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Palliative Pearls

Low Dose Opioids for Dyspnea

February 2019 – Treating dyspnea improves function in late stage COPD and CHF. Consider using low dose opioid 30 – 60 minutes before planned exertion to improve activity tolerance.  ...

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Moral Distress

January 2019 – That pit in your stomach means you need to talk to a team member or colleague about a patient’s care. Moral distress occurs when you think you know the right thing to do, but yo...

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Routine Opioids at End-of-Life

December 2018 – Many dying patients are unable to ask for comfort medicines. More patients are dying in senior facilities without 24 hour staff able to assess nonverbal pain and dyspnea or use ...

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Deactivating Cardiac Devices at End of Life

November 2018 – There is a big difference between AICD deactivation and pacemaker deactivation. More patients (or their surrogates) are requesting deactivation of cardiac devices at end of life....

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A Moment of Self-Care

October 2018 – Double-booked patients, charts, emails, curbsides, phone calls, meetings. . . Work late and start again the next day. It is important to find a way to rest in the middle of things...

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Delivering difficult news

August 2018 – Providing serious medical information is challenging.  These are helpful steps and phases.  Use simple language. “I wish I had better news, but the biopsy showed cancer...

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What is the difference between Palliative Care and Hospice?

September 2018 – A picture speaks a thousand words. All hospice is palliative care; not all palliative care is end-of-life or hospice care For more information contact Dr. Leslie Estep or Dr. An...

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Supplements: Less is More at End-of-Life

July 2018 – De-escalating supplements can improve quality of life. Patients referred to hospice are often on multiple supplements. They are relieved when some pills can be stopped. Consider disc...

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Fall Risk Screen

June 2018 –  Falls are the number one cause of death from injury in patients over 65. A simple fall risk screen for elders developed by the CDC includes the following three questions: Have you ...

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The CPR discussion– Part 3

May 2018 – Make a recommendation. You can reduce your patient’s and family’s distress by making a recommendation about CPR based on what you know about CPR as a medical procedure. “Do ever...

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