Michelle Knight

Matron and lead nurse in palliative care.

[Michelle Knight @MichelleKnght]

First ever ascent of Mt Snowden. In training for a much higher challenge next year #arthurrankhospice

[Sharron Davies HoL MBE @sharrond62]

Shame on the @iocmedia for allowing women to be beaten up by men as a sport. RT if you agree #ShameOnTheIOC

[Audrey Ludwig MBE @AudreySuffolk]

If you accept disability and age categories in sport on grounds of safety and fair competition and to prevent unjustified discrimination , then logical to accept and apply strict sex categories

[Michelle Knight @MichelleKnght]

https://t.co/tzfWCHEfuS @BBCNews

[Michelle Knight @MichelleKnght]

@BBCNews so, a decision to grant the building of Europe’s largest incinerator next to a small Georgian town with no motorway or dual carriageway transport links gets the go ahead before the environment agency consultation is finished. In the constituency of the Environment sec!

[Resuscitation Council UK @ResusCouncilUK]

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[Michelle Knight @MichelleKnght]

@Panther_Taxis I would like to nominate Arthur Rank Hospice

[Michelle Knight @MichelleKnght]

A rare position has become available at the Alan Hudson Centre at North Cambs. If you are interested in joining a small, friendly and dynamic team, check this out 😊

https://t.co/F53tbZkcYn

[Sharon Allen @sharonallenarhc]

So pleased to welcome Hospice Patron Belinda Sutton @ElgoodsBrewery1 followed by @HSheriffCambs and his wife, both visiting and supporting @ArthurRankHouse Alan Hudson Centre #Wisbech @MichelleKnght. Lots going on supporting people with life limiting illness & great to see 1/2

[Tony Duffy @Existential_Doc]

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 least) to opioids.

If someone describes the immediate release opioid working after 5 minutes and wearing off after 30minutes then the pain is unlikely to be responding to the current opioid regimen. Either the dose is too low or the pain is not opioid responsive. If the dose is increased be very very cautious ⚠️ Arrange review early for any benefit in pain fitting the pharmacology, if it starts to fit then the opioid is probably helping. If the reported effect is still rapid onset 5-10mins and lasting <30mins or no benefit despite an increase is opioid dose- speak with a palliative care specialist before making any other changes.

Another trend to look for is called “End of dose failure”
Modified release opioid preparations are usually taken 12 hours apart.
Many patients will not experience a full 12 hours of pain relief due to differences in metabolism and pharmacokinetics.
Patients will often report increased pain late afternoon-early evening as their morning modified release dose wears off- look for increased use of breakthrough medication at this time as a clue.
The same can happen in the early hours of the morning as patients wake with pain and describe taking a while “to get on top of things in the morning”
The night time dose of MR opioid os wearing off as the patient sleeps.

There are a number of ways to help this:
-An closely monitored increase in the twice daily dose of modified release morphine
-Use of immediate release opioid around the time of taking the modified release opioid to cover the fall in analgesic levels. This often works best first thing in the morning.
-Occasionally a change in route of administration to transdermal patch or continuous subcutaneous infusion
-Use of non-opioid analgesics to smooth out variations in pain thresholds

The effects of opioids change over time just like pain can change. Regular review is essential- ask about the timings not just the effects on pain scores

[BBC Morning Live @BBCMorningLive]

Presenter @jonnieirwin was diagnosed with terminal cancer almost 3 years ago. He's joined by @DrRanj to talk about palliative care.

Jonnie talks about how it has helped him, his experiences and that hospice care isn't just for end of life but can be for weeks, months or years.

[Elitsa Krumova @Eli_Krumova]

🍊🫐🥑 Very useful vitamin cheat sheet! 👍🏽
Thank you for sharing @CurieuxExplorer!

CC @mvollmer1 @Nicochan33 @FrRonconi @labordeolivier @Shi4Tech @jblefevre60 @sallyeaves @HealthcareLdr @Innov_Medicine @sminaev2015 @enilev @marcusborba @DrHugue @TanyaSinha_ @RLDI_Lamy @bimedotcom @DrFerdowsi @LaurentAlaus @PawlowskiMario @Fabriziobustama @Khulood_Almani @KanezaDiane @sudhirsethi1 @mdrechsler @fogle_shane @IanLJones98 @sonu_monika @DrAjaykishore82 @Victoryabro @postoff25 @EstelaMandela @tobiaskintzel @DrNikolova_Rumi @KanezaDiane @Analytics_699 @BetaMoroney @enricomolinari @kashthefuturist

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[Sharon Allen @sharonallenarhc]

Each star a symbol of love, names of loved one(s) written on them, all of whom we will celebrate at #LightUpALife on Sunday 11 December, 17.00 @ArthurRankHouse
Please join us if you would like to https://t.co/qAsIvgPvdu

[Sharon Allen @sharonallenarhc]

Pleased to spend today with @MichelleKnght &amp; our team working from Alan Hudson Day Treatment Centre Wisbech supporting local people in the Fens. Heard so much fantastic care from skilled &amp; compassionate colleagues as well as real challenges in a deprived part of our county

[Michelle Knight @MichelleKnght]

@Panther_Taxis @ArthurRankHouse

[Michelle Knight @MichelleKnght]

@Ben_Bowers__ @TheQNI @CrystalOldman Well done Ben 👏🏻👏🏻

[Michelle Knight @MichelleKnght]

@NEndoscopy

[Cambridge Palliative & End of Life Research Group @PELi_Cam]

Mixed views of anticipatory prescribing

Many bereaved relatives had a good experience but 18% reported issues, including practical problems (waiting too long for administration) and emotional impacts

@cmfaull outlines findings of a mixed-methods study

https://t.co/W83MG5bq2F

[Arthur Rank Hospice @ArthurRankHouse]

Do you have a @coopuk membership card? You'll be pleased to know that as well as earning yourself money off your shopping, you can also make a difference in your community. Choose ARHC as your local cause &amp; help raise much needed funds. #ItsWhatWeDo https://t.co/gArJqzWujN

[Arthur Rank Hospice @ArthurRankHouse]

Don't miss your opportunity to look round the 'Outstanding' rated Alan Hudson Day Treatment Centre at their upcoming Open Day on 20 Aug. Look round the Centre &amp; it's newly designed garden and find out more about the exceptional care they provide to people across The Fens.