Godzilla, representing polypharmacy and overmedication, meets Fervid Trimble, a patient admitted to a health center for recovery. However, Fervid becomes overmedicated, confused, and delirious due to a prescribing cascade where symptoms of potential adverse drug reactions are treated as new conditions with additional medications. The Little Red Hen, representing Fervid's family, questions the numerous prescriptions and lack of improvement. Research reveals Fervid experienced serotonin syndrome from an interaction between her antidepressant and pain medication. The family's advocacy improves Fervid's condition after reducing her medications, but polypharmacy weakens her and contributes to later health issues.
Josh died from prostate cancer even though he had warning signs like back pain. He failed to see a doctor to check for underlying causes. Some family members also had prostate cancer, putting him at higher risk. Early detection and treatment could have saved Josh's life and allowed him to continue playing soccer in college.
A case study of a woman in a hispanic community who sought healthcare for a Urinary Tract Infection, but it was discovered that she was being seriously sexually abused. How it was handled and difficulties encountered.
This document discusses providing culturally competent end-of-life care to diverse populations. It outlines key cultural considerations and customs for Hispanic, African American, and Asian groups related to family structure, health beliefs, symptom management, rituals of death and dying, and grief. It emphasizes establishing trust, understanding cultural norms, avoiding stereotypes, and addressing individual needs and variations within cultural groups to provide effective end-of-life care.
This document contains summaries from multiple people about their experiences with Lyme disease. It includes details about when they first experienced symptoms, whether they knew about a tick bite, their symptoms over time, how many doctors they saw before receiving a diagnosis of Lyme disease, what types of treatments they have tried, and how the disease has affected them and their loved ones. Many report seeing over a dozen doctors, receiving multiple incorrect diagnoses, experiencing debilitating physical symptoms as well as mental health impacts, and Lyme disease devastating their families as well in many cases.
August 2013 PLUS HIV and its impact on mental healthPositive_Force
Receiving an HIV+ diagnosis can cause strong emotional reactions like distress, sadness, denial, anxiety or anger. Common emotional symptoms include denial, shame, anger, depression, anxiety, and suicidal thoughts. It is important to cope through self-care, social support, education, and managing stress. Seek counseling or medical help if symptoms are severe or persistent, or if having suicidal thoughts. Support services are available to help with mental health and adjusting to an HIV diagnosis.
Depression is a serious illness that negatively affects mood and behavior. It causes feelings of sadness, irritability, and loss of interest in activities. Depression is caused by stressful life events, genetics, medical conditions, and substance abuse. Symptoms include changes in sleep, appetite, energy level, concentration, and self-image. Diagnosis involves questionnaires to assess symptoms and duration. Treatment includes antidepressant medication and therapy, which aim to change brain chemistry and relieve symptoms. Managing depression requires lifestyle changes like exercise, social support, and addressing underlying causes.
HIV AIDS Lecture Presented by me in my Community Dentistry Class, BIBI ASIFA DENTAL COLLEGE, SHAHEED MOHTARMA BENAZIR BHUTTO MEDICAL UNIVERSITY LARKANA, SINDH, PAKISTAN.
Clara's House provides comprehensive primary health care services to uninsured individuals living in poverty through an all-volunteer staff. The services are offered at no charge and include initial visits, labs, health assessments, prescriptions, eyeglasses, prosthetics, nutrition consultations, immunizations, chronic disease management classes, and patient advocacy. Clara's House aims to disrupt poverty and disease one person at a time by meeting a variety of health needs for those in need.
Josh died from prostate cancer even though he had warning signs like back pain. He failed to see a doctor to check for underlying causes. Some family members also had prostate cancer, putting him at higher risk. Early detection and treatment could have saved Josh's life and allowed him to continue playing soccer in college.
A case study of a woman in a hispanic community who sought healthcare for a Urinary Tract Infection, but it was discovered that she was being seriously sexually abused. How it was handled and difficulties encountered.
This document discusses providing culturally competent end-of-life care to diverse populations. It outlines key cultural considerations and customs for Hispanic, African American, and Asian groups related to family structure, health beliefs, symptom management, rituals of death and dying, and grief. It emphasizes establishing trust, understanding cultural norms, avoiding stereotypes, and addressing individual needs and variations within cultural groups to provide effective end-of-life care.
This document contains summaries from multiple people about their experiences with Lyme disease. It includes details about when they first experienced symptoms, whether they knew about a tick bite, their symptoms over time, how many doctors they saw before receiving a diagnosis of Lyme disease, what types of treatments they have tried, and how the disease has affected them and their loved ones. Many report seeing over a dozen doctors, receiving multiple incorrect diagnoses, experiencing debilitating physical symptoms as well as mental health impacts, and Lyme disease devastating their families as well in many cases.
August 2013 PLUS HIV and its impact on mental healthPositive_Force
Receiving an HIV+ diagnosis can cause strong emotional reactions like distress, sadness, denial, anxiety or anger. Common emotional symptoms include denial, shame, anger, depression, anxiety, and suicidal thoughts. It is important to cope through self-care, social support, education, and managing stress. Seek counseling or medical help if symptoms are severe or persistent, or if having suicidal thoughts. Support services are available to help with mental health and adjusting to an HIV diagnosis.
Depression is a serious illness that negatively affects mood and behavior. It causes feelings of sadness, irritability, and loss of interest in activities. Depression is caused by stressful life events, genetics, medical conditions, and substance abuse. Symptoms include changes in sleep, appetite, energy level, concentration, and self-image. Diagnosis involves questionnaires to assess symptoms and duration. Treatment includes antidepressant medication and therapy, which aim to change brain chemistry and relieve symptoms. Managing depression requires lifestyle changes like exercise, social support, and addressing underlying causes.
HIV AIDS Lecture Presented by me in my Community Dentistry Class, BIBI ASIFA DENTAL COLLEGE, SHAHEED MOHTARMA BENAZIR BHUTTO MEDICAL UNIVERSITY LARKANA, SINDH, PAKISTAN.
Clara's House provides comprehensive primary health care services to uninsured individuals living in poverty through an all-volunteer staff. The services are offered at no charge and include initial visits, labs, health assessments, prescriptions, eyeglasses, prosthetics, nutrition consultations, immunizations, chronic disease management classes, and patient advocacy. Clara's House aims to disrupt poverty and disease one person at a time by meeting a variety of health needs for those in need.
This document discusses perinatal loss and grief. It begins by outlining expected learning outcomes related to defining perinatal loss, identifying types and risk factors, and describing emotional responses and the grief process. It then defines perinatal loss and describes the main types - ectopic pregnancy, miscarriage, stillbirth, and neonatal death - providing details on signs, risks, and causes. Statistics on the frequency of perinatal loss are presented. Emotional responses are discussed, as well as the grief and mourning process. Finally, potential nursing diagnoses and interventions are outlined, focusing on ineffective sexuality patterns, complicated grieving, and the importance of support.
Delirium is a disturbance in attention, awareness and cognition that develops over a short period of time and tends to fluctuate. It is common in terminally ill patients, affecting up to 85%. Delirium causes distress for patients and families and conflicts with patient goals of cognitive awareness. It is important to assess for delirium using tools like the Confusion Assessment Method. The first step in managing delirium is to treat any underlying causes, such as infection, dehydration, or medication side effects. Non-pharmacological interventions include reorienting the patient, maintaining their sleep-wake cycle, and engaging family. As a last resort, antipsychotics may be used but they increase the risk of death.
Delirium is a common and serious condition experienced by up to 85% of terminally ill cancer patients. It causes cognitive impairment, increased hospital stays and costs, worse patient and caregiver outcomes, and conflicts with patient goals of cognitive awareness at the end of life. Delirium has multiple potential causes including medications, metabolic imbalances, infections, and environmental changes. It is reversible in about 50% of cases with treatment of underlying causes and both pharmacological and non-pharmacological interventions. Early recognition and treatment are important for managing delirium and its impacts.
Kari Ulrich is a registered nurse who was diagnosed with two rare diseases, Fibromuscular Dysplasia and Ehlers-Danlos. While training for a half marathon, she experienced symptoms that led to her diagnosis. She has since advocated for patients with rare diseases, helping a young patient from South Africa receive treatment in the US. Rare disease research is important but often underfunded. An NIH study on connective tissue diseases was stopped in 2013, setting back progress. Patients must be involved in rare disease research to improve outcomes and access to informed decisions about treatment.
The document discusses Ebola, including that it originated in Liberia and has caused over 11,000 deaths. It spreads through direct contact with body fluids or tissues of infected people or animals. Those at highest risk are healthcare workers, family members of infected individuals, and those participating in funeral rituals involving direct contact with bodies. While there is no vaccine, treatment focuses on supportive care and fluid replacement. Proper handling by healthcare workers and regular hand washing are recommended to prevent spread.
This document presents a case study of 16-year-old Soumya who was brought to the hospital with fever, shortness of breath, and vomiting. After examination, she was diagnosed with progeria. Progeria is an extremely rare genetic condition where children exhibit rapid aging symptoms. It is caused by a genetic mutation that prevents prelamin A from being properly processed. Children with progeria have short stature, loss of hair and body fat, stiff joints, heart disease, and typically die in their early teens. While currently incurable, research is ongoing to develop treatments to target the underlying genetic cause.
This document provides guidance on treating HIV/AIDS, including recommendations on when to initiate treatment based on CD4 count, what antiretroviral regimens to use for treatment-naive patients, the importance of compliance, and potential complications and side effects of treatment. Guidelines recommend treating anyone willing to take medication, with a focus on achieving viral suppression through compliance to improve individual health and reduce community viral load.
The document discusses a case study of a 27-year old patient named Sophie who experienced numerous unexplained medical symptoms over several years. Despite seeing many specialists, she received diagnoses of functional neurological disorder, migraine, anxiety and Raynaud's disease. Frustrated by a lack of answers, Sophie researched her symptoms extensively online. This led her to suspect she may have Hughes syndrome (antiphospholipid syndrome). Upon sharing her research and photos with a professor, she received an official diagnosis of sero-negative antiphospholipid syndrome, and found relief with new treatment. The document concludes patients should not be dismissed as hypochondriacs, doctors should consider evidence patients provide, and rar
This document discusses various topics related to menopause, including:
- Perimenopause is the transition period leading up to menopause where estrogen levels gradually decline, causing irregular periods and symptoms like hot flashes and mood swings. It typically lasts 6-10 years.
- Menopause is confirmed after 12 months without periods and is a natural process where fertility ends, occurring on average at age 51.
- Hot flashes, sleep issues, headaches, memory problems and mood changes are common menopause symptoms that can usually be managed through lifestyle changes or over-the-counter remedies.
- Supplements are not proven as effective as FDA-approved medications for treating menopause symptoms
Pass the CASC - Neuroleptic Malignant Syndrome - ScriptPass the CASC
Scripted case study for explanation of Neuroleptic Malignant Syndrome to a father who's daughter has been admitted and receiving treatment for NMS. Pass the CASC exam gives real life scenario scripts to help with training for MRCPsych CASC course.
Denial in cancer patients by Raquel Rodriguez Quintana Jonathan McFarland
Raquel is a Psycho-oncologist working at Son Llatzer Hospital, in Palma de Mallorca. In this presentation she talks about Denial In Cancer Patients; an important and fascinating talk.
The document discusses Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder. It provides details on the diagnostic criteria, symptoms, prevalence, course, treatment, and portrayal in media. DID is characterized by distinct personality states and an inability to recall personal information. Estimates suggest it affects between 250,000-2.5 million people in the US. Long term treatment includes psychotherapy and medication. Celebrities like Britney Spears have been speculated to have the disorder due to exhibiting different personalities.
The document discusses Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder. It provides details on the diagnostic criteria, symptoms, prevalence, course, treatment, and portrayal in media. DID is characterized by distinct identities that recurrently take control of behavior and amnesia. It affects an estimated 250,000 to 2,500,000 people in the US. Long term treatment includes psychotherapy and medication. Celebrities like Britney Spears have been speculated to have the disorder due to exhibiting different personalities.
This presentation was done for Clinical Decision Making in Psychiatry; explains the difference between Factitious disorder and Malingering in a simple way.
During a routine wellness exam, the veterinarian thoroughly checks the pet from nose to tail to ensure overall health and catch any potential problems. The exam includes checking the ears, eyes, mouth, skin, heart and lungs, muscles and bones, abdomen, and performing tests for internal and external parasites as well as common diseases. Vaccinations are also discussed to prevent deadly illnesses and keep pet health records up to date.
Let's address these issues through a
multidisciplinary approach:
1. Optimize pain control
2. Engage chaplain/social work for emotional support
3. Explore faith/legacy through chaplain
4. Involve family for familiarity/comfort
5. Consider non-pharm interventions like massage
This comprehensive approach may help resolve his agitation.
Delirium Management
STEP 3: PHARMACOLOGIC APPROACH
When non-pharmacologic approaches are not sufficient
or the patient is a danger to self or others.
Pharmacologic Approach
• Benzodiazepines: lorazepam, midazolam
- Short
This family is suffering from a rare fictional disease called THIN (Threadlike Haggarding Intractible Narrowitis) that causes fatigue, constant hunger, brittle bones, and bodily shrinkage. THIN is hereditary but can sometimes skip children in a family. While it can be cured with healthy eating and exercise, those with THIN have an aversion to both. The family works hard jobs and begs to afford their unending hunger for junk food. They try desperately to feed their children healthy food to no avail. Help is needed by donating food and encouragement to help this family beat the disease.
This document discusses evidence-based guidelines for diabetes treatment. It addresses where clinical judgement comes from, including tradition, authority, science, analysis of evidence, and personal factors. It also discusses the concept of evidence, the rise of "robot physicians" following guidelines rigidly, and issues with how guidelines are developed and can extend disease boundaries and therapeutic futility. Overall, the document questions some aspects of clinical practice guidelines and their relationship to evidence, authority, and competing interests.
This document discusses evidence-based guidelines for diabetes treatment. It addresses where clinical judgement comes from, including tradition, authority, science, analysis of evidence, and personal factors. It also discusses the concept of evidence, the rise of "robot physicians" following guidelines rigidly, and issues with how guidelines are developed and can extend disease boundaries and therapeutic futility. Overall, the document questions some aspects of clinical practice guidelines and their relationship to evidence, authority, and competing interests.
More Related Content
Similar to D3 - Johanna Trimble - Godzilla Meets the Little Red Hen
This document discusses perinatal loss and grief. It begins by outlining expected learning outcomes related to defining perinatal loss, identifying types and risk factors, and describing emotional responses and the grief process. It then defines perinatal loss and describes the main types - ectopic pregnancy, miscarriage, stillbirth, and neonatal death - providing details on signs, risks, and causes. Statistics on the frequency of perinatal loss are presented. Emotional responses are discussed, as well as the grief and mourning process. Finally, potential nursing diagnoses and interventions are outlined, focusing on ineffective sexuality patterns, complicated grieving, and the importance of support.
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The document discusses Ebola, including that it originated in Liberia and has caused over 11,000 deaths. It spreads through direct contact with body fluids or tissues of infected people or animals. Those at highest risk are healthcare workers, family members of infected individuals, and those participating in funeral rituals involving direct contact with bodies. While there is no vaccine, treatment focuses on supportive care and fluid replacement. Proper handling by healthcare workers and regular hand washing are recommended to prevent spread.
This document presents a case study of 16-year-old Soumya who was brought to the hospital with fever, shortness of breath, and vomiting. After examination, she was diagnosed with progeria. Progeria is an extremely rare genetic condition where children exhibit rapid aging symptoms. It is caused by a genetic mutation that prevents prelamin A from being properly processed. Children with progeria have short stature, loss of hair and body fat, stiff joints, heart disease, and typically die in their early teens. While currently incurable, research is ongoing to develop treatments to target the underlying genetic cause.
This document provides guidance on treating HIV/AIDS, including recommendations on when to initiate treatment based on CD4 count, what antiretroviral regimens to use for treatment-naive patients, the importance of compliance, and potential complications and side effects of treatment. Guidelines recommend treating anyone willing to take medication, with a focus on achieving viral suppression through compliance to improve individual health and reduce community viral load.
The document discusses a case study of a 27-year old patient named Sophie who experienced numerous unexplained medical symptoms over several years. Despite seeing many specialists, she received diagnoses of functional neurological disorder, migraine, anxiety and Raynaud's disease. Frustrated by a lack of answers, Sophie researched her symptoms extensively online. This led her to suspect she may have Hughes syndrome (antiphospholipid syndrome). Upon sharing her research and photos with a professor, she received an official diagnosis of sero-negative antiphospholipid syndrome, and found relief with new treatment. The document concludes patients should not be dismissed as hypochondriacs, doctors should consider evidence patients provide, and rar
This document discusses various topics related to menopause, including:
- Perimenopause is the transition period leading up to menopause where estrogen levels gradually decline, causing irregular periods and symptoms like hot flashes and mood swings. It typically lasts 6-10 years.
- Menopause is confirmed after 12 months without periods and is a natural process where fertility ends, occurring on average at age 51.
- Hot flashes, sleep issues, headaches, memory problems and mood changes are common menopause symptoms that can usually be managed through lifestyle changes or over-the-counter remedies.
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The document discusses Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder. It provides details on the diagnostic criteria, symptoms, prevalence, course, treatment, and portrayal in media. DID is characterized by distinct personality states and an inability to recall personal information. Estimates suggest it affects between 250,000-2.5 million people in the US. Long term treatment includes psychotherapy and medication. Celebrities like Britney Spears have been speculated to have the disorder due to exhibiting different personalities.
The document discusses Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder. It provides details on the diagnostic criteria, symptoms, prevalence, course, treatment, and portrayal in media. DID is characterized by distinct identities that recurrently take control of behavior and amnesia. It affects an estimated 250,000 to 2,500,000 people in the US. Long term treatment includes psychotherapy and medication. Celebrities like Britney Spears have been speculated to have the disorder due to exhibiting different personalities.
This presentation was done for Clinical Decision Making in Psychiatry; explains the difference between Factitious disorder and Malingering in a simple way.
During a routine wellness exam, the veterinarian thoroughly checks the pet from nose to tail to ensure overall health and catch any potential problems. The exam includes checking the ears, eyes, mouth, skin, heart and lungs, muscles and bones, abdomen, and performing tests for internal and external parasites as well as common diseases. Vaccinations are also discussed to prevent deadly illnesses and keep pet health records up to date.
Let's address these issues through a
multidisciplinary approach:
1. Optimize pain control
2. Engage chaplain/social work for emotional support
3. Explore faith/legacy through chaplain
4. Involve family for familiarity/comfort
5. Consider non-pharm interventions like massage
This comprehensive approach may help resolve his agitation.
Delirium Management
STEP 3: PHARMACOLOGIC APPROACH
When non-pharmacologic approaches are not sufficient
or the patient is a danger to self or others.
Pharmacologic Approach
• Benzodiazepines: lorazepam, midazolam
- Short
This family is suffering from a rare fictional disease called THIN (Threadlike Haggarding Intractible Narrowitis) that causes fatigue, constant hunger, brittle bones, and bodily shrinkage. THIN is hereditary but can sometimes skip children in a family. While it can be cured with healthy eating and exercise, those with THIN have an aversion to both. The family works hard jobs and begs to afford their unending hunger for junk food. They try desperately to feed their children healthy food to no avail. Help is needed by donating food and encouragement to help this family beat the disease.
This document discusses evidence-based guidelines for diabetes treatment. It addresses where clinical judgement comes from, including tradition, authority, science, analysis of evidence, and personal factors. It also discusses the concept of evidence, the rise of "robot physicians" following guidelines rigidly, and issues with how guidelines are developed and can extend disease boundaries and therapeutic futility. Overall, the document questions some aspects of clinical practice guidelines and their relationship to evidence, authority, and competing interests.
This document discusses evidence-based guidelines for diabetes treatment. It addresses where clinical judgement comes from, including tradition, authority, science, analysis of evidence, and personal factors. It also discusses the concept of evidence, the rise of "robot physicians" following guidelines rigidly, and issues with how guidelines are developed and can extend disease boundaries and therapeutic futility. Overall, the document questions some aspects of clinical practice guidelines and their relationship to evidence, authority, and competing interests.
Similar to D3 - Johanna Trimble - Godzilla Meets the Little Red Hen (20)
2. Godzilla Meets the
Little Red Hen
Or, the Prescribing Cascade
Meets the Bedside Observer
Johanna Trimble
Patient Representative
Sponsored by:
Community Engagement Advisory Network, Vancouver Coastal Health Authority
Member:
World Health Organization Patient Safety Champion
BC Patient Voices Network
Patients for Patient Safety Canada (CPSI)
5. Sometimes known as…
• The Prescribing Cascade
• Polypharmacy (stand-alone risk)
• Overmedication (dose, treating test)
• Too many (9 drugs average in RC, 0-55)
9. Fervid’s admission to the Health Centre
• After a ‘flu and dehydration episode, admitted
to the Health Centre for a few days
recuperation
• Instead she became bedridden, confused,
delirious, unable to recognize family plus
other puzzling symptoms
• SSRI anti-depressant had been prescribed
• Other drugs had been changed or prescribed
12. Why don’t we ask questions of the professionals?
• “They’re the professionals, they must know” –
Wrong! they know medicine -- you know the
patient
• “They’re busy and we’ll annoy them” – Wrong!
this is your loved one, make an appointment!
• “We’ll make them mad and they’ll call us difficult
and take it out on her” – Wrong! Do your
research, be clear, respectful and persistent
• “I’m part of the team!” – RIGHT! You can help
because you’re nearby observing, comparing
against baseline and asking questions.
18. UTI or Serotonin Syndrome?
• Fervid was repeatedly prescribed antibiotics
for urinary tract infections
• Delirium, elevation of white blood cells,
frequent urination and fever of SS mistaken
for a UTI
• Now we’ve got lots of antibiotics prescribed
and eventually we’re going to see c. difficile
19. Treating UTI’s and c. difficile
• Starting to be addressed in BC
• Both VCH and Fraser Health are
working on improving UTI treatment
protocols to address antibiotic
overuse & c. difficile
20. Serotonin Syndrome
• Symptoms include cognitive, autonomic and
somatic effects & range from barely
perceptible to fatal
• Clonus, hyperreflexia and flushing are the
most specific signs.
• Fervid was delirious, making unexplained
repetitive arm movements (clonus),
sometimes “asleep” and we couldn’t wake her
21. Fervid’s Prescribing Cascade
Unrecognized drug adverse effects,
symptoms of Serotonin Syndrome,
were treated with additional drugs
as if these symptoms were new
conditions.
23. A Common Mistake?
Fervid’s Cascade:
• SS onset can be either dramatic or insidious
making it harder to recognize
• Symptoms of SS were treated as a common UTI
(with nitrofurantoin, Beer’s list antibiotic)
• Rapid heartbeat, symptom of SS, was treated
with heart medication digoxin (Beer’s list)
• Delusions, hallucinations, confusion were about
to be addressed using Aricept
• The family declined it and any other prescriptions
unless consulted first.
28. Yes, it can happen twice…
• 3 years later Fervid was admitted to hospital with
a stomach bleed
• Several new drugs prescribed in hospital
• On return, confusion and delirium ensued
• A new doctor prescribed remeron (serotonergic)
• Symptoms of SS started JUST like 3 years ago
• Antibiotics were prescribed “for UTI” -- again
• Remeron was stopped and Fervid quickly
returned to normal
29. Polypharmacy & c. difficile
• Fervid had many antibiotic treatments for UTI’s or
respiratory infections
• Probably other residents did too
• 5 other residents had c. difficile
• Cleaning & infection protocols substandard or
inconsistent
• Frequent transfer of staff and patients
• 5 or 6 courses of vancomycin weakened Fervid
greatly
• No fecal transplant offered except in Australia
30. Fecal transplant in 2008? (only in Australia)
Now, in 2013, it is in the news:
• The US Centers for Disease Control has
issued an urgent plea for fecal transplant
donors after the recent studies show its
efficacy
• After much deliberation, CDC Vice-
Director Dr. Steven Gerrard has
announced that the drive for fecal donors
is being launched with the slogan:
“Save a life. Get your shit together.”
31. C. difficile
• Fervid may not have died OF c. diff
but she was greatly weakened and
died WITH c. difficile
• The important factor is the overuse
of antibiotics and the growing
resistance of organisms
34. “It’s (about) quality of life…for my residents. I've seen
dramatic differences in the quality of their life when the
BURDEN of their medication is reduced...”