GENERAL practice staff are being urged to encourage their nonclinical employees to take part in free training to promptly identify patients with suspected signs of impending heart attack or stroke.

Reception staff are usually the first to see patients presenting with symptoms of severe chest pain, and an online training tool has been developed to help non-clinical staff identify such patients.

The triage strategy, called BeAWARE of warning signs of heart attack and stroke, is a tool put together by the Heart Foundation and National Stroke Foundation.

Heart Foundation CEO Dr Lyn Roberts said reception staff are the eyes and ears of general practice. “For this reason it is vital reception staff are trained to appropriately identify and deal with patients presenting with the warning signs of heart attack and stroke, so they can make potentially life-saving decisions,” she said.

A Heart Foundation study found 15% of patients who experience severe chest pain attend their GP surgery or call a health professional, rather than call 000.

Research has shown nine out of 10 practice nurses have had patients present with heart attack warning signs rather than calling an ambulance.

On completion of the module, the practice receives a resource kit. To register, visit Heart Foundation online learning

Article originally published in Medical Observer, National 22 Jun 2012

In 2011, the National Stroke Foundation (NSF) Stroke Services team increased its capacity to focus more on education and resource development. One of our initial activities centred on improved adherence to the best-practice recommendations for lifestyle modification contained in the Clinical Guidelines for Stroke Management.

Lifestyle modification is an essential strategy to reduce the risk of secondary stroke. We evaluated the barriers to the provision and documentation of lifestyle advice post stroke and produced resources in consultation with a range of health professionals.

We developed the workshop ‘Motivational interviewing for lifestyle change after stroke’ with Dr Stan Steindl to provide motivational interviewing (MI) training. MI can help you deliver lifestyle modification advice that recognises your patient’s values, knowledge and desire to change.

The workshop lecture and a role play demonstrating MI in practice are now available on our website. We encourage you to watch these videos to learn more about this technique that has been shown to benefit patient mood and mortality post stroke.
This workshop is supported by a range of practical resources to aid your discussions with patients:

‘Help lower stroke risk with lifestyle modification’ clinical poster

‘Lifestyle modification discussion guide’

‘Documenting lifestyle modification advice’ information sheet

‘Meaningful patient engagement’ information sheet

‘Secondary stroke prevention: Addressing lifestyle risk factors and behaviour modification’ PowerPoint presentation

All of these resources are available here.

Mayo Clinic

Article via Mayo Clinic.

Editor’s Note: Mark Ryan, M.D., is a member of the External Advisory Board for the Mayo Clinic Center for Social Media.
“Art is not a mirror held up to reality but a hammer with which to shape it.”  — Bertolt Brecht

In two prior posts, I have discussed the issue of professionalism and social media.  I have also taken issue with medical organizations’ extant social media guidelines.  In some of these posts’ comments, it has been noted that there is no corresponding guideline or document that expressly discusses appropriate, positive use of social media in health care communications.

As a result, I am taking the liberty of making some suggestions as to what I think are important guiding principles for effective physician use of social media.  This will include some cautions that I feel are especially useful, but I would also like to explain how and why I think physicians can use social media in positive and useful ways.

Part of this task includes defining physician professionalism.  There are various definitions, but they share the common themes of respect for patients’ autonomy, individualism, and privacy; response to and concern for societal needs; embodiment of humanistic values of altruism, empathy, compassion, honesty, and integrity; focus on the scientific basis of medical knowledge; accountability to peers; and commitment to professional development and competence.

With those guiding principles, here are my suggestions for how physicians can effectively use social media:

1.    Do not discuss patient’s illnesses, medical conditions, or personal information online.  Unless you have a patient’s express permission to share their information, then do not discuss anything about them online.  The simple fact is that even if we believe we have made information anonymous, it is hard to do so completely.  If a patient has given you their permission, make that clear in the post.  Otherwise, do not discuss real patients’ information via social media.  Rather than choosing to discuss a specific recent case that you might have seen, it would be better to offer a broader perspective or discussion on the issues at hand.  This is especially true in a smaller community, where even broad descriptions of patients and clinical situations might allow patients to be identified.

2.    Use social media to share information that promote quality health care and up-to-date medical information.  There is a wealth of information available on Twitter, for example, that provides current information regarding medical research and treatments.  The New England Journal of Medicine, the Journal of the American Medical Association, the American Academy of Family Physicians, the National Institutes of Health, and the Centers for Disease Control (among many, many others including individual medical specialty organizations and journals) all have accounts that provide regular updates with a focus on basic science and clinical care.  By following these accounts and sharing relevant and actionable information, we promote its dissemination.

3.    Address those societal needs that you think are most important, or that motivate you.  Social media use will undoubtedly be an added responsibility during your free time, and so using it to focus on issues that are relevant to you makes it easier to sustain the effort.  For example, I am a strong believer in the need to enhance our primary care workforce via family medicine and I support the Patient Protection and Affordable Care Act (PPACA) of 2010.  As a result, my Twitter feed focuses on these topics.  I share updates about how the PPACA will enhance patients’ access to health care and reform health insurance company practices, about the importance of family medicine (and primary care) and the need to reform our system to support and train more family physicians, etc.  Each of us will be motivated by our specific interests, but we should use social media as tool to call for necessary change to benefit society as a whole.

4.    Recognize that you represent your profession, and help others recognize that they do, too.  When someone views your social media posts, they will likely see the post through the lens of your profession.  If they see my posts, it might not be seen as “Mark Ryan thinks such-and-such” but rather “Dr. Mark Ryan thinks such-and-such.”  It might then be tempting to presume that others in the same profession feel the same.  So, take care not to post updates that would violate the definition of professionalism identified above.  If you see someone else posting updates that seem unprofessional, I think it is appropriate to connect with them and discuss this issue–not in a punitive way, but rather to help promote the proper use of social media tools.

5.    Promote the humanistic values identified as congruent with medical professionalism.  Be honest, forthright, helpful, and compassionate.  Offer help, answer questions, and suggest resources when you are able to do so.  Be open to contact from others, and participate in discussions when time allows.

6.    I do not think it is necessary to separate personal and professional content online.  My social media presence is a reflection of who I am, and expresses my beliefs and my priorities.  These are what make me the person and the physician that I am, that define the societal needs that I seek to address, and determine my perspective on any number of issues.  To be personal, my social media presence must reflect my beliefs.  However, I do use a disclaimer to note that my opinions are mine alone (not those of my employer), and I understand that there are those who will disagree with me.  Social media is an opt-in phenomenon: if someone wants to read my opinions, they will have to come find my accounts…and they can choose to ignore me and any of my posts.

7.    I do not think we must keep our social media content locked behind tight privacy restrictions.  My accounts’ privacy settings depend on my anticipated use: I keep my Twitter and Tumbr accounts public because I intend for the information to be public.  I keep my Facebook account private because I do not intend to use it for public information, but rather to keep up with friends and family.

8.    Do not practice medicine via social media.  It seems self-evident, but it is worth making clear.  I do not provide any individual, specific medial care or medical advice via social media.  The most I have done is to provide links to already-available online resources for people to review and to help them make their own decisions as to how to proceed with any given medical issue.  I do not knowingly interact with any patients on Twitter but, if I did, I would interact with them the same way I interact with anyone in a public setting.  I do not friend patients on Facebook because of how I choose to use Facebook.

9.    Presume that everything said online can be found if someone looks hard enough, and is going to be available forever.  This might be an exaggeration, but it provides guidance when thinking about what information should be shared.  I assume that nothing is actually private, and so I do not post any information (even via direct messages) that I would be bothered if it were made public.  For the same reason, I choose not to use any anonymous accounts: I assume that someone out there could identify me if they tried hard enough.  This helps me edit what I put online and what stays in my head.

I hope that this post accomplishes its goal: to provide some suggestions and guidelines on how to use social media effectively and professionally as a physician.  Social media is not simply a way to reflect what is happening around us, but rather a way to play an active role in changing society for the better.

Article from AVERT Newsletter Feb 2012

Reaching milestones is a cause for celebration. There have been so many along the way: becoming an ‘International’ trial; reaching half way (1052 patients); becoming the largest stroke rehabilitation trial ever! We need to celebrate each achievement but keep our sights firmly set on reaching our final number of 2104 and the sooner the better.

The study will then be large enough to get a reliable answer to our trial question; “Does early exercise improve health outcomes for people affected by stroke?” We still need to recruit 995 patients, intervene and follow up each for 12 months to see us to the end. We now have the highest number of recruiting centres (45) ever involved in the trial, another reason to celebrate).

We need between 30 and 40 patients recruited each month to finish in about 2014. One of the remarkable things about this trial is the commitment of the hospital teams who participate. Since our last newsletter, the first hospital to recruit to AVERT, the Austin Hospital, has recruited its 200th patient. This is an amazing effort by the very dedicated team.

Over the last 6 months, AVERT has really expanded internationally. There are now 21 hospitals in Scotland, Northern Ireland, Wales and England that have recruited patients to the trial. Thankfully we have had Rosemary Morrison based in Glasgow, dedicated to helping new hospitals get trained and ready to participate in this exciting study.

Being an international study gives us a greater understanding of differences in stroke care in various regions of the world, and our results will apply broadly.

We thank all of our hospital teams for their dedication and commitment to helping find ways of improving outcomes for patients who have suffered a stroke.

More aboout AVERT

ELECTRICAL STIMULATION IN NEUROLOGICAL REHABILITATION
A SERIES OF UPPER LIMB WORKSHOPS

Introductory Session:
Tuesday 8th May, 2012 (12.00-5.00), $110 (inc GST)
Functional Training Session (Advanced):
Tuesday 22nd May, 2012 (12.00-5.00), $110 (inc GST)
Both workshops will be held at The Alfred Hospital, 55 Commercial Road, Prahran, Vic.

Who Should Attend:
The Introductory half-day workshop (May 8): occupational therapists, physiotherapists and AHAs who wish to extend their basic knowledge and experience of using electrical stimulation (ES) in upper limb rehabilitation. The Advanced half-day workshop (May 22): therapists with experience in using ES (including those who have attended the introductory session) and would like to advance their skills and knowledge in using ES during upper limb functional task specific training.

Benefits of Attending:
Workshop participants will increase knowledge and proficiency in using electrical stimulation with neurological rehabilitation clients. There will be both practical and theoretical information to assist participants to increase skills. Efficacy evidence will be presented, along with demonstrations of protocols in daily clinical practice.

About the Presenter:
Dr Natasha Lannin, is an Associate Professor at The Alfred Clinical School, La Trobe University. Dr Lannin is a Master Trainer for Electrical Stimulation in Neurology and regularly conducts workshops with clinicians both in Australia and internationally, integrating her knowledge of best-practice evidence, electrical stimulation and rehabilitation.

Course Content Will Cover:
Introductory Workshop An overview of ES, diagnoses and indicators, legislative requirements, and clinical mandate for ES. Precautions and contraindications of using ES in clinical settings. Overview of therapeutic ES interventions (differences between the types of ES interventions). Evaluation, application, clinical guidelines, clinical outcomes and efficacy of upper limb ES Practical individual and small group work to provide opportunity to develop basic ES skills.

Advanced Workshop Brief review of precautions and contraindications, basic interventions and evaluation process of using ES for functional movement training. Neuroscience: Physiological effects and evidence of FES on neuroplasticity of brain and movement. EMG triggered ES interventions: overview of machines and benefits of different options to clinicians. Maximising benefits, identifying successful strategies, promoting best practices in ES clinical practice. Practical individual and small group work including program planning with clients to achieve outcomes.

To apply click here to download the flyer.

This article is from Synapse Bridge Magazine. It is an article written for Health Professionals, however there are interesting ideas for survivors and carers to take from the article.

Understanding family issues

ABIOS explains some of the common family issues that can arise after brain injury.

ABIOS is a specialist community-based rehabilitation service to enhance the service system for people with ABI (Acquired Brain Injury) and their families.

The first two years after a brain injury are usually busy with the process of recovering, and social activities usually take a back seat to rehabilitation. But in the long run, the loss of friends, employment opportunities and meaningful activities are one of the most difficult ongoing problems.

Brain Injury can have a significant impact on an individual, but it can also result in changes for all members of a person’s family and community. For family members in a close relationship with the person with the brain injury, there can be a range of changes in roles and responsibilities, and involvement in a person’s life that we need to understand to work effectively with them and with the person with ABI.

Impact of brain injury on the family
It is important to understand that families have had little opportunity to prepare for a brain injury. Some families have good skills in coping with a major trauma or illness, some families may not have acquired those skills. No one finds it easy to adapt and to cope with all the changes in their lives that a brain injury may bring. Families themselves may need counseling to assist them in coping with the major challenges that they have in front of them.

Uncertainty about the future for themselves or their family member may be an issue, particularly early on after an injury. There may be quite dramatic changes in finances, employment, driving, community involvement or relationships with others, A future that was certain or predictable may no longer be that way.

Changes in roles

There may be changes in roles in the family as the person with the ABI is unable to continue in their previous roles or responsibilities.

Family members may have extra responsibility for work, transport, managing finances, managing family decision making, and for providing emotional or practical care.

Burden of care

Burden of care for family can increase over time. As the person recovers from the initial injury, and support from extended family, friends, workmates, and community diminishes or decreases, family members may find their burden of care or work increasing steadily.

Competing demands

Family members can have a range of competing demands and needs, both for their time, energy involvement and participation. Caring for someone with an ABI may mean that a family member has less time for other relationships within the family or with friends.

Partners, spouses and children may sometimes feel left out, neglected, or excluded from decision making. This can sometimes lead to competition and conflict.

Relationships with others in the family and with friends can be damaged or lost as a result of difficulty in responding to everyone’s needs.

They may find they do not get time for their own interest, recreation or relationships, and don’t pay enough attention to their own psychological or physical health. They may not take time out from being a carer or have rest and relaxation and to renew their own energy.

Isolation over time

As time goes on following an injury, after months and years have passed, family can find they have become increasingly socially isolated and alone. Demands to provide care and support can take up so much time, they may lack the time, energy and recourses to maintain their own family, social and community networks, As a result families may have less emotional or practical support over time.

Grief and loss

Families may have ongoing issues with grief, loss and adjustment to changes associated with ABI. Families experience the losses for the person with the ABI (loss of hopes, dreams, ambitions and ability to be independent) but also their own losses (of friendship, loss of sexual relationship, loss of financial security, loss of family, loss of time alone). They may experience sadness, anger, confusion anxiety and depression.

Family relationships & dynamics

It is important to be sensitive to existing family structures and relationships in working with the whole family. Individuals with ABI and their family may have lost some of their sense of independence, autonomy and their personal privacy, as they become involved with the medical or hospital system, sometimes for the first time. For many, communicating and negotiating with professionals in services is a new thing, and may be something they were not prepared for.

Family may be wary or reluctant to disclose information, to be involved, or to commit their energy and time to people making demands or providing community based services.

Family may have a range of experiences (negative and positive) with medical, health or community services that present barriers to new working relationships.

Building a good working relationship, working on communications and building trust are key areas to consider in working successfully with families.

Carer fatigue

Family members may sometimes be overwhelmed and exhausted by the emotional and physical demands of providing long-term care to a person with ABI. This is particularly the case where one or a few family members take the responsibility of care over a number of years.

Placing demands on family to provide care, to implement strategies or to work towards new goals, can sometimes present a huge challenge or demand that is hard for the family to meet.

Family can seem to be difficult, critical or unsupportive of new ideas or plans but they may not have the energy to do more than they are already doing. It is important to take into consideration the capacity of each family to take on new ideas and tasks.

Protectiveness

Family members can sometimes be more protective of the person with ABI following a severe injury. Particularly in cases of sudden injury, such as a traumatic brain injury or a stroke, where a person was severely injured, or close to death, they may be reluctant to risk further injury or have harm come to their family member.

Families can sometimes be cautious, wary of new ideas, and worried regarding the consequences of small changes and what might happen in the future.

Meet Tamsin, who answers your calls on StrokeLine 1800 787 653. StrokeLine is the National Stroke Foundation’s phone support for stroke survivors, carers and health Professionals.

How long have you been on StrokeLine?
For aprox 8 months.

What is your professional background?
I have a Bachelor of Occupational Therapy and Graduate Diploma in Neurosciences.  I have a variety of experience working in acute hospitals, rehabilitation, regional and metropolitan areas - including stroke care units.

What sorts of questions do you get on StrokeLine?
We get a variety of questions around prevention of stroke, stroke signs and symptoms, treatment of stroke, rehabilitation and recovery, services and supports.

Around 30 per cent of calls relate to prevention – questions about blood pressure, risk factors for stroke, signs of stroke, such as:
“‘do you have to have all the FAST signs of stroke for it to be a stroke?”.

Aprox 20-30 per cent of calls relate to treatment when in hospital:
“I attended Emergency and they sent me home once my symptoms of a transient ischaemic attack had resolved, they gave me a letter for my GP to get an Echocardiogram (heart ultrasound) and carotid Doppler (ultrasound to test blood flow of arteries in the neck) – how urgent is it that I have these tests?”
“we are having a family meeting on Friday to talk about Dad’s discharge plan, what will be discussed?”

Aprox 50-60 of calls relate to recovery, such as:
“is there a stroke support group near me?”
“how do I find a physiotherapist?”
“my mum isn’t coping and dad is crying all the time. What can I do?”

How does it feel when you help people through StrokeLine?
It is very rewarding to try and help people navigate the medical and health system which can be very overwhelming.

Most memorable moment?
Tough question!  There are so many calls each day.  I do like it when people call back to thank me!  There are many sad and happy calls I find it hard to pick one.

New research warnings about the safety of daily doses of aspirin in people who do not have a history of heart attack or stroke reflect soon-to-be-released Australian guidelines on the management of cardiovascular risk, the National Vascular Disease Prevention Alliance (NVDPA) announced.

Professor Stephen Colagiuri, Chair of the NVDPA Expert Working Group that developed the new Guidelines for the Management of Absolute Cardiovascular Risk, said that previous studies have also shown that when people with no previous history of heart attack or stroke are taking medication for blood pressure or cholesterol lowering, adding aspirin has limited benefit.

“In fact aspirin can do more harm than good in these people because of the increased risk of serious gastric bleeds,” Professor Colagiuri said.

A UK-led study this week released research suggesting that healthy people who take aspirin to prevent a heart attack or stroke could be doing more harm than good.

The study, an analysis of more than 100,000 patients and published in Archives of Internal Medicine, concluded the risk of internal bleeding was too high.

Researchers stressed that aspirin has been shown to be safe and effective for people who have had a heart attack or stroke and it is still recommended for people who are able to take it who have had a cardiovascular event.

The new Australian guidelines recommend that aspirin or other similar agents should not be taken routinely by people with no previous history of heart attacks or stroke.

Professor Colagiuri recommended that people concerned about their risk of cardiovascular disease should see their doctor to have a risk assessment, which will calculate their likelihood of developing disease in the next five years based on a number of risk factors such as smoking status, blood pressure, cholesterol, age and diabetes. He said, however, that no one should stop taking their regular medication without first consulting their GP.

The Guidelines for the Management of Absolute Cardiovascular Disease Risk have been prepared by the National Vascular Disease Prevention Alliance, a consortium comprising Diabetes Australia, Kidney Health Australia, the National Heart Foundation of Australia and the National Stroke Foundation.

Patrick Groot from Warrnambool in Victoria has won the NSF Stroke Care Champion Award for his dedicated work with stroke survivors and stroke clinicians since 2004. Patrick, a registered nurse, works as stroke liaison and clinical nurse consultant with South West Healthcare in Warrnambool and is also Regional Stroke Coordinator with the Victorian Stroke Clinical Network.

As part of his role as a clinical nurse specialising in stroke, Patrick sees all stroke and min-stroke admissions at Warrnambool Base Hospital, part of Southwest Health Care. He works with survivors, carers and families across the entire stroke care continuum, ensuring seamless transition from hospital to rehabilitation and then home. The region he works in sees on average 110 stroke patients and 50 mini-stroke patients a year.

He is also a leading community educator, running programs to raise public awareness of stroke.

Patrick said he enjoyed working in the area of stroke because of the many opportunities it presented where he could to improve the lives of people affected by the condition.

“I have found that with stroke you have a wonderful opportunity to make a difference to people’s lives,” he said.

“There is a lot you can achieve and I like striving towards the goal of better services.”

Patrick will this year complete his Masters in Health Science, Stroke Specialisation as part of his continuing education in the area of stroke.

His nominator wrote:

“Patrick has worked tirelessly in the southwest region of Victoria improving the lives of stroke survivors and the skills and knowledge of regional clinicians. He has been instrumental in the development of the Southwest Health care stroke unit and thrombolysis service … resulting in being one of the first regional areas in Victoria to have access to these facilities.”

This award is conferred jointly with the Stroke Society of Australia.

Only seven per cent of Australian stroke patients eligible for life-saving treatment received it in 2010, a new report on acute stroke care services has revealed.

The National Stroke Foundation Acute Services Clinical Audit, which provides a snapshot of acute stroke care in Australia, also shows that patients who do not get access to a hospital with a stroke unit are far less likely to receive an appropriate level of care and treatment, increasing their chances of death and severe disability.

Launching the report in Melbourne today National Stroke Foundation CEO Dr Erin Lalor said one of the reasons for the low incidence of stroke patients receiving clotbusting drugs in Australia was delay in getting to an appropriate hospital.

The clotbusting treatment, known as thrombolysis, must be administered within a few short hours of the onset of stroke symptoms and only one in three people experiencing symptoms of stroke arrived within three hours.

“This report confirms the importance of getting in an ambulance and to a hospital with a stroke unit at the first sign of stroke,” Dr Lalor said.

“Stroke patients who are not treated at a hospital with a stroke unit are less likely to receive the standard of care recommended in the clinical guidelines for stroke and therefore more likely to suffer permanent disability,” Dr Lalor said.

“Once a stroke occurs it is vital that patients get to a hospital and receive treatment immediately,” Dr Lalor said.

“It is imperative that everyone can recognise the signs of stroke so immediate action can be taken to save lives and reduce disability.”

The Acute Services Clinical Audit examined the treatment of over 3000 people with acute stroke during 2010.
Stroke is Australia’s second leading cause of death and a major cause of adult disability. A stroke occurs in Australia every 10 minutes.

But Dr Lalor said stroke was not only preventable but treatable if prompt specialist medical care was given. The National Stroke Foundation promotes the FAST message as a way of identifying the earliest signs of stroke.

FAST stands for Face – Has the person’s mouth drooped? Arms – Can they raise both arms? Speech – Is their speech slurred? Can they understand you? And Time – if any of these symptoms are present call an ambulance (000) immediately.

Dr Lalor said the FAST campaign was known to improve awareness of the onset of stroke and has increased calls to ambulances. She said the FAST message needed improved funding so it could be rolled out in community awareness programs in all states.

“The treatment of stroke patients remains inadequate, with processes known to save lives from death and disability not used in enough cases.”

The audit found although there were improvements in various processes of care since 2007, many gaps remained.

“Right now in Australia people who have a stroke do not have any guarantee that they will be able to receive the level of care that is available, and that should be available, to every individual,” Dr Lalor said.

The National Stroke Foundation says the most significant shortfalls in Australian strokeservices include:

Only seven per cent of patients with ischaemic stroke were thrombolysed with the clot busting drug tissue plasminogen activator (rtPA). When successful in clearing the blood clot, this treatment is known to increase the chance of a better outcome following stroke by 30 per cent.

Too few people with stroke are arriving at hospital quickly - prompt assessment and treatment on a stroke unit in hospital saves lives – better funding is needed for broad community awareness campaigns.

People who do not make it to a stroke unit are less likely to get appropriate care and are more likely to suffer permanent disability than stroke patients treated on a stroke unit.

“The audit shows there is an urgent need for federal and state governments to devote greater resources to stroke care to reduce the impact of Australia’s second biggest killer,” said Dr Lalor.

Download Audit Report 2011