#ecuimres transcript

Healthcare Social Media Transcript

From: Fri Sep 21 0:00:00 PDT 2012
To: Fri Sep 21 8:00:00 PDT 2012

What is #ecuimres? Who were the influencers during this time period? #ecuimres analytics


Healthcare Conference  - Healthcare Tweet Chats  -  Healthcare Analytics

nephondemand
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#ecuimres #grandrounds 9/21: Dr Lang presents Depression in Primary Care. Profile http://t.co/5fXrio8c http://t.co/xOXtDPcM
nephondemand
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#hcsm #meded #ecuimres #grandrounds 9/21: Dr Lang presents Depression in Primary Care. Profile http://t.co/5fXrio8c http://t.co/xOXtDPcM
nephondemand
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#ecuimres #grandrounds #meded 9/21: Audience Participation requested on Twitter &/or Facebook http://t.co/J1NMKS3p
nephondemand
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#ecuimres #grandrounds #meded 9/21: @ecuimchiefs welcome Dr Lang to launch our 2012-13 Grand Rounds lecture series. http://t.co/JxPwQi1v
nephondemand
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#ecuimres #grandrounds #meded 9/21: Dr Lang is part of the NC Academic Consortium 4 Cost Effective Pharmacological Treatment (NC ACCEPT)
nephondemand
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#ecuimres #grandrounds #meded 9/21: critical 2 be able 2 manage depression in primary care setting b/c of shortage of psychiatrists in ENC
nephondemand
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#ecuimres #grandrounds #meded 9/21: doesn't matter which screening Instrument u use 4 depression as long as u use 1 (USPSTF 2009, grade B).
ecuimchiefs
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#ecuimres #grandrounds Gaynes et al report Internists are managing as many pts with depression as Psychiatrists.
nephondemand
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#ecuimres #meded 9/21: any tx 4 depression should b given 6-8 wks be4 being considered a failure. "Depression is a game of patience"
ecuimchiefs
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#ecuimres #grandrounds should ensure maximal (tolerable) doses for 6-8 weeks before deeming "treatment failure".
nephondemand
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#ecuimres #meded 9/21: most 1st line antidepressants will have a 60-70% response; after 2 different med trials, remission is unlikely
nephondemand
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#ecuimres #meded 9/21: treatment phases of MDD shown here. There is a 6 mo phase when u don't adjust med dose http://t.co/tE4Bnjag
nephondemand
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#ecuimres #grandrounds #meded 9/21: it is a false belief that pts w/MDD must be on lifelong antidepressive meds
ecuimchiefs
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#ecuimres #grandrounds titrate treatment beyond just "response", goal is "remission" and maintain for 4-9 months.
ecuimchiefs
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#ecuimres #grandrounds Dr Lang recommends PHQ-9 scale bc >95% sensitivity and specificity for detecting depression.
nephondemand
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#ecuimres #grandrounds #meded 9/21: Dr Lang rec'ds using the PHQ-9 for depression screening. http://t.co/kwPPaXUv
nephondemand
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#ecuimres #grandrounds #meded 9/21: Understanding the PHQ9 results shown here. Score of >=10 is a positive screen 4 MDD http://t.co/UdP6pIVc
ecuimchiefs
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#ecuimres #grandrounds Must rule out mania in your pts screened with depression to r/o bipolar disorder or psychosis.
nephondemand
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#ecuimres #grandrounds #meded 9/21: if u have a + MDD screen, u must r/o mania or psychotic sxs. If these r +, pls refer 2 psych
ecuimchiefs
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#ecuimres #grandrounds Dr Lang recommends referring ALL your pts with bipolar d/o and psychosis to Psychiatry.
ecuimchiefs
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#ecuimres #grandrounds Dr Lang recommends Internists learn 4 psychiatric medications and "know them well".
ecuimchiefs
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#ecuimres #grandrounds Pts should f/u q4 weeks during acute phase of treatment.
nephondemand
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#ecuimres #grandrounds #meded 9/21: remission = PHQ9 < 5. Original article here http://t.co/KHj56AfU
nephondemand
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#ecuimres #grandrounds #meded 9/21: so the PHQ9 can be used for screening & objective monitoring of success or failure
nephondemand
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#ecuimres #grandrounds #meded 9/21: remission = PHQ9; partial response PHQ9 5-9; no response >9
nephondemand
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#ecuimres #grandrounds #meded 9/21: gr8 cheat sheet for commonly used antidepressive drugs here http://t.co/9zeLBvFC
ecuimchiefs
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#ecuimres #grandrounds Total daily dose range of common anti-depressants (chart). http://t.co/NW2NGb34
ecuimchiefs
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#ecuimres #grandrounds It does not matter WHICH antidepressant to use first.
nephondemand
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#ecuimres #grandrounds #meded 9/21: ur psychiatric armamentarium = familiarity w/2 SSRIs & 2 non-SSRIs http://t.co/QnC3JAmG
ecuimchiefs
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#ecuimres #grandrounds Several large trials demonstrate no substantial difference in efficacy amongst anti-depressants.
ecuimchiefs
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#ecuimres #grandrounds Side effects - nausea/vomiting more with venlefaxine, somnolence with trazadone
ecuimchiefs
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#ecuimres #grandrounds Fewer sexual side effects for bupropion than for fluoxetine, paroxetine and sertaline.
ecuimchiefs
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#ecuimres #grandrounds Suicidal Ideation (image) http://t.co/TXJPJxHA
nephondemand
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#ecuimres #grandrounds #meded 9/21: "suicidal ideation is the chest pain of psychiatry"
ecuimchiefs
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#ecuimres #grandrounds Per Dr Lang, suicidal ideation is the "chest pain" of Cardiology. Therefore judge RISK.
ecuimchiefs
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#ecuimres #grandrounds Differentiate between ACTIVE vs PASSIVE and CURRENT vs NOT.
nephondemand
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#ecuimres #grandrounds #meded 9/21: active suicidal ideation ~ STEMI; passive ideation ~ ischemia
ecuimchiefs
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#ecuimres #grandrounds Suicidal ideation + plan + intent = dangerous.
ecuimchiefs
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#ecuimres #grandrounds Major risk factors - age >65 and adolescents 15-24, single or living alone, male sex.
nephondemand
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#ecuimres #grandrounds #meded 9/21: white males > 85 yrs old most likely to commit suicide 59 per 100,000 pts
ecuimchiefs
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#ecuimres #grandrounds Religion (any) is considered protective, having pets is protective!
ecuimchiefs
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#ecuimres #grandrounds Suicidal Risk stratified based on MacArthur Foundation Toolkit: http://t.co/rBER6tK7
ecuimchiefs
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#ecuimres #grandrounds Dr Lang recommends against use of Abilify for depression. It is FDA approved for AUGMENTATION of therapy.
ecuimchiefs
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#ecuimres #grandrounds Abilify (aripiprazole) costs ~$800 /month. Compare with Zoloft (sertraline) ~$4 /month.
nephondemand
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#ecuimres #grandrounds #meded 9/21: references here. http://t.co/beecj66h
nephondemand
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#ecuimres #grandrounds #meded 9/21: remember u can participate in any ECU IM conference thru twitter or Facebook.C link http://t.co/R2Vq2LNZ
nephondemand
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#ecuimres #meded 9/21: Full video of today's #grandrounds will be available at https://t.co/0pBgTOyf #medschool #internship #psychiatry
ecuimchiefs
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#ecuimres #grandrounds In elderly pts, Dr. Lang recommends to GO LOW AND GO SLOW, with respect to dose initiation and titration.
hotzoloftonline
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#ecuimres #grandrounds Abilify (aripiprazole) costs ~$800 /month Compare with Zoloft... Buy Zoloft Online -> http://t.co/gI9t4SXC

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