Literature Review

Today's Heartwarming Story

The greatest teacher is not the one who imparts knowledge, but the one who inspires curiosity. ~Timotheus of Miletus

Addressing challenges with sedation in end-of-life careJournal of Pain and Symptom Management, by Columba Thomas, MD; Yesne Alici, MD; William Breitbart, MD; Eduardo Bruera, MD; Liz Blackler, MBE, LCSW-R; Daniel P. Sulmasy, MD, PhD; 4/24Unfortunately, little is known about actual sedation practices at the end of life in the United States. This may be due in part to a lack of conceptual clarity about sedation in end-of-life care. We argue that, until more is known about what sedation practices occur at the end of life, and how practices can be improved by research and more specific guidelines, “palliative sedation” will remain more misunderstood and controversial than it might otherwise be. 

Health trajectories of skilled nursing facility patients with Alzheimer's Disease and Related Dementias: Evidence for practicing nursesJournal of Gerontological Nursing, by Mark Toles, Cameron Ulmer, Jennifer Leeman; 4/24Older adults with Alzheimer's disease and related dementias (ADRD) are at high risk for acute medical problems and their health trajectories frequently include hospital admission and care in a skilled nursing facility (SNF). Their health trajectories after SNF discharge are poorly understood. Therefore, in the current study, we sought to describe health trajectories and factors associated with hospital read-missions for older adults with ADRD during the 30 days following SNF discharge.

The challenges of advance care planning for acute care registered nursesCanadian Journal of Nursing Research, by Lori L Rietze, Kelli I Stajduhar, Mary Ellen Purkis, Denise Cloutier; 4/24Nurses were challenged to meet multiple competing demands, leaving them to scramble to manage complex and critically ill acute care patients while also fulfilling organizational tasks aligned with funding metrics, accreditation, and strategic planning priorities. Such factors limited nurses' capacity to engage their patients in ACP. ... Acute care settings that align patient values and medical treatment need to foster ACP practices by revising organizational policies and processes to support this outcome, analyzing the tasks of healthcare providers to determine who might best address it, and budgeting how to support it with additional resources.

A process evaluation of a palliative care social work intervention for cancer patients in skilled nursing facilitiesJournal of Palliative Medicine, by Sarguni Singh, MD; Ashley Dafoe, MA; Dana Lahoff, LCSW; Laurel Tropeano, LCSW; Bree Owens, LCSW; Erin Nielsen, LCSW; John Cagle, MSW, PhD; Hillary D. Lum, MD, PhD; Brooke Dorsey Holliman, PhD; Stacy Fischer, MD; 4/24Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care social work intervention that aims to improve delivery of goal-concordant care for hospitalized older adults with cancer discharged to skilled nursing facilities. ... ALIGN offers support in prognostic understanding, communication, and decision making during a pivotal time when patient and caregivers' goals have not been met and they are reassessing priorities.

Exploring parent experiences with early palliative care practices in the NICUAdvances in Neonatal Care, by Megan Quinn, Sheila Gephart, Janice Crist; 4/24Parents' descriptions of decision-making were contextualized in gathering information to make a decision, the emotional impact of the decision, and influences on their decision-making. In experiences with care planning, parents described learning to advocate, having a spectator versus participant role, and experiencing care planning as communication. Key themes expressed regarding parental coping were exposure to trauma, survival mode, and a changing support network.

We are not okay: Moral injury and a world on fireAmerican Journal of Bioethics, by Keisha S. Ray; 4/24Moral injury gives name to a feeling that I have been having lately as I’m asked to show up to work and my life as if there aren’t people who didn’t wake up today because of violence, disease, and greed. I’ve celebrated holidays and my own professional accomplishments, but I can’t escape that lump in my throat, that nagging feeling that this is all meaningless given the state of the world. After all, my principles won’t feed the starving, shelter the bombed, free the captive, or care for the sick. I don’t have the answer. I do not know what we are supposed to do about our perpetual moral injury. I do find some comfort in the origins of moral injury—calling out a broken system rather than broken individuals (Talbot and Dean Citation 2018). I am not broken; I am just a bioethicist and a human forced to work and live within a broken world.

Providers still navigating Change outage as systems are restored Modern Healthcare, by Lauren Berryman; 4/10/24 Providers are seeing some improvements following the Change Healthcare cyberattack nearly two months ago, but not necessarily because they are reconnecting to restored systems. Hospitals and medical groups are submitting claims to payers through alternate vendors, allowing them to generate cash. But the level of claims and payments moving among healthcare organizations that had heavily relied on Change Healthcare is still far from normal.

Friday. The golden child of the weekdays. The superhero of the workweek. The welcome wagon to the weekend. — Anonymous

How MA Plan design affects utilization, health equity MedCity News, by Marissa Pescia; 4/8/24 A new study found that enrollees with zero-premium MA plans are three times as likely to be non-White compared to other MA enrollees and traditional Medicare enrollees. ... The study was published by Harvard Medical School and Inovalon, a provider of cloud-based software solutions. It used Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry dataset, which “tracks demographic characteristics and outcomes for about 30% of all MA members at any given point in time,” according to the report.

New York’s home health, personal care workforce achieves fastest growth in nation: BLS McKnights Home Care, by Adam Healy; 4/10/24 New York is adding home health and personal care jobs faster than any other state, growing its supply of such workers by 12% between May 2022 and May 2023, according to new data from the Bureau of Labor Statistics. The state added roughly 62,000 home health and personal care aides during that time period, which was more than double that of any other state and accounted for over one third of nationwide home care aide employment growth, according to an analysis by the Empire Center, an independent, nonpartisan, nonprofit think tank based in New York. 

Executive personnel changes