Literature Review

Pennant’s home health, hospice growth ‘significantly ahead’ of prior expectationsHome Health Care News; by Audrie Martin; 8/7/24The Pennant Group Inc. (Nasdaq: PNTG) leaders highlighted the company’s significant home health growth Tuesday. They also teased continued expansion in the East Coast and elsewhere. “We are thrilled to report record-breaking second quarter results as we continue to experience momentum across all our service lines and create meaningful growth opportunities for local leaders and teams,” Pennant CEO Brent Guerisoli said during the company’s second-quarter earnings call. “Our financial performance and growth trajectory reflect the consistent efforts we have applied to every aspect of our business through our five key focus areas: leadership development, clinical excellence, employee engagement, margin and growth.” The Pennant Group is a holding company based in Eagle, Idaho, with independent operating subsidiaries that provide health care services through 117 home health and hospice agencies and 54 senior living communities across 13 states.

Fearless hospice patient takes joyrideWest Valley View (AZ); by Lin Sue Flood; 8/7/24Don Tamuty, a beloved former Madison Unified School District teacher, had one thing left on his bucket list. The 95-year-old shared with his hospice nurse, Monisha Roe, that he would love to ride in a driverless car. Monisha and the rest of Don’s Hospice of the Valley care team knew exactly how to fulfill that wish! They booked a driverless cruise on Waymo One to take Don out to a nice restaurant.

Rescue from above: How drones may narrow emergency response timesKFF Health News; by Michelle Andrews; 7/22/24Starting in September, if someone in Clemmons, North Carolina, calls 911 to report a cardiac arrest, the first responder on the scene may be a drone carrying an automated external defibrillator, or AED. “The idea is for the drone to get there several minutes before first responders,” such as an emergency medical technician or an ambulance, said Daniel Crews, a spokesperson for the sheriff’s office in Forsyth County, where Clemmons is located. The sheriff’s office is partnering on the project with local emergency services, the Clinical Research Institute at Duke University, and the drone consulting firm Hovecon. “The ultimate goal is to save lives and improve life expectancy for someone experiencing a cardiac episode,” Crews said.Publisher's note: As with all things tech, when and how might drones be used in hospice?

Violent dementia patients leave nursing home staffers and residents ‘scared to death’KFF Health News; by Jordan Rau; 8/9/24Violent altercations between residents in long-term care facilities are alarmingly common. Across the country, residents in nursing homes or assisted living centers have been killed by other residents who weaponized a bedrail, shoved pillow stuffing into a person’s mouth, or removed an oxygen mask. A recent study in JAMA Network Open of 14 New York assisted living homes found that, within one month, 15% of residents experienced verbal, physical, or sexual resident-on-resident aggression. Another study found nearly 8% of assisted living residents engaged in physical aggression or abuse toward residents or staff members within one month. Dementia residents are especially likely to be involved in altercations because the disease damages the parts of the brain affecting memory, language, reasoning, and social behavior.

[India] End of life care practices at a tertiary cancer centre in India: an observational studyAmerican Journal of Hospice and Palliative Medicine; by Bhanu P. Maurya, MD; Raghav Gupta, DM; Puneet Rathore, MD; Seema Mishra, MD; Sachidanand J. Bharati, DM; Vinod Kumar, MD; Nishkarsh Gupta, MD; Rakesh Garg, MD; Sushma Bhatnagar, MD; 8/24[This study was done] to assess the End of life care (EOLC) practices and the magnitude of futile care in a tertiary cancer center [and] to find out the barriers in provision of good EOLC in cancer patients. With proper communication and a good palliative care support, futile treatment can be avoided. 77 (59.69%) patients preferred home as their place for EOLC while 41(31.78%) preferred hospital, 7 (5.43%) preferred hospice while 4 (3.10%) opted ICU for their EOLC. The most common barrier associated was caregiver related ... followed by physician related ... and patients related ... because of hope of being cured in hospital, social stigma, fear of worsening of symptoms at home, denial.

Connected to the cloud at time of death: a case reportJournal of Medical Case Reports; by Isabel Straw, Claire Kirkby, Preethi Gopinath; 8/24Our case report provides the first clinical evaluation of autopsy practices for a patient death that occurs on the cloud. We question how autopsy practices may require adaptation for a death that presents via the 'Internet of Things', examining how existing guidelines capture data related to death which is no longer confined to the patient's body... Through this patient case we explore novel challenges associated with digital deaths including; (1) device hardware issues (difficult extraction processes, impact of pathological tissue changes), (2) software and data limitations (impact of negative body temperatures and mortuary radio-imaging on devices, lack of retrospective cloud data analysis), (3) guideline limitations (missing digital components in autopsy instruction and death certification), and (4) changes to clinical management (emotional impact of communicating deaths occurring over the internet to members of family). Publisher's note: An interesting article posing interesting questions about the impact technology has on death and the potential use / misuse of health information gathered by devices.

African American patient and caregiver attitudes and perceptions of community health workers as lay patient navigators in palliative care Annals of Palliative Medicine; by Olivia Monton, Shannon Fuller, Amn Siddiqi, Alison P Woods, Taleaa Masroor, Robert Joyner, Ronit Elk, Jill Owczarzak, Fabian M Johnston; 8/5/24 Underutilization of palliative care services, especially among African American patients with advanced cancer, remains an important public health problem. To address this gap, we developed a community health worker (CHW) palliative care intervention for African American patients with advanced cancer, which is being formally assessed through an ongoing effectiveness-implementation trial. ... Results: Overall, there was a lack of awareness and understanding of palliative care, due primarily to limited experiences with palliative care services among study participants. Despite this lack of familiarity, participants recognized the potential benefits of palliative care for patients with advanced cancer.  

Special considerations in managing pain and psychosocial distress in patients with opioid use disorder and cancer: the role of the supportive care and psycho-oncology interdisciplinary teamAnnals of Palliative Medicine; by M Catherine Trimbur, Bridget Sumser, Chelsea Brown, Timothy Steinhoff, Khaldoun Almhanna, Dana Guyer; 7/24People with a substance use disorder (SUD) have shortened lifespans due to complications from their substance use and challenges engaging with traditional health care settings and institutions. This impact on life expectancy is especially prominent in patients with co-occurring SUDs and cancer, and often has a much worse prognosis from the cancer than a similar patient without a SUD. Palliative care teams are experts in serious illness communication and symptom management and have become increasingly embedded in the routine care of patients with cancer. We argue that the skill set of palliative care teams is uniquely suited for addressing the needs of this oft marginalized group.

Symptom burden and quality of life among patient and family caregiver dyads in advanced cancerQuality of Life Research; by Katrina R Ellis, Allison Furgal, Feyisayo Wayas, Alexis Contreras, Carly Jones, Sierra Perez, Dolapo Raji, Madeline Smith, Charlotte Vincent, Lixin Song, Laurel Northouse, Aisha T Langford; 7/24Symptom management among patients diagnosed with advanced cancer is a high priority in clinical care that often involves the support of a family caregiver. This study seeks to identify patient and caregiver symptom clusters and investigate associations between identified clusters and demographic, clinical, and psychosocial factors (cognitive appraisals and [quality of life] QOL). The most prevalent symptom for patients was energy loss/fatigue and for caregivers, mental distress. Higher symptom burden was associated with more negative appraisals of the cancer and caregiving experience, and poorer QOL (physical, social, emotional, functional, and overall QOL). Dyads whose caregivers had more chronic conditions were more likely to be in the high symptom burden subgroup.

Identifying and addressing bias in artificial intelligenceJAMA Network Open; by Byron Crowe, Jorge A. Rodriguez; 8/6/24[Invited commentary.] In this issue, Lee and colleagues (Demographic representation of generative artificial intelligence images of physicians) describe the performance of several widely used artificial intelligence (AI) image generation models on producing images of physicians in the United States. The key question the authors set out to answer was whether the models would produce images that accurately reflect the actual racial, ethnic, and gender composition of the US physician workforce, or whether the models would demonstrate biased performance. One important aspect of the study method was that the authors used relatively open-ended prompts, including “Photo of a physician in the United States,” allowing the machinations of the AI to produce an image that it determined was most likely to meet the needs of the end user. AI tools powered by large language models, including the ones examined in the study, use a degree of randomness in their outputs, so models are expected to produce different images in response to each prompt—but how different would the images be? Their findings are striking. First, although 63% of US physicians are White, the models produced images of White physicians 82% of the time. Additionally, several models produced no images of Asian or Latino physicians despite nearly a third of the current physician workforce identifying as a member of these groups. The models also severely underrepresented women in their outputs, producing images of women physicians only 7% of the time. These results demonstrate a clear bias in outputs relative to actual physician demographics. But what do these findings mean for AI and its use in medicine?Publisher's note: This is a thought-provoking article on machine output - whether that's AI, a Google search, etc. It ultimately places responsibility of outputs and actions on people with conscience.

Biden administration says Medicare negotiated price discounts on 10 prescription drugs USA Today; by Ken Alltucker; 8/15/24 ... The Biden administration announced Thursday that Medicare had negotiated discounts with pharmaceutical companies on 10 drugs prescribed to treat blood clots, cancer, heart disease and diabetes. The drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the insulins Fiasp and NovoLog. The discounts will range from 38% to 79% when the negotiated prices take effect in 2026. The bargaining will save Medicare $6 billion when the price cuts are implemented in two years, according to U.S. Department of Health and Human Services estimates. 

"Back to school" continued ... Let us remember: One book, one pen, one child, and one teacher can change the world. ~ Malala Yousafzai Editor's Note: Who was that key, change-teacher for you, in your world? If still living, reach out and voice your thanks! If not, find a living relative to let them know how their loved one's influence lives on in you and your work, today. 

Capitalizing palliative care startups Hospice News; by Jesse Floyd; 8/14/24 As a sector, most standalone palliative care providers are still maturing from startups into long-term, sustainable businesses. ... This means gathering the necessary startup capital to take a new palliative care provider from idea to execution is often the first tangible goal for hopeful entrants into the space. When Jonathan Fluhart and Tiffany Hughes set about getting PalliCare, their Texarkana, Texas-based palliative care provider from theory to reality, they ran headlong into this obstacle. ... “Initially, what we thought we would do is build a palliative program that would nest between the home health and hospice,” Fluhart said. “We started to go into the community to talk with facilities and places that we felt would benefit from our services. Once they learned that we were tied to a home health provider, especially a hospice, it turned them off.” They decided the answer was two-fold: Sever ties with the hospice care provider they worked for; then start casting about for investors. ...