Literature Review

Health disparities in hospice - home health transitions in Hispanic older adults with co-occurring dementia and cardiovascular diseaseAmerican Journal of Hospice and Palliative Care; by Sharon E Bigger, Kathy Howard Grubbs, Yan Cao, Gail L Towsley; 12/24We aimed to determine if there were demographic and/or diagnostic variables associated with the frequency of transitions between skilled HH and hospice... Hispanic older adult beneficiaries with Alzheimer's disease and related dementias (ADRD) and co-occurring cardiovascular disease (CVD) had significantly higher rates of care transitions from hospice to skilled HH than other racial and ethnic groups with both diagnoses... Our findings provide evidence of disparities in care transitions from hospice to skilled HH for Hispanic older adults living with ADRD and CVD.

High-risk opioid prescribing and nurse practitioner independenceJAMA Health Forum; Lucas D. Cusimano, BS; Nicole Maestas, MPP, PhD; 12/24In 2021, more than 1 in 5 opioid overdose deaths were attributed to prescription opioids in the US, and the rate of such deaths has increased 5-fold since 1999. Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs) ... In this difference-in-differences analysis of opioid prescribing in 16 states, there was no change in the rates of high-risk opioid prescribing in the 6 states that adopted nurse practitioner independence compared with 10 nonadopting neighboring states during the 24 months following adoption. The study found no association between legislation that granted independence to nurse practitioners and rates of risky opioid prescribing. 

[India] Mechanisms and clinical applications of palmitoylethanolamide (PEA) in the treatment of neuropathic painInflammopharmacology; Ardra Das, Preetha Balakrishnan; 12/24Palmitoylethanolamide (PEA) is emerging as a promising therapeutic agent for neuropathic and other pain-related conditions. PEA's interaction with endocannabinoid receptors decreases the inflammatory cytokine and chemokine production and thereby a descending pain sensation. Experimental evidence shows that PEA not only reduces pain and inflammation but also lowers the need for higher dosages of other drugs hence minimizing the risk of drug toxicity. The bioavailability of PEA has been enhanced by recent technological developments, which emphasize continuous research efforts to maximize PEA's therapeutic potential in pain treatment and associated medical sectors.

[Iran] The relationship between the quality of oncology nursing care and the resiliency and hope of patients with cancer: a cross-sectional studyInternational Journal of Palliative Nursing; Nadia Sedri, Mohammad Ali Zakeri, Hakimeh Sheykhasadi, Ala Shamsi, Hosna Akbari, Mostafa Hejazi, Asghar Tavan; 12/24Patients with cancer require emotional support in addition to specialised medical treatments for their physical ailments. The quality of nursing care, resilience and hope can influence a person's cancer trajectory, and understanding these factors and their relationship can be influential in improving the process for these patients. Given the interrelationship between 'resilience' and 'hope' for patients with cancer, it is necessary to focus on the factors that impact these qualities. In addition, paying attention to the concept of resilience can improve the level of hope in patients with cancer. Based on the results, it is recommended that interventions to increase QON [quality of oncology nursing] in patients with cancer be planned and implemented. 

Silent invader: A rare case of enterobacter aerogenes empyema in a hospice patient with complex comorbiditiesCureus Case Reports; Hansani Angammana, Kafayat Omadevuae, Victoria Bengualid, Rawand Khader; 11/24Enterobacter aerogenes (recently renamed Klebsiella aerogenes) is an uncommon pathogen in pleural infections and empyema, typically associated with nosocomial urinary and gastrointestinal infections. This case report describes a 69-year-old male patient with chronic kidney disease, diabetes mellitus, and other comorbidities, who developed empyema despite broad-spectrum antibiotics. Despite initial improvement with cefepime and metronidazole, the patient's respiratory status deteriorated, and due to his do not resuscitate/do not intubate (DNR/DNI) status and extensive comorbidities, no further aggressive interventions were pursued, leading to his passing. This case highlights the diagnostic and therapeutic challenges posed by E. aerogenes in pleural infections, emphasizing its rarity in pulmonary involvement and its potential for antibiotic resistance. It also underscores the importance of considering atypical pathogens in complex infections and the need for multidisciplinary management while balancing aggressive treatments with patient-centered care, particularly in end-of-life scenarios.

US FDA approval of pediatric artificial intelligence and machine learning–enabled medical devicesJAMA Pediatrics; Ryan C. L. Brewster, MD; Matthew Nagy, MD, MPH; Susmitha Wunnava, PhD; Florence T. Bourgeois, MD, MPH; 12/24Despite rapid growth in the availability of AI/ML [artificial intelligence and machine learning]-enabled devices in recent years, only a small number have been authorized for pediatric use. The current regulatory framework may expose children to off-label use, differential performance of algorithms, and safety risks. Additionally, the lack of standardized reporting of pediatric device characteristics precludes informed decision-making by health care clinicians on appropriate device use. Pediatric AI/ML-enabled devices should be validated using representative datasets and should include complete and standard documentation on pediatric testing and authorization. Such changes will require cooperation across regulatory and industry stakeholders with a commitment to safe, equitable, and effective AI/ML development for children. 

Developing evidence-based health policy for dementia careJAMA Health Forum; Katherine Baicker, PhD; Kosali Simon, PhD; 12/24The rising prevalence of Alzheimer disease and related dementias (ADRD) represents a profound challenge to health care and long-term care systems. Promising diagnostic tools, medicines, and interventions for ADRD are on the horizon, but these medical advances will come with substantial costs. By 2050, the annual cost of care for patients with ADRD is projected to reach $1.5 trillion in the US, with 75% covered by Medicaid and Medicare. In addition to payment policy, the decision-making environment (what, when, and how information is presented and the way that different choices are framed) for both patients and clinicians will determine the quality and value of care delivered and how that varies across patient populations. With a rapidly aging population and rising prevalence of ADRD, the need for these efforts is urgent.

A scoping review of end-of-life discussions and palliative care: Implications for neurological intensive care in Latin America and the CaribbeanJournal of Palliative Medicine; Monica M Diaz, Lesley A Guareña, Bettsie Garcia, Christoper A Alarcon-Ruiz, Stella M Seal, Clio Rubinos, Dulce Cruz-Oliver, J Ricardo Carhuapoma; 12/24Palliative care (PC) is essential to improve quality of life for individuals with life-limiting acute neurological conditions, particularly in resource-limited settings. In Latin America and the Caribbean (LAC), there is limited health care professional training and education on PC. Our review demonstrates a need to improve PC knowledge and access to end-of-life care resources. Regional educational efforts are needed to improve PC knowledge among health care providers who care for patients with acute neurological conditions in LAC. 

Quality of hospices used by Medicare Advantage and traditional fee-for-service beneficiariesJAMA Network Open; Lindsay L. Y. White, PhD, MPH; Chuxuan Sun, MPA; Norma B. Coe, PhD; 12/24In this cross-sectional study including 4 215 648 decedents and 2 211 826 hospice enrollees, regular Medicare Advantage and fee-for-service beneficiaries enrolled in hospices of similar quality. However, beneficiaries in Medicare Advantage special needs plans were significantly more likely than fee-for-service beneficiaries to use hospices of inferior quality, with referral networks playing an important role in hospice quality choice. These results suggest that policymakers should consider incentivizing referrals to high-quality hospices and approaches to educating beneficiaries on identifying high-quality hospice care. 

Characteristics of patients enrolled in hospice presenting to the emergency department American Journal of Emergency Medicine; by Kayla P Carpenter, Fernanda Bellolio, Cory Ingram, Aaron B Klassen, Sarayna S McGuire, Alisha A Morgan, Aidan F Mullan, Alexander D Ginsburg; 12/9/24, online ahead of print Emergency Departments (EDs) frequently care for patients with life-limiting illnesses, with nearly 1 in 5 patients enrolled in hospice presenting to an ED during their hospice enrollment. This study investigates the reasons patients enrolled in hospice seek care in the ED, the interventions they receive, and their outcomes. ... Patients enrolled in hospice most frequently presented to the ED for trauma [36%; with 15% for pain, 12% for catheter/tube malfunction]. Most received laboratory studies and imaging. Nearly half of patients were admitted to the hospital and short-term mortality was high, particularly for patients enrolled in hospice for needs for ED care? Ie.,

The patient portal messaging crisisJAMA Neurology; Carrie K. Grouse, MD; Gregory J. Esper, MD, MBA; 12/24The patient portal has improved patient access to medical records and facilitated direct communication between patients and their health care teams, improving patient satisfaction, enhancing health care utilization, and increasing treatment adherence. Work associated with portal messaging has fallen primarily on physicians, requiring time outside clinical work hours to respond. Appointment access limitations have driven more asynchronous care delivery, resulting in more complex and time-consuming messages. This trend is causing higher levels of physician burnout, and female physicians are disproportionately affected. Burnout associated with excessive after-hours work in EHRs [electronic health records] is now noted among neurologists.

Promoting the resilience of health care information systems—The day hospitals stood stillJAMA Health Forum; Daniel B. Kramer, MD, MPH; Kevin Fu, PhD; 11/24On Friday, July 19, 2024, health care workers woke to emails declaring systemwide information technology (IT) emergencies. Because Crowdstrike had access to the most sensitive core parts of the Windows operating system, the automated process caused an immediate global outage of computer systems using the Crowdstrike Falcon product, which is embedded in many computer systems at health care organizations. Rather than accept this event as inherent to a complex, digitized, and wired health care ecosystem, we urge the US Congress, health care regulators, and the public to insist on proactive preventive methods to avoid future IT catastrophic events rather than simply waiting for the next disruptive crisis requiring an emergent response.

International comparison of underlying disease among recipients of medical assistance in dyingJAMA Internal Medicine; Brandon Heidinger, BSc; Colleen Webber, PhD; Kenneth Chambaere, PhD; Eliana Close, PhD; Luc Deliens, PhD; Bregje Onwuteaka-Philipsen, PhD; Thaddeus Pope, JD, PhD; Agnes van der Heide, MD, PhD; Ben White, DPhil, LLB, (Hons); James Downar, MD, MHSc; 12/24In 2023, 282 million individuals lived in jurisdictions allowing medical assistance in dying (MAID). But regardless of jurisdiction, cancer and amyotrophic lateral sclerosis (ALS) consistently account for up to 80% of MAID cases, despite accounting for fewer than 30% of all deaths. This observation is consistent with the idea that MAID is driven heavily by illness-related factors common to people with those illnesses and inconsistent with the idea that MAID is driven substantially by factors that are external to the individual and that vary by jurisdiction, such as eligibility criteria, culture, social assistance, or palliative care service availability. The overall incidence of MAID increased over time (per 1 calendar year ... )