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GeriPal

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GeriPal

Alex Smith, Eric Widera

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A geriatrics and palliative care podcast for every health care professional. We invite the brightest minds in geriatrics, hospice, and palliative care to talk about the topics that you care most about, ranging from recently published research in the field to controversies that keep us up at night. You'll laugh, learn and maybe sing along. Hosted by Eric Widera and Alex Smith.
 
"Heavy lies the crown" is a common misquote of "uneasy lies the head that wears a crown" from Shakespeare's Henry IV, Part 2. It refers to the responsibility and insecurity of governing an entire kingdom. Likewise, "heavy lies the helmet" refers to the responsibility we face as critical care transport providers working in an autonomous and often unpredictable environment. Our minds are eased with education that better prepares us for any situation that we may encounter. That is exactly what ...
 
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show series
 
It’s been a while since we’ve done a Covid/bioethics podcast (see prior ethics podcasts here, here, here, and here). But Covid is not over and this pandemic keeps raising challenging issues that force us to consider competing ethical considerations. This week, we discuss an article by bioethicists Govind Persad and Emily Largent arguing that the NI…
 
A patient is on morphine and you want to convert it to another opioid like hydromorphone (dilaudid). How do you do that? Do you do what I do, pull out a handy-dandy opioid equianalgesic table to give you a guide on how much to convert to? Well on today’s podcast we invited Drew Rosielle on our podcast who published this Pallimed post about why opio…
 
In today’s podcast we talk with Dr. Rajagopal (goes by “Raj”), one of the pioneers of palliative care in India. Raj is an anesthesiologist turned palliative care doctor. He is also author of the book, “Walk with the Weary: Lessons in Humanity in Health Care,” and was featured in this Atlantic article. Raj is the founder of Pallium, an organization …
 
Think about the last time you attended a talk on communication skills or goals of care discussions. Was there any mention about the impact that hearing loss has in communication or what we should do about it in clinical practice? I’m guessing not. Now square that with the fact that age-related hearing loss affects about 2/3rd of adults over age 70 …
 
Mores lies! But this time, we focus on empirical use of spinal immobilization devices and the harm associated with them. The dogma surrounding this topic is staggering, to say the least. From EMS agencies to Level 1 tertiary centers, cervical collars and long spine boards (LSB) remain a "standard" predicated on a lack of evidence. What evidence DO …
 
Comics. Cartoons. Graphic Novels. Graphic Medicine. I’m not sure what to title this podcast but I’ve been looking forward to it for some time. Heck, I’m not even sure to call it a podcast, as I think to get the most out of it you should watch it on YouTube. Why, because today we have Nathan Gray joining us. Nathan is a Palliative Care doctor and an…
 
In celebration of National Poetry Month, we are delighted to share with you the second podcast in our series on poetry and medicine. In the first podcast, we talked with Guy Micco and Marilyn MacEntyre about poetry and aging. In this second part in our series, we welcome Mike Rabow and Redwing Keyssar to talk about palliative care and poetry. As wi…
 
Diabetic Ketoacidosis (DKA) is a common metabolic disorder, particularly in the pediatric population. If treated inappropriately, these patients can quickly decompensate to the point of hypovolemic shock, acute respiratory failure, and even cerebral herniation. What are the physiological differences behind DKA verses HHS (Hyperglycemic Hyperosmolar…
 
Buprenorphine. It’s been around for a long time but is acting like the hot new kid in town. Just look at this year’s AAHPM meeting, where it felt like every other session was talking about how hot buprenorphine is right now. But does this drug really live up to the hype? On today’s podcast we talk with three experts on buprenorphine on why, when, a…
 
In her essay “Why Read a Poem in a Time Like This?”, Marilyn McEntyre writes: All of us need it. We need it because good poems do something prose can’t do. They invite and enable us to notice the precarious fissures in what we think is solid ground. They direct us toward the light at the edge of things — the horizon, the fragment of dream before da…
 
There are a lot of "lies"/misunderstandings surrounding appropriate use of paralytics AKA neuromuscular blocking agents (NMBAs). When are these medications truly indicated? How do we appropriately administer them? How do we accurately monitor these patients? And how do we reverse the effects of NMBAs? Tune in to another pharmacologically driven pod…
 
One of my favorite Piece of My Mind essays in JAMA is by Rebecca Sudore, titled, “Can We Agree to Disagree?” And today our guests agree to disagree. And yet, and yet… They also agree across a whole range of issues, some of which surprised us. This is the latest in our series of podcasts on concerns about, and potential of advance care planning. If …
 
If you develop dementia, odds are you will spend the last months to years of your life in a nursing home or assisted living facility. While we like to think about how our goals and preferences will influence what that life looks like, including whether you will get potentially burdensome interventions, your fate is probably influenced more by facto…
 
The clotting cascade, particularly in the context of anti-coagulation reversal can be complex to understand. Unfortunately, many of our patients are on anti-coagulation agents that require reversal in the presence of life-threatening hemorrhage. How do we choose the most appropriate agent based on which step of the coagulation cascade that it antag…
 
A little over a decade ago, Ken Covinsky wrote a GeriPal post about a Jack Iwashyna JAMA study finding that older adults who survive sepsis are likely to develop new functional and cognitive deficits after they leave the hospital. To this day, Ken’s post is still one of the most searched and viewed posts on GeriPal. This idea that for critically il…
 
There is a lively debate going on in academic circles about the value of Advance Care Planning (ACP). It’s not a new debate but has gathered steam at least in palliative care circles since Sean Morrisons published a JPM article titled “Advance Directives/Care Planning: Clear, Simple, and Wrong.” Since then there has been a lot of back and forth, wi…
 
Which is the lesser evil, opioid or naloxone overdose? To avoid adverse effects, how should we be administering naloxone in the presence of opioid overdose? In this podcast episode, we are joined by Dr. Arne Skulberg, anesthesiologist and lead author, to discuss his recently published RCT comparing intranasal with intramuscular naloxone. We highlig…
 
My mom is an Asian woman in her 70s with osteoporosis. She tried an oral bisphosphonate and had horrible esophagitis. She said never again, though she eventually tried an IV bisphosphonate. She had terrible flu-like symptoms. She said never again. But based on reports that symptoms are worse the first time, she tried the IV again the next year and …
 
This week many of our listeners will gather for the annual American Academy of Hospice and Palliative Medicine (AAHPM) & Hospice and Palliative Nursing Association (HPNA) annual meeting. While the majority of this meeting is focused on subspecialty care in the US, the majority of individuals who are in need of palliative care live in low and middle…
 
In prior podcasts we talked about racism and COVID, lack of diversity in the palliative care workforce, racial and ethnic differences in end of life care, and implicit bias in geriatrics and palliative care. Today our focus is on structural, institutional, and interpersonal racism, and how these different but related constructs negatively impact th…
 
An incapacitated pilot scenario is an unfortunate but potential reality of working in rotor and fixed wing EMS. What do you do as medical crew members if your pilot becomes incapacitated? What training and capabilities do you have to revive the pilot and/or get the aircraft on the ground? Do some Controlled Flight Into Terrain (CFIT) incidents actu…
 
Patients with end stage liver disease and decompensated cirrhosis have an average life expectancy of 2 years without transplant. Outcomes are worse among those who are frail. Symptoms are common, including pain, ascites, encephalopathy, and pruritus. Patients with end stage liver disease are often some of the most disadvantaged patients we care for…
 
More Health Policy this week! Today, we discuss “SNPs” but this is not a podcast about haircuts during the pandemic. We take a deeper dive into the world of Medicare Advantage and what it means for vulnerable patients facing serious illness and those at the end of life. We are joined by UCSF geriatrics fellow Alex Kazberouk to talk to Dr. Claire An…
 
Transport of patients with ongoing CPR to the correct treatment center is a high risk but potentially lifesaving intervention. Mechanical CPR (mCPR) devices are recommended to reduce risk and maintain chest compression quality. However, such transports have inherent pitfalls to both patient and provider safety. This is a poorly studied field of our…
 
Investor money and venture capital funding is pouring into Medicare Advantage (MA) plans. Enrollment in MA plans has more than doubled from 12 million members in 2011 to 26 million in 2021. What does this mean for us and our patients? Do these plans deliver better care for vulnerable older adults? Or are they a money making machine driving up healt…
 
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