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Warming Hearts, Cloaking Grief

By Lori RuderHe moves over and she snuggles in close to her fianc é. She pulls their blanket over them. A special blanket made just for this moment. “I love you” she murmurs, soaking in his face and his warmth. “Goodnight lovebirds,” his mother teases as she turns out the lights.This moment is both tender and tragic: tender because they are demonstrating their love for each other, tragic because this is happening in the ICU. Her fianc é is on life support and he is dying. He moved over because I moved him over to make room for her in his narrow hospital bed. I repositioned his ventilator tubing and central lines out of her way, closed the side rail behind her for support, and helped her pull their blanket over them. This blanket was made by ICU nurses for moments like this: to have something to offer when medicine doesn’t.Using our own time and money, we gather together to make blankets. We make them in many colors and patterns, to match the many styles that come from all walks of life. They are simple fleece tie blankets, the kind a Girl Scout might make, but they are soft and warm. They are something soft amidst the harsh reality of critical illness and death, and something to provide warmth and comfort--to touch a loved one during last moments as if to capture their essence before they are gone. The blankets are a memento of touch to take with them when they leave this place and their loved one behind.We give our blankets wh...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: blanket cancer comfort icu lori ruder Source Type: blogs

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As I walked in the room, I noticed it immediately: Norman was worse. The recurrent invasive cancer in his neck was impairing the drainage of fluid from his face making it difficult for him to turn his head, and it had progressed overnight. Despite his alarming appearance, he seemed calm. There were no more cancer-specific treatment options: the surgeons had declined to operate again; he had received maximum dose radiation; and the risks of chemotherapy outweighed any potential benefits. His pain required doses of opioids high enough that he often fell asleep in the middle of conversations. Because of his tracheostomy, Norm...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Hospital-Based Medicine Palliative Care Source Type: blogs
We present 18F-fluorocholine PET/CT imaging of prostate cancer with very rare lytic bone metastases.
Source: Clinical Nuclear Medicine - Category: Nuclear Medicine Tags: Interesting Images Source Type: research
Conclusion Pain is a critical underestimated problem in elderly patients. A timely systematic evaluation of the pain would call attention to palliative care needs and reduce the negative effects of uncontrolled pain on the quality of life.
Source: International Journal of Gerontology - Category: Geriatrics Source Type: research
DiscussionWhile there appears to be no immediate short-term differences, those who live longer than 3  months experience a significant improvement in dysphagia score using a stents combination therapy approach vs stents alone. The combination therapy significantly improves the overall survival as well as showed improvements in quality of life scores. Larger randomized controlled trials are needed t o assess improvements in dysphagia score, overall survival, quality of life, and adverse events.
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research
Supporting patients ’ spiritual needs is central to palliative care. Adolescents and Young Adults (AYAs) may be developing their spiritual identities; it is unclear how to navigate conversations concerning their spiritual needs.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
Early integration of palliative care (PC) in the management of children with high-risk cancer is widely endorsed by patients, families, clinicians, and national organizations. However, optimal timing for PC consultation is not standardized, and variables that influence timing of PC integration for children with cancer remain unknown.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
DISCUSSION: Only a few studies focused primarily on the improvement of parameters related to quality of life-although this is the primary therapeutic goal for many patients suffering from incurable and advanced cancer. The study results encourage regular inclusion of symptom- and QoL-related data in clinical studies and to more explicitly address the potential of systemic anticancer therapy in relieving pain and other symptoms, thereby supporting the goals of palliative care. PMID: 29411116 [PubMed - as supplied by publisher]
Source: Schmerz - Category: Anesthesiology Authors: Tags: Schmerz Source Type: research
Pediatric palliative care consults for children with cancer often occur late in the course of disease and close to death, when earlier involvement would reduce suffering. The perceptions that pediatric oncology providers hold about the pediatric palliative care service (PPCS) may shape referral patterns.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
The Edmonton Symptom Assessment System (ESAS) is a widely used multi-symptom assessment tool in cancer and palliative care settings but its psychometric properties have not been widely tested using modern psychometric methods such as Rasch analysis.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
by Chad KollasOn February 1, 2018, the Centers for Medicare&Medicaid Services (CMS)published its Advance Notice of Methodological Changes for Calendar Year 2019. Included in these proposed rules were several directives intended to reduce" Opioid Overutilization ” (see p. 202), including formal adoption of the “90 morphine milligram equivalent (MME) threshold cited in the CDC Guideline, which was developed by experts as the level that prescribers should generally avoid reaching with their patients (p. 203). ” CMS proposed “adding additional flags for high-risk beneficiaries who use ‘po...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: CMS health policy kollas medicare opioids Source Type: blogs
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