Tony Duffy @Existential_Doc Twitter profile

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Tony Duffy

5 months

Every palliative care thread 🧵 I’ve ever done in one place. Just click on the box below and you will find them in the replies section- updated every month ⭐️

Tony Duffy

@Existential_Doc

4 years

⚡️ “Palliative care threads”

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Tony Duffy

@Existential_Doc

3 years

I am a palliative care doctor. I had COVID prior to any vaccinations, it genuinely scared me how unwell I was. I’m triple vaccinated now to protect myself and those I look after. I follow the science carefully to inform my choices and it is clear that #GetVaccinated saves lives

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Tony Duffy

@Existential_Doc

4 years

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Tony Duffy

@Existential_Doc

4 years

Steroids in palliative care: A thread When we say steroids it normally refers to corticosteroids such as prednisolone and dexamethasone. Steroids are widely used in oncology and palliative care. Let’s take a closer look at some of their uses.

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Tony Duffy

@Existential_Doc

4 years

Hypercalcaemia in malignancy A thread

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Tony Duffy

@Existential_Doc

4 years

Regent street today No really 5th December 2020

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Tony Duffy

@Existential_Doc

4 years

“The best first-line antidepressant for older people is probably companionship” BMJ learning Powerful statement

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Tony Duffy

@Existential_Doc

1 year

Palliative care gifs - a Collection 🧵

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Tony Duffy

@Existential_Doc

3 years

🇯🇵❤️

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Tony Duffy

@Existential_Doc

9 months

Cheyne Stokes respiration at end of life- Thread Can be scary to witness for family, loved ones and health care professionals looking on. Understanding a little about what is happening may help alleviate some of that distress 🧵

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Tony Duffy

@Existential_Doc

4 years

Palliative care pearls 🛡 Please add your own and share: “Carry a pocket torch and look at you patient’s mouth regularly: mouth care is a vital but often overlooked aspect of comfort and dignity.”

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Tony Duffy

@Existential_Doc

4 years

Syringe drivers: A palliative care thread Let’s cover a topic that can be very emotive and frequently misrepresented Administration of medications via continuous subcutaneous infusion (CSCI) First lets cover some common concerns we may encounter when considering using a CSCI

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Tony Duffy

@Existential_Doc

2 years

Palliative care: Opioids 🧵 Alfentanil and Fentanyl belong to the Phenylpiperidine family and have a much higher affinity for Mu opioid receptors than Morphine and Oxycodone which belong to the Phenanthrene class. They are more potent but this difference has other implications

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Tony Duffy

@Existential_Doc

3 years

Methadone: A palliative care thread

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Tony Duffy

@Existential_Doc

4 years

Analgesia: a quick thread (Mostly for fun) Paracetamol: old faithful and only surviving analine analgesic. Mild pain and pyrexia. Beware low body weight and pill burden esp in severe pain.

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Tony Duffy

@Existential_Doc

3 years

Twitter at its finest

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Tony Duffy

@Existential_Doc

2 years

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Tony Duffy

@Existential_Doc

4 years

Malignant bowel obstruction: A palliative thread Possibly one of the most complex and challenging presentations in palliative care. Eating, drinking and going to the toilet are habits of a lifetime. Obstruction can lead to sudden medicalisation of what comes naturally.

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Tony Duffy

@Existential_Doc

4 years

Equivalent of 10mls of lactulose one daily tackling a week of ondansetron, ferrous fumarate and morphine.

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Tony Duffy

@Existential_Doc

4 years

Breathlessness: A palliative care thread “Breathe deeply, until sweet air extinguishes the burn of fear in your lungs and every breath is a beautiful refusal to become anything less than infinite” – D. Antoinette Foy

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Tony Duffy

@Existential_Doc

3 years

Pancreatic cancer: Palliative care reflections A thread 🧵 Difficult to manage on so many levels. My mum died from this condition and I was very grateful that she had the support of palliative care at home, in hospital and eventually the hospice. Some things I’ve learned 👇

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Tony Duffy

@Existential_Doc

2 years

Patients with oral cancer can find oramorph causes stinging due to the alcohol content. A switch to oxycodone oral solution can help reduce this dose related pain

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Tony Duffy

@Existential_Doc

3 years

Palliative care tip for Friday Trying to explain the multiple dimensions of pain/suffering to someone can be overwhelming for all involved. This diagram based on Dame Cicely Saunder’s work has proven really useful to help people see beyond the physical aspects of pain

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Tony Duffy

@Existential_Doc

4 years

District nurses are amazing That is all

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Tony Duffy

@Existential_Doc

1 year

Always ask about opioid timings in palliative care Immediate release morphine and Oxycodone take at least 20-30minutes to have any effect on pain in most people. Effects last from 2-4hours. If someone describes this pattern then their pain is convincingly responsive (in part at

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Tony Duffy

@Existential_Doc

3 years

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Tony Duffy

@Existential_Doc

2 years

Malignant Spinal Cord Compression (MSCC)- A Thread 🧵 Old fashioned medical tools of history and clinical examination are the key Trust your instincts with this diagnosis

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Tony Duffy

@Existential_Doc

2 years

Been a while 😂

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Tony Duffy

@Existential_Doc

3 years

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Tony Duffy

@Existential_Doc

1 year

@nandwics Avoiding under or over investigation for undifferentiated abdominal pain is surely one of the most difficult skills going imo. Knowledge of obs/gyn, urology, gastro, infection, surgery, vascular, paeds, endocrine, pharmacology all factor. Bad example

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Tony Duffy

@Existential_Doc

1 year

@LibbyMbc So sorry to hear this Libby, I hope any pain is well controlled and you can talk with someone about what care is available

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Tony Duffy

@Existential_Doc

4 years

Benzodiazepines: A palliative care thread As a group the benzodiazepines are one of the most commonly used medications in palliative care. Although they can be helpful to relieve many symptoms, their evidence base is small and patient selection is key. Let’s explore further

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Tony Duffy

@Existential_Doc

1 year

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Tony Duffy

@Existential_Doc

2 years

Managing bleeding in palliative care A Thread 🧵 One of the most difficult topics to discuss. Bleeding reminds us all of our own fragility and elicits an immediate response from all who witness this. Lets’s start with bleeding from local areas

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Tony Duffy

@Existential_Doc

2 years

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Tony Duffy

@Existential_Doc

4 years

There’s so much more that could go on this. Anyone up for the challenge? @mancunianmedic @DrDomPimenta

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Tony Duffy

@Existential_Doc

4 years

⚡️ “Palliative care threads”

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Tony Duffy

@Existential_Doc

3 years

Palliative care practice vs evidence Current evidence shows that Anti-secretory medications no better than placebo at reducing noisy breathinf at end of life So why do we continue to use them?

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Tony Duffy

@Existential_Doc

2 years

Absolutely delighted to have accepted a future consultant post at @StColumbas hospice care. Really excited to be working alongside such fantastic, caring colleagues and to be part of the wider @lothian_nhs palliative care team.

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Tony Duffy

@Existential_Doc

3 years

Fever and Fentanyl patches don’t mix well. Increased absorption due to increased local blood flow to the skin can lead to toxicity and respiratory depression. Particularly risky in those with cyclical pyrexia secondary to underlying malignancy.

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Tony Duffy

@Existential_Doc

3 years

Me talking to new trainees

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Tony Duffy

@Existential_Doc

3 years

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Tony Duffy

@Existential_Doc

2 years

Opioid rotation - A Thread 🧵 All opioids work the same right? Well not really. Let’s take a closer look at how rotating from one opioid to another may produce different results

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Tony Duffy

@Existential_Doc

3 years

One of the most powerful ways to improve outcomes in palliative care must be continuity of contact with the same person/team. Just my observation ✋ Not always possible but if there is a good relationship and trust then it may make more difference than any medications

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Tony Duffy

@Existential_Doc

3 years

Anti-depressant discontinuation A thread 📝 Think carefully before de-prescribing anti-depressants. A very unpleasant syndrome can occur if stopped abruptly, including towards end of life. A few things to consider

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Tony Duffy

@Existential_Doc

3 years

Palliative care research A light hearted approach

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Tony Duffy

@Existential_Doc

4 years

Opioid toxicty: A thread (with a palliative theme) Let’s start by thinking about tue difference between side-effects of opioids from toxicity.

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Tony Duffy

@Existential_Doc

2 years

Ketamine in palliative care A Thread 🧵 An interesting drug that divides opinion in palliative care. Let’s have a look at how it works and when it might have a role

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Tony Duffy

@Existential_Doc

2 years

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Tony Duffy

@Existential_Doc

4 years

We need a better approach to delivering 7 day a week palliative care/end of life for those at home than the current model. Early hours of Saturday and Sunday morning are fragile periods often leading to avoidable acute admission and distress Time to fund 7 day Palliative care

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Tony Duffy

@Existential_Doc

9 months

I hope this may be a helpful thread to help reduce some of the distress surrounding this area Normalising talking about dying as a wider society is important but we must never forget the uniqueness of everyone’s experiences and personal loss involved

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Tony Duffy

@Existential_Doc

2 years

Delighted to find out I have been awarded the Ilora Finlay medal by @cardiffuni for my MSc dissertation in palliative medicine. Baroness @IloraFinlay is a wonderful advocate for palliative care

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Tony Duffy

@Existential_Doc

9 months

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Tony Duffy

@Existential_Doc

5 months

@EM_RESUS Death bed phenomenon. The difference between this and delirium/opioid toxicity is that the familiar visions are comforting and do not cause distress. Experienced across cultures and often in the last hours of life, although sometimes longer.

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Tony Duffy

@Existential_Doc

3 years

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Tony Duffy

@Existential_Doc

4 years

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Tony Duffy

@Existential_Doc

4 years

@Medic_Russell @DrLindaDykes Was once asked this as an opener by a senior, I replied with “Fy2.... can I ask you how old you are?” “30” was the response. “So am I, so lets talk to each other like 30 year olds” and we did. How do we learn if unable to interact with those higher up the hierarchy?

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Tony Duffy

@Existential_Doc

4 years

Nausea and Vomiting: A thread (mostly for fun) First a little background adapted from Dylan Harris: lecturer at University of Cardiff.

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Tony Duffy

@Existential_Doc

4 years

Head and Neck cancer: A palliative care thread When people ask “What is the definition of SPECIALIST palliative care?” Well, I hope after reading this thread that question will be answered

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Tony Duffy

@Existential_Doc

2 years

CESR awarded 🙌 A huge thank you to everyone who helped me with the process @AllyMedic @laird_barry @LezaQuate @coulty78 Fiona Finlay @FionaRawlinson1 Duncan Brown @libbyferguson13 Graeme Lumsden Neil McGowan Katrina Weir and John Welsh

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Tony Duffy

@Existential_Doc

3 years

Excellent read 🙌 “Palliative care is a right” -may be a more realistic goal.

Hospice care is a right, not a luxury

I have seen the value of good palliative care. It’s time the NHS took it seriously – and made it available to all those who need it

www.theguardian.com

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Tony Duffy

@Existential_Doc

3 years

One the best things about community palliative care is the reminder it gives you of the challenges that everyone faces day to day. Patients, families, friends, carers, district nurses, GPs, AHPs, ANPs, pharmacists, CNS teams, community nurses. Everyone is vital

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Tony Duffy

@Existential_Doc

4 years

Appears to be one reason here 😂

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Tony Duffy

@Existential_Doc

2 years

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Tony Duffy

@Existential_Doc

4 years

Anyone else fond of a diagram when explaining things to patients?

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Tony Duffy

@Existential_Doc

4 years

Head and Neck cancer: A palliative care thread When people ask “What is the definition of SPECIALIST palliative care?” Well, I hope after reading this thread that question will be answered

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Tony Duffy

@Existential_Doc

3 years

Helped out with some bystander CPR a few weeks ago. Seeing the person walking their wee dog tonight was really nice. The ambulance crew were fantastic, I don’t think we give paramedics enough praise for what they do

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Tony Duffy

@Existential_Doc

2 years

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Tony Duffy

@Existential_Doc

1 year

@rxtoriarsenault

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Tony Duffy

@Existential_Doc

1 year

Community palliative care logistics It’s Friday afternoon around 3pm Newly referred patient requires a syringe driver with 3 medications to manage pain and nausea due to loss of oral route Pall care CNS phones GP to ask for a prescription and for a drug chart to be written

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Tony Duffy

@Existential_Doc

4 years

I have managed to combine all the recent palliative care threads into one group. Hope this is helpful. Enjoy 💙

Tony Duffy

@Existential_Doc

4 years

⚡️ “Palliative care threads”

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Tony Duffy

@Existential_Doc

3 years

Myeloma and palliative care - A thread Myeloma is type of cancer that effects mature B-lymphocyte cells known as plasma cells These cells normally produce antibodies that help fight infection. In myeloma these cells are overproduced and lead to high levels of antibodies

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Tony Duffy

@Existential_Doc

4 years

Itch: A palliative care thread As with Nausea and Vomiting the best approach is to identify the underlying cause if possible. Treatment can be targeted to best improve symptoms and reduce side-effects Start with a good history as always

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Tony Duffy

@Existential_Doc

2 years

Biochemistry in palliative care 🧵 Can you really tell that much from a set of blood results? Are they useful in palliative care?

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Tony Duffy

@Existential_Doc

4 years

Autonomic dysreflexia: quick thread An important condition to be aware of and be prepared for in any patient with a spinal cord injury or malignant compression at the level of T6 or above

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Tony Duffy

@Existential_Doc

10 months

The thing I admire most about really good GPs is there ability to accept and sit with certain levels of risk in a management approach It’s an incredibly difficult skill and often misunderstood.

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Tony Duffy

@Existential_Doc

3 years

@DrGeropsych

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Tony Duffy

@Existential_Doc

1 year

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Tony Duffy

@Existential_Doc

3 years

Palliative tip for Wednesday Deprescribing towards end of life Polypharmacy in the last year of life is common. The study below showed that an average of 10.7 medications were prescribed at the time of participants dying

The Burden of Polypharmacy in Patients Near the End of Life - PubMed

There is a significant medication burden placed on patients with advanced illness. Although most medications were prescribed for supportive care, we observed a high prevalence of medications for...

pubmed.ncbi.nlm.nih.gov

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Tony Duffy

@Existential_Doc

3 years

Palliative care tip for Sunday De-medicalise your patient encounters and you might learn more about what is driving their symptoms. Don’t go straight to asking about pain or constipation or the patient may automatically focus on this next time. Ask about what matters to them

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Tony Duffy

@Existential_Doc

1 year

@drkeithsiau

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Tony Duffy

@Existential_Doc

4 years

Constipation- A quick thread Often overlooked, not deliberately but if we don’t ask we will never know. First step in management is to take a good history

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Tony Duffy

@Existential_Doc

4 years

Postie left the scroll at the back door for me. Wee blast on the radiator and we are sorted.

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Tony Duffy

@Existential_Doc

4 years

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Tony Duffy

@Existential_Doc

4 years

Had a colleague mention my recent threads on palliative care today and how they found them helpful. (Blush) It was really nice as I’ve missed face to face teaching over the past year, great to know we can still pass somethings on via twitter

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Tony Duffy

@Existential_Doc

2 years

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Tony Duffy

@Existential_Doc

3 years

Drug name fun Sinemet= without vomiting Nystatin = New York State Institute EMLA = Eutectic mixture of local anaesthetic Vicodin = 6 times more potent than codeine Warfarin = Wisconsin Alumni Research Foundation + coumARIN Tacrolimus = Tsukuba Macrolide Immunosuppressant

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Tony Duffy

@Existential_Doc

2 years

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Tony Duffy

@Existential_Doc

3 years

Palliative pharmacological points of debate that come up weekly -NSAIDs in cancer bone pain -clonazepam in neuropathic pain -ketamine -methadone -topical opioids -tapentadol -paracetamol -lidocaine plasters -steroids -octreotide -nystatin -cannabis #backtoscience

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Tony Duffy

@Existential_Doc

3 years

Look at the deaths occurring at home. GPs and District nurses have had a very difficult year

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Tony Duffy

@Existential_Doc

3 years

Palliative care tip Bedsheets can become surprisingly heavy towards end of life. Keep them loose and light if possible. Weighty sheets can cause painful plantar strain on ankle tendons, reduced chest expansion and transfer weight onto vulnerable pressure areas

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Tony Duffy

@Existential_Doc

1 year

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Tony Duffy

@Existential_Doc

3 years

When the consultants are talking about discharging someone and you just sent a D-dimer, BNP and Troponin

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Tony Duffy

@Existential_Doc

9 months

@RuthDavidsonPC @Daily_Express @ERantzen @dignityindying Can’t the country talk about normal dying first and how to improve care for all who are dying?

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Tony Duffy

@Existential_Doc

10 months

Uncontrolled distress in someone who is dying should be seen as an emergency -Training to improve recognition -Initial general measures to manage -Escalation with clear flowchart/numbers -Real time management and ongoing review -Communication is the cornerstone -Debrief

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Tony Duffy

@Existential_Doc

3 years

So i'm doing something I have wanted to do for many years- I have started a blog. There are some experiences I'd like to share that I hope might help others and I have an interest in writing so why not eh? You'll find it at

Palliative Reflection: Talking about life

Personal blog page of Tony Duffy. Talking about palliative care and many many other things in life

www.palliative-reflections.com

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Tony Duffy

@Existential_Doc

4 years

3 years ago we shared our last Mother’s day as a family 2 months later we shared our last moments together Tell your mum how much you love her tomorrow no matter where she may be. Always in our hearts 💙