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Artificial intelligence (AI) integration in healthcare has become more prevalent through the advancements of ChatGPT, an OpenAI-developed AI language model based on deep learning that produces human-like text. ChatGPT has many questioning its role in healthcare, specifically its use in nursing education.
Accurate documentation is important in elder care. Given these challenges, its important to understand the difficulties involved in documentation. Lets explore the role of medical scribes in enhancing elder care and how partnering with a scribe agency can benefit geriatric practices.
This began a series of discussions that led to what Jain called a “David and Goliath document” that sketched out the vision for HealthRight and its potential differentiators from the for-profit giants in the space. As the prospect of the combination started to bloom, the SCAN term broached the idea in a letter to CareOregon leadership.
Lastly, Soo Borson is a self-described primary care leaning geriatric psychiatrist, developer of the Mini-Cog, and co-leads the CDC-funded BOLD Center on Early Detection of Dementia. Alex 00:09 We are delighted to welcome S oo Borson, who is a primary care oriented geriatric psychiatrist. Who do we have with us today?
Abhilash Desai, MD , geriatric psychiatrist, adjunct associate professor in the department of psychiatry at University of Washington School of Medicine, and poet! Alex: And we have Ab Desai, who’s a geriatric psychiatrist in Idaho. How about transforming care in healthcare institutions? Anne: Great to be here. We have to.
This foundation of nursing excellence, combined with the support and collaboration of all our healthcare professionals, is the essence of what makes us a Magnet hospital.” The Magnet recognition has proven beneficial to healthcare organizations, their patients, and their communities.
There are certification courses that are available for healthcare providers to take as well,” explains Robin Arends, DNP, CNP, FNP-BC, PMHNP-CE, CNE, FAAN, FAANP, the APRN Program Director at South Dakota State University as well as a nurse practitioner at Avel eCare. It is important to stay current with this trend. Arends agrees.
Geriatric A nurse who specializes in geriatric care may be in the hospital setting or in a nursing home. In-home Nurses working in the in-home environment have similar responsibilities to the geriatric nurse. Learn about some best practices of a supportive healthcare environment here.
I am an acute care and adult and geriatric certified nurse practitioner. Taylor: Yes, I think, too, in light of the pandemic, number one, we’ve seen healthcare providers that cannot meet the demands of their patients, so who do they rely on? Axxess empowers healthcare in the home with technology solutions to make lives better.
Summary Transcript Summary The comprehensive geriatric assessment is one of the cornerstones of geriatrics. But does the geriatric assessment do anything? Evidence has been mounting about the importance of the geriatric assessment for older adults with cancer, the subject of today’s podcast. Precision medicine?
Alex 01:27 We’re delighted to welcome back Tim F a rrell, who’s a geriatrician, associate chief for Age Friendly care at the University of Utah and chair of the American Geriatric Society Ethics Committee. All right, and finally we have Yael Zweig, who is a geriatric nurse practitioner at NYU. Tim, welcome back to GeriPal.
We talk on this podcast about potential uses of AI in geriatrics and palliative care with natural language processing guru Charlotta Lindvall from DFCI, bioethicists and internist Matt DeCamp from University of Colorado, and prognosis wizard Sei Lee from UCSF. Sei Lee is Professor of Medicine at UCSF in the division of geriatrics.
J Am Geriatr Soc. 2017 The Illegal Marketing Practices by Pharma promoting ineffective: The Neurontin Legacy — Marketing through Misinformation and Manipulation NEJM 2009 Narrative review: the promotion of gabapentin: an analysis of internal industry documents. Cochrane Database of Systematic Reviews Review. Annals of IM. Tasce: Right.
Alex: Also returning Rebecca Sudore, who is professor of medicine at the UCSF in the division of geriatrics, and is a geriatric and palliative care doctor. Susan: I’ll just say, I think that could happen outside of the healthcare setting pretty easily and frequently does. I think Bob also noted documenting it.
end of life care and advance care planning) to more geriatrics focused (e.g. Alex: And we’re also delighted to welcome back to the GeriPal podcast Kenny Lam, who’s assistant professor of medicine at UCSF in the Division of Geriatrics. It’s what happens in lots of different fields, including geriatrics.
I’d hazard that maybe half the patients I care for at the intersection of geriatrics and palliative care fall in the gray zone. They had it, the note then documents that they don’t have it. Emily’s expanded notion of consent is grounded in the concept of “relational autonomy.” Anne Rohlfing: I think that is a positive aspect.
Missouri set a very high bar, explicit written documentation that applies to this specific circumstance, which the Cruzan’s eventually cleared. But legislation can change, clinical practice can change, but I think what we’ll talk about today is how we’re now opening the door to conversations rather than legal rules and documents.
The Beers Criteria is one of the most frequently cited reference tools in geriatrics, detailing potentially inappropriate medications to prescribe to older people. We’re delighted to welcome Mike Steinman, who’s a geriatrician professor of medicine at UCSF in the division of geriatrics, prior guest on this podcast.
As Thor notes, capturing patient stories has face validity as positively impacting the patients who share their stories and have them documented, and for the clinicians who get to truely and deeply know their patients in far greater depth than “what brought you to the hospital?” Every Veteran has a story. Our mission is to help them tell it.
Alex: Today, we are delighted to welcome James Deardorff, who is a geriatrician and a T-32 research fellow in UCSF’s Division of Geriatrics. He’s a Geriatrician Palliative Care Clinician Researcher, also in the UCSF Division of Geriatrics. Eric: And Alex, who do we have with us today? Welcome to the GeriPal podcast, James.
Certainly SOME of those avoided hospitalizations, CPR, and ICU stays were due to documentation of those orders in the POLST. Because we haven’t done our job to document the value of what we’re doing. And I use that as that documentation about what they want, recognizing that not everybody does that.
Tell me how your illness has impacted your relationships with others, your healthcare team, your family, friends, your beliefs, your values, your preferences. And now my program of research is around testing that person-centered narrative intervention or PCNI because you have to give them an acronym in healthcare.
It was really at the level of the ED across 33 EDs in random order, and then tried to see if we could make a difference in healthcare utilization, primarily the primary outcome was admission to the hospital, acute care admission. Do they have documents in the record like medical orders for life sustaining treatment or a healthcare proxy?
I’d also think, is it reciprocity if we prioritize frontline healthcare workers or is it like that instrumental value where actually, we don’t care what they did in the past, we care that they’re able to work in the future. Govind: Yeah. Govind: So you’re right that those often go together. Govind: Yeah.
This idea that for critically ill patients in the ICU, geriatric conditions like disability, frailty, multimorbidity, and dementia should be viewed through a wider lens of what patients are like before and after the ICU event was transformative for our two guests today. I’m going to turn to you Lauren.
But you know, we’re told if, if we say we’re increasing it for pain and we document that and then send it back to the methadone clinic, the methadone clinic won’t be able to increase, continue with that increased dose. We try to document that it’s for cravings or withdrawal symptoms or Sach.
Accreditation In support of improving patient care, UCSF Office of CME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Alex: We are delighted to welcome back to the GeriPal podcast, Katie Fitzgerald Jones, who’s a nurse scientist at the New England Geriatric Research Education and Clinical Center, and a palliative and addiction nurse practitioner at the VA in Boston. It’s not well-documented. AMA PRA Category 1 credit(s) ™. Katie: Sure.
Alex 08:07 There’s no documented photographic evidence that I. And that was the last time that he’d been seen by our healthcare system. It’s from Michigan. Eric 08:00 Alex, you had a mullet. Alex 08:01 I had a mullet. Eric 08:03 Can we share that back online on GeriPal listeners? Eric 08:12 I think there probably is.
Alex: And we have Hillary Lum, who is a geriatrics and palliative care researcher at the University of Colorado. Hillary: And then I also see us measuring advance care planning documents on file in the health system so that that’s not where I want us to be. We have Sarah Nouri, who is a palliative care doc and researcher at UCSF.
In the US, geriatrics “grew up” as an academic profession with a heavy research base. Clinical growth of geriatrics programs has lagged academic research, despite the rapid aging of the population. . And so it’s within normal practice to have a reasoning and be accountable for it and document that.
Does every institution need to get a community advisory board to tailor their rural tele-palliative care initiative (or geriatrics intervention) to the local communities served? Like, would you include the doctors that I work with, healthcare providers where I live in Marin? We are going to have healthcare utilization data as well.
That’s why we do this podcast- to address real world issues in palliative care, geriatrics, and bioethics. How do you clearly articulate the value in what you deliver when we can’t even fully document it in our notes so that we can sit at tables and boardrooms and say, “Look, we’re more than just mobility training.
And I learned, so you have this wonderful paper that just came out in JAGS, Journal of the American Geriatrics Society, titled Patients Living with Dementia Have Worse Outcomes When Undergoing High-Risk Procedures. I mean, financially, the bulk of the American healthcare system is a fee-for-service system. Yep, for geriatrics?
These hick pick codes are available to any chaplain in a healthcare system. And I told her I quote LaVera every year when I teach the geriatrics fellows, the palliative care fellows, I would love for you to tell the story that I quote because you experienced it. It’s now available. Eric: So, let me ask this then.
What we did was ask clinicians earlier in the ICU stay for very sick patients to document prognosis, and for those who they thought would survive, to document six-month functional prognosis. I’m just stunned even writing that! We’ve come so far as a field. And also leveraging that idea that we all have these biases. Eric: 3,500 people.
And what my goal was was to try to get a 360 degree view of the healthcare system by interviewing as many different types of people that will influence care for people who are at the end-of-life or people with serious illness in the hospital. Alex: I found your quotes particularly hard hitting here.
I think as researchers, we need to do our due diligence to follow that and healthcare providers, of course, ’cause we want to be sensitive. Even when we’re engaging with the healthcare system, there’s a lot of literature that talks about the discrimination that is often Black families face, and then it is true.
And I think when COVID started, I was in a number of meetings about how we were going to think about CPR from this point forward, given that it was would really expose healthcare workers to easy transmission of this virus that we didn’t fully understand yet. You’ve had three documented conversations to “clarify code status.”
Why don’t people want to document serious illness conversations? I think this is actually bread and butter geriatrics. And then there’s this other time, and this gets to the geriatric patients, where you’re adapting to change and loss and then it’s a new normal that you’re trying to adapt to.
Healthcare, just the way healthcare is structured, that’s not something that’s feasible unless there’s a specific symptom management need that allows for more care, but just to provide simple care doesn’t exist. There’s a consistency of understanding and approach that I think is helpful.
And it’s a bit of a hokey title, but what I try and impress on readers there is that, the reflection that patients see of themselves, at least metaphorically in the eye of the healthcare provider, needs to be one that is affirming of patient dignity. I mean, we all give lip services saying, “Person-centered care is important.”
Yeah, but I mean, in healthcare you need to appreciate the risks, benefits and alternatives of the proposed intervention. And so I think of it as more like the patient who’s on document dialysis, who. It’s a, it’s a, it’s a past self directing healthcare for a future self. But it’s a risk, right?
And the big findings were better quality of life scores, less depression, more documentation of preferences, less aggressive care at the end of life. Most people aren’t coming to UCSF or MGH for their healthcare. And the kicker was they lived, what, two to three months longer? Jennifer: Yep. Eric: So I got another question.
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