Author Archives: soniafullerton

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About soniafullerton

Palliative physician, mum of three.

Fellowship in health care policy and practice – 12 months in the USA

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Got an interest in health care policy?

Check out the Harkness fellowship for a paid 12 month period in the USA for you and your family. It’s available to applicants from Australia and New Zealand (due by 8th Sept) and also Canada, France, Germany, the Netherlands, Norway, Sweden, and the United Kingdom (due in November).

You will probably need a Master’s degree or a PhD, or at least a bachelor’s degree plus applicable work experience.

They would like “a research proposal that falls within the scope of The Commonwealth Fund’s mission …… the Fund’s priority areas include: expanding access to affordable health insurance coverage; transforming the health care delivery system to improve patient outcomes and control costs through payment reform, primary care, and coordinated care systems, with a particular focus on the sickest and most vulnerable patients; learning from successful international delivery system innovation.”

Love that they are looking for “the kinds of game-changing ideas that can potentially disrupt the current health care system in positive ways.”

http://www.commonwealthfund.org/grants-and-fellowships/fellowships/harkness-fellowships

Let’s talk about death, baby!

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Let’s talk about you, and me.

Let’s talk about all the good things, and the bad things, that may be

Let’s talk about death……

Start by reading this article! I confess I am slightly surprised (and very pleased) to see this in my newspaper this morning.. what do you think?

http://www.theage.com.au/nsw/everything-you-ever-wanted-to-know-about-death-but-were-too-afraid-to-ask-20150730-gij35d

Mad cow disease does not exist!

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There was an annoyingly inaccurate article concerning CJD  in national newspapers last week.

CJD is a degenerative neurological  disorder which occurs at a frequency of about one in a million per year. In Australia, 90% are sporadic and 10% of cases are genetic. There has never been a case of variant CJD (contracted by eating contaminated meat) in Australia.

As it’s so rare, often doctors have never seen a case before. It can be quite traumatic for patients and families to go through the process of diagnosis.

Articles such as that which appeared last week contribute to the stigma experienced by families. Linked is a well informed article by Mandy Newton, whose father and sister died of CJD and who herself caries the gene and will go on to die of CJD.

As a hardworking palliative care specialist I have cared for around 10 patients with CJD (which is a lot apparently!) My colleagues and I are presenting a talk at the PCA conference in September about 14 patients and their presenting features and course.

Have you had experience with patients dying from CJD and their families?

http://www.smh.com.au/comment/mad-cow-disease-doesnt-exist-but-creutzfeldtjakob-disease-is-all-too-real-20150713-giawgv.html

Shifting the focus of care from disease to people – heartfelt article about dying in acute hospitals

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This article is going a bit viral on social media. Does it mirror your experiences? It certain does mine, having worked for a long time in consultation services in acute hospitals. There have been a number of comments and letters to the Age supporting the message of the article, written by a senior doctor about the death of his father. http://www.theage.com.au/comment/hospitals-must-shift-focus-of-endoflife-care-from-disease-to-people-20150707-gi6joz

Palliative Care Australia National Awards 2015

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Here’s a great idea!

Palliative Care Australia has established a series of awards for outstanding teams and individuals working in palliative care in Australia. Entry is free and will close at the end of July. Winners will be announced at the PCA conference in September 2015 in sunny Melbourne.

“The National Awards are aimed at recognising innovation, teamwork and emerging talent in the palliative care sector. The awards recognise the efforts of those who support and care for people who are dying through public recognition of organisations and individuals who provide support and care to those people.”

There are two team and two individual awards: for an emerging leader, emerging researcher, innovation in palliative care, and outstanding teamwork in palliative care.

More details are here

Who will you nominate?

Sonia

Malignant Psoas Syndrome

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Malignant psoas syndrome is said to be extremely rare, but I keep seeing it. Admittedly, working in the pain and palliative care service in a specialist cancer centre, if anyone was going to see it, you would think it would be my team.

I have had three patients with MPS this year and because each time it’s something that the clinical staff are not familiar with, I thought I would share a  short summary with the Palliverse.

The original description of MPS in 1990 (1) described patients with:

  1. Metastatic cancer involving the psoas major muscle either intrinsically (direct intramuscular metastasis), or extrinsically from metastatic retroperitoneal lymph- adenopathy infiltrating into the muscle.
  2. Painful flexion of the ipsilateral hip with positive psoas stretch test (‘‘reverse’’ straight leg raise) related to psoas muscle spasm or irritation.
  3. Clinical evidence of proximal (L1–L4) lumbar plexopathy with spontaneous, burning and lancinating pain associated with hyperalgesia (allodynia and hyperesthesia).
  4. Absence of osseous lumbar vertebral metastases and/or concomitant lumbar polyradiculopathy due to other causes (e.g., malignant neuraxial dissemination, chemotherapy-associated or radiation-induced neurotoxicity).

In 2010, Stevens et al wrote a helpful review (2) of MPS with a case review, mechanisms and theories. Five years ago, according to the paper, there had only been 28 cases reported in the English speaking literature.

I will leave interested readers to explore the papers themselves, but it describes polymodal pharmacotherapy (aka throw everything at it), plus some novel strategies like local anaesthetic block of psoas sheath.

What has encouraged me to put fingers to keyboards tonight though is the referral of yet another patient with psoas syndrome, plus this Japanese case series by Takase et al (3). It describes three patients with MPS who had excellent results with methadone (15-30 mg/day). Their average pain scores were reduced by an astounding 7 points with greatly improved function.

I am pretty keen to try adjuvant methadone for my new referral.

Have you seen any malignant psoas syndrome cases before?Were they recognised and treated as such? How did it go? Particularly keen to hear whether anyone has tried methadone. 

Sonia

References:

1. Stevens MJ, Gonet YM: Malignant psoas syndrome: Recognition of an oncologic entity. Australas Radiol 1990; 34:150–154.

2. Mark John Stevens, Charlotte Atkinson, and Andrew M. Broadbent. Journal of Palliative Medicine. February 2010, 13(2): 211-216. doi:10.1089/jpm.2009.0193.

3. Takase Naoto, Ikegaki Junichi, Nishimura Harumi, Yuasa Sayoko, Ito Yumiko, and Kizawa Yoshiyuki. Journal of Palliative Medicine. July 2015, 18(7): 645-652. doi:10.1089/jpm.2014.0387.

free smartphone app for GPs providing palliative care

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There’s an app for that! ABC news writes that a new smartphone app can help guide GPs in management of patients approaching the end of life.

It’s free from iTunes and provided to you by the lovely chaps at Flinders University in SA.

We would love to hear from GPs or trainees  – what do you think?

Sonia

ASCO 15 – Early palliative care in an inpatient oncology setting improved outcomes and satisfaction

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Sadly, I am not actually AT ASCO, the annual meeting of the American Society for Clinical Oncology which is taking place in Chicago this year.

However thanks to the modern day marvels of social media I was able to watch this lecture  by Dr Riedel and a team at Duke University Medical Centre.

Dr Riedel introduced  a model where palliative physicians ( “palliatricians”. What do you think? I love a neologism, myself….) co-rounded with the oncologists in the inpatient oncology unit.

Statistically significant reductions in length of stay (LOS), 7 and 30 day readmissions, and ICU admissions were demonstrated. Nurse and doctor satisfaction was increased. Nurses felt the quality of care was improved.

All the medical oncologists surveyed felt that the palliatricians added to the care of the patient and that they learned some stuff about symptom management. I know I learn heaps when I round with medical oncologists! Communication and collaboration was improved.

It was a shame they didn’t look at patient satisfaction, but hopefully that might happen in future.

Seen anything interesting coming out of ASCO this year?

Sonia

Vital talk – resources for improving your communication skills

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Have picked up some great tips from these guys when I have seen them at palliative conferences.

Communication skills are something that you can always improve, even if you have been in the field for a long time!

The site offers videos with examples of communication skills and also cheat sheets of suggestions on how to structure difficult conversations.

Do you find them useful?

http://www.vitaltalk.org/clinicians

Melbourne 16 May 2015: Unique healthcare social media event

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