Delirium update at #ANZSPM17 Update

delirium @#ANZSPM17

We think delirium is a pretty big deal here at Palliverse, having devoted quite a few blog posts over the years to discussing this important issue in palliative care.

Well, delirium will be the focus of the first session at the upcoming 4th Australian and New Zealand Society of Palliative Medicine (ANZSPM) Medical & Surgical Update for Palliative Medicine (#ANZSPM17), which will be held between June 23-24th at the Royal Children’s Hospital, Melbourne, Australia.

Chaired by @Meera_Agar – the lead author of the seminal paper examining the role of antipsychotics in the management of delirium symptoms in the palliative care setting, which was published in JAMA Internal Medicine earlier this year – the session will feature presentations from Professor Agar, as well as:

  • Dr Simon Allan, palliative care physician, Director of Palliative Care at Arohanui Hospice in New Zealand and the current President of the Australasian Chapter of Palliative Medicine, the Royal Australasian College of Physicians,
  • Dr Chris Moran, geriatrician from Alfred Health and research fellow at Monash University, and
  • Dr Justin Dwyer, psychiatrist and Medical Director of the Psychosocial Cancer Care service at St Vincent’s Hospital, Melbourne.

After the presentations, a panel discussion involving the speakers will offer the audience plenty of opportunities to further explore this hot topic in palliative care.

Of course, delirium is just one of the many great topics that will be examined in detail during the fourth iteration of this biennial meeting. To find out more about the #ANZSPM17 Update, and to take advantage of the early bird registration rate until May 24th, go to: https://willorganise.eventsair.com/QuickEventWebsitePortal/2017-anzspm-update/update

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Social media activity during the 13th Australian Palliative Care Conference

13APCC conference analytics

With a theme of ‘Fit for the Future’, the 13th Australian Palliative Care Conference utilised a coordinated and multifaceted social media strategy to enhance the delegates’ experience and reach new audiences globally. This was achieved through the concerted efforts of team Palliverse (@Palliverse) and other key individuals, including Christian Sinclair (@ctsinclair).  Continue reading

MyPal Podcasts

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Do you like technology? Innovation? Palliative care? Research? Why, these things are what @palliverse is all about – and why you/we are here in the first place!

Guess what? These things are exactly what the #MyPal podcasts from @amaranwosu are all about as well. How about that!

Check it out here and also on iTunes. Be amazed. Happy listening!

Malignant Psoas Syndrome

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.

National Palliative Care Week 2015 at Alfred Health

How would you choose to live, if you were diagnosed with a life-threatening illness?

What are the most important things in your life? What can’t you live without?

Pal and Carey - #NPCW15 mascots #dyingtotalk

Pal and Carey – #NPCW15 mascots #dyingtotalk

The theme of National Palliative Care Week (24-30th May) this year is “Dying to talk; talking about dying won’t kill you”. In fact, talking about how you want to live and die can be empowering and bring you closer to those who matter most to you. On the other hand, not talking about it can lead to regret – both for you but also for those you leave behind.

As part of National Palliative Care Week, the Palliative Care Service at Alfred Health hosted a public forum on Monday, discussing the topic: “The Top Five Regrets of the Dying”, based on a book by Australian palliative care nurse Bronnie Ware.

Continue reading

Posters from the 11th Asia Pacific Hospice Conference

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Here is a collection of posters from the recent Asia Pacific Hospice Conference in Taipei – primarily by researchers and clinicians from Australia and New Zealand. Enjoy!

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Hospice New Zealand Palliative Care Lecture Series 2015

Hospice NZ PC lecture series 2015

Hospice New Zealand is once again presenting a lecture series on palliative care this year. The lectures are held on the first Thursday of every month at 7:30am NZDT/NZST and are available by teleconference at various sites across New Zealand. The first lecture on nausea and vomiting was delivered last week by Dr Michael Downing.

You can also listen to lectures from the previous series by simply registering here. Awesome!

Elsewhere in the palliverse – Weekend reads without Elissa

Dear Friends,

Another week has passed and there is much to tell, but before we get into let spare a quick (and envious) thought for Elissa who can’t be with us to post today because she is in the middle of a well earned holiday.

Now down to business.

This clip from the Center to Advance Palliative Care (CAPC) describes a novel analogy for our selves that works neatly with a description of palliative care.

The animation is part of a suite of resources that the CAPC has made available here. Continue reading

twitter 102 – I know what a hashtag is, what’s next?

Greetings tweeps.
That’s not an insult by the way, a tweep is a person who uses twitter, think twitter/people.

So maybe by now you have had a look at twitter and know what a handle is, i.e. a person’s user name that starts with an @ symbol.
And you know we use hashtags like #palliative to “tag” topics of interest so other people can find them.
Hopefully you have registered and have a handle of your own.

What’s next? Time to dive into the fabulous world of tweetchats. A tweetchat is an event on twitter that can happen as a regular event, or as a one off or occasional event.

One of my favourties is #hpmglobal which is hospice and palliative medicine global. It’s hosted by Prof Jim Cleary (@jfclearywisc) who works at the University of Wisconsin Carbone Cancer Center as an oncologist and palliative medicine physician. He passionately promotes global access to opioids. https://twitter.com/jfclearywisc
Each week at a particular time, which at the moment is Monday 22:00 AEST, he hosts a multidisciplinary discussion which is attended by people interested in palliative care from all over the world, including clinicians in Africa, the Americas, Europe, and of course a strong showing from Australasia.

Your well-run tweetchat has a theme that is decided and promoted on Twitter ahead of time. Examples from the past have included discussions of opioid availability in developing countries, and end of life care policies in your country. It has an international emphasis. Another great chat, #hpm, is terrific but sadly at a bad time for ANZ tweeps, in work hours on a Thursday. See the link below.

The tweetchat hour may be structured like this:
The topic has been announced, often with a link to a blog written by the host of the tweetchat or by the co-host of that week’s chat.
1. restatement of the topic and relevant link
2. introductions
3. topics one, two and three (marked as T1 etc)
4. CT (closing thoughts)
5. Announcement of next week’s topic
6. Sometimes the data analysis of the tweetchat is tweeted

It’s really fun and you meet great people. You are welcome to just listen in and not say too much (“lurk”).

Once you have the hang of this, it’s time to start trying out other twitter related platforms like tweetchat, tweetdeck and hootsuite. These make it easier to follow several conversations at once, and tweet as different identities. So for example, sometimes I tweet as @sonialf and sometimes as @palliverse.

Other tweetchats I enjoy are #hcldr (health care leaders), #hcsmanz (health care social media Australia/New Zealand) and #hpmjc (hospice and palliative medicine journal club).

I hope to see you at 22:00 Monday night, i.e. tomorrow (Melb/Sydney time) for a combined #hpmjc and #hpmglobal. Let us know if you are there as a result of @palliverse!
Here is the tweet about it including the link…
#hpmglobal meets #hpmjc “How good r we at diagnosing dying?” Join @drol007 Mon Sept 29 12n GMT (10pSYD; 1pLON; 8aNYC) http://spcare.bmj.com/content/4/3/263.full.pdf

What is your favourite tweetchat? Let us know in the comments.

Cheers, sonia

Article by Christian Sinclair @ctsinclair about #hpm
http://www.pallimed.org/2014/07/hospice-and-palliative-medicine.html