to the relative simplicity, portability, and brevity of the MMSE, as well as its ability to track the change in cognition over time. DYING WITHOUT DIALYSIS There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis THE DANGERS OF FLEET ENEMAS The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. BRAIN DEATH: A PODCAST WITH ROBERT TRUOG Listen to GeriPal Podcasts on: iTunes ; Google Play Music; Soundcloud; Stitcher; TRANSCRIPT. Eric: Welcome to the GeriPal podcast. This is Eric Widera. Alex: This is Alex Smith. Eric: And Alex, who do we have with us today? Alex: Today we are honored to be joined by Bob Truog, who is the Francis Gleeson Lead Endowed Professor of Legal Medicine and the Director of the Center for PARENTERAL FLUIDS AT THE END OF LIFE It is better to die dry than wet. At least that is the gist of traditional thinking in hospice and palliative care, where parenteral (IV) fluids are often avoided at the very end of life to prevent fluid buildup in the lungs and other organs. STATE OF HEART FAILURE & PALLIATIVE CARE: PODCAST WITH 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 billionannually).
ALL ABOUT IMPLANTABLE CARDIAC DEFIBRILLATORS AND We had fun on this in-studio podcast with Dan Matlock, geriatrician and palliative care clinician researcher at the University of Colorado, and frequent guest and host on GeriPal. We most recently talked with Dan about Left Ventricular Assist Devices and Destination Therapy. Today we talked with Dan about Implantable Cardiac Defibrillators (ICD) - everything a geriatrician or palliative care A NEW TREATMENT FOR ATRIAL FIBRILLATION IN THE ELDERLY Atrial Fibrillation is a very common heart rhythm that substantially increases the risk for stroke. The likelihood of having atrial fibrillation increases markedly with age. WHEN TO STOP MEDICATIONS IN ADVANCED DEMENTIA Since I became a consultant and was then fully responsible for my acts, decided that this was the main role of a Geriatrician, few specialities actually focus on when to stop and what not to do rather than continue on prescribing and adding non sense DO THICKENED LIQUIDS BENEFIT PEOPLE WITH SWALLOWING There are a lot of people with swallowing difficulty who are currently getting thickened liquids. For instance, in one study published in 2004 in the Journal of the American Dietetic Association, one out of twelve nursing home residents in the U.S. were getting thickened liquids.Of these individuals getting thickened liquids, 30% were getting honey consistency thickened liquids and 60% were LENGTH OF STAY IN NURSING HOMES AT THE END OF LIFE The authors also found that length of stay varied based on a number of demographic, social, and clinical factors. For instance: men died sooner after admission than women (men had a median length of stay of around 3 months versus 8 for women) TRAMADON'T: A PODCAST WITH DAVID JUURLINK ABOUT THE 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 Jurrlink would say, 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." CAN SOMEONE WITH DEBILITY OR ADULT FAILURE TO THRIVE STILL I’m hearing a lot of questions about whether someone with frailty, debility, or adult failure to thrive can still be admitted to hospice, especially since CMS will no longer beaccepting either debility or adult failure to thrive (AFTT) as a principal diagnosis on hospice claim forms starting on Oct. 1, 2014. The answer is YES and what follows is my attempt to help clarify the issue and Skip to main contentGERIPAL
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IMMUNE CHECKPOINT INHIBITORS: PODCAST WITH LAURA PETRILLOMay 29, 2020
Immune Checkpoint Inhibitors. They are revolutionary and transforming cancer care. They shrink tumors and extend lives. Plus they have a better side effect profile than traditional therapies for conditions like metastatic lung cancer, so when those with really poor performance status can't tolerate traditional chemotherapy, immune checkpoint inhibitors are an attractive option. But shouldthey be?
We talk on today's podcast with Laura Petrillo, a palliative medicine clinician and investigator at Massachusetts General Hospital and Harvard Medical School. Laura was the first author of a paper published in Cancer titled "Performance Status and End-Of-Life Care Among Adults With Non-Small Cell Lung Cancer Receiving Immune Checkpoint Inhibitors."
In this study, Laura looked at 237 patients with advanced non-small cell lung cancer who initiated immune checkpoint inhibitors from 2015 to 2017. She found that those with impaired performance status hadsignificantly s…
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HOSPITAL-BASED NURSES HELP MITIGATE COVID-19 IN NURSING HOMESMay 28, 2020
by: Terry E. Hill, Taejoon Ahn, Rebecca Rozen, Joe Greaves For some of us, the cruelest month was mid-March to mid-April, during which our warnings about COVID-19 infections in long-term care (LTC) seemed to get little response. Here in one Bay Area county, that changed when hospital nurses engaged LTC facilities and triggered county-wide public-private coordination. As a result, an opportunity for creativity rather than finger-pointing has emerged. The wakeup call that everyone should have heard came from a March 18threport of the
index nursing home in King County, Washington: 81 of 130 residents had been infected, of whom 46 were hospitalized and 22 died. According to the follow-up New England Journal of Medicine paper, those numbers
quickly grew to 101 residents infected, of whom 55 were hospitalized and 34 died, in addition to 50 infections among health care workers and 16 among visitors. COVID-19 infections had spread to 30 other LTC facilities in the county.Two days af…
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RAMPING UP TELE-GERIPAL IN A PANDEMIC: CLAIRE ANKUDA, CHRIS WOODRELL, ASHWIN KOTWAL, & LYNN FLINTMay 26, 2020
As Ashwin Kotwal and Lynn Flint note in the introduction to their Annals of Internal Medicine essay,
one year ago people were outraged at the thought of a physician using video to deliver bad news to a seriously ill man in the ICU. And look at where we are today. Video and telephone consults at home, in the ICU, and in the ED are common, accepted, and normal. What a difference a year makes. This week, in addition to Ashwin and Lynn, we talk with Claire Ankuda and Chris Woodrell from Mt Sinai in NYC about their experience with telephone and video palliative care. Claire and Chris recently published a terrific NEJM Catalystpiece about
their remarkable ramp up of a telephone based palliative care consult service. Take a look at the figuredepicting time
trends of health system confirmed/suspected COVID19 cases in their health system and the dramatic rise in tele-palliative care consults. Their service peaked at 50 consults per day, and as they note, that is likely an undercount.…Share
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PALLIATIVE CARE FOR INDIVIDUALS WITH PARKINSON’S DISEASE: PODCASTWITH BENZI KLUGER
May 22, 2020
Parkinson disease affects 1% to 2% of people older than 65 years. Most known for its distinctive motor symptoms, other distressing symptoms are pain, fatigue, depression, and cognitive impairment. About 2/3rds of individuals with Parkinson's will die from disease-related complications, making it the 14th leading cause of death in the United States. While there are great palliative care needs for this population, little has been published on how best tomeet these needs.
On today's podcast we talk with Benzi Kluger from the University of Rochester Medical Center and the lead author of a JAMA Neurology paper that compares outpatient integrated palliative care with standard carealone
in
210 patients and 175 caregivers. Every 3 months for a year, participants received palliative care visits either in person or via telemedicine from a neurologist, social worker, chaplain, and nurse with guidance from a palliative medicine specialist. Benzi's study demonstrated the palliative…Share
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COVID19 IN PRISONS: PODCAST WITH BRIE WILLIAMS, ADNAN KHAN, & ERIC MASERATI-E ABERCROMBIEMay 19, 2020
Eight of the 10
largest outbreaks in the US have been in correctional facilities. Physical distancing is impossible in prisons and jails - they're not built for it. Walkways 3 feet wide. Bunk beds where you can feel your neighbor's breath. To compound the issue, prisoners are afraid that if they admit they're sick they will be "put in the hole" (solitary confinement). So they don't admit when they're sick. Many people think of prisons as disconnected from society. Like a cruise ship. "It's happening between those walls, behind the barbed wire, not out here." But for every two people in a correctional facility there's about 1 person who works in the correctional facility and lives in the community. The workers are bringing whatever they've been exposed to in prison out into the community, and bringing whatever they've been exposed to in the community into the prisons. This is a national problem, not a prison or a jail pro…Share
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DO SITTERS PREVENT FALLS FOR HOSPITALIZED PATIENTS? A PODCAST WITH ADELA GREELEY AND PAUL SHEKELLEMay 15, 2020
One million inpatient falls occur annually in U.S. acute care hospitals. Sitters, also referred to as Continuous Patient Aids (CPA's) or safety attendants, are frequently used to prevent falls in high-risk patients. While it may make intuitive sense to use sitters to prevent falls, it does beg the question, what's the evidence thatthey work?
We discussed with Drs. Adela Greeley and Paul Shekelle from the West Los Angeles Veterans Affairs Medical Center their recent systematic review published in Annals of Internal Medicine. Their review
identified 20 studies looking at this issue (none of which are randomized trials). To sum up their findings, there were only two studies comparing sitters to usual care and they came up with conflicting conclusions (in one, the fall rate was lowered; in the other, it was not). In the other 18 studies, alternatives to sitter use were evaluated. The only thing that seems to have some evidence for was video monitoring (fall rates either …Share
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SHOULD AGE BE USED TO RATION SCARCE RESOURCES? PODCAST WITH TIM FARRELL AND DOUG WHITEMay 12, 2020
We are rationing in the US. We may not be explicitly rationing, as we're going to discuss on this podcast, but we are rationing - in the way we allocate fewer tests and less PPE to nursing homes compared to hospitals, in the way we allow hospitals and states to "fend for themselves" resulting in those hospitals/states with better connections and more resources having more PPE and testingavailability.
And in some parts of the world, ICU and ventilator resources are scare, and they are rationing by age. We talked on our last podcast about decisions Italy made to ration by age, and on this podcast we talk about two countries in South America we have heard are using age as a criteria for rationing ventilators. In this context, we are fortunate to welcome Tim Farrell, Associate Professor of Geriatrics at the University of Utah and Vice Chair of the American Geriatrics Society (AGS) Ethics Committee, and returning guest Doug White, Vice Chair and Professor at the Universit…Share
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SURGICAL PALLIATIVE CARE: A PODCAST WITH RED HOFFMANMay 08, 2020
The cross-over episode is an American tradition that is near and dear to my heart. My childhood is filled with special moments that brought some of my very favorite characters together. Alf crossed over with Gilligan's Island. The Fresh Prince of Bel Air crossed over with The Jeffersons. Mork and Mindy crossed with Happy Days and Laverne and Shirley at the same time. To honor this wonderful tradition, GeriPal is crossing over with the Surgical Palliative CarePodcast for
this weeks podcast!
The Surgical Palliative Care Podcastis hosted
by Dr. Melissa "Red" Hoffman. Red is both an acute care surgeon and hospice and palliative medicine physician in North Carolina. She has been podcasting since this beginning of this year and my goodness she has been quite busy in doing so. Her podcast featured some of the founders and the leaders of the surgical palliative care community, including Dr. Balfour Mount (the father of Palliative Care in North America), Robert Milch, Z…Share
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WHAT IS EMOTIONAL PPE? PODCAST WITH DANI CHAMMASMay 06, 2020
We are delighted to have Dani Chammas, psychiatrist and palliative care physician, back on the GeriPal podcast to talk about emotional PPE. None of us can recall who originated the term, but we've all heard it bandied about much needed for front line providers treating patients with coronavirus. Headlines about the New York emergency room doctor committing suicide are likely only the tip of the iceberg in terms of the trauma, distress, and moral injury taking place. We talk with Dani about key issues and questions, including: What is trauma? What is moral injury?Is this a big deal? What evidence do we have?What can we do about it? Dani goes over 3 broad buckets of responses, organized with the letter C: Connection, Culture, and Coping.Normalizing rather than stigmatizing clinicians seeking mental health support We also decided to add a page to GeriPal titled "emotional PPE" with a list of resources for providers caring for patients with COVID, and we will link to th…Share
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PROACTIVE INTEGRATION OF GERIATRICS AND PALLIATIVE CARE PRINCIPLES INTO COPD: PODCAST WITH ANAND IYERApril 30, 2020
What's the role of geriatrics and palliative care in the care of individuals with COPD? We talk this week with Anand Iyer, the lead author of this weeks JAMA IM article on this subject.
It's a little off from our ongoing COVID topics, but given that his along with his co-authors (Randy Curtis and Diane Meier) JAMA IM piece just got published, we figured now is the right time to highlight#PalliPulm.
What is #PallPulm? #PalliPulm is something that Anand Iyer founded, and is an online community of clinicians, investigators, patients, and others interested in the intersection of palliative care and geriatrics. Anand is also an Assistant Professor in Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Alabama at Birmingham (UAB) and faculty at the Center for Palliative and Supportive Care at UAB. Anands research on this subject has shown a lot of things, including that COPD patients are often referred too late to palliative care andhospice, …
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GRIEVING AT A DISTANCEApril 29, 2020
by: Bridget Blitz, LCSW The death had nothing to do with COVID-19 and the funeral had everything to do with the virus. To lose a young member of the family with no warning or preparation is emotionally wrenching. To lose this same bright and eager person during social distancing limitations felt like a supreme torture as all the usual rituals were marred by masks, distance, rules and fear. Each attendee to the funeral service wore a mask and stood at a distance of at least six feet from another guest, unless the guests came together from the same family. Clusters of family members gathered in the cold wind and tried to express the loss, love and appreciation for the person who had left us. We caught up in small bunches and discussed how everyone was managing this loss, work, loss of employment and social distancing. Some families came separately from younger, independent family members who returned home from lonely urban apartments whose occupants had fled to their own paren…Share
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THE OUTSIZED IMPACT OF COVID IN NURSING HOMES & IN DEMENTIA: GUESTS KATHLEEN UNROE & ELLEN KAEHRApril 28, 2020
Many of you listened to our prior podcast with Jim Wright and David Grabowski about COVID in long term and post acute care settings. In this follow up podcast, we talk about the situation in long term and post acute care in Indiana with Kathleen Unroe, Associate Professor at Indiana University, a scientist at the Regenstrief Institute , and a PI of Optimistic and founder of Probari , and Ellen Kaehr, Assistant Professor of Clinical Medicine at Indiana University and geriatrician and medical director of a nursing home. A few highlights to wet your appetite: About 2/3 of the Ellen's nursing home is COVID positive. This has led to so many challenges - how did this happen? (asymptomatic staff). How to cohort? Issues with PPE, with transitions to the hospital, with visitors.We talked about the unique impact of COVID on people with dementia. For example, mobile persons with dementia wander, which has negative aspects, but does keep them functional/mobile. Now they're confined t…Share
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GeriPal (Geriatrics and Palliative care) is a forum for discourse, recent news and research, and freethinking commentary. Our objectives are: 1) to create an online community of interdisciplinary providers interested in geriatrics or palliative care; 2) to provide an open forum for the exchange of ideas and disruptive commentary that changes clinical practice and health care policy; and 3) to change the world.TOTAL PAGEVIEWS
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No confidential patient information should be placed on GeriPal , nor should any confidential information be placed in the comments. The information provided on GeriPal is designed to complement, not replace, the relationship between a patient and and his/her own medical providers. The editors (Alex Smith and Eric Widera) reserve the right to remove comments that are deemed inappropriate due to the commercial, abusive, or offensive nature of a comment. If you think your comment was deleted for inappropriate reasons, please email either Alex or Eric. GeriPal's mission is to improve the disemination of information in both geriatics and palliative medicine. GeriPal was created with the support of the Division of Geriatrics at the University of California San Francisco . Its content though is strictly the work of its authors and has no affiliation with or support from any organization or institution. All opinions expressed on this website are solely those of its authors & do not reflect the opinions of any academic institution or medical center. This web site does not accept advertisements. All email addresses collected by GeriPal for feed distribution will be kept confidential and will never be used for commercial reasons. If you reproduce the material on the website please cite appropriately. For questions regarding the site please email Alex Smith, MD (aksmith@ucsf.edu) or Eric Widera,
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