Literature Review

Healthcare under siege: Defending hospitals from ransomware threats Cylera; by Maureen Sahualla; 1/22/25 Hospitals today are very concerned about ransomware attacks - and rightly so. A recent research report from Comparitech, Ransomware Roundup: 2024 End-of-Year Report (published on January 9th, 2025) found:

[Sweden] The process of pain assessment in people with dementia living in nursing homes: A scoping reviewPalliative Care and Social Practice; Caroline Kreppen Overen, Maria Larsson, Adelheid Hummelvoll Hillestad, Ingela Karlsson, Siren Eriksen; 1/25Studies have documented a pain prevalence in people with dementia living in nursing homes of 35%–43%, but a possible prevalence of 60%–80%. Self-reported information is the most appropriate when assessing pain, as symptom experience is subjective and highly personal. However, for people with dementia living in nursing homes, self-reporting represents a challenge due to cognitive impairment, including difficulties with language and communication. People with dementia might express pain with different behavioural expressions or signs, such as agitation, apathy, restlessness or wandering. Numerous observational assessment tools targeting pain in people with dementia have been developed and evaluated and systematic use of standardized observational tools has been recommended.

Medical professionals’ perceptions of and experiences with terminally ill Orthodox Jewish patientsAmerican Journal of Hospice and Palliative Medicine; by Moshe C. Ornstein, David Harris; 1/25Orthodox Jewish patients with terminal illnesses have unique goals and desires, often driven by halakha (Jewish law and ethics) and cultural norms. Compared to the general population, Orthodox Jewish patients with terminal illnesses are more likely to request aggressive measures at end-of-life and are less likely to have completed advanced directives and health care power of attorney documentation. They also do not always have a rabbinic authority involved in decision-making. Health care professionals highlighted strong religious and community support as positive elements of caring for this population and recommend that medical teams establish early and direct communication with rabbinic authorities for those patients for whom a rabbi’s involvement is desired.

Stillwater Hospice CFO: A winning recipe for improving rural hospice care Hospice News; by Holly Vossel; 1/23/25 Montana-headquartered Stillwater Hospice has found a successful rhythm to strategic rural-based growth and sustainability. The strategy hinges on building culture, staffing resources and a reputation for quality, according to CFO and Co-founder Chris Graham. Launched in 2017, the hospice company serves predominantly rural-based populations in Montana, northern Wyoming and South Dakota. ... What are the most significant concerns among rural-based hospice providers currently? How have the challenges of rural care delivery evolved in recent years? "Staffing is very hard. You’ve got to find staff who are willing and like to travel because they have a lot of windshield time. It’s also the logistics of remote care. We have patients that live 75 miles or more outside of a town, then once you get there it’s another 20 miles on a dirt road that could be covered in snow and ice. ..." [Click on the title's link to continue reading.]

Jan. 27, 2025, International Holocaust Remembrance Day [click here for link 1]--paired with--A little-known story about a Jewish refugee and Cicely Saunders [click here for link 2]Compilation by Joy Berger, editor; for 1/27/25Do you know? Today's modern hospice movement was born out of the terminal illness of a Polish, Jewish ghetto refugee and his lasting influence on the young Cicely Saunders. Upon his death in 1948, he left money for her to create a new place for peaceful dying. She opened St. Christopher's Hospice in 1967.

The challenge of leadership is to be strong, but not rude; be kind, but not weak; be bold, but not a bully; be thoughtful, but not lazy; be humble, but not timid; be proud, but not arrogant; have humor but without folly. ~Jim Rohn

Truth-telling, and ethical considerations in terminal care: an Eastern perspectiveNursing Ethics; Qing Ma; Yi Wu; Ronghua Fang; 1/25 Truth-telling for terminally ill patients is a challenging ethical and social issue for Chinese health care professionals. However, despite the existence of ethical and moral standards for nurses, they frequently encounter moral dilemmas when making decisions about truth-telling to patients with end-stage diseases in China. This article focuses on nursing morality, ethics, norms, and philosophy in health care and discusses countermeasures taken by nurses in truth-telling decision-making in combination with Chinese Confucian culture. The analysis identifies key ethical strategies tailored to Chinese nurses’ practices, emphasizing individual autonomy, cultural sensitivity, and family dynamics in truth-telling decisions.

[UK] Identifying challenges related to the management of comorbidities in people with dementia in residential care: Expert delphi consensus exerciseJournal of Applied Gerontology; Serena Sabatini, Frances Hawes, Kelechi Eluigwe, Eugene Y. H. Tang; 1/25Improving early detection, management, and treatment of comorbid conditions to dementia in residential care could slow down cognitive and functional decline, and increase residents’ quality of life. ... Mental illnesses, delirium, and sensory impairments were identified as the most difficult comorbidities to dementia to deal with. Medication management, symptom management, shortage of staff, lack of training among staff, and limited resources from the broader healthcare system were identified as the most difficult issues when dealing with dementia comorbidities. To address disparities between different residential care homes there is the need of mandatory standards of care across UK residential care homes, and of clear guidelines on topics such as pathways of care for residents’ medical problems, staff to resident ratios, and minimum wages.

Use of digital health technologies by older US adultsJAMA Network Open; Cornelius A. James, MD; Tanima Basu, MS, MA; Brahmajee K. Nallamothu, MD, MPH; Jeffery T. Kullgren, MD, MPH, MS; 1/25Older adults use various types of DHT [digital health technologies], and they use patient portals most often. Although some older adults have unique physical and cognitive needs that can affect the utility and usability of DHTs, in aggregate they share some predictors of DHT use with younger adults. Additionally, our study showed a statistically significant association between non-Hispanic Black race and ethnicity and DHT use. Various factors may contribute to this finding, including medical mistrust among Black patients leading to decreased engagement with the health system and increased reliance on DHTs. This study highlights the need to carefully consider the unique characteristics of older adults when developing and deploying DHTs to avoid worsening the digital divide. 

Hospice care in the Emergency Department: An evolving landscapeJournal of Palliative Medicine; by Eliot Hill, Ky Stoltzfus, Joanna Brooks; 1/25Despite the increasing focus on goal-concordant care in the emergency department (ED), there is limited data about patients who receive a new hospice referral and the care paths of patients on hospice who present there. [In this study,] six patients received a new hospice referral. Of these, four had a primary diagnosis of cancer, three received a palliative care consult, and three were discharged to an inpatient hospice facility (hospice house). No patients had repeat health care encounters at our hospital. 42% (31/74) of patients enrolled in hospice required admission. Conclusion: New hospice referrals in the ED are possible but rare. Further research should investigate possible missed opportunities to provide goal-concordant care.

Experts are debating whether some cancers shouldn’t be called thatJAMA; Rita Rubin, MA; 1/25Back in 2012, the National Cancer Institute (NCI) convened a conference to discuss the overdiagnosis and overtreatment of indolent tumors—asymptomatic lesions unlikely to progress for years—that are detected by mammography, prostate-specific antigen (PSA) testing, and other screening tools. “I don’t think the name is that important,” acknowledged Hwang, who participated in the 2012 NCI conference about overdiagnosis and overtreatment. “It’s how we react to the diagnosis and how we convey risk to the patients.” In other words, stop calling low-risk tumors cancer, but make sure patients understand that such lesions are risk factors for cancer and, therefore, require diligent monitoring. Or keep calling the tumors cancer, but make sure patients understand that these lesions are unlikely to cause problems, so active surveillance, not immediate treatment, is appropriate.

Overcoming barriers to make patient-reported outcome collection the standard of care in oncologyJAMA Oncology; James A. Colbert, MD, MBA; Louis Potters, MD; 1/25Multiple studies have demonstrated the clear benefits of collecting patient-reported outcomes (PROs) in oncology care. These benefits include measurable effects on patient symptom burden, toxicity, emergency department (ED) use, and even cancer survival. Despite these well-recorded advantages, adoption of PRO collection beyond research studies and clinical trials remains low. Barriers to more widespread adoption in oncology care include clinician skepticism, historical technological limitations, and the challenges related to change management. We owe it to patients to make PRO collection standard practice. Achieving this will require additional education, the embrace of new technologies, and a willingness among clinicians to follow the data and adopt new routines that will necessitate changing established patient care models.