National Healthcare Decisions Day sparks events on EOL care | Barbara Bush's death shines light on comfort care | Experts outline resources for older caregivers
April 18, 2018
Hospice and Palliative Medicine SmartBrief
News for physicians caring for the seriously ill
Top Story
National Healthcare Decisions Day sparks events on EOL care
The nonprofit Goals of Care Coalition of New Jersey held its first meeting in conjunction with National Healthcare Decisions Day, advocating that people consider their end-of-life care wishes, discuss them with family and friends and put them in writing. The Kenosha County Care Transitions Coalition organized a similar meeting in Wisconsin, and Helen Sampson of the Kenosha County Aging & Disability Center said the group wanted to help people who face difficult decisions.
NJ Spotlight (New Jersey) (4/16),  Kenosha News (Wis.) (4/16) 
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Palliative & Hospice Care Update
Barbara Bush's death shines light on comfort care
Former first lady Barbara Bush's announcement that she would stop treatment for congestive heart failure and chronic obstructive pulmonary disease and seek comfort care sparked questions about what that means. Palliative care experts were quick to counter suggestions that comfort care means no medical care is provided to patients.
Kaiser Health News (4/16) 
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Patient & Family Perspective
Experts outline resources for older caregivers
Older caregivers can put off their own health care and end up sicker or dying earlier than peers who are not caregivers, said Amanda Hartrey, a family consultant with the Family Caregiver Alliance in San Francisco. A local agency on aging can help older caregivers access helpful services in their area, and C. Grace Whiting of the National Alliance for Caregiving says caregivers can seek training, support and advice from associations that focus on a patient's medical condition.
Kiplinger online (4/17) 
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Medical Research
Merck's Keytruda improves overall survival in advanced lung cancer trial
Data from a late-stage trial involving more than 600 newly diagnosed patients with advanced non-small cell lung cancer showed Merck's immunotherapy Keytruda, or pembrolizumab, in combination with chemotherapy significantly improved overall survival compared with chemotherapy alone. The findings, presented at the American Association for Cancer Research meeting and published in The New England Journal of Medicine, showed 69.2% of patients treated with the Keytruda and chemotherapy regimen were still alive after one year compared with 49.4% of patients who received chemotherapy alone.
Reuters (4/16),  National Public Radio (4/16) 
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BP control may reduce odds of dementia in older adults, study finds
Researchers examined more than 1,200 African-Americans ages 65 and older who received ACE inhibitors, beta blockers, calcium channel blockers or diuretics for hypertension found that reduced blood pressure, and not antihypertensive drugs themselves, was associated with a lower likelihood of dementia. The findings in the Journal of General Internal Medicine suggest that BP control at all ages may curb dementia risk, said researcher Michael Murray.
HealthDay News (4/12) 
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Microglial cell memory may prompt Alzheimer's disease
German researchers found that mouse models with microglia immune cells "trained" by an initial inflammatory stimulus to have a stronger response to another inflammatory stimulus, indicating microglial memory of previous inflammation, had increased amyloid plaque production associated with Alzheimer's disease, but those that became inflammation-tolerant after a fourth stimulus had reduced amyloid accumulation. The findings in the journal Nature also showed epigenetic changes in both trained and tolerant microglia, prompting researchers to suggest that inflammatory diseases occurring outside the brain may spur epigenetic reprogramming within the brain.
Medical News Today (4/14) 
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Health Policy & Practice
Bill would allow hospice staff to dispose of unused drugs
The bipartisan Safe Disposal of Unused Medication Act of 2018 would allow hospice staff, including physicians and registered nurses, to dispose of expired medications or medications that remain unused following the death of a patient at home. The bill would require hospices to have a written policy and procedure for disposal that is distributed to a patient's family, hold conversations about drug disposal with family or representatives of the family, and document disposal in the clinical record.
The Register-Herald (Beckley, W.Va.) (4/17) 
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Many physicians practice at multiple sites, study finds
Data on 20,116 Georgia physicians found 63.2% had multiple practice sites, with the average number of sites being 2.6 for primary care physicians and 3.6 for other physicians, according to a study in the Journal of the American Board of Family Medicine. Researcher Imam Xierali at the University of Texas Southwestern Medical Center said similar practice patterns likely are found elsewhere in the country.
Healio (free registration) (4/13) 
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HHS OIG: $3.7M in Medicare telehealth claims fell short of requirements
Medicare payments for telehealth claims rose from $61,302 in 2001 to $17.6 million in 2015, but an audit by the HHS Office of Inspector General found that nearly one-third of a sample of 100 distant-site telehealth claims from 2014 to 2015 failed to meet reporting requirements. "We estimated that Medicare could have saved approximately $3.7 million during our audit period if practitioners had provided telehealth services in accordance with Medicare requirements," OIG said.
HealthLeaders Media (4/13) 
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Trends & Technology
March for Science puts spotlight on public health
The second March for Science rally in Washington, D.C., over the weekend focused on advocacy to address public health issues, including opioid abuse, gun violence and medical research. Interim Executive Director Dr. Caroline Weinberg said there is a "lack of science informing policy."
Medscape (free registration) (4/16) 
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2018 Virtual Conference -- Register now!
It's that time of year! Time to save the date for the 2018 Virtual Conference: Turning Points -- Mastering Transitions in Care, hosted by NHPCO, HPNA, and AAHPM. This conference will discuss improvements to communication, identify key points of transition in care, and include strategies to providing high quality care during transition. Mark your calendars for July 18-19, 2018. Learn more.
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What is comfort care?
After former First Lady Barbara Bush decided to forgo curative-focused treatments and chose to receive comfort care, questions about what makes up comfort care have been sent to the National Hospice and Palliative Care Organization. Read the news release from NHPCO answering the question, What is Comfort Care?
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Change your opinions, keep to your principles; change your leaves, keep intact your roots.
Victor Hugo,
poet, novelist and dramatist
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