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PC Trials at State of Science: Tom LeBlanc, Kate Courtright, & Corita Grudzen

GeriPal

Kate: So it was an embedded alert in the electronic health record and they just clicked those two answers very quickly. Kate: It was done in 10 hospitals, 17 ICUs in Atrium Health down in North Carolina. It did not change the frequency of palliative care consultation, the timing of such, ICU mortality, or six-month mortality.

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Who should get Palliative Care? Kate Courtright

GeriPal

Palliative care, in contrast, saw explosive growth in US hospitals. And palliative care was as a program was just growing at Penn moving from just consult hospice to actually having a team when I was training. I have never myself called a palliative care consult as a trainee because we didn’t have one.

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Nudges for Prognosis and Comfort Care in the ICU: Kate Courtright, Scott Halpern, & Jaspal Singh

GeriPal

Prior podcasts on the ethics of nudging , and a different trial conducted by Kate and Scott in which the default for hospitalized seriously ill patients was to receive a palliative care consult. Many were community hospitals. The intervention was a negative study for the primary outcome, hospital length of stay.

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RCT of PC in ED: Corita Grudzen, Fernanda Bellolio, & Tammie Quest

GeriPal

Today we discuss: Why the study was negative for the primary (hospitalization) and all secondary outcome (e.g. Tammie 03:04 Depends on how long they were pre-hospital. So that study was focused on patients admitted to the hospital. hospice use). Tammie 02:56 It usually doesn’t work no matter what. So that’s great.

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Dementia and high risk surgery: Joel Weissman and Samir Shah

GeriPal

Should she have an operation, and risk the pain, potential complications, and attendant delirium associated with the operation? Joel: The Brigham and Women’s Hospital likes me to say that too. Alex: And the Brigham and Women’s Hospital. And she was rushed to the hospital. She falls and breaks her hip.

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Artificial Intelligence: Charlotta Lindvall, Matt DeCamp, Sei Lee

GeriPal

Audio: [electronic voice] Alex Smith has been taken over by an artificial intelligence. So there’s some stuff out there like that, but also using AI to determine who at high risk and should get a palliative care consult. Matt: We have seen pilot level studies, interventions like that one to do clinical ethics consultation.

IT 99
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Allowing Patients to Die: Louise Aronson and Bill Andereck

GeriPal

He had a 14 month recovery in hospital and rehab and continually asked to have life sustaining treatment suspended so that he could be allowed to die. So she bled a lot and finally called for help and was transferred to the hospital, where she started crashing in the trauma room. She didn’t die in the hospital.