Clinical Impact Symposium 2015 Pre-Conference

By Maggie Cunningham

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The 2015 Clinical Impact Symposium started off with a bang today with two breakout sessions for the pre-conference. While one room spent the afternoon focusing on balance and fall prevention, the other took a deep dive into the role of pharmacists in Interdisciplinary Teams (IDT). Later in the afternoon, registration opened up for the full conference, which kicks off at 8:00 AM Tuesday, November 10.

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Speaker Jennifer Ellis (PT, DPT, MS, GCS, and COS-C) began by detailing core characteristics found in clinical experts across all disciplines. It's worth highlighting that the key component of being a clinical expert is being a non-expert. While being a systematic thinker and having a wealth of content knowledge are crucial, the two most important qualities that all clinical experts possess are self-reflection and an ability to change their behaviors based on what they continue to learn. They find out what they don't know, and they learn it. In other words, a clinical expert doesn't necessarily know everything, but they are aware enough to realize when they need to seek answers, and they succeed in finding them.

Perhaps the biggest takeaway of the talk was the set of falls statistics that Ellis shared. Three quarters of falls occur in the home, and there are one-and-a-half falls per bed, per year in assisted living facilities and other hospitals and nursing centers. On top of that, "fall sequalae" (subsequent, related consequences of falls) is the primary reason for older adults to be admitted into skilled nursing facilities.

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If you ask around, Ellis says, the people most concerned about falls are the parents of the baby-boomers. This population knows that when you lose your balance, you lose your independence, and that is a consequence that they understand more personally than anyone. While clinicians used to think of fall risk assessment as "light switch" problems with yes or no clear-cut answers, Ellis explained that we now understand that a fall is more like a dimmer switch: multi-factorial and capable of constantly changing.

Another large part of this session was devoted to dynamic regulation and sensory re-weighting. Ellis described walking into gyms across the country and finding people who had passed a walking test only to fall a week or so later. This can only happen because we missed something, so we, as clinical experts, must become self-reflective and change our behavior so that we capture every possible, pertinent detail during an assessment. Clinicians accomplish this through interaction and improving practice patterns.

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There were several case studies examined using the Sensory Organization Test (SOT) and its cousin, the Clinical Test for Sensory Interaction on Balance (CTSIB). Both of these are practical ways of testing several different planes and visual disturbances to identify which sensory interaction is holding the patient back and causing the most disturbance. Once the test is taken, clinicians can immediately make suggestions to the patient to modify their home or living situation in order to adjust the most affected sensory component.

 

The latter half of the afternoon was spent in the pharmaceutical pre-conference, where attendees learned that despite the growing size of their demographic population, geriatric medicine is often considered the "red-headed step child' of healthcare." Mark Lehman, PharmD, pointed out that in elderly patients, it is important that any and all symptoms are considered as possible drug side effects until otherwise proven.

Seniors are at a greater risk for medication-related problems. However, the big question here was: why?  For starters, not many clinical drug trials include seniors that are on multiple medications, yet the better part of this population is on at six to eight. The second major factor is that drugs change how they affect us as we age. A drug that may have greatly helped us when we were thirty may have more adverse effects when we are sixty five.

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This is why the best doctor for a geriatric patient is one who knows what he/she doesn't know. Again, an outstanding clinical is not necessarily someone who knows everything but is someone who is willing to commit to lifelong learning and active in continued education and training. They are constantly self-reflecting, and this allows them to identify knowledge gaps find gaps they may be missing, and more importantly, find a way to fill them.

A common mantra about dosage, especially in geriatrics, is "start low, go slow." But Lehman said the mantra should be "start low, go slow… but don't stop too soon." He highlighted that while you shouldn't stop until you define a therapeutic end-point, you also need to assess when you should stop drug therapy. This is typically when the conversation becomes a palliative conversation.    

The conference makes its official kickoff first thing in the morning, with continued registration and the welcome breakfast between 6:45 AM and 8:30 AM. We will be continuing our live-blog and live-tweet coverage, and the easiest way to follow and contribute to this impactful conversation is to join us on our social channels! Follow us on Facebook as Kindred Healthcare.Tweet and Instagram about your CIS experiences at KindredHealth and follow our blog at kindredhealthcare.com/blog) all while using the #CIS2015 hashtag.