Literature Review

[Denmark] Opioids and dementia in the Danish populationJAMA Network Open; Nelsan Pourhadi, MD; Janet Janbek, PhD; Christiane Gasse, Dr rer medic; Thomas Munk Laursen, PhD; Gunhild Waldemar, DMSc; Christina Jensen-Dahm, PhD; 11/24This study found that opioid use of less than 90 TSDs [total standardized doses] was not significantly associated with increased dementia risk. Above 90 TSDs of opioid use was associated with an elevated dementia risk before age 90 years, which persisted in individuals with chronic noncancer pain and in individuals solely exposed to weak opioids. Further research should ascertain whether the findings denote causality between opioids and dementia risk.

[China] Psychological resilience and frailty progression in older adultsJAMA Network Open; Bo Ye, PhD; Yunxia Li, MPH; Zhijun Bao, PhD; Junling Gao, PhD; 11/24In this cohort study of community-dwelling older adults, a longitudinal association between PR [psychological frailty] and frailty progression was found. The results suggest that monitoring changes in PR can help forecast future frailty trajectories, particularly highlighting the need to support individuals facing declines in resilience. Targeted interventions that prioritize enhancing PR have potential to prevent and ameliorate frailty.

Applying natural language processing to electronic health record data—From text to triageJAMA Network Open; Grace K. Sun, BS; Andrew P. Ambrosy, MD; 11/24Most information about a patient’s clinical status, disease progression, and response to treatment lies in qualitative clinician documentation in the electronic health record (EHR). The New York Heart Association (NYHA) classification was developed to standardize functional status assessments and treatment decisions ... [but] ... due to inconsistent implementation in routine care, much of the critical information remains in unstructured EHR data that is difficult to capture and analyze. Natural language processing (NLP) is an emerging tool that uses artificial intelligence to process unstructured or semistructured free-text data, such as the embedded assessments of HF symptom status in clinician documentation. NLP, a field of artificial intelligence that focuses on understanding, interpreting, and generating human language, is capable of evaluating these data and providing large-scale insights into patient progress and treatment response, with some limitations. Overall, these findings suggest that deep learning approaches may be used to address meaningful gaps in clinician documentation.

Care of the patient nearing the end of life in the Neurointensive Care UnitNeurocritical Care; by Hanna Ramsburg, Abigail G Fischer, Meredith MacKenzie Greenle, Corey R Fehnel; 12/24Neurologically critically ill patients present with unique disease trajectories, prognostic uncertainties, and challenges to end-of-life (EOL) care. Acute brain injuries place these patients at risk for underrecognized symptoms and unmet EOL management needs, which can negatively affect their quality of care and lead to complicated grief in surviving loved ones. To care for patients nearing the EOL in the neurointensive care unit, health care clinicians must consider neuroanatomic localization, barriers to symptom assessment and management, unique aspects of the dying process, and EOL management needs. We aim to define current best practices, barriers, and future directions for EOL care of the neurologically critically ill patient.

Trends in hepatocellular carcinoma mortality rates in the US and projections through 2040JAMA Network Open; Sikai Qiu, MM; Jiangying Cai, MM; Zhanpeng Yang, MM; Xinyuan He, MD; Zixuan Xing, MD; Jian Zu, PhD; Enrui Xie, MD; Linda Henry, MD; Custis R. Chong, MD; Esther M. John, MD; Ramsey Cheung, MD; Fanpu Ji, MD, PhD; Mindie H. Nguyen, MD, MAS; 11/24Primary liver cancer imposes a substantial global disease burden, ranking as the sixth most commonly diagnosed cancer worldwide and the third-leading cause of global cancer-related mortality in 2020. In this cross-sectional study of 188,280 HCC [hepatocellular carcinoma]-related deaths, ASMRs [age-standardized mortality rates] increased from 2006 to 2022 and were projected to continue rising until 2040, primarily due to increased deaths from alcohol-associated liver disease (ALD) and metabolic dysfunction–associated steatotic liver disease (MASLD); deaths from viral hepatitis were under control and were projected to decrease. Large disparities were observed in HCC-related ASMRs by age, sex, and race and ethnicity. ...these findings may serve as a reference for public health decision-making and timely identification of groups at high risk of HCC-related death.

Patient, caregiver, and clinician perspectives on the time burdens of cancer careJAMA Network Open; Arjun Gupta, MD; Whitney V. Johnson, MD; Nicole L. Henderson, PhD; Obafemi O. Ogunleye, MEd; Preethiya Sekar, MD; Manju George, MVSc, PhD; Allison Breininger, MA; Michael Anne Kyle, PhD, RN; Christopher M. Booth, MD; Timothy P. Hanna, MD, PhD; Gabrielle B. Rocque, MD; Helen M. Parsons, PhD; Rachel I. Vogel, PhD; Anne H. Blaes, MD, MS; 11/24Cancer and its care impose significant time commitments on patients and care partners. These commitments, along with their associated burden, have recently been conceptualized as the “time toxicity” of cancer care. Patients with advanced solid tumors spend approximately 20% to 30% of their days alive with health care contact. In this qualitative analysis of patients, informal care partners, and clinicians, participants highlighted the diverse sources of time burdens, how these time burdens affected care partners alongside patients, and how the time burdens extended to the wider network around them. Time burdens had outcomes ranging from causing psychosocial distress, and “seemingly short” ambulatory appointments turning into all-day affairs. These findings will guide the oncology community to map, measure, and address time burdens for persons affected by cancer.

Palliative nursing in home health care across the lifespanAmerican Journal of Nursing; by Murali, Komal Patel; Ma, Chenjuan; Harrison, Krista L.; Hunt, Lauren J.; Rosa, William E.; Boyden, Jackelyn Y.; 12/24Primary palliative nursing in home health care (HHC) can be delivered to medically complex patients across the lifespan. Primary palliative nursing provides patient- and family-centered care for serious illness by alleviating the stress and symptoms of illness; coordinating care; and supporting the social, cultural, and psychological aspects of care. In this article, two case scenarios of patients in different phases of life serve as examples of primary palliative nursing in HHC. Key elements and challenges of delivering primary palliative nursing care in HHC are also highlighted.

Saturday newsletters focus on headlines and research - enjoy!

New alliance steps up as voice for providers & patients HomeCare; by Hannah Wolfson; 12/3/24 Stopping Medicare cuts, ensuring Medicare Advantage beneficiaries have good access to care, passing groundbreaking hospice legislation and bringing homecare into the forefront are all priorities for the newly-formed National Alliance for Care at Home, said CEO Steve Landers. “We’ve got to start improving access to home health care, and the way that we do that is we end this march of payment cuts that are being set forward by Medicare,” Landers said at the Alliance’s Homecare and Hospice Conference and Expo, which was held in October in Tampa, Florida. ... The alliance has automatically enrolled members of both legacy organizations, but Landers said that for renewals or new members, participants will be required to sign an attestation that says they have a program in place for quality and compliance, that they monitor the Office of Inspector General’s expulsion list and don’t take referrals or staff from organizations on that list and that they strive to participate in Medicare’s quality reporting programs.

Dallas’ Analog Informatics emerges from stealth to modernize patient engagement in over 150 languages Dallas Innovates, Dallas, TX; by Lance Murray; 12/4/24 AIC aims to "bridge the communication gap" between healthcare providers and patients worldwide by leveraging secure AI and modern communication tools. CEO Philip Lieberman created the platform based on his experiences in caring for his hospitalized mother-in-law during the COVID pandemic. ... Shocked that he knew “more about his Amazon packages” than the state of his loved one, Lieberman vowed to use the experience and resources he’d gained from the previous multinational companies he created “to bring compassionate yet automated continuous communication to every patient and their families.” ... AIC aims to "bridge the communication gap" between healthcare providers and patients worldwide by leveraging secure AI and modern communication tools.  ... AIC said its platform “bridges the communication gap” between healthcare providers and patients, offering continuous automated logistical support in more than 150 languages. 

Aging and unhoused: What end-of-life care looks like Next Avenue; by Terry Ann Donner; 12/2/24 Karen Robyn is a 62-year-old homeless woman on disability; ... she fears dying alone on the streets or in a hospital hooked up to machines she doesn't want to use. ... For the 138,098 people aged 55 and older experiencing homelessness and 5 million older adults living below the poverty level, dying alone and unhoused is a real concern.  ... However, a viable solution has been quietly growing in communities across the country. Small nonprofit community homes provide hope for terminally ill people who do not have a reliable caregiver or a stable living environment. These small homes, usually caring for up to 4 to 10 guests at a time, provide "family" caregivers and a safe place to receive end-of-life care. They are developing outside of the health care system and receive no federal or state funding. Kelley Scott, executive director of the Omega Home Network and Clarehouse in Tulsa, Oklahoma, explains that the network's mission is to "foster the development of nonprofit community homes for people who are dying and have no caregiver support" due to a lack of family, homelessness or family dysfunction. The network has 135 members with 55 homes providing care and another 70 to 80 homes in development.

5 principles of servant leadership Forbes; by Nancy Padberg; 12/3/24 Servant leadership isn’t just a philosophy; it’s a choice that redefines what leadership should feel like. It’s about prioritizing your associates first. Servant leadership shifts the focus from the traditional leadership model—where the leader’s primary goal is to accumulate power and control—to one where the leader prioritizes the needs of their team, community and organization. This approach builds a healthy workplace culture through collaboration, trust and empowerment. Here are some ways you can embody the principles of servant leadership to improve your company culture from the top down.

PIH Health hospitals targeted in ransomware attack CBS News KCAL, Los Angeles, CA; by Laurie Perez and Dean Fioresi; 12/4/24 PIH Health was targeted in a ransomware attack, forcing officials to completely shut their network offline and leaving millions in the dark when it comes to healthcare. ... Officials say that they were targeted on Sunday by a "criminal act" that "compromised their network." In turn, network services were turned off at their hospitals in Downey, Whittier and downtown LA. ... "Meeting the healthcare needs of our communities remains our highest priority," said a statement from PIH Health. "We continue to provide care during our downtime procedures at all of our facilities, including all three hospitals, medical offices, home health, hospice, outpatient imaging and laboratory."