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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.

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Tramadon't: a podcast with David Juurlink about the dangers of Tramadol

Tramadol. Is it just a misunderstood opioid that is finally seeing its well deserved day in the sun, or is it as our podcast guest David 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."


26 Jun 2018

Rank #1

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Palliative Care, Chronic Pain, and the Opioid Epidemic: GeriPal Podcast with Jessie Merlin

In this week's GeriPal podcast, we talk with Jessie Merlin, Palliative Care Faculty at the University of Pittsburgh, who is addressing another important aspect of this issue: the role of palliative care in chronic pain. We disucss issues such as: - Do outpatient palliative care providers see patients with chronic pain currently? (please take this survey to help Jessie figure this out!) - Should palliative care fellowship training include management of chronic pain? - Is there really a distinction between "cancer pain" and "non-cancer pain?" - To what extent is or should prognosis be a factor in determining treatment of pain? - Everybody Hurts by REM (and a hack rendition)


5 Dec 2017

Rank #2

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Delirium: A podcast with Sharon Inouye

In this week's GeriPal podcast we discuss the research into delirium with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.


2 May 2019

Rank #3

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All the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson

All the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson by Alex Smith and Eric Widera


5 Oct 2018

Rank #4

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Vicki Jackson and David Ryan: Living with Cancer

Vicki Jackson and David Ryan: Living with Cancer by Alex Smith and Eric Widera


7 Aug 2017

Rank #5

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Managing Behavioral Symptoms in Dementia: Podcast with Helen Kales

In this week's podcast we talk with Helen Kales, Professor of Psychiatry at the University of Michigan the VA Center for Clinical Management and Research. We've spent a great deal of effort in Geriatrics describing what we shouldn't do to address behavioral symptoms in dementia: physical restraints, antipsychotics, sedating antidepressants. Helen Kales was lecturing around the country about all of these things we shouldn't do a few years back, and people would raise their hands and ask, "Well, what should we do?" She realized she needed to give caregivers tools to help. Dr. Kales went on to develop the DICE approach to managing behavioral and psychiatric symptoms in dementia. Listen or read the full podcast to learn more! You'd be "crazy" not to! (hint: song choice).


7 Sep 2018

Rank #6

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Patient Priorities Care: Podcast with Mary Tinetti

We have had some amazing guests on our Podcast. True luminaries in geriatrics and palliative care. This week we are fortunate to be joined by none other than Mary Tinetti, MD, to talk about her recent JAMA Internal Medicine trial of Patient Priorities Care (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2752365). In this study of older adults with multiple chronic conditions, patients are guided through a process of identifying their health priorities and objectives, and this information is communicated to their primary care physicians. The trail resulted in more medications discontinued, fewer self-managment and diagnostic tests, and less report of treatment burden. This podcast builds on our prior podcast on this topic with Aanand Naik (awesome song choice, Lumineers' Gun Song). We talk with Mary Tinetti about what exactly Patient Priorities Care is, how it differs from geriatrics and palliative care (or does it?), and how to disseminate this program widely (hint: start by going to their amazing website at patientprioritiescare.org). And...ah...Mary made me sing Joni Mitchell's Ladies of the Canyon. My deepest apologies to fans of Joni Mitchell... by: @AlexSmithMD


27 Nov 2019

Rank #7

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Integrating Social Care into Health Care: Podcast with Kirsten Bibbins-Domingo

In this weeks podcast we talk with Kirsten Bibbins-Domingo, general internist, Professor of Medicine and Epi/Biostats at UCSF, and chair of a National Academies of Sciences task force on Integrating Social Care into the Delivery of Health Care. See Kirsten's JAMA paper summary here (https://jamanetwork.com/journals/jama/article-abstract/2752359), and the full report here (http://nationalacademies.org/hmd/Reports/2019/integrating-social-care-into-the-delivery-of-health-care). This podcast spans the gamut from the individual clinician's responsibility to be aware of the social needs of their patients and impacts on health (think homeless person with no place to store their insulin), and adjustment to meet these needs (such as keeping on oral medications), to larger health policy issues including the need to integrate health and social policy. This was a fun podcast, as you'll hear. This is a topic that lends itself well to discussion. Eric really pushes this issue: to what extent are meeting the our patient's needs for housing, transportation, and food a health issue? Are these issues that a doctor should care about, and why? And our rendition of "Waiting on the World to Change" was perfect in every possible way!!! Enjoy! by: Alex Smith, @AlexSmithMD GeriPal is funded by Archstone Foundation (https://archstone.org/). Archstone Foundation is a private grantmaking foundation whose mission is to prepare society in meeting the needs of an aging population


19 Dec 2019

Rank #8

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The Future of Palliative Care: A Podcast with Diane Meier

There are few names more closely associated with palliative care than Diane Meier. She is an international leader of palliative care, a MacArthur "genius" awardee, and amongst many other leadership roles, the CEO of the Center to Advance Palliative Care (CAPC). We were lucky enough to snag Diane for our podcast to talk about everything we always wanted to ask her, including: * What keeps her up at night? * Does palliative care need a national strategy and if so why and what would it look like? * The history of CAPC and the leadership centers * Advice that she has for graduating fellows who want to continue to move palliative care forward as they start their new careers * What she imagines palliative care will look like in 10 or 15 years? * What is the biggest threat facing palliative care? We hope you join us for this great podcast!


14 Jun 2019

Rank #9

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Health Navigators Improve Dementia Care: Podcast with Kate Possin and Sarah Dulaney

Do you remember the scene from the movie The Graduate where Ben's dad says, "One word: Plastics"? Well, I write this blog post from the National Palliative Care Research Center's annual Foley retreat, a who's who of palliative care researchers. The words on everyone's lips: "Lay Health Navigators." This is not to draw equivalency between environmentally destructive materials and people who help those with serious illness and caregivers navigate our complex health care system. Rather, it's to point out that revolutions occur in palliative care research just as they do in business. In this week's podcast, we talk with Kate Possin, PhD and Sarah Dulaney, RN CNS of UCSF about the Care Ecosystem project. In this remarkable study, published in JAMA Internal Medicine, lay health workers helped caregivers of persons with dementia navigate the health care system by providing support, education, and care coordination with dementia specialists. The intervention was mainly by telephone, with about 1 phone call per month. Results were remarkable, including improved quality of life for persons with dementia, reduced emergency department visits, and reduced caregiver depression and burden. As Nick Dionne-Odom pointed out yesterday, "Caregiving in dementia is a monumental task. There is tremendous room for improvement." Listen or read on for more! Also - be sure to check out the outstanding Care Ecosystem website: https://memory.ucsf.edu/research-trials/professional/care-ecosystem. The training materials are all FREE to use! by: @AlexSmithMD


24 Oct 2019

Rank #10

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Rehabbed to Death NEJM Perspective: Podcast with Lynn Flint

Three reasons you should listen to this podcast: The issue of patients cycling back and forth between the hospital and skilled nursing facilities near the end of life is common, will ring true to those of you who are clinicians, and has largely been ignored in the literature. It's about a hot off the press article published today in the NEJM. Lynn Flint, Palliative care doc at UCSF in the Division of Geriatrics, first author, and our guest, makes me sing "Hit Me Baby One More Time" by Brittany Spears. This moment is either a new high or a new low for the GeripPal podcast, I can't tell which. You really need to listen to the final seconds when Eric joins in singing, "still believe" in high falsetto.


30 Jan 2019

Rank #11

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Practical Advice for the End of Life: A Podcast with BJ Miller

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End." As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care. His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times. As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement. The book he and Berger wrote is filled to the brim with practical advice. I mean, nuts and bolts practical advice. Things like: - How to clean out not only your emotional house but your physical house (turns out there are services for that!) - Posting about your illness on social media (should you post to Facebook) - What is the difference between a funeral home and mortuary - Can I afford to die? How much will it cost? We focus our discussion with BJ on his reasons for writing the book, sexuality and serious illness, and priming people to check the instincts of a medical system that favors aggressive/intensive/invasive care and crappy deaths. And BJ came up with some nice harmonies to "Tonight, You Belong to Me." Enjoy! AlexSmithMD


1 Aug 2019

Rank #12

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Allowing for Chemotherapy in Hospice: A Podcast About Concurrent Care With Vince Mor

A recent study by Vince Mor published in JAMA Oncology found that veterans with advanced lung cancer treated in Veterans Affairs (VA) Medical Centers with high hospice use were more likely to receive concurrent cancer care and also less likely to receive aggressive care. On top of that, veterans treated at facilities with high levels of hospice use also incurred lower costs of care. This is a strong case for the concept of concurrent care in which individuals can avoid the "terrible choice" between hospice and life prolonging therapies. On this weeks podcast, we interview the lead author, Vince Mor, about this study and whether concurrent care is ready for prime time outside of a integrated health care system like the VA. We also put a plug in the end for the NIA Imbedded Pragmatic AD/ADRD Clinical Trials (IMPACT) Collaboratory that Vince is helping to lead. If you want to learn more about the collaborators, please check out our GeriPal website at https://geripal.org for links to this and other info. by: Eric Widera


31 Oct 2019

Rank #13

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Rejecting Neutrality - Reducing Burdensome Hospitalizations For Nursing Home Residents

Nursing home residents are often sent to the hospital for care that often offers little hope of improving quality of life or changing the course of illness. Some facilities though seem to do much better in preventing these "potentially burdensome hospitalizations". We discuss with Andrew Cohen, the lead author of a recent JAMA IM paper on this subject, to learn a little about what is in the secret sauce of these exceptional nursing homes.


15 Dec 2016

Rank #14

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Prognostication with Christian Sinclair

For this weeks podcast, we talk all about prognostication with Christian Sinclair. Christian is a palliative care physician at University of Kansas Medical Center, past president of AAHPM, recent AAHPM "Visionary" awardee, and Pallimed social media guru. We go over a lot of topics at the heart of prognostication in hospice and palliative care including: - The importance that prognostication plays in daily practice, especially in goals of care discussions - Helpful tools and skills to estimate prognosis - How prognosis changes the way we think about prescribing opioids - How to think about prognosis when it comes to hospice eligibility and why it may be that one of the most important tools used for prognostication in the hospice setting, the hospice eligibility guidelines, were last updated over two decades ago. So we have a ton to talk about and we would love for you to continue this discussion in the comment section of this blog, on Facebook or on twitter.


11 Dec 2017

Rank #15

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Palliative care on the front lines of COVID: Podcast with Darrell Owens

Many of us with clinical roles are waiting for the other shoe to drop. Today we hear from Dr. Darrell Owens, DNP, MSN, head of palliative care for the University of Washington's Northwest campus, a community hospital in Seattle. The UW Northwest hospital has born the brunt of the COVID epidemic in one of our nation's hardest hit areas. Darrell has stepped up the the plate in remarkable, aspirational ways. First, he is on call 24/7 to have goals of care conversations with elderly patients in the emergency department under investigation for COVID who do not have an established a code status. On the podcast Darrell walks us through the language he uses to speak with these patients about the poor outcomes of CPR and ventilation among older adults with COVID. We note on the podcast that the Center to Advance Palliative Care recently put together Toolkit for COVID including a thoughtful communication guide spearheaded by Tony Back and our friends at VitalTalk. Second, Darrell has established an inpatient palliative care service at his hospital for patients on exclusively comfort measures. Darrell and his team admit and are first call for these patients. This service off-loads the hospitalists so they can care for other patients. Darrell talks with us about the challenges of titrating medications for symptomatic patients when you're trying to minimize using protective equipment going in and out of the room, and the challenges of returning home from work to his family after treating patients with COVID all day. By closing let me repeat two things from the podcast. First, we too can and should step up to the plate. By engaging patients in goals of care discussion at the time of admission we are likely to help patients reach different decisions than they otherwise might have made had discussions occurred with rushed and less skilled clinicians (i.e. the usual code status discussion). Before we get to rationing, we can and should engage patients in the highest quality informed goals of care discussions. The results of these informed discussions are likely to decrease the need for scarce ICU beds and ventilators. That is why Darrell is specifically on call for these conversations. Simply put, we do it better. We have the best skill. Further, like Darrell, we too can create or expand inpatient palliative care services to provide the best possible care for these patients and free up hospitalists and others to meet the growing clinical needs due to the pandemic. Second, Eric and I have never been prouder of our fields. Every day we hear stories of geriatricians, palliative care clinicians, and bioethicists rising to the occasion to meet needs of this moment. As Eric notes, we will found out a great deal about ourselves and what we stand for these next few weeks and months. Thank you for all that you do. -@AlexSmithMD


23 Mar 2020

Rank #16

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Mark Supiano Podcast - How Low Should We Go with Blood Pressure in Older Adults

In this GeriPal Podcast we talk with Dr. Mark A. Supiano about a blood pressure management in older adults in the light of new evidence from the Systolic Blood Pressure Intervention Trial (SPRINT). In particular, we talk about a recent paper he co-author with Jeff Williamson in the Journal of the American Geriatrics Society (JAGS) titled "Applying the Systolic Blood Pressure Intervention Trial Results to Older Adults."


28 Feb 2017

Rank #17

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Implicit Bias and Its Impact in Geriatrics, Hospice and Palliative Care

On this week's podcast, we have invited Dr. Kimberly Curseen to talk about how implicit bias influences us as providers in geriatrics, hospice, and palliative care, as well as the role of that cultural competence and cultural humility should play in our practice. Kimberly Curseen, M.D. is an Associate Professor of Internal Medicine at Emory School of Medicine and Director of Outpatient Supportive/Palliative Care, Emory Healthcare.


27 Oct 2017

Rank #18

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Jessica Zitter on Palliative Care in the ICU

We talk with Dr. Jessica Zitter, a pulmonary critical care and palliative medicine physician, and author of Extreme Measures: Finding a Better Path to the End of Life. We talk with Jessica about her experience transitioning from being an ICU doctor to an ICU/Palliative doctor, how she is treated differently when she sees patients as an ICU attending vs a palliative care attending, the Big 3 (CPR, mechanical ventilation, and feeding tubes), and most importantly WHO she is wearing to the Oscars!


20 Feb 2017

Rank #19

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Fever, malaise, AMS -- Is it an infection? Podcast with Jeff Caterino

Geriatrics teaches us that older adults with infections often present with non-specific symptoms rather than typical localizing symptoms of infection present in younger adults. Sometimes they present with fever, delirium, malaise, or fatigue. In today's GeriPal/JAGS joint podcast, Jeff Caterino challenges this common teaching by examining the extent to which non-specific symptoms are predictive of infection for older adults presenting to the emergency department. Turns out - they're not so predictive as you might think!


23 Jan 2019

Rank #20