Literature Review

California wildfires and healthcare: Compiled articlesCompiled from various news sources; 1/9/25Click on links below to go to the source articles.

Researchers compared hospital early warning scores for clinical deterioration—Here’s what they learnedJAMA Network; Roy Perlis, MD, MSc; Jennifer Abbasi; 1/24This conversation is part of a series of interviews in which JAMA Network editors and expert guests explore issues surrounding the rapidly evolving intersection of artificial intelligence (AI) and medicine. Arecent head-to-head study at Yale New Haven Health System compared 6 different early warning scores designed to recognize clinical deterioration in hospitalized patients, including 3 proprietary AI tools. Among the best was the National Early Warning Score (NEWS), a publicly available non-AI tool, while the Epic Deterioration Index “was one of the worst” of the batch, the authors reported in October in JAMA Network Open.

Do It Anyway by Mother Teresa / Kent M. KeithPeople are often unreasonable, illogical, and self-centered; forgive them anyway.If you do good, people may accuse you of selfish, ulterior motives; do good anyway...

You've gotta dance like there's nobody watching, Love like you'll never be hurt, Sing like there's nobody listening, And live like it's heaven on earth. ~ William W. Purkey

Whom should we regard as responsible for health record inaccuracies that hinder population-based fact finding?AMA Journal of Ethics; Kathleen M. Akgün, MD, MS; Shelli L. Feder, PhD, APRN; 1/25EHR [electronic health record] use has revolutionized health information collection and analysis. This growth has led to opportunities to generate important reports about the health of hundreds of millions of people practically in real time. Steadfast commitment to high-quality data collection and reporting is necessary for all parties along the pathway of data generation: from EHR developers, programmers, and vendors to patients, clinicians, and epidemiologists. Pulling back the curtain on how each of these groups generate and interact with EHR data is imperative to assure measurement of accurate population-level health outcomes.

Public healthAlzheimer's and Dementia; Stephanie Frilling; 12/24A Medicare Voluntary Advance Directive Framework (Framework) would enable the creation, storage, and sharing of advance directive documents, ensuring end-of-life care appropriately honors the individual and their care wishes, while supporting healthcare teams and family members in making care decisions for their patients and loved ones. With Medicare enrollment reaching over 65 million beneficiaries in 2023, and Alzheimer's becoming one of the most expensive conditions - CMS policy makers have a growing responsibility to improve care quality at end-of-life. 

Advance care planning among diverse U.S. older adults with varied cognition levelsAlzheimer's & Dementia; by Zahra Rahemi, Swann Arp Adams; 1/25Older adults from minority groups often experience elevated rates of chronic diseases and cognitive impairment, coupled with lower rates of engagement in advance care planning (ACP) and comfort care as they approach end of life... Our study revealed that individuals facing cognitive impairments exhibited lower rates of engagement in ACP. Notably, among the variables examined, race, ethnicity, rural residence, education, and age emerged as significant predictors of ACP in a national sample of older adults in the U.S. These findings underscore the importance of incorporating these sociodemographic factors into the design of interventional studies aimed at enhancing ACP and mitigating disparities.

Medicare to Veterans Affairs cost shifting—A challenging conundrumJAMA Health Forum; Kenneth W. Kizer, MD, MPH, DCM; Said Ibrahim, MD, MPH, MBA; 12/24In this issue, Burke et al highlight how costs previously paid by Medicare for VA-Medicare dual eligible enrollees are now being paid by the VA under the VCCP [Veterans Community Care Program]. Today, there is reason to be concerned whether VA health care will be adequately funded because of the rapidly rising VCCP expenditures (driven in part by Medicare to VA cost shifting) and the impact of caring for an additional 740,000 enrollees who have entered the system in the past 2 years. This has created a $12 billion medical care budget shortfall for FY 2024. The substantial budgetary tumult that has resulted from these dynamics is adversely impacting the front lines of care delivery at individual VA facilities, leading to delays in hiring caregivers and impeding access to VA care and timely care delivery, as well as greatly straining the traditional roles of VA staff and clinicians trying to manage the challenging cross-system referral processes. The intertwined issues of Medicare to VA cost shifting and the rising costs of the VCCP present a challenging policy and programmatic conundrum.

“I aim to fulfill my promise”: Dementia caregiving from the perspective of spouses and partnersJournal of Applied Gerontology; Haley M. Shiff, Theresa A. Allison, Madina Halim, Kenneth E. Covinsky, Alexander K. Smith, Deborah E. Barnes, Jennie M. Gubner, Kara Zamora; 1/25In the United States, spouses provide 17% of in-home care for people living with dementia. We found common features underlying the care provided by spouses/partners, including challenges and motivators guided by notions of loyalty and commitment. As cognition and function declined, care partners found the relationship increasingly difficult. They shared the feeling of being stuck as well as the loss of identity and freedom. This finding follows what Westrelin et al. (2024) describe in their study on spousal caregivers of partners living with dementia, in which spouses perceived changes not only in their partner but also in themselves and oscillated between their identity as a caregiver and as a spouse, highlighting the dynamic nature of caregiver identity construction within the context of caring for a partner living with dementia.

Transition to hospice: how it impacts the mental health of caregivers of persons with dementiaAlzheimer's & Dementia; by Oonjee Oh, Debra Parker Oliver, Karla Washington, George Demiris; 2024In this study, we aimed to examine caregivers’ mental health indicators and their correlation structure based on the timing of hospice transition... In the context of dementia care, our results highlight that caregivers who just entered hospice are undergoing a challenging transition that often finds them in a mentally vulnerable position. To develop and implement effective strategies for caregivers of persons with dementia, we need to understand the needs and vulnerabilities of caregivers during hospice transition and identify the best timing for the delivery of supportive tools.

[Canada] Qualitative bereavement experiences and support in community-dwelling older adults: A scoping reviewOmega-Journal of Death and Dying; Samantha Teichman, Barbara A. Mitchell, Indira Riadi, Habib Chaudhury, Albert Banerjee, William Odom; 12/24This scoping review examines qualitative studies on bereavement experiences and support mechanisms for community-dwelling older adults. This area of research is especially timely given rapid population aging and the interplay of heightened vulnerability, cumulative losses, shrinking support systems, and the critical need for bereavement support. Such support not only acts as a preventative health measure but can also serve as a catalyst for fostering meaning-making and navigating grief in later life. Through a scoping search and synthesis of relevant qualitative studies ..., the findings reveal four key themes: the impact of grief on wellbeing, grief perceived as an individual issue, challenges in seeking and receiving support, and positive support experiences and transformations. This discussion contributes to developing targeted bereavement support strategies for community-dwelling older adults.

Which health facilities have been impacted by L.A.-area fires? AI may paint a clearer picture DirectRelief; by Andrew Schroeder; 1/14/25 Geospatial AI and remote sensing advance health system impact analysis shows where facilities have been damaged or destroyed -- and where medical needs may be greatest. One of the most important factors for humanitarian responders in these types of large-scale disaster situations is to understand the effects on the formal health system, upon which most people — and vulnerable communities in particular — rely upon in their neighborhoods. Evaluation of the impact of disasters ... is traditionally a relatively slow and manually arduous process, involving extensive ground truth visitation by teams of assessment professionals. Speeding up this process without losing accuracy, while potentially improving the safety and efficiency of assessment teams, is among the more important analytical efforts Direct Relief can undertake for response and recovery efforts.

Light tomorrow with today. ~ Elizabeth Barrett Browning