David Juurlink SMACC Chicago talk 'Drug Interactions That Can Kill (and How to Avoid Them)’ takes us on a journey of drug interactions, case studies, and avoidance strategies.

Juurlink starts by educating us on the two different drug-drug interactions (DDI) - effects of one drug altered by the use of another . First of which is Pharmacokinetic where by one drug alters the level of another, the second Pharmacodynamic being no change in drug levels, and uses this as a basis for his following case studies.

Juurlink speaks of the dreadful literature that is available on the thousands of drug interaction per year, stating that most information comes from case reports and volunteer studies, and suggests that majority of these interaction are avoidable.

Juurlink then goes on to discuss the findings of 4 case studies involving the following Drug-Drug Interactions and their effects on the patients.

SMX/TMP + sulfonylureas
Macrolides + digoxin
APAP + warfarin

Juurlink provides us with a short list of trigger drugs that we should be aware of, a list of meds that warrant extra caution and list of possible safer alternatives. He also suggests that it is of the up most importance to have a good pharmacist to turn to as they are given more information on drugs interactions then physicians. And, to utilise resources such as pharmacy times - where you can get information on drug interactions at a push of the button.

Juurlink also suggests that an Informed patient is a very useful safety mechanism.

Direct download: Day_1_C5_David_Juurlink.mp3
Category:general -- posted at: 5:00am AEST

Rick Body’s SMACC Chicago talk 'Is compassion a Patients Right?' takes us on a journey of emotions in critical care.

Starting with his rendition of john Lennons ‘Love’. Body, explains the origin of the word compassion - a move to act based on someone else suffering, a sharing of suffering with.

Body, initially focuses on a study conducted within his hospital of 125 patients, who were interviewed when admitted to their emergency department and when they where discharged. From the study it was depicted that, what patients truely wanted was simple human intervention; reassurance, friendliness, explanation, basic care. These responses were then coded into 5 different themes to depict how patients believe their suffering should be addressed;

1. Emotional distress
2. Physical symptoms - including pain (but not restricted to)
3. Information - Included reassurance and explanation
4. Care - Basic care
5. Closure - patients want to put this horrible episode behind them

Body notes that patients are telling us that they want something positive from us. They don’t want us to focus on what we shouldn’t do. They want us to be thinking about what we can do to help… suggesting that if we follow the above ‘EPPIC' we could provide more compassionate care. The problem is this is not compassion as compassion is an emotion and needs to be felt.

Body then explores whats stopping us (care providers) from showing compassion? Sighting the The Good Smaritian Study: that depicts the more in a rush one is the less likely they are to show compassion. The By Standers Affect: if a large crowd is doing nothing, you are more likely to do nothing. Unclear of Who is Responsible: less likely for anyone to respond and Personal Reasons: the responsibility for other peoples lives, fatigue, tough, resilient to showing emotion, emotion been seen as a weakness and a feeling as doctors we are not meant to show emotions.

Body, then shows a picture of a doctor crouched slumped over and inconsolable, shortly after the image was taken the doctor loses a 19 year old patient he was treating and minutes later the he walks back into the emergency room and continues working. This picture went viral on social media and the doctor pictured was seen as admorable. Body sites this example to state that clearing having compassion and showing compassion is right, but is it a right?. And, asks the question 'Would you prefer the surgeon who shaking with emotion as you go into surgery or the surgeon who is composed, objective, calm, tough, resilient, unmovable and efficiently get on with the task in hand?'.

Body believes that patients don’t have a right to compassion as it is an emotion and means to suffer with but asks for health providers to be emotionally intelligent. Explaining that emotional Intelligence recognises that there is a difference between traditional intelligence, IQ and our ability to form effective forms of interpersonal relationships. Siting the 5 domains of emotions intelligence as;
1. Know your emotions - know what we are feeling
2. Manage your emotions - cool rational and object in the rests room, show emotion with patients and family
3. Motivating ones self
4. Recognising emotions in others - empathy
5. Handling Relationships - interpersonal Skills - relate to other people

Body suggest that these are skills that can be developed as ones life goes on and by building skills in emotional intelligence that maybe one can be both a compassionate and effective doctor.

Body concludes by asking the question 'How are you going to care more for your patients?'

Direct download: Rick_Body.mp3
Category:general -- posted at: 2:30pm AEST