Literature Review

From small to tall: breed-varied household pet dogs can be trained to detect Parkinson's DiseaseAnimal Cognition; Lisa Holt, Samuel V Johnston; 10/24Parkinson's Disease (PD) is a clinically diagnosed disease that carries a reported misdiagnosis rate of 10-20%. Recent scientific discoveries have provided evidence of volatile organic compounds in sebum that are unique to patients with PD. Twenty-three canines of varying breeds, ages, and environmental backgrounds were included. For this two-year reporting period, when averaged as a group, the 23 dogs were 89% sensitive and 87% specific to olfactory distinction between PD-positive and PD-negative human donor samples. Study findings support the application of companion dogs, trained with force-free, reward-based methodologies, for the detection of PD-positive and PD-negative samples under controlled conditions.

Racial, ethnic, and socioeconomic differences in critical care near the end of life: A narrative reviewCritical Care Clinics; Katrina E Hauschildt, Judith B Vick, Deepshikha Charan Ashana; 10/24Patients from groups that are racially/ethnically minoritized or of low socioeconomic status receive more intensive care near the end of life, endorse preferences for more life-sustaining treatments, experience lower quality communication from clinicians, and report worse quality of dying than other patients. There are many contributory factors, including system (eg, lack of intensive outpatient symptom management resources), clinician (eg, low-quality serious illness communication), and patient (eg, cultural norms) factors. System and clinician factors contribute to disparities and ought to be remedied, while patient factors simply reflect differences in care and may not be appropriate targets for intervention.

Harnessing natural language processing to assess quality of end-of-life care for children with cancerJCO Clinical Cancer Informatics; Meghan E Lindsay, Sophia de Oliveira, Kate Sciacca, Charlotta Lindvall, Prasanna J Ananth; 9/24Data on end-of-life care (EOLC) quality, assessed through evidence-based quality measures (QMs), are difficult to obtain. Natural language processing (NLP) enables efficient quality measurement and is not yet used for children with serious illness. Conclusion: A high proportion of decedents attained specified EOLC-QMs more than 30 days before death. Our findings indicate that NLP is a feasible approach to measuring quality of care for children with cancer at the end of life and is ripe for multi-center research and quality improvement.

Top ten tips palliative care clinicians should know about hospice live dischargeJournal of Palliative Medicine; Stephanie P Wladkowski, Lauren J Hunt, Elizabeth A Luth, Joan Teno, Krista L Harrison, Cara L Wallace; 9/24Hospice care is designed to support the medical and psychosocial needs of individuals with serious illness and their caregivers through the dying process. Some individuals, though, leave hospice prior to death, generally referred to as disenrollment or a "live discharge." Live discharge from hospice is a common and often distressing issue for hospice patients, their caregivers, and also for hospice professionals and agencies. This paper discusses common issues surrounding live discharge that clinicians and other healthcare professionals should consider when dealing with live discharge in their own clinical practices. Where applicable, we provide practical steps for hospice and palliative care clinicians to better support patients and families through this critical care transition. Further, we offer strategic directions interprofessional clinicians can take to affect systemic change to improve live discharge experiences.

Alzheimer dementia among individuals with down syndromeJAMA Network Open; Eric Rubenstein, PhD; Salina Tewolde, ScM; Amy Michals, MPH; Jennifer Weuve, ScD; Juan Fortea, MD; Matthew P. Fox, ScD; Marcia Pescador Jimenez, PhD; Ashley Scott, MPH; Yorghos Tripodis, PhD; Brian G. Skotko, MD; 9/24In this cohort study of  ... adults with Down syndrome enrolled in Medicaid or Medicare between 2011 to 2019, 23.3% of adults had Alzheimer dementia diagnoses, and the mean age of death was 59.2 years. These findings suggest that Alzheimer dementia is almost universal among people with Down syndrome, and administrative claims data may offer valuable insights into improving care for this diverse population.

Well-being outcomes of health care workers after a 5-hour continuing education intervention-The WELL-B randomized clinical trialJAMA Network Open; J. Bryan Sexton, PhD; Kathryn C. Adair, PhD; 9/24To test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based continuing education program [was developed] to deliver ... interventions to improve 4 dimensions of HCW [health care workers] well-being (ie, emotional exhaustion, emotional thriving, emotional recovery, and work-life integration). [The] ... sessions improved short-term HCW emotional exhaustion, emotional thriving, emotional recovery, and work-life integration. Health care worker impressions of WELL-B were positive. These findings suggest that WELL-B is a beneficial intervention. 

Screening familial risk for hereditary breast and ovarian cancerJAMA Network; by Daniel Kiser, Gai Elhanan, Alexandre Bolze, Iva Neveux, Karen A Schlauch, William J Metcalf, Elizabeth T Cirulli, Catherine McCarthy, Leslie A Greenberg, Savanna Grime, Jamie M Schnell Blitstein, William Plauth, Joseph J Grzymski; 9/25/24In a large health system, how many ungenotyped patients meet family history genetic testing criteria for hereditary breast and ovarian cancer? In this cross-sectional analysis, 2.9% of patients had no evidence of prior genetic testing but had electronic health records indicating they met family history criteria. These criteria were associated with significantly increased prevalence of genetic risk variants among 38 003 genotyped patients. These findings suggest that substantial gaps exist in identifying and testing patients meeting family history criteria for hereditary breast and ovarian cancer, and other methods may be needed to close these gaps.

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative studyJournal of the American Geriatrics Society; by Cameron J Gettel, Courtney Kitchen, Craig Rothenberg, Yuxiao Song, Susan N Hastings, Maura Kennedy, Kei Ouchi, Adrian D Haimovich, Ula Hwang, Arjun K Venkatesh; 9/24Emergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-pocket spending in a nationally representative sample. One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half-year of life, with evidence of associated considerable total and out-of-pocket spending.

Using AI and social media to understand health disparities for transgender cancer careJAMA Network Open; Augustine Annan, PhD; Yeran Li, PhD; Jingcheng Du, PhD; Yezhou Sun, MS; A. I. Asante-Facey, MD; Xiaoyan Wang, PhD; Matthew Monberg, PhD; 8/24Transgender individuals experience lower health care use and higher health care discrimination rates. This qualitative study revealed 3 barriers in transgender cancer care: lack of awareness, access issues, and clinical challenges. The consistent reporting of clinical challenges indicates the need for tailored medical guidelines and gender-affirming support systems. Addressing these disparities requires enhanced clinician education, evidence-based guidelines, policy reforms, and inclusive health coverage. Despite potential biases and limitations in the representativeness of social media data, this study may offer valuable insights to guide future initiatives toward achieving equitable health care for transgender individuals.

Racial differences in palliative care and hospice among adults with chronic obstructive pulmonary diseaseRespiratory Medicine; by Natalia Smirnova, Sarah H Cross, Amanda Light, Dio Kavalieratos; 9/24Individuals with COPD often experience frequent hospitalizations and high-intensity care at the end-of-life (EOL). Although people with COPD experience a higher symptom burden and worse functional status than patients with other serious illness such as cancer, people with COPD are less likely to receive specialty palliative care (PC) or hospice and more likely to die in the hospital or the intensive care unit (ICU). Furthermore, evidence of inequities within COPD exist. For example, Black individuals and those with lower socioeconomic status are likelier to experience COPD exacerbations and have worse quality of life than White individuals and those with higher socioeconomic status.

Racial disparities in cancer stage at diagnosis and survival for adolescents and young adultsJAMA Network Open; Kekoa Taparra, MD, PhD; Kaeo Kekumano, BS; Ryan Benavente, BS; Luke Roberto, BS; Megan Gimmen, BS; Ryan Shontell, PhD; Henrietta Cakobau; Neha Deo, MD; Connor J. Kinslow, MD; Allison Betof Warner, MD, PhD; Curtiland Deville, MD; Jaimie Z. Shing, PhD, MPH; Jacqueline B. Vo, PhD, MPH, RN; Manali I. Patel, MD, MPH; Erqi Pollom, MD, MS; 8/24This cohort study of AYA [adolescent and young adult] patients suggests that stage at diagnosis and survival varied across races for the 10 deadliest AYA cancers. ... the risk of late-stage diagnosis was significantly higher for Asian, Black, and Native Hawaiian or Other Pacific Islander patients compared with White patients. However, compared with White patients, the risk of death was significantly higher for American Indian or Alaska Native, Black, and Native Hawaiian or Other Pacific Islander patients but lower for Asian patients. These results support the need for tailored interventions and informed public policy to achieve cancer care equity for all races.

Caregiver and employee experience among big hospices-ranking of the largest US hospices by three quality indicatorsAmerican Journal of Hospice & Palliative Care; by Jason Hotchkiss, Emily Ridderman, Brendan Hotchkiss; 9/24Caregiver and employees had better experiences with non-profits than for-profits. Anger and frustration was expressed toward large, for-profit providers more focused on admissions, profiteering, and paying dividends than actual care. The CAHPS appears to draw more satisfied caregivers. Whereas, online reviewing provides open-ended, real-time voicing of care quality concerns. Even with distinct methods, CAHPS survey and review sentiment analysis converge on caregiver satisfaction, yet CAHPS paints a much rosier picture of hospice quality than online reviews.

Trends in mortality after incident hospitalization for heart failure among Medicare beneficiariesJAMA Network Open; Adam S. Vohra, MD, MBA; Ali Moghtaderi, PhD; Qian Luo, PhD; David J. Magid, MD, MPH; Bernard Black, JD, MA; Frederick A. Masoudi, MD, MSPH; Vinay Kini, MD, MSHP; 8/24In this study of Medicare fee-for-service beneficiaries, there was a substantial decrease in in-hospital mortality for patients hospitalized with incident HF [heart failure] from 2008 to 2018, but little to no reduction in mortality for subsequent periods up to 3 years after hospitalization. These results suggest opportunities to improve longitudinal outpatient care for patients with HF after hospital discharge.