Download Concurrent Sessions D Saturday 4 September 2.30pm – 3.30pm

Concurrent Sessions D
Saturday 4 September
2.30pm – 3.30pm
D1 – 2.30pm – 3.30pm
PRESCRIPTION DRUG MISUSE – OPIOIDS AND CHRONIC NON-CANCER PAIN
TOOP, LES
Prescription medicine diversion and misuse is a significant problem in New Zealand and
around the world. Much of the problem with illicit and IV drug use in Christchurch comes from
prescribed controlled drugs. Many of the prescriptions may be inappropriate or for larger
quantities than are necessary, as evidenced by the amount of these medications being
diverted. We, as general practitioners, need to address this problem.
The aim of this interactive presentation is to promote safe and responsible prescribing of
controlled drugs, to create awareness about drug diversion in our community, to highlight
supports/contacts available for health professionals with challenging patients, and to improve
communication between general practice and community pharmacy. Collaboration and
communication between members of the primary healthcare team is vital when drugs of
potential misuse are involved. Although there may not be any absolute answers, this
workshop is intended to at least promote thought and discussion.
You will learn about:
• The evidence for opioid use in chronic non-cancer pain and risks associated with
long-term use
• Setting ground rules and instituting pre-treatment agreements when initiating opioid
therapy
• Caution signs to look for in your patients on long-term opioids
• The usefulness and limitations of urine testing in assisting clinical decision-making
• How good communication between general practice and community pharmacy can
help you manage challenging patients.
‘Prescription Drug Misuse’ was a topic covered in the 2010 Pegasus Health Small Group
Education programme. This presentation was run for General Practitioners in June this year.
D2 – 2.30pm – 3.30pm
RATIONAL DRUG USE
POLYPHARMACY
MANGIN, Dee
IN
THE
ELDERLY:
ADDRESSING
AND
MINIMISING
Associate Professor, Director Primary Care Research Unit Christchurch School of Medicine.
Improved medical technology is associated with significant extensions in life expectancy in
elders. Guidelines for drug use in younger people are based on a single disease models
developed in younger populations. The reality for most older patients is multiple coexisting
chronic conditions, and the workshop will demonstrate how such linear models are not
appropriate in older populations, where complexity is the norm. Polypharmacy can be almost
inevitable, with the risk that the burden of medications and their harms outweighs the burden
of disease. It can be difficult to make decisions on which medications to prioritise when
dealing with polypharmacy. This workshop will use a case based interactive format for
participants to explore the issues around polypharmacy in the elderly.
You will learn
- to apply a model for thinking about and prioritizing medications in older patients
- the available evidence on drugs for primary prevention in older populations
- practical approaches to stopping medications
- the evidence for risks and benefits of drug discontinuation in older populations
Participants will go away with a practical and evidence based approach for addressing and
minimizing the risks of polypharmacy.
D3 – 2.30pm – 3.30pm
DERMOSCOPY
LANGFORD, David
The use of dermoscopy by practitioners who are experienced in the skill, is one of the major
recommendations in the current Australasian Melanoma Guidelines. Dermoscopy allows the
diagnosis of melanoma (and other skin cancers) at an early (curable) stage when detection
using clinical examination alone, is impossible. An overview of dermoscopy, designed to
stimulate interest in the subject, will be presented.
Dr Langford has been in full-time dermoscopy practice for 12 years. He is the principal and
founder of Molecheck®, and is a co-author of multiple papers published in journals including
the Archives of Dermatology, The Journal of the American Academy of Dermatology and the
British Journal of Dermatology. He has been both a speaker and a chairman at international
dermoscopy conferences.
Dr Langford has been privileged to be NZ’s only doctor on the Board of the International
Dermoscopy Society since its inception in 2003. The aim of the IDS is to promote clinical
research in dermoscopy with a view to helping and improving education of doctors in
dermoscopy. The Board of the IDS is composed of most of the world's leading experts in
dermoscopy.
D4 – 2.30pm – 3.30pm
WHEN DO PATIENT RIGHTS’ TRUMP PROFESSIONAL PRIDE?
TAYLOR, Tane and other TBA
Background: In mid 2009, in the mids of the “swine flu” pandemonium a 56 year old
previously healthy male was referred to Auckland Hospital ICU with total respiratory failure,
for ECMO (extracorporeal membrane oxygenation). The patient had contracted H1N1 Swine
flu (confirmed) while on holiday overseas, and had developed what is known as ‘white out’
pneumonia.
After 20 days of life-sustaining ECMO treatment and other critical care, the patient, who was
in an induced coma, had not responded. The ICU team advised the family of the likely
outcome and had prepared them for the possibility of the patient’s death. They were about to
turn off the lifesupport.
The family made an unusual request – to use as a last resort high dose intravenous sodium
ascorbate(vitamin C). The ICU team consulted with experts in this area and proceeded.
Within the first 36 hours they noted remarkable improvement. After 5 days the ECMO was
discontinued as the patient was now clinically stable.
Although the decision to administer intravenous sodium Ascorbate resulted from an open,
frank, companionate joint family-clinician process, when another clinical team took over the
care this was unilaterally discontinued.
The patient was eventually transferred to Waikato ICU.
The family was unhappy with the situation and engaged legal counsel that directed the
hospital to uphold the family’s wishes.
This was very uncomfortable for the clinicians, nursing staff but more importantly for the
patients family.
The patient has fully recovered and back on his farm.
This case raises multiple important issues ;
• How well do GP’s and specialists listen and incorporate patients worldviews in
planning and managing their care.
• How can clinical decisions be so radically apposing in the same hospital setting? –
especially in cases of life and death situations.
• What barriers do we as health professionals consciously and subconsciously put in
front of our patients.
• What is our Right (as medical professionals) to refuse treatments that we are either
not aware of or uncomfortable with.
• Ethical and moral - the hospital has just finished or was still valuating the ECMO
intervention as part of a research process - there was a clear vested interest.
The workshop objectives are:
1.
2.
3.
4.
to walk the patients journey and understand the barriers
discuss legal and ethical implications
increase awareness for patient/whanau centeredness
improve communication interprofessional, doctor-patient/whanau
Early indications are that Judi Strid, Director of Advocacy, Office of the Health & Disability
Commisioner and Mai Chen from Chen & Palmer who have both been involved with this case
will participate in the forum.
D5 – 2.30pm – 3.30pm
TRANSFORMING
CONSULTATIONS
–
HOW
CAN
WE
IMPROVE
OUR
CONSULTATIONS? Part 2
1
2
ARROLL, Bruce and THOMPSON, Nigel
1
Head of Dept of General Practice and Primary Health Care University of Auckland , Senior
2
Lecturer University of Otago and GP in Queenstown
Speakers: This seminar is designed to learn clinical skills that will facilitate patient
transformation. It will develop some of the skills of Neurolinguistic Programming to show how
they can be put to good use. There will also be time for the attendees to bring examples of
transformation from their own work. Dr Nigel Thompson is a Queenstown GP who has
extensive training in Neurolinguistic Programming and has many creative skills to “unpack”
his consultations and provide creative interventions.
Audience: This seminar will be suitable for any clinicians who have an interest in developing
their communication skills and effectiveness.
Aim of Workshop
To acquire new skills in both diagnosis and management for common problems such as
anxiety, depression, phobias, pain and to increase concordance with treatment/medication etc
and to appreciate that we can get more out of consultations with some extra tools in the tool
kit. While very little research work has been done on these techniques they are often clearly
effective for patients. Also this work makes sense in terms of the new understanding of the
plasticity of the human brain
D6 – 2.30pm – 3.30pm
THE ROLE OF GPS IN REHABILITATION AND RETURN TO WORK – PART OF THE
PROBLEM OR PART OF THE SOLUTION?
BEAUMONT, David
Sponsored by ACC
Dr David Beaumont will address this crucial issue at the RNZCGP Conference on Doing the
Right Thing, on 4 September in Christchurch. His thought-provoking workshop, The role of
GPs in rehabilitation and return to work – part of the problem or part of the solution?, will
show the patient benefits of workplace rehabilitation and put the case for greater GP
proactivity in helping patients recover at work. Dr Beaumont will review international research
which considers the role played by GPs in this area, which is currently high on the national
agenda.
Dr Beaumont is an occupational medicine specialist and New Zealand Lead for Realising the
Health Benefits of Work – a position statement of the Australasian Faculty of Occupational
and Environmental Medicine. It highlights evidence that long term work absence is very
harmful to health, and that helping patients return to work is not only beneficial for health, but
speeds recovery and improves functional outcomes. To realise the benefits of this will require
a paradigm shift in thinking and practice.