Literature Review

10 Years of making the world a more livable place for all bereaved people Evermore; by Joyal Mulheron, Executive Director; 12/21/24   Fourteen years ago today, I was sitting on my couch, trying to make sense out of what just happened to our family. Our terminally ill daughter, Eleanora, had died a few weeks prior. While others sang holiday songs and gleefully exchanged gifts, it was a profoundly painful, dark, and isolating time for me. Within a few short years, I quit my career because I saw tragedies saturating our national headlines, leaving a trail of unseen and unsupported bereaved people in their wake, and I believed our nation should prioritize the needs of all bereaved people. ... This is what I set out to change. ... Evermore’s groundbreaking advocacy efforts resulted in our nation’s first Report to Congress, which provided an overview of grief and bereavement services in the United States. Next year, a report analyzing more than 8,000 scientific studies will be published, reviewing the highest quality interventions for bereaved people — which was championed by Evermore and endorsed by Congress. Editor's note: Click on the title's link to continue reading Evermore's trailblazing, state-of-the-art leadership and advocacy with Congress, with the government's Substance Abuse and Mental Health Services Administration (SAMHSA), Newsweek, PBS, Harvard's Public Health magazine, Penn State, the University of California, and more. Click here to join Evermore's mailing list, and to learn from Joyal Mulhuron, Evermore's innovative, inspirational Founder/Executive Director. 

In the end, it's not the years in your life that count. It's the life in your years. ~Abraham Lincoln 

Recommendations to ensure safety of AI in real-world clinical careJAMA; Dean F. Sittig, PhD; Hardeep Singh, MD, MPH; 11/24As HCOs [health care organizations] adapt their clinical and administrative workflows to new AI [artificial intelligence]-driven technologies, unintended adverse consequences will inevitably occur, particularly during transitions. To address these risks, HCOs and AI/EHR [electronic health record] developers must collaborate to ensure that AI systems are robust, reliable, and transparent. HCOs must proactively develop AI safety assurance programs that leverage shared responsibility principles, implement a multifaceted approach to address AI implementation, monitor AI use, and engage clinicians and patients. Monitoring risks is crucial to maintaining system integrity, prioritizing patient safety, and ensuring data security. 

Evolution in documented goals of care at end of life for adolescents and younger adults with cancerJAMA Network Open; Rosemarie Mastropolo, Colin Cernik, Hajime Uno, Lauren Fisher, Lanfang Xu, Cecile A Laurent, Nancy Cannizzaro, Julie Munneke, Robert M Cooper, Joshua R Lakin, Corey M Schwartz, Mallory Casperson, Andrea Altschuler, Lawrence Kushi, Chun R Chao, Lori Wiener, Jennifer W Mack; 12/24Little is known about the nature of change in goals of care (GOC) over time among adolescents and younger adult (AYA) patients aged 12 to 39 years with cancer near the end of life. Understanding how GOC evolve may guide clinicians in supporting AYA patients in making end-of-life decisions. In this cross-sectional study of AYA patients who died of cancer, palliative goals were rarely documented before the last month of life, highlighting the need for timely and ongoing GOC discussions.

Behavioral symptoms and treatment challenges for patients living with dementia: Hospice clinician and caregiver perspectivesJournal of the American Geriatrics Society; Karolina Sadowska BA; Molly Turnwald BA; Thomas O'Neil MD; Donovan T. Maust MD, MS; Lauren B. Gerlach DO, MS; 12/24Dementia affects one in three older adults over age 85 and individuals with dementia constitute the fastest growing population of patients entering hospice care. While cognitive impairment is the hallmark of dementia, behavioral symptoms are reported in nearly all patients with advanced dementia, contributing to both the complexity of end-of-life care and caregiver burden. Behavioral symptoms of dementia are highly prevalent among the US hospice population and are often managed with psychotropic medications prescribed off-label. There are limited treatment guidelines in this population, so the appropriate risk and benefit balance may be highly individual. This qualitative study can help to inform the decision-making of hospice clinicians and caregivers regarding anticipated behavioral changes and limitations of treatment options in dementia end-of-life care. 

Estimation of cancer deaths averted from prevention, screening, and treatment efforts, 1975-2020JAMA Oncology; Katrina A. B. Goddard, PhD; Eric J. Feuer, PhD; Jeanne S. Mandelblatt, MD, MPH; Rafael Meza, PhD; Theodore R. Holford, PhD; Jihyoun Jeon, PhD; Iris Lansdorp-Vogelaar, PhD; Roman Gulati, MS; Natasha K. Stout, PhD; Nadia Howlader, PhD; Amy B. Knudsen, PhD; Daniel Miller, BA; Jennifer L. Caswell-Jin, MD; Clyde B. Schechter, MD; Ruth Etzioni, PhD; Amy Trentham-Dietz, PhD; Allison W. Kurian, MD, MSc; Sylvia K. Plevritis, PhD; John M. Hampton, MS; Sarah Stein, PhD; Liyang P. Sun, MS; Asad Umar, DVM, PhD; Philip E. Castle, PhD; 12/24Overall US mortality has declined over time for most major cancer sites because of progress in prevention, screening, and treatment. Nevertheless, the reignited Cancer Moonshot goal to reduce the age-adjusted cancer mortality rate by 50% in the next 25 years will not be achieved without accelerating progress. In this model-based study using population-level cancer mortality data, an estimated 5.94 million deaths were averted from these 5 cancers [breast, cervical, colorectal, lung, and prostate] combined. Prevention and screening accounted for 8 of every 10 averted deaths, and the contribution varied by cancer site. A comprehensive plan to reduce cancer mortality includes interventions in cancer prevention, detection, diagnosis, treatment, and survivorship care.

High-risk opioid prescribing and nurse practitioner independenceJAMA Health Forum; Lucas D. Cusimano, BS; Nicole Maestas, MPP, PhD; 12/24In 2021, more than 1 in 5 opioid overdose deaths were attributed to prescription opioids in the US, and the rate of such deaths has increased 5-fold since 1999. Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs) ... In this difference-in-differences analysis of opioid prescribing in 16 states, there was no change in the rates of high-risk opioid prescribing in the 6 states that adopted nurse practitioner independence compared with 10 nonadopting neighboring states during the 24 months following adoption. The study found no association between legislation that granted independence to nurse practitioners and rates of risky opioid prescribing. 

[India] Mechanisms and clinical applications of palmitoylethanolamide (PEA) in the treatment of neuropathic painInflammopharmacology; Ardra Das, Preetha Balakrishnan; 12/24Palmitoylethanolamide (PEA) is emerging as a promising therapeutic agent for neuropathic and other pain-related conditions. PEA's interaction with endocannabinoid receptors decreases the inflammatory cytokine and chemokine production and thereby a descending pain sensation. Experimental evidence shows that PEA not only reduces pain and inflammation but also lowers the need for higher dosages of other drugs hence minimizing the risk of drug toxicity. The bioavailability of PEA has been enhanced by recent technological developments, which emphasize continuous research efforts to maximize PEA's therapeutic potential in pain treatment and associated medical sectors.

PBMs secretly profited from opioid crisis: New York Times Becker's Hospital Review; by Alexandra Murphy; 12/17/24 Pharmacy benefit managers were paid by drugmakers, including Purdue Pharma, to keep opioid prescriptions flowing even as overdose deaths soared across the U.S., according to an investigation by The New York Times. The Dec. 17 report highlighted how Express Scripts, CVS Caremark and Optum Rx, which control access to medications for millions of Americans, negotiated deals with opioid manufacturers to prevent restrictions on painkiller prescriptions in exchange for lucrative rebates. Between 2003 and 2012, Purdue Pharma paid PBMs roughly $400 million annually to avoid limits on opioid prescriptions, which included measures that could have curtailed overprescribing, such as requiring additional physician justifications or limiting the number of pills dispensed. Internal documents reviewed by the Times show how the PBMs repeatedly collaborated with opioid manufacturers to influence insurers' decisions and block restrictions.

Increasing awareness of hospice services among Latinos on the border YouTube - Borderzine Reporting across fronteras; features Hospice El Paso; 12/25/24 El Paso's Latino Community is seeing a rise in the use of hospice care ... Hospice in Mexico is a place and so a lot of Hispanics--true Mexicans--feel that you're going to take a loved one out of their home when it comes to hospice care. ... Latino families make up a growing portion of hospice users, reflecting national efforts in bilingual outreach and cultural sensitivity programs I had heard. The term "hospice"--I didn't know I didn't know what it meant. I didn't know what it involved but after my dad was enrolled in hospice ... I realized [that it] provided emotional and medical support ... [and] comfort that respects their cultural values. We were very fortunate that the individuals that came in that met with us beforehand and after were bilingual. I noticed that they spoke in English and in Spanish so that they would look between myself, my mom my sister to make sure we were nodding, agreeing, listening, hearing. I think that made a difference. It was very comforting. My dad at one point even said, "They gave me a bath but they didn't get the bed wet." That was our big joke and the fact that he was very comfortable. As more Hispanic families turn to hospice they're finding it offers not just medical care, but a way to honor their loved ones with dignity respect and familiar comforts in their final days.Editor's note: For data on the Hispanic population in the areas you serve, click here for the 

Look at how a single candle can both defy and define the darkness. ~ Anne Frank We honor Hanukkuh with this powerful quote from  Anne Frank when she was a young teenager. She died in the Bergen-Belsen concentration in February/March 1945. If she were still alive, she would be 95.

Executive Personnel Changes - 12/27/24

CMS scraps value-based Medicare Advantage model [VBID]Modern Healthcare; by Bridget Early; 12/20/24Citing overspending, the Centers for Medicare and Medicaid Services is calling an early end to an initiative that aimed to provide better, more efficient care to Medicare Advantage enrollees. The Value-Based Insurance Design model, or VBID, will sunset at the end of 2025, CMS announced, just 20 months after the agency extended it until 2030. The latest data show “substantial and unmitigable costs” totaling $4.5 billion in 2021 and 2022, an amount "unprecedented in CMS innovation center models," CMS said in a news release Monday.