Literature Review

We invite you to listen to our latest podcast: Imagine Heaven, with John Burke TCN Talks (Teleios Collaborative Network); podcast by Chris Comeaux; 10/30/24 In this inspiring episode of TCNtalks, Chris Comeaux sits down with John Burke, New York Times bestselling author of Imagine Heaven and Imagine the God of Heaven, for a soul-stirring conversation on near-death experiences (NDEs) and their profound implications. John shares the overwhelming evidence of the commonalities of near-death experiences (NDEs) and the evidence that supports their validity from across the world and from across many different cultures.  Chris begins by recounting his own transformative experience reading Imagine Heaven over his summer sabbatical, describing it as a refreshing oasis for the parched soul. John delves into the fascinating and consistent patterns found in NDEs worldwide, revealing how people from vastly different backgrounds describe similar encounters of leaving their bodies, seeing with a spiritual clarity—even those blind from birth—and entering realms filled with light, love, and peace. 

How to initiate goals of care discussions with familyExpertClick, Denver, CO; by Pamela D. Wilson; 10/30/24 ... While many adults set these conversations aside until a health diagnosis or other situation occurs, having goals of care discussions early in life allows more effective planning.

Providence Alaska Medical Center tests virtual care model, announces hospice partner Alaska Business - Healthcare, News; 10/28/24 Providence Alaska Medical Center (PAMC) recently launched a new way of caring for patients that combines bedside nursing with a virtual or remote nurse and a dedicated patient care technician or certified nursing assistant. Known as co-caring or virtual nursing, the bedside nurse manages direct patient-care duties while the virtual nurse coordinates other support tasks. Also this month, the Washington-based not-for-profit healthcare system that operates PAMC announced it will partner with Compassus...Co-Caring Model Leverages Skilled Nurses: Virtual nursing is a response to a strained labor market. A study by the National Center for Health Workforce Analysis shows Alaska is projected to lead the nation in nursing vacancies, with as many as 23 percent of openings unfilled, by 2030. The co-caring model helps address the impending shortage while providing added patient care, Providence officials say.

A moral code: Ethical dilemmas in medicine — three physicians face crossroads in patient care MedPage Today; podcast by Genevieve Friedman, Perspectives Editor; 10/25/24 We are back for another episode of our medical podcast, which we hope isn't really a podcast about medicine, but a podcast about life, death, dilemma, the challenges, and sometimes the joys of medicine. ... Now, medicine is complicated because a lot of times there aren't hard and fast rules ... One treatment isn't always right or wrong for someone. One surgery isn't always successful or unsuccessful, and one diagnosis isn't always correct. Decisions aren't black and white, they're varying shades of gray. So we come up with principles to help handle this -- codes if you will. But even those get a bit marred by complexity at times. As you'll hear in this episode of Anamnesis with the theme of "A Moral Code: Ethical Dilemmas in Medicine," one of our biggest codes is "do no harm." But what is harm? Who decides what harm is, what happens if we disagree?

‘Let patients lead the way’: Hospice veterans’ advice for new nurses Hospice News; by Jim Parker; 10/25/24 ... A key barrier to building [the hospice and palliative care] workforce is that, with some exceptions, most clinicians receive little to no exposure to those types of care during their training. Nurses who are new to the hospice space often face a learning curve, according to Briana Hilmer, an Iowa-based admissions nurse for St. Croix Hospice.

Diagnosed with disease he studied, Stanford doctor puts his personal story at center of new class. NBC Bay Area; 10/24/24 Stanford Medicine physician Dr. Bryant Lin is the perfect professor to teach the course “From Diagnosis to Dialogue: A Doctor's Real-Time Battle with Cancer” at Stanford. And that’s not necessarily a good thing. The class focuses on the cancer journey of a non-smoking patient diagnosed with lung cancer. Dr. Lin is that patient. “I want to take something that is obviously very negative to me personally and get some benefit out of it for at least for other people,” Dr. Lin said. 20 years ago, Dr. Lin chose a career in medicine for a simple reason. “I wanted that personal connection and that satisfaction from helping people on a day-to-day basis,” Dr, Lin said. This same motivation led Dr. Lin to co-found Stanford’s Center for Asian Health Research and Education in 2018, with a particular focus on lung cancer in non-smokers. This is why Dr. Lin was (and in a way was not) surprised when earlier this year he found himself part of the 20% of lung cancer patients who have never smoked. ...  [Click on the title's link to continue reading this inspirational story.]

Busting palliative care misconceptions in cancer care Cure; by Alex Biese; 10/22/24 Palliative care can serve a crucial function for patients living with serious illnesses such as cancer, as an expert explained in an interview with CURE®. “Palliative care is sub-specialized health care for patients living with serious illness, where we're really focused on alleviating the symptoms and the stress associated with illness, and our goal is to improve quality of life for patients and their families,” said Dr. Cari Low of the University of Utah Huntsman Cancer Institute. ... However, some misconceptions persist regarding palliative care — most prominently that it is synonymous with hospice care. ... "We [i.e., palliative care] follow patients from the time of diagnosis through their curative cancer treatment and throughout their journey and into survivorship. ... Hospice is really focused on end-of-life care and comfort when cancer treatments no longer make sense. So, I really think of palliative care as this great big umbrella of support throughout the entire journey, where hospice is just a tiny piece of that umbrella.”

Poetry, again, confronts death JAMA; by Rafael CAmpo, MD, MA; 10/16/24Poetry can help physicians in many ways at the border between life and death. Though we might think first of the consoling power of elegy in confronting mortality, other poems, like “Again,” [referenced] aid us in wrestling with what death is in the first place—and are even more useful when research falls short in attempting to demystify it. One such scientific controversy surrounds in-hospital resuscitation, especially for older adults, with studies showing inconsistent rates of meaningful survival after these potentially life-saving interventions, confounded by the physical and emotional trauma that accompanies them, poor understanding of patients’ and families’ wishes, unclear definitions of “meaningful,” and varying patient selection criteria. [The poem titled] “Again” distills some sense out of this complexity as only poetry can, with the urgent repetition of “again” expressing the ingrained imperative to act when patients experience cardiac arrest while echoing both the many previous resuscitations hospital staff well remember, along with the 2-beat, up-down muscle memory of performing chest compressions. ... Thus, a reflexive, futile endeavor becomes a human being’s dying moment, allowing us to feel closure. Debates around in-hospital resuscitation suddenly quieted, we recognize life’s inevitable finality, underscored by the poem’s ironically dignified resignation in its concluding line: “Never again did you wake.”Editor's note: Click here to access the poem, "Again."

Clinic combines ILD, palliative care to improve access for underserved patients Healio; by Richard Gawel; 10/18/24 Boston, MA - A subspeciality clinic that combined pulmonary and palliative care improved access to these treatments for diverse and underserved populations, according to an abstract presented at the CHEST Annual Meeting. The clinic also was effective in supporting patients as they completed advanced care planning, compared with a clinic for interstitial lung disease, Meghan Price, MD, internal medicine resident, Johns Hopkins Hospital, and colleagues wrote. ... Rebecca Anna Gersten, MD, assistant professor of medicine, established the Breathlessness Clinic (BC) in 2022 to provide both pulmonary and palliative care to treat patients with significant dyspnea and other symptoms due to their advanced lung disease. The clinic aims to provide targeted management of symptoms in addition to improving access to palliative care for patients who may have encountered obstacles in accessing palliative care, the researchers said.

Exploding physician union membership signals a significant labor market shift NJToday.net; 10/16/24 As of 2022, about 70,000 medical doctors in the United States, or about 8% of the physician workforce, belonged to a union—a notable increase of 26.8% since 2014. This shift reflects significant changes in the employment landscape for doctors, with nearly half of all physicians now working for health systems or large medical groups. The rise in union membership comes amidst broader labor movements in healthcare, highlighted by the 2023 Kaiser Permanente strike, recognized as the largest healthcare worker strike in U.S. history. While nurses have typically led these efforts, physicians and residents are increasingly exploring unionization as a means to advocate for improved pay, benefits, and working conditions. 

How physicians can navigate ethical conflicts when caring for patients Physician's Weekly; 10/14/24 ... According to the president of The Physicians Foundation, Gary Price, MD, ethics in medical care are particularly complicated regarding end-of-life choices. While decades ago, a patient’s primary care provider (PCP) would have been involved in that patient’s hospitalized care and their end-of-life decisions within the hospital, the fragmented nature of today’s healthcare system has all but eliminated PCPs from involvement in hospitalized patient care. As such, patients often make end-of-life decisions based on the guidance of doctors with whom they have no pre-existing relationship. Other factors that blur ethical lines in healthcare, adds Dr. Price, are the new state of healthcare ownership and financing. Dr. Price mentions, for instance, conflicts of interest due to the US’s biggest employer of physicians, Optum, being a subsidiary of the same company that owns UnitedHealthcare. This situation allows for an insurer who controls reimbursement and who could, as the physician’s employer, influence decisions made regarding patient care. Sadly, this influence largely comes from financial concern instead of concern for the patient’s best health outcomes. 

Care utilization for neurodegenerative diseases compared to patients with cancer Physician's Weekly; 10/14/24 Neurodegenerative diseases are a leading cause of death, yet healthcare utilization and costs during the end-of-life (EoL) period are poorly understood.  Researchers conducted a retrospective study to describe and compare resource utilization among U.S. Medicare decedents with neurodegenerative diseases and cancer. ... The results showed 1,126,799 Medicare beneficiaries, of which 357,926 had a qualifying diagnosis. Individuals with neurodegenerative diseases were older and more frequently received Medicaid assistance than those with brain or pancreatic cancer. ... The study concluded that individuals with neurodegenerative diseases were more likely to visit ED and less likely to utilize inpatient and hospice services at the EoL compared to those with brain or pancreatic cancer. 

Kaiser Health Care: Navigating Aging: Older men’s connections often wither when they’re on their own Tahlequah Daily Press; by Judith Graham; 10/12/24 At age 66, South Carolina physician Paul Rousseau decided to retire after tending for decades to the suffering of people who were seriously ill or dying. It was a difficult and emotionally fraught transition. … Seeking a change of venue, Rousseau moved to the mountains. … Soon, a sense of emptiness enveloped him. … His work as a doctor had been all-consuming. Former colleagues didn’t get in touch, nor did he reach out. His wife had passed away after a painful illness, … His isolation mounted as his three dogs, his most reliable companions, died. Rousseau was completely alone — without friends, family, or a professional identity — and overcome by a sense of loss. “I was a somewhat distinguished physician with a 60-page resume,” Rousseau, now 73, wrote in the Journal of the American Geriatrics Society in May. “Now, I’m ‘no one,’ a retired, forgotten old man who dithers away the days.” In some ways, older men living alone are disadvantaged compared with older women in similar circumstances. Research shows that men tend to have fewer friends than women and be less inclined to make new friends. Often, they’re reluctant to ask for help.