2. 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/ctsinclair
Arnold's subject - Things that I thought were true that are not
Arnold reading 'The Journey Down the Sidewalk of Life' http://bit.ly/hggOCm good poem for mistakes in health care
Mistakes help one see how the future might be different. -Arnold
Arnold - Talent is overrated - what you need is intense practice, intentional and focused, immediate feedback with a coach
As 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 -Arnold
Arnold - Focus on the role of behavioral economics and the role of emotions influencing preferences
Affect functions as info; spotlights certain info, motivates gathering more info, serves as common currency - Arnold
Arnold - Teaching is about creating a space where learning can occur - motivate and catalyze, make explicit connections #meded
Walker Percy "If you listen carefully to your patients they will tell you not only what is wrong with them but what is wrong with you
RT @hospicepharmacy: Legislation filed to legalize medical marijuana in #Kansas http://bit.ly/fHOsbZ #cancer #hospice
Detmer - 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 Detmer
RT @renee_berry: "We really need to be focusing on the people side of this far more than what were doing" -Detmer
Detmer - "We've 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. - Leider
Leider - 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 #rena'
Nearly 80,000 patients died with End Stage Renal Disease (had been on HD), only 21% received hospice services - Moss
Moss - "Only about a dozen nephrologists in US that are certified in hospice and palliative medicine" Love to meet them #renal
Moss - Most common cause of death in patients with end stage renal disease is actually cardiovascular disease
Question in session on #Renal: Wouldn't methadone be preferred over Fentanyl given incr chance of neuropathic pain? Moss (and me) Yes
53% of Hospice physicians felt that other people misperceived actions as hastening death in natl survey - Goldstein
Goldstein - 25 docs had some investigation about possible hastening death. Mostly by other health care team members, hospital based
Goldstein's presentation->sobering. Palliative docs underestimate the risk of being investigate and practices likely to be investigated
Goldstein recs: open lines of comm with other HC staff, meticulous documentation (document opioid calculations), mediation efforts
Goldstein - Publishing this study needs to be done with measured caution because of significant risk of misunderstanding/soundbites
Rushton - Avoid labeling parents as 'difficult' or 'uncaring' get to know their challenges, their view point #peds
Staff labeled mother as uncaring. Her response- I'm home getting life in order in case he gets discharged. He is safe w/ you -Rushton
Mcpherson - Dalfasmpridine (Ampyra) for #MultipleSclerosis Can help with function, but Cots $1000 for 30d, watch out for seizures
Macpherson - Dabigatran etexilate mesylate (Pradaxa) new competitor with Warfarin, stroke embolism risk reducer #pharma
Macpherson - Pradaxa fewer drug interactions, no INR checks like coumadin, but at what cost. $7/day vs. 50cents for coumadin
Macpherson - Must be careful in storing Pradaxa - once opened only good for 30days #pharma
Macpherson - Fentanyl SL tablet (Abstral) 5th rapid acting trans mucosal (actiq, gen actiq, Onsolis, Fentora) #pharma
RT @gcooneymd: Opioid tolerant defined as 60 MG OMS daily for one week
Macpherson - 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 town
Macpherson - FDA def of opioid tolerant - 60mg morphine, 24mcg fent patch, 30mg oxycodone, or 8mg hydromorphone per day
Macpherson - BuTrans Transdermal buprenorphine - patch worn for 7 days, need to titrate patient down before starting
Macpherson - Primary care providers have warm/fuzzy feeling towards transdermal systems -"Totally agree, but variable understanding'
Macpherson - Nuedexta (Dextromethorphan/Quinidine) for uncontrolled laughing/crying in multiple neurological diseases #ALS #MS
Macpherson - Acetaminophen IV (Ofirmev) - Finally I have wanted to have this so many times
Macpherson - OxyContin Reformulation-60 tab AWP $375, insoluable in alcohol, forms viscous gel with water, some pts say not effective
Macpherson - Cryostat - Most important palliative care therapy I am talking about - cold pack for hemorrhoid relief
Macpherson Palliative related med Pipeline Ereska, Fentora Long Acting, Posidur, Rylomine 'get used to these names'

3. "Art is about arresting life and making it available for contemplation" - Bertman
"Death is about continuing bonds of attachments not severing them" - Bertman
My favorite quote from Bertman (so far) "We are Body and biography"
Religion is for people afraid of going to hell and spirituality is for those who have been there.- #quote from anon patient
Humor is such a healing modality. We meaning making creatures and art at its best remind us of the contradictions that plague us all
RT @GriefHealing: "Religion is for people afraid of going to hell and spirituality is for those who have been there" -R. G. Ingersoll
Every patient invites the doctor to combine the role of the priest the philosopher the poet the lover - Anatole Brovard from Bertman
ng @ctsinclair Quotation also attributed to Dr. Abraham J. Twerski, Deepak Chopra and AA ~ so who knows?! :o)
"That which is to provide light must endure burning" - Victor Frankl - Great #quote from Showalter
Why didn't you tell the taxi driver what you do (#hospice)? You had 40 minutes and you paid them $50' - Showalter @DrSES
Russell - cases made for anyone on the liver transplant waiting list is #hospice eligible since high mortality. Make sure goals align.
Russell - Adv age, anorexia were stronger predictors of survival than current hospice guideliens for #dementia
Russell - "We set up failure when we are overly optimistic with prognostication" agreed
Russell-How do we meet the patients need in prognositcation? Know the data/tools; know the bias, know the uncertainty
Russell - Avoid 'Truth Dumping' on patients. It is not communciation. #epatient
The @AA just announced they will be moving forward with the #Hospice Medical Directors Certification Pathway, ready by 2013
RT @equijada: Whidden- topical preps: EMLA - no, MS - yes, ibuprofen - no, lidocaine - yes. -> for wound pain; "dermafil best of all
New paper Wygart on Childhood Sexual Abuse (CSA) in Pallaitive Care: 1 in 3 women and 1 in 6 men have had CSA
Only one study to date looking at CSA in #palliative care/advanced #cancer settings
Wygart - CSA impacts adherence to medical treatment, increased co-morbidities. Exacerbated by decline in physical/cognitive fxn
CSA may be revealed by another family member and not the patient. - Wygart
CSA survivors may repress, history of victim blaming/shaming, no safe place to report; Health care staff not sure how to respond.
Comfort care module are exercises based on PALS (ped adv life support modules) - mult scenarios - pain, dyspnea. delivering bad news
Now up Dr. Gordon Wood from University of Pittsburgh on "CODE: Chronic Opioid Documentation Evaluation" innovative teaching
Now up Dr. Susan Glod from @PennStHershey on 'Experiencing Loss Through Patients Eyes.'
Glod describes the 'Grim Reaper' exercise to help medical students recognize loss.
419 million media impressions for the Early #Palliative Care in Lung #Cancer study published in @NEJM - holy cow!
79% rec'd prognostic info from docs, only 47% of families partially used that info to help with dec making
Survival Graph with Pneumonia in patients with advanced #dementia (no real diff for oral, IV, or intramuscula http://twitpic.com/41ih7m
Graph of medical decisions before and after video assisted advanced care planning #HaveTheTalk http://twitpic.com/41ilqo
Videos are not replacements for provide-patient discussion. They are a supplement - Anderson
Media training boot camp @AA: Stay on message. Avoid jargon. Use plain language. Be confident.
RT @drpippa: link for info on Volandes ACP videos - www.acpdecisions.org cc @DrJESimon
Induced/Therapeutic Hypothermia for patients after cardiac arrest first published in 2002. 55% v 39% favorable neuro outcome NNT 6 #
Hypothermia may decrease the clearance of sedatives by effects on P450, decreased distribution volume - Chen
RT @suzanakm: Advice from Foley to Chochinov: just put in article physicians should just not be jerks-lessons from Osler #epatient #
"The secret of the care of the patient is caring for the patient," - Francis Peabody Harvard University 1921 via @DianeEMeier
"We are not the audience; no public engagement, no policy change." - @DianeEMeier
Conflict about use of term 'medical torture' when suffering is not addressed in medicine - 'i dont like it myself, politics of fear'
So glad that @DianeEMeier made a strong ask to this audience to engage online and in Social media.
Submit public comments when asked - they are taken extremely seriously in Washington. Dont delete them like we all do - @DianeEMeier
"Tell me your story" the four most important words in the English language - Block via Conway
RT @renee_berry: "This is our moment & we need to grab it" @DianeEMeier
RT @Doctor_V: Dayyyy-am, these palliative folks are social. "Yes we are! We do like to communicate after all."
Prelim Twitter #'s from @AA conf- 300+users, 2000+ tweets, 300k+ accts reached, @ctsinclair "thanks from those of us stuck at home
RT @dwensel: FourSeasons census of 250 with 5.5 FTEs and bill about 90% of FTF visits. 'Wow'

4. mbly