Literature Review

Ambiguous loss: Implications for perinatal and neonatal nursesNeonatal Network; Rachel A Joseph, Mary Highton; 3/25Ambiguous loss, a term coined by Pauline Boss, is a state in which there is no actual "death" and, therefore, no "grieving" or closure associated with it. Pregnancy is a happy event most of the time; however, the loss of pregnancy can be distressing to the parents. While the birth of a child is expected to be a joyful event, premature birth and subsequent admission to the NICU for prolonged periods with fluctuating conditions force the parent to be in a constant crisis mode where the outcome is unknown. This can mentally, physically, and emotionally drain the parents and may cause depression or other mental health challenges. Perinatal and neonatal nurses are uniquely positioned to recognize the warning signs of emerging grief crises in the parents and support them appropriately.

A mother’s goodbye-Barriers to microtransitions in careJAMA Internal Medicine; Aval-Na’Ree S. Green, MD, MHA, CMD; Benjamin E. Canter, OTD; 3/25After a long, debilitating battle with lupus, my cousin died at the doorsteps of our health system. The funeral was at 11:00 am. I arrived at the facility at 8:45 am. Although the catheter was in place, my aunt was undressed, with remnants of breakfast on her gown. She had not been bathed. The staff and I wheeled my aunt outside and attempted to load her into the van. Once my aunt was in the chair, it could not fit through the van door. Because this transition was not a medical health care appointment, the facility did not coordinate the resources, including use of the van, that were necessary for it to occur successfully. In contrast, had this been a medical outing, such as a weekend dialysis appointment, the facility would have been required to provide transportation. If this microtransition had been treated like a major health care transition, perhaps it would have had a better chance of success. Nursing teams use checklists during major care transitions; similar procedures should apply to microtransitions.

Antimicrobials in serious illness and end-of-life care: Lifting the veil of silenceThe Lancet. Infectious Diseases; William E Rosa, Shila Pandey, Renee Wisniewski, Craig Blinderman, Mark Wing Loong Cheong, Juan Esteban Correa-Morales, Diego Alejandro Cubides-Diaz, Sharif Folorunso, Nahla Gafer, Mohja Marhoom, Tiffanny Newman, Christian Ntizimira, Temitope Oyewole Obadare, Cihan Papan, Pedro Emilio Pérez-Cruz, Lukas Radbruch, Giri Shan Rajahram, Tomás Alejandro Reyes-Barros, Naveen Salins, Kavitha Saravu, Donald R Sullivan, Edward Christopher Dee; 3/25Global rates of antimicrobial consumption increased by 65% between 2000 and 2015, by 16% between 2016 and 2023, and are estimated to increase by an additional 52% by 2030. Antimicrobial use and misuse remains high among people with serious illness and at end of life, despite scarce evidence of benefit. In addition, the overuse and misuse of antimicrobials at end of life further exacerbate antimicrobial resistance, which is a substantial public and global health concern. These examples are combined with a case of non-beneficial end-of-life antimicrobial use and clinical guidance for patient and family communication regarding antimicrobial treatment. This Personal View also provides recommendations to improve antimicrobial stewardship with the goal of engaging multidisciplinary stakeholders and decreasing inappropriate antimicrobial use at end of life.

Proposed FY26 Hospice Wage Index and Payment RateCMS press release; 4/11/25On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that proposes updates to Medicare payment policies and rates for hospices under the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Updated Proposed Rule (CMS-1835-P). [Major provisions include:]

[Canada] Care utilization patterns among patients dying with advanced chronic obstructive pulmonary diseaseCanadian Journal of Respiratory, Critical Care, and Sleep Medicine; Aleisha Fernandes, Shuaib Hafid, Anastasia Gayowsky, Tetyana Kendzerska, Aaron Jones, Erin Gallagher, Colleen Webber, James Downar, Sophie Corriveau, Douglas G. Manuel, Sunita Mulpuru, David Da Silva-Krul, Amy Hsu, Peter Tanuseputro, Sarina R. Isenberg, Michelle Howard; 3/25Despite primary care providing majority of outpatient care, inpatient utilization is higher amongst patients who are notaccessing PC [palliative care]. These patients are also more likely to die in an acute setting. This study provides insight into the proportion of care patients are being provided from different specialties as well as the distribution of end-of-life outcomes amongst these patterns of care. Future research will benefit from exploring the association between these different patterns and end-of-life outcomes to identify the most optimal care pattern for improving end-of-life outcomes for patients with ACOPD [advanced chronic obstructive pulmonary disease].

Proposed FY26 Hospice Wage Index and Payment RateCMS press release; 4/11/25On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that proposes updates to Medicare payment policies and rates for hospices under the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Updated Proposed Rule (CMS-1835-P). [Major provisions include:]

Alzheimer’s risk rises when amount of deep sleep falls, study suggests CNN Health; by Sandee LaMotte; 4/8/25 Need another reason to prioritize your sleep? Not spending enough time in the two deep stages of sleep — slow-wave and rapid eye movement, or REM, sleep — may hasten the deterioration of parts of the brain associated with Alzheimer’s disease, a new study found. Deficits in slow-wave and REM sleep appear to shrink parts of the brain known to be early indicators of cognitive deterioration and Alzheimer’s disease, said lead study author Gawon Cho, a postdoctoral associate in internal medicine at the Yale School of Medicine in New Haven, Connecticut. [Continue reading ...] 

Doctors are getting creative with artificial intelligenceMedscape; by Tatum Anderson; 4/7/25Artificial intelligence (AI) is becoming more embedded in the work life of some physicians who are taking the initiative to test its use in various scenarios. “I use [generative AI] all the time,” Mohamed Elsabbagh, MBBCh, endocrinology consultant with Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England, told Medscape Medical News. “I’m a big fan of it, and it has helped me a lot to find papers, summarize guidelines, or compare protocols.” Mohammad Abdalmohsen, MBBS, a lung cancer fellow at Oxford University Hospitals NHS Foundation Trust, told Medscape Medical News that he also uses generative AI, like ChatGPT, often. “If you give it very specific questions, it comes up with great answers. I just asked ChatGPT for a protocol that I couldn’t find, and it got it for me in 5 seconds.”

VNA Hospice NWI celebrates some of its most dedicated volunteers at Volunteer Appreciation Breakfast NWI.LIFE, Valparaiso, IN; by Philip Bolton; 4/7/25 On the morning of Saturday, April 5, VNA Hospice of Northwest Indiana hosted its annual Volunteer Appreciation Breakfast at Christ Lutheran Church in Valparaiso. Volunteers who assist with VNA’s many services, including hospice and palliative care, the Medical Guardian help button program, the We Honor Veterans program, the Phoenix Center for Grief, and VNA Meals on Wheels of Porter County, were recognized. ... Matthew Naillieux, a VNA Hospice NWI volunteer, has proudly worked with the organization for 20 years. “Everything VNA Hospice NWI does is good for the community,” Naillieux said. ... "Usually, we’re volunteering at different locations at different times, and we aren’t able to get together like this very often." ... During the award presentation segment of the event, volunteers were recognized for milestone achievements. These included awards for achievements like 5, 10, 15, 20, and 25 years of service ... [Continue reading ...]Editor's note: Reminder that April is National Volunteer Month; April 20-26, 2025 is National Volunteer Week.

Hospice of Americus-Sumter County Georgia establishes nursing scholarship at GSW Georgia Southwestern State University, Americus, GA; 4/9/25 The Hospice of Americus-Sumter County Georgia has announced the creation of a new scholarship aimed at supporting students enrolled in Georgia Southwestern State University’s (GSW) Associate of Science in Nursing (ASN) program. Designed to foster local talent and address the growing need for qualified healthcare professionals, the scholarship specifically targets non-traditional students with healthcare experience or those who are first responders from Sumter County and the surrounding region. ... By prioritizing individuals already embedded in healthcare and emergency services, the fund supports career advancement and ensures that compassionate, experienced caregivers remain within the community. [Continue reading ...]

In everyone's life, at some time, our inner fire goes out. It is then burst into flame by an encounter with another human being. We should all be thankful for those people who rekindle the inner spirit. ~ Albert Schweitzer

Rural US loses 43% of independent physicians: 5 things to know Becker's Hospital Review; by Kelly Gooch; 4/7/25 The number of independent physicians in U.S. rural areas declined 43% over five years — from 21,956 in January 2019 to 12,467 in January 2024 — according to an Avalere study sponsored by the Physicians Advocacy Institute. ... Five things to know:

Rochester’s Art of Observation program helps medical students and clinicians cultivate essential clinical skills University of Rochester, Rochester, NY; by Melissa Pheterson; 4/8/25 After a day of seeing and treating patients, eight faculty-physicians from the University of Rochester Medical Center met at the University’s Memorial Art Gallery (MAG). They sat on folding stools before a painting of a woman and three children gathered around a table, on which the woman appeared to be cutting something. ... “What do you see?” said Natercia Rodrigues ’19M (MS), an assistant professor at the School of Medicine and Dentistry, a family physician in the UR Medicine Primary Care network, and the group’s facilitator. Designed to enhance observational skills for healthcare professionals, the sustained viewing and structured dialogue help participants unpack their assumptions, consider different perspectives, and avoid jumping to conclusions—among other cognitive biases— ... [Continue reading ...]