Literature Review

Health care system adaptation and resilience during the wildfire crisisJAMA Network; by Attila J. Hertelendy, PhD, Jeremy Maggin, MD, MS, and Gregory Ciottone, MD; 3/19/25 ... Within a span of hours, the Palisades and Eaton fires, propelled by record-breaking Santa Ana winds reaching 150 miles per hour, consumed more than 37,000 acres, destroyed more than 16,000 structures, and claimed 29 lives. All told, greater than 186,000 residents were placed under evacuation orders. ... The experience in Los Angeles County demonstrates the value of maintaining dual-purpose resources: facilities and personnel who can transition between routine operations and emergency response functions. This approach is exemplified by Kaiser Permanente’s successful deployment of mobile health vehicles and the use of clinically trained administrative leaders in direct patient care roles during crisis events. Key elements of successful resource mobilization include:

Hastening death by stopping eating and drinking: Hope Wechkin, Thaddeus Pope, and Josh Briscoe GeriPal Podcasts; by Hope Wechkin, Thaddeus Pope, and Josh Briscoe Eric and Alex have featured discussions about complex bioethical concepts around caring for people at the end of life, including voluntarily stopping eating and drinking (VSED), and multiple episodes about the ethical issues surrounding medical aid in dying (MAID). Recently, discussion has emerged about how these issues intertwine in caring for patients with advancing dementia who have stated that they would not want to continue living in that condition: for those with an advanced directive to stop eating and drinking, how do we balance caring for their rational past self and their experiential current self? Should these patients qualify for medical aid in dying medications? And is there a middle path to provide some degree of comfort while also hastening the end of life?

Certified nurses at Mount Sinai: Representing a commitment to excellence and to their profession Mount Sinai Today - Featrued, Nursing; 3/18/25 Nursing Certification is an important, independent validation of specialized nursing knowledge and expertise that meet or exceed professional standards. In fact, empirical evidence shows an association between nursing certification and better patient outcomes, ... Across the Mount Sinai Health System, an impressive near 50 percent of nurses have earned board certification in their chosen specialties. Their patients, families, colleagues, and teams are the direct beneficiaries of nursing expertise that is recognized as meeting or exceeding the highest professional standards. ... [From Carla Alves-Miraldo, MS, MSN-Ed, RN, CHPN, KP6,] "Becoming a Certified Hospice and Palliative Care Nurse is a reflection of my commitment to ensuring every patient receives comfort, dignity, and compassionate care during life’s most challenging moments. This certification is more than a title—it represents my dedication to guiding patients and families with expertise, empathy, and unwavering support."

From heroes to burnout: How we failed our frontline health workers MedPage Today's KevinMD.com, and excerpt from Health Care Nation; by Tom Lawry; 3/15/25 Of all the lessons learned from fighting a pandemic, none was more frightening or important than discovering how dependent the system is on how we treat our doctors, nurses, and frontline caregivers.  They were already in short supply, with burnout on the rise, when the pandemic hit. As multiple waves of COVID-19 variants washed over us, frontline health workers stepped in at great risk and personal sacrifice to care for highly infectious patients. ... Some witnessed more deaths on a double shift than they did in a normal year. They delivered the bad news to families and managed end-of-life care. They were often the last face and warm voice a COVID-19 victim saw and heard. In the end, they not only saved lives but saved the system from total collapse. ... We called them heroes. And we promised to do better in how we treated them once the COVID-19 crisis passed. Promises made should be promises kept. While we continue to talk about workforce burnout using polite terms with concern in our voices, let us be clear: A system with a mission of healing continues to harm in record numbers the very people in short supply who are there to take care of the rest of us. ... [Click on the title's link for more.]

Willow Point Nursing Center raises pay by nearly 20% WIVT Binghampton, Vestal, NY; by Samantha Rich; 3/17/25 A local nursing home is recognizing the selfless contributions of its employees by significantly increasing its pay scale. The Broome County Legislature recently approved 16-20% pay raises for multiple healthcare roles at Willow Point Rehabilitation and Nursing Center in Vestal. The pay scale was raised for Supervising Nurses, Certified Nursing Assistants (CNAs), and Licensed Practical Nurses (LPNs). Willow Point has also added several new openings in each role.

Revamped tool can reliably assess pain symptoms in dementia patients: researchers McKnights Long-Term Care News; by Zee Johnson; 3/17/25 ... A team of researchers reconstructed the End-of-Life Dementia-Comfort Assessment in Dying, or EOLD-CAD, after a multifacility study showed that caregivers could adequately and reliably address a host of pain symptoms seen in end-of-life dementia patients. ... When clinicians working in the SNFs that were part of the trials used the EOLD-CAD, they were able to detect patterns in more than 600 residents that fell into four categories: physical distress, symptoms of dying, emotional distress, and well-being. Common symptoms observed across these categories were restlessness, shortness of breath, choking, gurgling, difficulty in swallowing, fear and anxiety. ...

Where are all the nurses? Data show that some states have a far higher number of nurses per capita than othersMedscape; by Jodi Helmer; 3/7/25 During their 12-hour shifts, registered nurses (RNs) in Arizona and Arkansas perform many of the same tasks as RNs in Wisconsin and Wyoming: Assessing patients, monitoring vital signs, administering medications, and charting records to provide the best patient care. The work might be similar, but there are vast differences in the number of RNs in each state. ...  Even states with the largest number of nurses per capita are not immune to the nursing shortage. The National Bureau of Labor Statistics estimates that there will be 195,400 job openings for RNs from 2021 to 2031.  ....

[International] Healthcare on the brink: Palliative Care Unit and Late Shift The 75th Berlin International Film Festival - Part 7, wsws.org; by Martin Nowak and Bernd Reinhardt; 3/16/25 Two films, the drama Late Shift (Heldin) and the documentary Palliative Care Unit (Palliativstation), featured at this year's Berlin International Film Festival, addressed the current situation in German and Swiss hospitals. The sold-out festival screenings reflected the burning public interest in this topic. This is particularly remarkable bearing in mind that Palliative Care Unit has a running time of more than four hours. ... [In the] documentary Palliative Care Unit by Philipp Döring, shot at the Franziskus Hospital in Berlin, ... [the] camera quietly observes the daily routine, staff consultations and the constant empathy of the head of the ward towards employees and seriously ill patients, who usually spend their last weeks here. The very calm, always discreet images emphasise the necessity of sufficient time for care and reflection when making life-critical decisions. ... How can the highest possible quality of life be achieved? The high ethical standard of treating incurable patients as active human beings ... is admirable and makes a lasting impression throughout the film.

Sarcopenia in terminally ill patients with cancer: Clinical implications, diagnostic challenges, and management strategies Journal of Hospice & Palliative Care; by Se-Il Go, Myoung Hee Kang, and Hoon-Gu Kim; 3/1/25 Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength, is a prevalent but often overlooked condition in patients with cancer who are terminally ill. It contributes to functional decline, increased symptom burden, and reduced quality of life, yet remains underrecognized in palliative care. Diagnosing sarcopenia in this population is challenging because conventional imaging techniques are often impractical. Instead, alternative assessments, such as the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F), anthropometric measurements, and bioelectrical impedance analysis offer feasible options. Management should focus on symptom relief, functional preservation, and patient comfort, rather than on muscle mass restoration.

El Paso doctor pays close to $500K to settle allegations of hospice healthcare fraud CBS 4 News, El Paso, TX; by David Ibave; 3/10/25 A doctor in El Paso agreed to pay almost half a million dollars on Monday to settle allegations that he was paid off by a hospice center to commit healthcare fraud back in 2021. According to the U.S. Department of Justice, John Patterson M.D. has agreed to pay the United States $468,626 to resolve allegations that he received kickback payments from Nursemind Home Care Inc. to certify patients for hospice care when they were not eligible for these services, submitting false claims to federal healthcare programs.

Intervention increases palliative cancer care consultations/lowers EOL care CancerNetwork.com; by Roman Fabbricatore; 3/11/25A palliative care (PC) intervention combining algorithm-based automated identification of patients eligible for PC led to an increase in PC visits and a decrease in end-of-life systemic therapy among patients with cancer, according to a randomized clinical study (NCT05590962) published in JAMA Network Open. ... "...  Prior efficacy trials in oncology have tested early PC in controlled, primarily academic settings.2To our knowledge, this is the first effectiveness randomized clinical trial of algorithm-driven default specialty PC in community oncology.”

Tumor: why not use the warrior’s metaphor anymore taketonews; 3/7/25 ... The term "warrior" is often used to describe cancer sick people, referring to their strength, determination and ability to fight the disease. Although the intention is positive, docts and psychologists believe that this metaphor can generate negative effects on people with an oncological disease. The "warrior" label is not always appropriate and can have unwanted psychological effect on cancer patients. ... Use a language that does not reduce the patient to his struggle, but that enhances his entirety, including weakness, depression and pain, can contribute to a more human and respectful experience of care. ... [Click on the title's link for this further information below.]

Assessing pain, anxiety and other symptoms of nursing home residents unable to speak for themselves Regenstrief Institute, Indianapolis, IN; by Kathleen T. Unroe, MD, MHA; 3/10/25 Revamped tool reliably addresses physical and emotional distress, well-being and end-of-life symptoms. As many as half of nursing home residents are cognitively impaired and may be unable to communicate symptoms such as pain or anxiety to the staff and clinicians caring for them. Therefore, information needed for the evaluation of symptoms and subsequent treatment decisions typically does not reliably exist in nursing home electronic health records (EHRs). A new paper reports on the novel adaptation of a commonly used symptom assessment instrument to more comprehensively acquire this difficult-to-obtain data with the ultimate goal of enabling knowledge-based expansion of palliative care services in nursing homes to address residents’ symptoms.