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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.