PEMBlog

SEPTEMBER 6, 2023

Patients with psychosis caused by medical illness usually have abnormal vital signs, altered mental status, and impaired orientation with compromised intellectual function. Laboratory evaluation should be based on individual patient history and exam. Visual and tactile hallucinations (as opposed to auditory) are frequently prominent.

Lab Testing 52

Lab Testing Medical Patients Mental Health 52

GeriPal

JUNE 8, 2023

Should we use Ozempic (if we can find it) in patients with serious illness, which often results in undesirable and profound weight loss? And my hypothesis is that’s because it’s no longer the individual managing their own diabetes, it’s the nursing home staff managing their diabetes. Listen in to learn more!

Diabetes 73

Diabetes Management Patient-Centered Family 73

GeriPal

APRIL 14, 2022

On today’s podcast we talk with three experts on buprenorphine on why, when, and how to use it in serious illness. Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness . Katie, before we jump into the topic of buprenorphine in serious illness, what’s the song request?

Illness 102

Illness Patient-Centered IT Patients 102

GeriPal

JANUARY 18, 2024

We start off the conversation by talking about whether patients with cancer and cancer pain are really that different, and their paper that was just published on January 11 th in JAMA Oncology showing that substance use disorder is not uncommon in individuals with cancer. Transcript Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Illness 136

Illness Patient-Centered Screening IT 136

GeriPal

AUGUST 31, 2023

Summary Transcript Summary How do people react when they hear they have a serious illness? And some people, in addition or instead, engage in deep introspection on how to make meaning or live with or understand this experience of serious illness. Shock, “like a car is rushing straight at me” (says Bill Gardner on our podcast).

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Illness IT Diagnose Medical 128

GeriPal

DECEMBER 19, 2024

Still, we havent talked about integrating palliative care into psychiatry or in the care of those with severe mental illness. What does it look like to take a palliative approach to severe mental illness? Is “terminal” mental illness a thing? For more details, please click here. (AP AP Recruit Job No.

Illness 101

Illness Mental Health IT Patient-Centered 101

GeriPal

JULY 28, 2022

GeriPal post on “fast food” style palliative care in chronic critical illness. Alex: And we are also delighted to welcome Areej El-Jawahri, who is an oncologist at Massachusetts General Hospital as well, who specializes in blood cancers. Additional links: Editorial on Areej’s study. Palliative care in lung and GI cancers. Transcript.

Illness 110

Illness Hospital Patient-Centered Patients 110

GeriPal

JUNE 9, 2022

Palliative care, in contrast, saw explosive growth in US hospitals. By diagnosis? We can’t possibly meet the needs of all people with newly diagnosed serious illness. She’s also a member of the PAIR Center, which stands for Palliative Advanced Illness Research Center. By prognosis? What is a pragmatic trial ?

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

GeriPal

AUGUST 29, 2024

Summary Transcript CME Summary Serious illness communication is hard. We must often deliver complex medical information that carries heavy emotional weight in pressured settings to individuals with varying cultural backgrounds, values, and beliefs. Eric 01:42 So we’ ve got an exciting topic today. Eric 05:03 Nice.

IT 132

IT Illness Family Families 132

GeriPal

FEBRUARY 23, 2023

Imagine her hearing for the first time that you’re sick, that you’re hospitalized, that you’re in the ICU, and that you can’t make your own decisions? ” and the answer is no, that probably was more just about do you need anybody to support you kind of emotionally or during this hospital stay, just give information to.

Families 97

Families Family Patient-Centered IT 97

GeriPal

JULY 21, 2022

Love to talk about also in the serious illness population. I’ve worked in hospital settings as an occupational therapist, inpatient rehab and outpatient rehab. Emmy: I was seeing people in the hospital setting, saying they had had a massive brain injury. Eric: Well, Terri and Emmy, thank you for joining on this podcast.

IT 102

IT Family Families Diagnosis 102

GeriPal

JUNE 30, 2022

Joel: The Brigham and Women’s Hospital likes me to say that too. Alex: And the Brigham and Women’s Hospital. Eric: So we’re going to be talking about dementia and considerations around surgery for individuals with dementia. And she was rushed to the hospital. Did I get that right? Joel: Oh yeah.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

GeriPal

JANUARY 11, 2024

To be eligible in Canada patients must have a “ grievous and irremediable ” condition, including disability ; they do not have to have a terminal illness with a prognosis of less than 6 months. A planned expansion of MAID to include people with mental illness was placed on hold until March 2024. So less than six months to live.

Illness 144

Illness IT Medical Provider 144

GeriPal

OCTOBER 19, 2023

Certainly SOME of those avoided hospitalizations, CPR, and ICU stays were due to documentation of those orders in the POLST. Additional links mentioned in the podcast: Recent JGIM article on POLST in California nursing homes, hospitalization, and nursing home care Karl’s GeriPal post on appropriate use of POLST Enjoy! Good to know.

Patient-Centered 126

Patient-Centered IT Patients Illness 126

GeriPal

FEBRUARY 27, 2025

Today we talk with experts Janet Ho, Sach Kale, and Julie Childers about opioid use disorder and serious illness. Eric 00:51 So we’re gonna be talking about caring for people with serious illness and substance abuse. Who has a song request for Alex before we talk about substance use disorder and serious illness?

Patients 72

Patients Clinic Patient-Centered Illness 72

PEMBlog

MARCH 27, 2024

She is a member of the Clinical Genome Resource Inborn Errors of Metabolism (IEM) Clinical Domain Working Group, where as a biocurator she assesses the pathogenicity of variants in IEM-associated genes to facilitate expedited genetic diagnosis for IEMs. Inborn errors of metabolism in infancy: a guide to diagnosis. Pediatr Rev.

Consulting 59

Consulting Individual Family Families 59

GeriPal

MAY 4, 2023

We remember bucking the rules, figuring out who you are, hair on fire, feeling invulnerable, trying to figure out who you are – and now those adolescents are stuck in the hospital, with doctors and parents telling them what to do, having their autonomy crushed by the medical institution, realizing they’re not invulnerable.

IT 83

IT Family Families Illness 83

GeriPal

JANUARY 30, 2025

But in reality, given workforce shortages and just the challenges and the resources necessary to be able to provide early integrated palliative care from the time of diagnosis of advanced cancer, the model simply is not implementable, at least not in our current state with our available infrastructure and resources. What do we do with that?

Telehealth 105

Telehealth Patient-Centered IT Patients 105

GeriPal

OCTOBER 20, 2022

And so there was a report in 2009 by the Institute of Medicine saying that we need to equip all of these individuals in caring for older person in an evidence based manner. So transmission of other drug resistant organisms and C difficile to other patients in the hospital reduces if you control. Diff rates, for example at a unit level.

Complication 52

Complication Patient-Centered IT Patients 52

GeriPal

MAY 9, 2024

all of whom focus their efforts on educating the general public about living and dying with a serious illness. So we are going to leapfrog over the healthcare system education and we’re going to go straight to the citizens of the world and we’re going to give them the insider tips to how to improve their illness experience.”

Education 127

Education IT Illness Healthcare 127

GeriPal

JULY 11, 2024

We get a bit of, in the veteran population, kind of a mix of a lot of mental health issues thrown into these comorbid illnesses, including cirrhosis, but it’s usually the decompensated cirrhotics or the folks with liver cancer and cirrhosis, or one of both. I’m embedded in the ICU in one of our smaller hospitals.

Patient-Centered 109

Patient-Centered IT Patients Clinic 109

GeriPal

AUGUST 25, 2022

Second, Hospice was originally designed for patients with advanced cancer, but the fastest growing admitting diagnosis is dementia. And yet, disenrollment from hospice, either due to patient/family revoking the benefit or stabilization of illness (extended prognosis) is remarkably high for people with dementia among some hospices.

Family 106

Family Families IT Patients 106

GeriPal

MAY 12, 2022

I mean, just such struggles around corruption in hospitals, access to opioid pain medication, and you almost had to wait until a friend of yours was in power, so you could have access, get permission. It’s easier to concentrate on cure, diagnosis, cure. People who are suffering are not very visible. They shared their experiences.

Community 115

Community IT Relationship Healthcare 115

GeriPal

FEBRUARY 9, 2023

For example, we spend the first half talking about a RCT simulation study of clinician verbal and non-verbal communication with a seriously ill patient with cancer. It also feels like, I also grew up in med school in a three hospital system. We find the same thing when you actually measure at the level of the hospital.

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Patient-Centered Patients IT Healthcare 111

GeriPal

JUNE 22, 2023

But now we have older people dying of older people illnesses. Alex: And are the regulations similar or different in terms of six month required prognosis or less, should the disease take its usual course, or illnesses leading to a short prognosis? When they built a new prison hospital in Stockton, the dialysis went there.

Family 132

Family Families IT Community 132

GeriPal

FEBRUARY 17, 2022

When we have a medication with up front harms and downstream benefits, it’s critical that we consider the time to benefit, or how long it will take an individual to benefit from a test or treatment. For individuals with a life expectancy less than the time to benefit, the up front harms outweigh the downstream benefits. .

Clinic 67

Clinic IT Patients Medical 67

GeriPal

SEPTEMBER 1, 2022

Social workers augment a team’s ability to provide whole-person care, often aiding to identify and meaningfully address the wide variety of challenges and unmet needs faced by individuals and families facing serious illness. What does this diagnosis mean to you? You begin with psychosocial assessment and care. Eric: Yeah.

IT 102

IT Family Families Clinic 102

Annals of Family Medicine

NOVEMBER 20, 2024

Context: Older adults with severe mental illness (SMI) who develop dementia are a particularly complex and understudied population with various healthcare needs. Objective: To describe individual characteristics and healthcare use in older adults with SMI across home care services (HCS) profiles before and after the first dementia diagnosis.

Diagnosis 130

Diagnosis Healthcare Illness Primary Care 130

GeriPal

OCTOBER 27, 2022

James: Yeah, so I guess just to start… I mean, prognosis in general is kind of a term for predicted course of disease, and I think people commonly use it to refer to an individual’s life expectancy or how long the person has to live. I think this is a really difficult topic to talk about with patients.

IT 95

IT Clinic Screening Patients 95

GeriPal

JUNE 26, 2025

But from our clinical work, many of us are familiar with people with dementia who experience sudden shocks to their health, think hip fracture, think hospitalization for pneumonia. And then when you see clinically patients coming into hospital, they’ll have, you know, they’ll be admitted for aspiration pneumonia.

Illness 93

Illness Hospital IT Patient-Centered 93

GeriPal

SEPTEMBER 19, 2024

Alex 00:34 We are delighted to welcome back Jennifer Tem e l, who is a thoracic oncologist at Massachusetts General Hospital in Boston. Alex 12:36 And most of our listeners are like clinician, practicing clinicians caring for older adults, people with serious illness. Within eight weeks of diagnosis of advanced disease.

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Patient-Centered IT Patients Hospital 119

GeriPal

JULY 25, 2024

The PPS is one of the most widely used prognostic tools for seriously ill patients, but the prognostic estimates given by the PPS are based on data that is well over a decade old. First time on the GeriPal podcast, Liz Lilley, who’s a surgeon and faculty in surgery at the Brigham Women’s Hospital and Harvard Medical School.

Family 106

Family Families Patient-Centered IT 106

GeriPal

MARCH 27, 2025

Alex 02:44 Still suffering from some illness from there, which is why I was sick and not in the office with Eric today. And is it at all individualized to the patient? Danny 12:07 I don’t know how individualized it is. Like, how close to the end of life is it all just in seriously ill patients, I guess. Yeah, yeah.

Primary Care 79

Primary Care IT Clinic Illness 79

GeriPal

MAY 1, 2025

And when she was here, she co founded the Golden Compass Clinic at San Francisco General Hospital for older adults living with HIV. Alex 16:55 My guess is probably not something that most geriatricians or internists or family medicine docs caring for older people have on their differential diagnosis. Is a new diagnosis of HIV.

Primary Care 94

Primary Care IT Provider Clinic 94

GeriPal

SEPTEMBER 14, 2023

Summary Transcript Summary Hospitals are hazardous places for older adults. These hazards include delirium, malnutrition, falls, infections, and hospital associated disability (which about ⅓ of older adults get during a hospital stay). 2020 Hospital at Home-Plus: A Platform of Facility-Based Care. Annals of Int Med.

Hospital 115

Hospital Patient-Centered Supply Chain IT 115

PEMBlog

DECEMBER 4, 2024

Pertussis infection in infants and children: Clinical features and diagnosis. In this episode, we’ll go over clinical presentation, diagnosis management, infection control, and post exposure protocols. Greater than 50 percent of kids under 12 months of age with pertussis could require hospitalization.

IT 52

IT Vaccination Diagnosis Complication 52

GeriPal

JULY 16, 2024

Ken Covinsky reminds us that we should not be making a diagnosis based on what we see on TV, and that if a patient’s daughter expressed a concern that their parent “wasn’t right,” we would conduct an in depth evaluation that might last an hour. Eric 04:17 How do you think about that? Ken 04:20 I think that was very well said, Louise.

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Diagnosis Diagnose IT Physicals 141