Transcript of "What I Learned at the 2011 AAHPM Conference in Tweets"
Author note: Edited Tweets from @ctsinclair who attended the 2011 American Academy of Hospice and Pallaitive Medicine Annual Assembly Pleas see disclaimer at slideshare.net/ctsinclairArnolds subject - Things that I thought were true that are notArnold reading The Journey Down the Sidewalk of Life http://bit.ly/hggOCm good poem for mistakes in health careMistakes help one see how the future might be different. -ArnoldArnold - Talent is overrated - what you need is intense practice, intentional and focused, immediate feedback with a coachAs a teacher my job is not to think about a problem learner, but to think abt how I can teach someone best to do something -ArnoldArnold - Focus on the role of behavioral economics and the role of emotions influencing preferencesAffect functions as info; spotlights certain info, motivates gathering more info, serves as common currency - ArnoldArnold - Teaching is about creating a space where learning can occur - motivate and catalyze, make explicit connections #mededWalker Percy "If you listen carefully to your patients they will tell you not only what is wrong with them but what is wrong with youRT @hospicepharmacy: Legislation filed to legalize medical marijuana in #Kansas http://bit.ly/fHOsbZ #cancer #hospiceDetmer - Demise of expert-based practice is inevitable, the information blows past ability for human cognition"Everyone complains of his memory, but no one complains of his judgement." - Duc De La Rochefoucauld from DetmerRT @renee_berry: "We really need to be focusing on the people side of this far more than what were doing" -DetmerDetmer - "Weve talked about working as teams (in health care) more than we have actually done it"If you want to improve care it is about reducing variations in care. - LeiderLeider - Quote from Dr. Marc Bard from Harvard - "Physicians practice alone, together" #MDchat #RNchat"Would I be surprised if this patient died in next year" accurate for prognostication from #renal docs in dialysis patients.Moss - increasing evidence showing even in the elderly dialysis may not be better than conservative/med management in survival #renaNearly 80,000 patients died with End Stage Renal Disease (had been on HD), only 21% received hospice services - MossMoss - "Only about a dozen nephrologists in US that are certified in hospice and palliative medicine" Love to meet them #renalMoss - Most common cause of death in patients with end stage renal disease is actually cardiovascular diseaseQuestion in session on #Renal: Wouldnt methadone be preferred over Fentanyl given incr chance of neuropathic pain? Moss (and me) Yes53% of Hospice physicians felt that other people misperceived actions as hastening death in natl survey - GoldsteinGoldstein - 25 docs had some investigation about possible hastening death. Mostly by other health care team members, hospital basedGoldsteins presentation->sobering. Palliative docs underestimate the risk of being investigate and practices likely to be investigatedGoldstein recs: open lines of comm with other HC staff, meticulous documentation (document opioid calculations), mediation effortsGoldstein - Publishing this study needs to be done with measured caution because of significant risk of misunderstanding/soundbitesRushton - Avoid labeling parents as difficult or uncaring get to know their challenges, their view point #pedsStaff labeled mother as uncaring. Her response- Im home getting life in order in case he gets discharged. He is safe w/ you -RushtonMcpherson - Dalfasmpridine (Ampyra) for #MultipleSclerosis Can help with function, but Cots $1000 for 30d, watch out for seizuresMacpherson - Dabigatran etexilate mesylate (Pradaxa) new competitor with Warfarin, stroke embolism risk reducer #pharmaMacpherson - Pradaxa fewer drug interactions, no INR checks like coumadin, but at what cost. $7/day vs. 50cents for coumadinMacpherson - Must be careful in storing Pradaxa - once opened only good for 30days #pharmaMacpherson - Fentanyl SL tablet (Abstral) 5th rapid acting trans mucosal (actiq, gen actiq, Onsolis, Fentora) #pharmaRT @gcooneymd: Opioid tolerant defined as 60 MG OMS daily for one weekMacpherson - REMS strategy for Abstral - good preview for other opioids in future. Prescriber are specially certified - Adoption rate?Macpherson - Abstral REMS the pharmacist and wholeseller also has to be specially certified. Good luck with getting all 3 in your townMacpherson - FDA def of opioid tolerant - 60mg morphine, 24mcg fent patch, 30mg oxycodone, or 8mg hydromorphone per dayMacpherson - BuTrans Transdermal buprenorphine - patch worn for 7 days, need to titrate patient down before startingMacpherson - Primary care providers have warm/fuzzy feeling towards transdermal systems -"Totally agree, but variable understandingMacpherson - Nuedexta (Dextromethorphan/Quinidine) for uncontrolled laughing/crying in multiple neurological diseases #ALS #MSMacpherson - Acetaminophen IV (Ofirmev) - Finally I have wanted to have this so many timesMacpherson - OxyContin Reformulation-60 tab AWP $375, insoluable in alcohol, forms viscous gel with water, some pts say not effectiveMacpherson - Cryostat - Most important palliative care therapy I am talking about - cold pack for hemorrhoid reliefMacpherson Palliative related med Pipeline Ereska, Fentora Long Acting, Posidur, Rylomine get used to these names