Literature Review
Socioeconomic status and major adverse transplant events in pediatric heart transplant recipients
10/20/24 at 03:20 AMSocioeconomic status and major adverse transplant events in pediatric heart transplant recipientsJAMA Network Open; Christina Hartje-Dunn, MD; Kimberlee Gauvreau, ScD; Heather Bastardi, PNP; Kevin P. Daly, MD; Elizabeth D. Blume, MD; Tajinder P. Singh, MD, MSc; 10/24In this cohort study of pediatric HT [heart transplant] recipients, there was no difference in posttransplant outcomes among recipients stratified by SES [socioeconomic status], a notable improvement from prior studies. These findings may be explained by state-level health reform, standardized posttransplant care, and early awareness of outcome disparities.
Patient considerations of social media account management after death
10/20/24 at 03:15 AMPatient considerations of social media account management after deathSupportive Care in Cancer; Rida Khan, Jacqueline Tschanz, Maxine De La Cruz, David Hui, Diana Urbauer, Astrid Grouls, Eduardo Bruera; 10/24Social media is widely used but few studies have examined how patients with advanced cancer want their accounts managed after death. The objective of this study was to determine the proportion of our patients with advanced cancer who have discussed the post-mortem management of their social media accounts with their family or friends. Conclusion: Few patients have had conversations on the management of their accounts after death, although more were interested in exploring their options further. More research is needed to examine the role of social media as a digital legacy and a coping tool for patients with advanced cancer.
Risk of dementia diagnosis after injurious falls in older adults
10/20/24 at 03:10 AMRisk of dementia diagnosis after injurious falls in older adultsJAMA Network Open; Alexander J. Ordoobadi, MD; Hiba Dhanani, MD, ScM; Samir R. Tulebaev, MD; Ali Salim, MD; Zara Cooper, MD, MSc; Molly P. Jarman, PhD, MPH; 9/24In this cohort study, new ADRD [Alzheimer disease and related dementias] diagnoses were more common after falls compared with other mechanisms of injury, with 10.6% of older adults being diagnosed with ADRD in the first year after a fall. To improve the early identification of ADRD, this study’s findings suggest support for the implementation of cognitive screening in older adults who experience an injurious fall that results in an ED visit or hospital admission.
Hospice care home provides peaceful place for low-income or homeless to die
10/20/24 at 03:05 AMHospice care home provides peaceful place for low-income or homeless to die Indiana Capital Chronicle; by Elise Shrock; 10/10/24 My neighborhood is full of wonderful places. Lovely places where people go to worship, to meet for meals, to do their errands, and, a lovely place to die. Let me explain. Tucked behind the busy near-north Keystone corridor is the Abbie Hunt Bryce Home, a no-cost home for terminally ill individuals who are low-income or homeless and would have no other home to go to during their last days or months of life. Operated by Morning Light, LLC, Abbie Hunt Bryce Home offers critical and compassionate services to Hoosiers in their final days. As the second largest residential hospice in the nation, our state is positioned to be a leader in providing compassionate end-of-life care. Not only is the Home a leader in size and scope, but all hospice residents stay free of charge, with no payment or insurance required. The Home is supported solely by community support and qualifies for Medicaid Waiver. ... [A case study follows with "Systemic challenges in Indiana." ...]
Today's Encouragement
10/20/24 at 03:00 AMEducation is the ability to listen to almost anything without losing your temper or your self-confidence. ~Robert Frost
Researchers raise concerns about the financial sector's rising role in US illness care
10/20/24 at 03:00 AMResearchers raise concerns about the financial sector's rising role in US illness care Medical Xpress; by Mary Ann Liebert, Inc; 10/16/24 The authors of a new article in Journal of Palliative Medicine state that the "growing role of the financial sector in home health and hospice, a reflection of larger trends in U.S. health care, is concerning and has major implications for care quality unless reforms are undertaken." Co-authors Lauren Hunt, Ph.D., RN, FN, with the University of California, San Francisco, and R. Sean Morrison, MD, with the Icahn School of Medicine at Mount Sinai in New York, observe that home health and hospice began as nonprofit organizations with close ties to their communities. However, the overwhelming majority are now for-profit entities, many of which have become targets for private equity buyouts. The authors note that "big business's emphasis on maximizing profit can be at odds with patient welfare. Indeed, a substantial body of evidence now demonstrates that care quality is consistently worse in for-profits as compared to nonprofits," they state. The authors further express concern that "pressure to achieve high returns on very short-term time horizons may conflict with the need for longer-term investments in quality, training, and staffing, thus reducing care quality.Publisher's note: I suspect this will be the next "big" article summarizing the role of private equity in hospice.
Sunday newsletters
10/20/24 at 03:00 AMSunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!
Music therapist helps patients navigate end-of-life journey on Long Island
10/20/24 at 03:00 AMMusic therapist helps patients navigate end-of-life journey on Long Island CBS New York / YouTube; by Jenna DeAngelis; 10/15/24 The healing power of music is being brought to hospice patients on Long Island, by Yuzuko DeGrottole, LCAT, MT-BC, a board-certified music therapist with MJHS Hospice. “Everyone has a song that takes them to a special place. “Are you going to sing with me?” [Sings a beautiful Jewish song.] That's the power of music. It moves us. It connects us, and for Sarah Jacobowitz it just makes her feel good. “I like it. It makes me happy.” The 95-year-old Holocaust Survivor is proud of her Jewish Heritage which she celebrates in song since she's bedridden. Yuzuko brings the music to her, even learning to sing in many languages for her patients. Music communicates with you directly to your heart. Music brings up a lot of emotion, with or without words. … Sarah's son who often sits bedside says music therapy hits all the right notes. Sarah is attentive instead of just sleeping all day or just doing nothing. Music brings back memories and it gives her pleasure just to be alive.Editor's note: Having a board-certified music therapist is significantly more valuable--therapeutically, clinically, meaning-making, mission-oriented--than simply having musicians play music. For more information visit "Facts for Music Therapy in Hospice Care" by American Music Therapy Association and the Certified Board for Music Therapists.
[Australia] Online plain language tool and health information quality-A randomized clinical trial
10/19/24 at 03:55 AMOnline plain language tool and health information quality-A randomized clinical trialJAMA Network Open; Julie Ayre, PhD; Carissa Bonner, PhD; Danielle M. Muscat, PhD; Erin Cvejic, PhD; Olivia Mac, MPH; Dana Mouwad, MHSc (Nsg); Heather L. Shepherd, PhD; Parisa Aslani, PhD; Adam G. Dunn, PhD; Kirsten J. McCaffery, PhD; 10/24National and international policies recognize that health literacy—a person’s capacity to access, understand, and act on health information—is a critical source of inequity in our health systems. Low health literacy contributes to higher mortality, morbidity, rates of hospitalization, emergency department visits, and medication errors independently of other social determinants of health, such as age, education, and socioeconomic disadvantage. In this randomized clinical trial, the Health Literacy Editor helped users simplify health information and apply health literacy guidelines to written text. The findings suggest the tool has high potential to improve development of health information for people who have low health literacy.
Today's Encouragement
10/19/24 at 03:55 AMOne of the most important things you can do on this Earth is to let people know they are not alone. ~ Shannon L. Adler
[Canada] Aerobic physical activity and depression among patients with cancer-A systematic review and meta-analysis
10/19/24 at 03:50 AM[Canada] Aerobic physical activity and depression among patients with cancer-A systematic review and meta-analysisJAMA Network Open; Matthew Kulchycki, MD; Henry Ratul Halder, MSc; Nicole Askin, MLIS; Rasheda Rabbani, PhD; Fiona Schulte, PhD; Maya M. Jeyaraman, MD; Lillian Sung, MD, PhD; Deepak Louis, MD; Lisa Lix, PhD; Allan Garland, MD, MA; Alyson L. Mahar, PhD; Ahmed Abou-Setta, PhD; Sapna Oberoi, MD, MSc; 10/24A cancer diagnosis increases the risk of anxiety, depression, and emotional distress among patients. Depression prevalence among patients with cancer ranges from 13% to 27%, which is 2 to 3 times higher than the general population. In this systematic review and meta-analysis, APA [aerobic physical activity]was associated with modest short-term and long-term reductions of depression among adults with cancer. Future studies should discern the effectiveness of APA in combination with other strategies for managing depression across various populations of patients with cancer.
Ethical considerations in the design and conduct of clinical trials of artificial intelligence
10/19/24 at 03:45 AMEthical considerations in the design and conduct of clinical trials of artificial intelligenceJAMA Network Open; Alaa Youssef, PhD; Ariadne A. Nichol, BA; Nicole Martinez-Martin, JD, PhD; David B. Larson, MD, MBA; Michael Abramoff, MD, PhD; Risa M. Wolf, MD; Danton Char, MD, MS; 9/24In this qualitative study, interviews with 11 investigators involved in clinical trials of AI [artificial intelligence] for diabetic retinopathy screening confirmed the applicability of current ethical principles but also identified unique challenges, including assessing social value, ensuring scientific validity, fair participant selection, evaluation of risk-to-benefit ratio in underrepresented groups, and navigating complex consent processes. These results suggest ethical challenges unique to clinical trials of AI, which may provide important guidance for empirical and normative ethical efforts to enhance the conduct of AI clinical trials. These considerations call for further guidance on where to focus empirical and normative ethical efforts to best support conduct clinical trials of AI and minimize unintended harm to trial participants.
Effectiveness of a mobile app (Meds@HOME) to improve medication safety for children with medical complexity: Protocol for a randomized controlled trial
10/19/24 at 03:40 AMEffectiveness of a mobile app (Meds@HOME) to improve medication safety for children with medical complexity: Protocol for a randomized controlled trialJMIR Research Protocols; Nicole E Werner, Makenzie Morgen, Sophie Kooiman, Anna Jolliff, Gemma Warner, James Feinstein, Michelle Chui, Barbara Katz, Brittany Storhoff, Kristan Sodergren, Ryan Coller; 9/24The Meds@HOME mobile app provides a promising strategy for improving PCG [primary caregiver] medication safety for CMC [children with medical complexity] who take high-risk medications. In addition, this protocol highlights novel procedures for recruiting SCGs [secondary caregivers] of CMC. In the future, this app could be used more broadly across diverse caregiving networks to navigate complex medication routines and promote medication safety.
Physician altruism and spending, hospital admissions, and emergency department visits
10/19/24 at 03:35 AMPhysician altruism and spending, hospital admissions, and emergency department visitsJAMA Health Forum; Lawrence P. Casalino, MD, PhD; Shachar Kariv, PhD; Daniel Markovits, JD, DPhil; Raymond Fisman, PhD; 10/24This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.
Racial differences in pain assessment and false beliefs about race in AI models
10/19/24 at 03:30 AMRacial differences in pain assessment and false beliefs about race in AI modelsJAMA Network Open; Brototo Deb, MD, MIDS; Adam Rodman, MD, MPH; 10/24Physicians undertreat Black patients’ pain compared with White patients, irrespective of setting and type of pain, likely from underassessment of pain and undertreatment of pain on recognition. Large language models (LLMs) encode racial and ethnic biases and may perpetuate race and ethnicity–based medicine. Although LLMs rate pain similarly between races and ethnicities, they underestimate pain among Black individuals in the presence of false beliefs. Given LLMs’ significant abilities in assisting with clinical reasoning, as well as a human tendency toward automation bias, these biases could propagate race and ethnicity–based medicine and the undertreatment of pain in Black patients. Mitigating these biases involves many strategies during dataset preparation, training, and posttraining stages.
Applying a health equity lens to better understand end-of-life prognostication
10/19/24 at 03:25 AMApplying a health equity lens to better understand end-of-life prognosticationAMA Journal of Ethics; by Newsha Nikzad, Joelle Robertson-Preidler, Faith E. Fletcher; 10/24Racial and ethnic inequity exists throughout the lifespan, including at the end of life (EOL). Although prognostication is inherently fraught with uncertainty, many underrepresented minorities get prognoses that are overly optimistic, which can exacerbate inequity by depriving patients of details needed to make informed decisions and plan for EOL care. This article applies a health equity lens to facilitate better ethical and clinical understandings of how to care for patients of color more equitably at the EOL.
Annual wellness visits and early dementia diagnosis among Medicare beneficiaries
10/19/24 at 03:20 AMAnnual wellness visits and early dementia diagnosis among Medicare beneficiariesJAMA Network Open; Huey-Ming Tzeng, PhD; Mukaila A. Raji, MD, MS; Yong Shan, PhD; Peter Cram, MD, MBA; Yong-Fang Kuo, PhD' 10/24Optimal dementia care depends on early recognition of cognitive impairment and timely diagnosis of Alzheimer disease and related dementias (ADRD). Optimal dementia care should reflect what matters most to patients and adhere to evidence-informed ADRD stage-specific health care. These findings indicate that AWV [annual wellness visit] recipients had a timelier first MCI [mild cognitive impairment] diagnosis than those who did not receive an AWV, but first ADRD diagnosis differed little. This study suggests that the Medicare AWV health policy may increase MCI identification, prompting more specialized care.
Home health care and place of death in Medicare beneficiaries with and without dementia
10/19/24 at 03:15 AMHome health care and place of death in Medicare beneficiaries with and without dementiaGerontologist; Hyosin Dawn Kim , Paul R Duberstein, Anum Zafar, Bei Wu, Haiqun Lin , Olga F Jarrín; 11/24Home health care supports patient goals for aging in place. Use of home health care during the last 3 years of life was associated with reduced rates of inpatient death without hospice, and increased rates of home death with hospice. Increasing affordable access to home health care can positively affect end-of-life care outcomes for older Americans and their family caregivers, especially those with dementia.
Telehealth vs in-person early palliative care for patients with advanced lung cancer-A multisite randomized clinical trial
10/19/24 at 03:10 AMTelehealth vs in-person early palliative care for patients with advanced lung cancer-A multisite randomized clinical trialJAMA; Joseph A. Greer, PhD; Jennifer S. Temel, MD; Areej El-Jawahri, MD; Simone Rinaldi, ANP-BC; Mihir Kamdar, MD; Elyse R. Park, PhD, MPH; Nora K. Horick, MS; Kedie Pintro, MS; Dustin J. Rabideau, PhD; Lee Schwamm, MD; Josephine Feliciano, MD; Isaac Chua, MD, MPH; Konstantinos Leventakos, MD, PhD; Stacy M. Fischer, MD; Toby C. Campbell, MD; Michael W. Rabow, MD; Finly Zachariah, MD; Laura C. Hanson, MD; Sara F. Martin, MD; Maria Silveira, MD; Laura Shoemaker, DO; Marie Bakitas, DNSc; Jessica Bauman, MD; Lori Spoozak, MD; Carl Grey, MD; Leslie Blackhall, MD; Kimberly Curseen, MD; Sean O’Mahony, MB, BCh, BAO; Melanie M. Smith, MD; Ramona Rhodes, MD; Amelia Cullinan, MD; Vicki Jackson, MD; for the REACH PC; 9/24 The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC [non-small cell lung cancer], underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery. [These] findings underscore the potential to increase access to evidence-based early palliative care through telehealth delivery.
Socioeconomic trends in palliative care: A six-year study
10/19/24 at 03:05 AMSocioeconomic trends in palliative care: A six-year studyCureus; by Andrej Sodoma, Muhammad Wahdan Naseeb,Samuel Greenberg, Nicholas J. Knott, Jonathan Arias, Argirios Skulikidis, Mary Makaryus; 10/24Our study investigates trends in PC utilization, focusing on socioeconomic characteristics. The National Inpatient Sample (NIS) from 2015 to 2020 was used to identify adults hospitalized in the United States (US). International Classification of Diseases, Tenth Revision (ICD-10), was used for PC encounters, code Z51.5. An equal number of random records, stratified by year and without this code, were selected to serve as controls [5.2M visits]. Men were more likely to receive PC consults. Medicare/Medicaid holders’ PC access was limited compared to private insurance holders. Racial minorities, particularly Hispanics and Blacks, were less likely to engage in PC. Compared to urban teaching hospitals, rural hospitals had a decreased rate of PC utilization. Smaller hospitals had significantly fewer PC referrals than large hospitals. A lower socioeconomic status was associated with a reduced propensity to utilize PC services compared to an upper socioeconomic status.
Low rates of hospice utilization in blood cancer patients
10/19/24 at 03:00 AMLow rates of hospice utilization in blood cancer patientsCU Anschutz News; by Tari Advani; 10/24Patients with hematologic malignancies enroll in hospice at significantly lower rates than patients with solid malignancies and are more likely to die in the hospital. Cost of transfusions in comparison to standard per diem reimbursement for hospice is greatest limitation to hospices offering transfusions to blood cancer patients and this lack of option for transfusion is limiting hospice utilization by patients with blood cancers overall and leading to late enrollment when it happens. It is felt that innovative hospice payment models to improve end-of-life care for patients with blood cancers would be the most useful course of action.
Saturday newsletters
10/19/24 at 03:00 AMSaturday newsletters focus on headlines and research - enjoy!
As IV shortage continues after hurricane, U.S. invokes wartime power to speed recovery
10/18/24 at 03:15 AMAs IV shortage continues after hurricane, U.S. invokes wartime power to speed recovery CBS News; by Alexander Tin; 10/15/24 The Biden administration says it has invoked the wartime powers of the Defense Production Act to speed rebuilding of a major American factory of intravenous fluids that was wrecked by Hurricane Helene last month. Damage to the plant in North Carolina has worsened a nationwide shortage of IV fluids, and hospitals say they are still postponing some surgeries and other procedures as a result. Some 60% of the nation's IV supplies had relied on production from the plant, run by medical supplier Baxter, before it was damaged by the storm. "Ensuring people have medical supplies they need is a top priority of the Administration. It's exactly why we are working closely with Baxter to support cleanup and restoration of the facility, including invoking the Defense Production Act to help production resume as quickly as possible," an official with the Department of Health and Human Services told CBS News on Tuesday.
Family and friends deliver early Christmas cheer to woman in final days of her life
10/18/24 at 03:10 AMFamily and friends deliver early Christmas cheer to woman in final days of her life CBS News, Antioch, IL; by Dana Kozlov and Tracy O'Brien; 10/16/24 Driving by a home in the far northwest suburbs, you might wonder what happened to Halloween, as each day more Christmas decorations keep showing up. The answer is a touching tribute to a loving mom, wife and friend; with a special message for everyone. Voices of holiday cheer rang outside a home on a warm fall day in Antioch during a festive gathering for Jamie Haley, a woman loved by many, watching from the front window. "It couldn't be better. I could not be happier," Jamie said. Hearing those words, you wouldn't realize Haley is in the final stages of her life, with hospice coming daily. Known for her lifelong love of Christmas, her family is bringing the joy of the season to her in a big way. "Everybody is showing up and strangers are showing up," said her daughter, Anna. "It's Christmas for as long as it can be. We just love her so much. … We are going to love her until we have to miss her." ... [Click on the title's link to continue reading this beautiful story.]
Heartlinks expands hospice, palliative programs with new adult family home
10/18/24 at 03:00 AMHeartlinks expands hospice, palliative programs with new adult family home Hospice News; by Holly Vossel; 10/16/24 Heartlinks is opening a de novo located in Sunnyside, Washington, with an aim of providing a range of services to seniors in the area. Hospice and palliative care will be a “strong focus” of services provided at the new senior living facility, Heartlinks Adult Family Home, said Shelby Moore, the organization’s executive director. Other services available include 24/7 access to personal care, assistance with activities of daily living, medication management and respite care. The new location is designed to create a peaceful and comforting space for individuals with advanced and life-limiting illnesses in an area that lacks resources for patients and their families, Moore stated.