Literature Review

Palliative care in the ICU: From oxymoron to standard of careIntensive Care Medicine; Nancy Kentish-Barnes, Judith E. Nelson; 6/25 Palliative care can be integrated into intensive care through ICU clinicians and palliative care specialists, and these approaches are complementary and synergistic. One study found that proactive specialist involvement in ICU rounds for high-risk patients led to more and earlier family meetings and shorter hospital stays. However, collaboration challenges, such as continuity of communication, highlight the need for close team cooperation. The integrative model trains intensivists and ICU nurses to embed palliative care into routine practice, ideally starting in medical and nursing education. Research has shown that improved communication and support from intensivists and ICU nurses are associated with better bereavement outcomes for families, including reduced post-traumatic stress, anxiety, depression, and prolonged grief.

Medicare Advantage plan disenrollment: Beneficiaries cite access, cost, and quality among reasons for leavingHealth Affairs; by Geoffrey J. Hoffman, Lianlian Lei, Ishrat Alam, Myra Kim, Lillian Min, Zhaohui Fan, Deborah Levine; 6/25Medicare Advantage (MA) is growing in popularity, but it is seeing substantial plan disenrollments among high-risk Medicare beneficiaries. Understanding and addressing factors associated with disenrollment are crucial for improving MA access and quality but are complicated by data issues, including the inability to adequately assess beneficiaries’ perceptions of access and quality in MA... Difficulty accessing needed medical care was more strongly associated with MA-to–traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.

[Italy] Palliative Performance Scale predicts mortality in cardiac intensive care unitOpen Heart; by Laura Sofia Cardelli, Lorenzo Gamberini, Beatrice Dal Passo, Silvia Zagnoni, Francesca Sciarra, Federica Frascaro, Alice Vitagliano, Valeria Carinci, Maria Laura Canale, Gianni Casella; 6/25Patients with PPS ≤70 had significantly higher 1-year all-cause mortality and in-hospital all-cause mortality. The PPS is a reliable and independent predictor of mortality in CICU patients. Incorporating PPS into clinical practice may enhance risk stratification, guide decision-making and optimise resource allocation in this high-risk population.

The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. ~ Martin Luther King, Jr.

I guess we all like to be recognized not for one piece of fireworks but for the ledger of our daily work. ~ Neil Armstrong

May we think of freedom, not as the right to do as we please, but as the opportunity to do what is right. ~ Peter Marshall

True heroism is remarkably sober, very undramatic. It is not the urge to surpass all others at whatever cost, but the urge to serve others at whatever cost. ~ Arthur Ashe

With freedom comes responsibility. ~ Eleanor Roosevelt

Those who deny freedom to others deserve it not for themselves. ~ Abraham Lincoln

America, you great unfinished symphony, you sent for me. You let me make a difference. A place where even orphan immigrants can leave their fingerprints and rise up. ~ Lin Manuel Miranda, as Alexander Hamilton, in Broadway's 2014 Hamilton

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator, with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. ~ The Declaration of Independence, 1776

CMS Age-Friendly Measure: Overview for hospitals and health systems Institute for Healthcare Improvement; retrieved from the internet 7/2/25 Starting with the 2025 reporting period, hospitals will attest to providing age-friendly care through a new measure introduced by the Centers for Medicare & Medicaid Services (CMS). The CMS Age Friendly Hospital Measure advances the Age-Friendly Health Systems movement’s vision to ensure that all older adults receive age-friendly care that is evidence-based and aligns with what matters most to the older adult and their family caregivers. To date, nearly 5,000 sites of care have been recognized as Age-Friendly Health Systems — Participants and celebrated by IHI and The John A. Hartford Foundation. The measure has five domains that cover all four elements of age-friendly care, known as the 4Ms: What Matters, Medication, Mentation, and Mobility.

Older adults spending excess time in ED, putting hospitals at risk of failing to meet new guideline, analysis finds McKnights Long-Term Care News; by Donna Shryer; 7/1/25 A new national analysis of hospital data shows that older adults in the United States increasingly are spending more time in emergency departments (EDs) than federal guidelines recommend — delays that can be harmful to aging patients. The findings come as hospitals prepare to comply with new Medicare rules aimed at improving emergency care for older adults. ... Among patients who were admitted to the hospital, more than one-third (36%) waited more than three hours after the decision was made to admit them, a delay known as boarding. These benchmarks — eight hours in the ED and three hours to admission — are part of the new Age-Friendly Hospital Measure introduced by the Centers for Medicare & Medicaid Services (CMS). As of January 2025, hospitals are required to confirm they have procedures in place to meet these time goals.