Literature Review

Alzheimer’s prognosis models should expand data sources McKnights Senior Living; by Kristen Fischer; 8/12/24 Integrating data from nursing home electronic health records and claims in addition to the minimum data set — data required for nursing home residents — could be better than just relying on the MDS sources to produce an accurate prognosis for nursing home residents with Alzheimer’s disease and related dementias, according to a report published Thursday in the Journal of the American Geriatrics Society. ... The authors of the report noted that a recent review of prognostic models for late-stage ADRD found that assessments commonly used to evaluate prognosis-based eligibility for hospice weren’t reliable. ... Only 15% of people enrolled in hospice have a primary diagnosis of ADRD. That’s because it’s challenging to estimate the six-month prognosis required to be eligible for hospice, and dementias have a prognosis of 12 to 18 months when they are in the late stage, the authors pointed out.

Prognostication in hospice care: Challenges, opportunities, and the importance of functional statusFederal Practitioner - Case Reports; by David B. Brecher, MD and Heather J. Sabol, MSN, ARNP; 7/24 Predicting life expectancy and providing an end-of-life diagnosis in hospice and palliative care is a challenge for most clinicians. Lack of training, limited communication skills, and relationships with patients are all contributing factors. These skills can improve with the use of functional scoring tools in conjunction with the patient’s comorbidities and physical/psychological symptoms. The Palliative Performance Scale (PPS), Karnofsky Performance Scale (KPS), and Eastern Cooperative Oncology Group Performance Status Scale (ECOG) are commonly used functional scoring tools.

Amid trauma and burnout, it ‘takes courage’ to reflect on mental, emotional well-being Healio; by Jennifer Byrne; 7/31/24 ... [William E. Rosa, PhD, MBE, MS] began to realize that in the stressful, devastating situations he and his colleagues faced daily, there was much to be learned from the principles of trauma-informed care. ... “This is the idea that cultivating an awareness can prevent us from re-traumatizing ourselves and others,” he said. “I think it starts with reflecting on — and telling the truth about — our mental and emotional well-being. That takes courage.” In acknowledging the emotional scars, brokenness and vulnerability that comes from tragedy and loss, individuals can begin to heal a lifetime of stored and unresolved trauma, Rosa said. “As a workforce, you and I see unacceptable rates of suicide, burnout, moral distress and attrition,” he said. “It’s time that we come to safe and supported terms with our trauma — not just as individuals, but as a collective, not only for the patients and families we serve, but for us to survive.”Editor's Note: In this article, Dr. Rosa identified "the emotional impact of taking yet another patient off the ventilator at the end of life." Recent articles we've posted in this newsletter about trauma-informed care been in our "Top Reads." While those articles focused on trauma-informed care of the persons you serve, this focuses on the persons who serve, your all-important direct patient care clinicians.

Becoming time rich with physician moms: Sarah Wittry and Nicole Perrotte MarketScale - Ripple of Change; by Todd Otten; 7/30/24 In today’s high-stress healthcare environment, physician mothers face the formidable challenge of balancing demanding careers with their personal lives. The conversation on work-life balance is more relevant than ever, with more women in medicine seeking ways to manage these dual responsibilities effectively. How can physician moms navigate this landscape to reclaim time for themselves without guilt? What strategies can physician moms employ to achieve a healthier work-life balance? This pressing question lies at the heart of today’s discussion on the Ripple of Change podcast. ... Key points of discussion:

End-of-life care planning ‘needs to become routine’ Nursing Times; by Gemma Mitchell; 7/30/24 Nurses need to support a "culture change" in end-of-life care whereby people's are better recorded and respected, a new report has urged. [Free trial / subscription required for full access.]

Proactive fall prevention: Elevating patient safety and healthcare excellenceHealthCare Business News; by Amy Hester; 7/26/24... The significance of fall prevention cannot be overstated, as it directly impacts patient outcomes and overall healthcare quality. With the patient safety solutions market growing at an expected rate of 11.2%, the importance of proactive fall prevention strategies becomes even more evident. ... In the United States, preventable medical errors, including falls, are the third leading cause of death. The impact of falls on patient health and recovery is profound, often leading to longer hospital stays, delayed recovery and increased risk of subsequent falls.Editor's Note: Proactive fall prevention is especially important for persons needing palliative or hospice care. As the person's health and mobility declines, they have to adjust to these changes mentally, emotionally, physically, and relationally. Recognizing decline can feel like defeat. Asking for help can be tough. Family members can expect the person to move more independently more than possible, leading to falls.

Practicing proactive palliative care in COPD management Medscape - "In Discussion"; podcast by Leah J. Witt, MD and Anand S. Iyer, MD, MSPH; 7/25/24Let's start talking COPD. Today, we're going to keep talking about Mr Rivera, a case we've been following all season. He's a 78-year-old man with COPD, and we're talking to you about palliative care and symptom management. He has group E COPD. He really has a lot of symptoms and frequent exacerbations.

Omega - Journal of Death and Dying - June 2024 Sage Journals - Omega - Journal of Death and Dying; June 2024 issue Omega - Journal of Death and Dying, a peer-reviewed journal that says it brings insight into terminal illness, the process of dying, bereavement, mourning, funeral customs and suicide, published research articles on the following topics in its June 2024 edition (Vol. 89, Issue 2). [A few sample topics include the following:]

AMA Advocacy issue briefsAmerican Medical Association; 7/24/24 Issue briefs summarize key health policy issues by providing concise and easily digestible content targeting both relevant stakeholders and those who may know little about the topic. Contents: Medicare & Medicaid; Telehealth; Scope of practice; Prior authorization; Reducing physician burnout; Practice management; Overdose and mental health/substance use disorder parity; Access to affordable, high-value care; Health care costs & price transparency; Drug costs & pricing; Hospitals & health systems; State medical liability reform; LGBTQ+ health; The business of medicine; Public health improvement; Essential Tools & Resources.

Rady Children's Hospital nurses strike begins after union turns down deal ABC News 10 San Diego, CA; by Perla Shaheen, Dani Miskell; 7/23/24 The Rady Children's Hospital nurses started hitting the picket line Monday morning. The union representing the nurses recently turned down the hospital's offer of a 25% pay bump over the next three years. The executive director for UNOCH Teamsters Local 1699 says this is the first time they've ever gone on strike. On Sunday, both sides thought they had a deal and would avoid the strike, but late last night, union members voted the agreement down.

Sasha McAllum Pilkington on grace and storytelling at the end of life Psychotherapy.net; by Lawrence Rubin; 7/22/24 Narrative Clinician, Sasha McAllum Pilkington [of New Zealand],  shares poignant stories she co-created with hospice clients which honor and celebrate their lives. [This interview includes: ...]

Navigating legal and ethical issues: Nurses’ role in accessing and using the Death Master File Daily Nurse; by Maya Payne; 7/22/24 Nurses have a great deal of responsibility when managing sensitive information, including access to the Death Master File (DMF), because they are healthcare professionals entrusted with patient care. This article explores the moral and legal issues that help nurses use the DMF in their practice in a morally responsible manner. ... Explore this detailed resource on DMF guidelines for further insights into responsibly using the Death Master File in healthcare settings. Editor's Note: About 10 years ago, the Social Security Office declared me as "dead." Yes. This affected everything financial and legal in my life. My husband even received standardized condolences from businesses with his name as my key contact. Clean up? A mess. Cause? The best that the Social Security Office could discern was that someone, somewhere entered a clerical mistake. I will never know. The effects of how this Death Master File is used--legally, ethically, and otherwise--cannot be understated.

Exhausted by prior auth, many patients abandon care: AMA survey AMA News Wire - American Medical Association; by Tanya Albert Henry; 7/18/24 Among America’s physicians, more than nine in 10 surveyed say that prior authorization has a negative impact on patient clinical outcomes. Most telling is that 78% of physicians reported that prior authorization often or sometimes results in their patients abandoning a recommended course of treatment, according to the results of the AMA’s annual nationwide prior authorization survey (PDF) of 1,000 practicing physicians. In addition to patients forgoing care, physicians also see the burdensome insurance company practice known as prior authorization leading to care delays and serious adverse events. [Click on the title's link for more specific stats.]