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Category: Health

  • Ten months of inspections at Roxborough Memorial Hospital: July 2025 — April 2026

    Ten months of inspections at Roxborough Memorial Hospital: July 2025 — April 2026

    Roxborough Memorial Hospital was cited by the Pennsylvania Department of Health for failing to properly dispose of medical waste and document patient treatment plans earlier this year.

    The incidents were among 11 times inspectors visited the hospital, which is part of California-based Prime Healthcare Foundation, to investigate potential safety problems.

    Here’s a look at the publicly available details:

    • July 17, 2025: Inspectors came to investigate a complaint but found the hospital was in compliance. Complaint details are not made public when inspectors determine it was unfounded.
    • July 22: Inspectors followed up on an April 2025 citation regarding failure to report suspected elder abuse and found the hospital was not in compliance. The hospital had been cited for failing to report suspected abuse of a patient at the behavioral health facility where they had been staying before arriving at Roxborough. In April, the hospital said it would update its policies to make clear suspected abuse should be reported as soon as possible and retrain staff. In July, inspectors found the hospital had reported the suspected abuse to the behavioral health facility, but not to the Pennsylvania Department of Health, as required. The hospital said it would clarify in its policies that all cases of suspected abuse should be reported to the health department.
    • Aug. 4: The hospital was cited for failing to properly transfer patients under federal EMTALA (Emergency Medical Treatment and Labor Act) protocol. In one of 11 patient records inspectors reviewed, staff transferred a patient to another facility without sending along their emergency records. The hospital was also cited for a staff member who had not completed mandatory annual EMTALA training since 2022. The hospital retrained staff on documenting patient transfers and agreed to hold monthly meetings on EMTALA compliance. Staff members who are not up-to-date on their EMTALA training will be removed from the schedule until they complete the required training.
    • Oct. 15: Inspectors followed up on the August EMTALA transfer complaint and found the hospital was in compliance.
    • Feb. 2, 2026: Inspectors followed up again on the April abuse reporting citation and found the hospital was in compliance.
    • Feb. 12: Inspectors came to investigate a complaint but found the hospital was in compliance.
    • March 4: Inspectors cited the hospital for improper medical waste disposal and unsafe equipment in behavioral health rooms. Inspectors found that a pharmaceutical disposal box was unlocked and lined with a black trash bag, which is not approved for pharmaceutical waste disposal containers. The hospital was also cited for cords attached to call bells on beds in the geriatric psychiatric unit, which could be dangerous for people at risk of self-harm. The hospital retrained staff on pharmaceutical waste disposal and replaced the corded call bells with wireless systems.
    • March 4: Inspectors visited for a mental health survey and cited the hospital for failing to complete written treatment plans for one of 12 patient files they reviewed. The hospital retrained staff on documentation and the importance of scanning any written documentation into patients’ electronic files.
    • March 25: Inspectors came to investigate a complaint but found the hospital was in compliance.
    • March 31: Inspectors visited for a mental health survey and found the hospital was in compliance.
  • From COVID to cancer: How Moderna’s stock jumped 177% in a day

    From COVID to cancer: How Moderna’s stock jumped 177% in a day

    COVID-19 vaccines made Moderna a household name, but the company’s fortunes cratered as demand for the shots plummeted. Hostility from the Trump administration also spooked investors. As of Tuesday, the company’s stock had fallen nearly 90% from its peak, a loss of $170 billion in market value.

    All the while, the company was quietly mounting a comeback in cancer.

    On Wednesday, those efforts began to pay off in a big way. Moderna and Merck, a big drugmaker, reported that their experimental cancer vaccine extended the time before melanoma recurred in a clinical trial — the first late-stage study of its kind to succeed. The two drugmakers announced their success in news releases, without providing numbers that would indicate how much patients had benefited. Moderna’s stock closed up 177% Wednesday.

    Moderna’s stock then gave up some of those gains, dropping 24% to close at $133.32 Thursday on the Nasdaq Stock Market.

    The investors were betting that Moderna could help jump-start a new approach to treating certain cancers. The experimental vaccine uses the same messenger RNA, or mRNA, technology that powered Moderna’s COVID-19 shot, but it works differently to treat cancer. Tailored to each patient’s tumor genetics, the vaccine delivers instructions to produce a fragment of a tumor to teach the body’s immune system to attack the cancer.

    Cancer vaccines using mRNA could become a hugely lucrative business, if the approach works across cancer types. Cutting-edge cancer drugs typically cost several hundred thousand dollars a year.

    For Moderna, cancer “is by far the most significant pipeline opportunity,” said Tyler Van Buren, an analyst at the Wall Street bank TD Cowen.

    Moderna’s CEO, Stéphane Bancel, said Wednesday on CNBC that the company’s work on the cancer vaccine was its latest effort to “take very big, scientific clinical bets.”

    The prospect of using mRNA vaccines to treat cancer has tantalized researchers for decades. But momentum in the field has accelerated only recently, as manufacturing and other technology has improved, thanks in part to investments during the pandemic.

    As of last year, more than 60 cancer vaccines using mRNA or similar technology were in development, being tested in more than 120 clinical trials, according to one count. Many of those studies are funded by philanthropies, the government, and smaller biotechnology companies.

    Four major drugmakers are leading the development efforts. Two are Moderna and Merck, whose collaboration on the approach dates back a decade; they are also testing the same vaccine as a therapy for cancers of the lung, kidney, and bladder. (In the study whose results were announced Wednesday, the cancer vaccine was given in combination with Keytruda, Merck’s blockbuster cancer immunotherapy.)

    BioNTech, another developer of an mRNA vaccine for COVID, is working with Roche’s Genentech unit to develop a vaccine to treat cancers of the pancreas and colon. Results from a small safety study of that therapy in pancreatic cancer generated excitement this spring.

    The approach has historically been seen as risky. The manufacturing is complex, the politics are fraught, and there had been little evidence it would work. Other large major cancer drugmakers, such as Pfizer and Bristol Myers Squibb, are not working on mRNA vaccines for cancer.

    Under Health Secretary Robert F. Kennedy Jr., the Trump administration has made a series of funding and policy changes hostile to mRNA technology. A year ago, the federal government canceled nearly half a billion dollars’ worth of contracts and other funding for mRNA technology.

    “Those political headwinds were serious, and it caused a lot of companies to take great pause,” said Jeff Coller, a scientist who works on mRNA at Johns Hopkins University. Coller advises several small mRNA companies and is on the executive committee of the Alliance for mRNA Medicines, a trade group.

    But the administration has signaled it may be more open when it comes to mRNA for treating cancer. This year, it quietly started a public-private partnership expected to fund clinical trials of different cancer vaccines, including those using mRNA. The Department of Health and Human Services did not return a request for comment Wednesday about the status of that initiative and how much funding the department has granted.

    Moderna was founded in 2010 in Cambridge, Mass., to develop medicines using mRNA. Its COVID vaccine, its first product, brought in tens of billions of dollars of revenue during the pandemic.

    But as the public and the government soured on its COVID shot, Moderna had hardly anything to replace it with. Over the past few years, Moderna looked for different ways to reinvent itself. It won approvals for mRNA vaccines for respiratory syncytial virus and, most recently, flu. It also explored experimental therapies for rare diseases.

    Last year, the company laid off more than 800 workers, a tenth of its workforce. It also lost more than $700 million in contracts to develop a shot to protect humans against bird flu after the Trump administration canceled the agreements. The company shelved vaccines to protect against herpes, chickenpox, and shingles.

    Even though it had started years before the pandemic, Moderna’s work on mRNA cancer vaccines flew relatively under the radar. In addition to the experimental cancer vaccine it is developing with Merck, Moderna solely owns several others that it is testing in different cancers.

    “People started to pay attention” as Moderna and Merck began presenting promising results from midstage clinical research, said Andrew Tsai, an analyst at the Wall Street bank Jefferies.

    Now, Moderna is back in the spotlight. Crucial questions remain: Will the promising results in melanoma, which has repeatedly proved to be more responsive to treatment, hold up in cancers that are tougher to treat? And will the detailed results look as good as the companies made them sound Wednesday? (The drugmakers said they would present the full data soon at a medical meeting.)

    But now that an mRNA cancer vaccine appears to have succeeded, Van Buren of TD Cowen said he anticipated that drugmakers would flock to the technology.

    “Now that this trial was successful,” he said, “I definitely think we can expect more investment by other pharma companies.”

    This article originally appeared in the New York Times.

  • Many treatments promise relief from tinnitus. Here’s what actually helps.

    Many treatments promise relief from tinnitus. Here’s what actually helps.

    It can sound like a fire alarm, a kettle whistle, a hiss of air escaping from a balloon, a chorus of tree frogs, or a roaring jet engine. For me, tinnitus is a blaring sound in my right ear, similar to the high-pitched whine that follows an explosion in a war movie, except it never fades away. The screeching sound is with me from the moment I wake up until I fall asleep.

    More than 740 million adults worldwide experience tinnitus and some studies suggest 1 in 10 people have it. Some barely notice it. Others can’t function because of the phantom noise. It steals their sleep, fractures their relationships, and triggers depression and anxiety. Severe tinnitus affects about 2% of adults overall.

    While there is no treatment proven to silence chronic tinnitus, there are a handful of strategies you can try to reduce symptoms and the discomfort they bring. Here’s what experts suggest.

    What causes tinnitus

    Tinnitus is a sound without an external source, heard in one or both ears, or elsewhere in the head. Commonly called ringing in the ears, it can be temporary and resolve on its own, or persist and become chronic. The noise can vary from a faint hum to a shrieking wail.

    Bruce Hubbard, a psychologist who also has tinnitus, likens his to a smoke alarm. “A smoke alarm is designed to get people’s attention and drive them away. And that’s what [some of us] have in our heads, basically a smoke alarm 24/7,” Hubbard said.

    Most people with tinnitus have some level of hearing loss. Mine began with sudden sensorineural hearing loss, a medical emergency that causes abrupt hearing changes and requires early treatment for the best chance of recovery, but tinnitus is also associated with age- or noise-related hearing loss — though it might not always be apparent on hearing tests.

    The Tinnitus Handicap Inventory measures how tinnitus affects your daily life, from slight to catastrophic. Two years after my tinnitus began, my score is severe. I miss silence.

    The leading theory for why tinnitus occurs is that when the brain receives less auditory information, the central nervous system adapts by increasing neural activity, said Stéphane Maison, director of the Tinnitus Clinic at Mass Eye and Ear, who also has tinnitus. “Tinnitus is not a sound in your ears. Tinnitus is the result of your brain trying to adapt to a lack of information that is no longer coming from your ears,” he said, comparing it to phantom limb pain.

    Medical evaluation can identify treatable or less common causes, including earwax, ear infections, head injury, vascular problems, an inner ear disorder, tumor, and jaw-joint problems. Some medications, such as powerful antibiotics called aminoglycosides and certain chemotherapy drugs, can cause hearing loss, tinnitus, or both.

    Strategies to make tinnitus less disruptive to everyday life

    There’s no cure for tinnitus, “but we’re working on it,” Maison said. (For some people with hearing loss, hearing aids or cochlear implants — surgically implanted devices that directly stimulate the auditory nerve — can improve hearing and may reduce tinnitus.)

    Tinnitus treatment is often focused on changing your perception of and reaction to the noise. “The idea is not so much to make the sound go away, although that’d be great, but to help that person coexist with this thing they don’t like by improving their understanding and their ability to rationally think about it,” said Marc Fagelson, an audiologist and professor who has tinnitus and works with veterans.

    Treatment options include the following:

    • Cognitive behavioral therapy (CBT), a type of talk therapy that focuses on recognizing and changing unhelpful thought patterns and resulting behaviors, has the clearest evidence for reducing tinnitus-related distress.
    • Acceptance and commitment therapy (ACT), another type of psychotherapy that focuses more on accepting thoughts and changing how you relate to them, may also be effective, though it can feel initially counterintuitive to people searching for a cure. “Acceptance is a practical choice,” Hubbard said.
    • Tinnitus retraining therapy (TRT) aims to promote habituation, the process of paying less attention and reacting less strongly to the sound, through education, counseling, and sound therapy. (The propensity to closely monitor and try to control tinnitus can keep your attention focused on the noise, making it harder to tune out.)
    • Tinnitus activities treatment (TAT) focuses on addressing four problem areas: thoughts and emotions, hearing and communication, sleep, and concentration. Individualized treatment may include counseling, communication and hearing strategies, exercises to redirect attention, and sound therapy.

    Mindfulness practices may help some people cope. Acupuncture, yoga, and meditation have not been shown to treat tinnitus directly, but Maison said people who find these activities relaxing can use them to reduce overall stress.

    James Henry, a retired tinnitus researcher who has tinnitus, suggested listening to an audiobook or podcast to help fall asleep at night. White noise, nature sounds, or calming music may help mask tinnitus or make it less noticeable. Tinnitus can feel more intrusive in some situations, such as when you’re in a quiet room, because there are no external sounds to mask the ringing, or after exposure to a very loud environment. (Some people with tinnitus also experience hyperacusis, a hypersensitivity to everyday sounds.)

    Having a strong support system can help reduce isolation, which people with tinnitus may feel if they avoid social situations because of difficulty following conversations, low tolerance of noisy environments, or fear that their tinnitus will worsen. But staying socially engaged is important, Fagelson said.

    Anxiety and depression may worsen tinnitus distress, and tinnitus may also contribute to anxiety and depression. While antidepressants or antianxiety medications can’t resolve tinnitus itself, they may be helpful for addressing any mental health concerns related to the condition.

    Tinnitus related to a traumatic incident can be associated with PTSD, Fagelson said. Tinnitus is the most common disability for U.S. veterans. Military service can involve repeated exposure to damaging noise, including gunfire and explosions, which can trigger lasting tinnitus. “The potential is there for the tinnitus to serve as a trauma reminder and be extremely burdensome in that regard,” Fagelson said.

    Although the sound may persist when trying the above tactics, many people may adapt over time and find it bothers them less or they eventually notice it less. “The brain is highly capable of adapting to it and even screening it out,” Hubbard said.

    What doesn’t the evidence support? Supplements such as zinc, Ginkgo biloba, magnesium, and Lipo-Flavonoid are touted online as offering relief, but studies have not shown they reliably improve tinnitus and guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation specifically recommend against using supplements to treat tinnitus. And while some people say that certain triggers fluctuate the volume of their tinnitus, including caffeine, salt, and alcohol, research doesn’t back up any specific dietary changes.

    Emerging technologies

    Bimodal neuromodulation, which stimulates two sensory systems at once to prompt changes in the brain, has emerged in recent years as a potential treatment for some people with tinnitus. Lenire, a prescription device that pairs sound delivered through headphones with mild electrical stimulation of the tongue, was authorized by the Food and Drug Administration in 2023 to temporarily relieve tinnitus symptoms in adults with at least moderate tinnitus. (That authorization does not establish that the device cures tinnitus or works for everyone.)

    Susan Shore, an auditory neuroscientist and researcher at the University of Michigan, developed another bimodal neuromodulation device that works a little differently. It pairs sounds tailored to a person’s tinnitus with precisely timed stimulation on the face or neck, with the aim of altering abnormal neural activity associated with tinnitus.

    Studies on these devices have been relatively small and largely conducted by the companies and researchers behind the devices so more independent research is needed. (Also of note: Lenire is offered only through audiologists, and according to the company’s website, is not broadly covered by major commercial insurance plans or Medicare.)

    The ultimate goals: Habituation and acceptance

    Without a proven way to silence chronic tinnitus, the most realistic long-term goal is habituation, Henry said. “Habituation means not paying attention to your tinnitus most of the time. And when you do pay attention to it, you don’t react to it.”

    Henry said he’s fully habituated and comfortable with his tinnitus, despite it being loud. “I hate it. I wish it would go away,” he said. “I wish there was a cure, but otherwise, I can live with it.”

    Hubbard compared tinnitus to losing a loved one and processing grief and loss. “I’ve got to somehow make peace with that in order to move on,” he said. He suggested focusing on your values and the life you want to live, while acknowledging that tinnitus can be extremely difficult to deal with.

    When my tinnitus first started, I couldn’t imagine spending one waking minute without noticing it. While I still make daily adjustments, avoid noisy restaurants, and listen to white noise, I can now spend hours without consciously noticing my tinnitus or letting it rule my life.

    For now, that’s success.

  • Better communication skills and ethical use of AI: How NBME’s new CEO sees the future of medicine

    Better communication skills and ethical use of AI: How NBME’s new CEO sees the future of medicine

    The National Board of Medical Examiners has named Suzanne Anderson the next CEO of the Philadelphia-based nonprofit that develops exams for medical licensing.

    She will succeed Peter Katsufrakis, who has led the organization since 2017, the board announced Monday.

    Anderson, who starts in October, will help steer the organization as the skills and competencies needed to practice medicine evolve. The organization creates the United States Medical Licensing Examination and other tests for medical students and resident physicians.

    Anderson anticipates greater emphasis on communication skills, the ethical use of AI, and what happens outside of the clinic setting.

    “Without having these assessments that ensure that people are developing the skills that they need, we wouldn’t have as high-quality a workforce as what we want in healthcare,” Anderson said.

    Anderson most recently served as regional president of SSM Health Wisconsin, a not-for-profit health system. She has also been involved in the National Board of Medical Examiners for the last 20 years, chairing the board and volunteering on committees.

    The Inquirer spoke to Anderson about the future of medicine in an interview lightly edited for length and clarity.

    What is your vision as the incoming CEO?

    My entire career, I’ve been really focused on the patient experience, quality and safety, and effective operations. The priorities for NBME will be to continue to innovate — because things are changing so rapidly — in order to continue to meet the needs of health professionals.

    That’ll mean focusing on competencies in addition to medical knowledge. Things like critical reasoning, communication, professionalism, and other competencies ensure that we have high-quality healthcare professionals.

    How have the exams evolved?

    Communication skills, as an example, are something that NBME is focused on and has new assessments to address. The goal is to help people have better communication with their patients and families.

    There are specific components of communication skills, in terms of creating a connection to the individual that you’re communicating with and communicating clearly in language that everyone can understand. It’s empathy.

    Are there any other trends that you’re seeing in how future doctors are tested and trained?

    One obvious trend is how AI will inform the development and assessment of skills. NBME has focused a lot on how we can use AI to support the human actions involved in providing human-centric care, as well as on the ethical use of AI.

    When professionals are presented with information from AI, how do they evaluate it critically and ensure that they’re getting the right information to support particular circumstances? And then, also, how can NBME use AI to help streamline the examination development process?

    What does the future of medicine look like?

    The future of medicine is going to be highly collaborative, with health professionals across all disciplines working together to meet people’s needs. There’ll also be more focus on what happens in the home.

    How do we help professionals work with patients outside of the normal office setting or hospital setting? You see it on the consumer side with wearables and having much more information at your fingertips that can help support the care that’s provided to you in more formal settings.

    How do you feel about becoming the next CEO?

    It’s an organization that is already performing at a very high level, and I’m just excited to be able to continue to help advance the mission.

  • My husband was kicked out of hospice for dying too slowly

    My husband was kicked out of hospice for dying too slowly

    “No more operations,” he said.

    It was mid-January 2026, and my then-73-year-old husband, Mike Salmon, had just started bouncing back from a three-month ordeal of three operations related to aortic aneurysms, sepsis, and a terrifying descent into delirium tied to a stay in the intensive care unit. Now, after another potentially fatal aortic aneurysm and ambulance ride, the doctors clustered around his hospital bed said the fix involved two more major, risky operations.

    If Mike did nothing, the aneurysm or sepsis would likely kill him, they predicted. How soon? “Weeks,” one doctor said. “I’m astonished I’ve made it this far,” Mike said. So, abruptly, we were shunted onto hospice care — the dead-end spur of the American medical system.

    Hospice agencies manage care for patients expected to die within six months. They don’t provide curative procedures or drugs. Instead, they aim to help families make terminally ill patients comfortable, typically at home, as an illness reaches its inevitable conclusion. Families provide most of the day-to-day care, and 85% have suggested they are very satisfied with their hospice’s services, which include supplies of drugs and medical equipment, and visits from nurses, therapists, and aides.

    More than 1.9 million Americans were enrolled in hospice in the last fiscal year. Over 80% of those patients stayed on hospice until they died — within four weeks, on average. But each year, about 6% of patients are kicked out because a hospice doctor decides they have stabilized or improved enough that they are no longer likely to die in the next six months.

    In May, Mike joined that select group. His experience in and out of the hospice system revealed surprising lessons about how families can manage care. And getting removed from hospice revealed a little-known process that can represent a welcome respite for families like ours — but can be devastating for patients with serious chronic illnesses.

    Here’s what we learned in our four months on and off hospice.

    Check before you choose

    “Choose one.” A hospital nurse handed me a list of local hospice agencies. The sooner we signed up, the sooner Mike could go home. Stunned by the suddenness of Mike’s health emergency, I just pointed to the name at the top of the alphabetical list, assuming they were pretty much the same.

    Big mistake. Medicare sets basic standards for the hospice agencies it reimburses, but some agencies are understaffed or poorly run. Amy Tucci, president of the Hospice Foundation of America, noted that some agencies provide extra therapy, aide support, and other services.

    The problems with the organization I had chosen started immediately. Staffers were often late. They entered inaccurate medical information on Mike’s paperwork and didn’t make corrections when alerted. Medicare allows you to quit or change agencies, so I asked neighbors for recommendations.

    That was a good start, but Kristina Newport, chief medical officer of the American Academy of Hospice and Palliative Medicine, said I should also have checked the quality ratings on Medicare’s Care Compare site and the National Hospice Locator. Those sites would have alerted me to our first agency’s low ratings. Ideally, Newport said, patients or caregivers should call their area’s top-rated agencies to find those that provide the services you need, such as staff members who speak the patient’s native language, provide spiritual care that aligns with the patient’s beliefs, or are stationed nearby to arrive quickly in an emergency.

    The local, long-established nonprofit that neighbors recommended handled the transfer seamlessly. Its staff was punctual, accurate, and kind. The chef’s kiss after we switched: A nurse from the original company we chose called to say she hoped I hadn’t initiated the change because of “concerns about our care of your mother.”

    Some people get better on hospice

    Research hasn’t yet fully explored why, but some people actually see their health improve under hospice care. Studies have found, for example, that hospice patients with congestive heart failure or lung cancer live about a month longer, on average, than similar patients in the standard medical system.

    Terry Berthelot, who teaches courses on elder law and hospice care at the University of Connecticut, said many patients benefit from hospice’s careful pain management and from leaving hospitals, where they risk infection and overtreatment. Returning home allowed Mike to get up and walk without waiting hours for an overworked nurse to unplug a bunch of monitors, and to enjoy real food. Also, the hospice nurse gave him medicine to help him sleep through the night. He soon started regaining weight and strength.

    You can flunk out of hospice for not dying quickly enough

    Medicare and many other insurers pay for hospice services only for patients whom physicians certify are likely to die within six months of the most recent assessment (not the date of enrollment), so hospice staffers regularly reassess patients. Medicare audits agencies to check for fraud and demands repayment of funds provided for care of patients its auditors deem have not proved to be terminal. Hospices, good and bad, worry about their bottom lines and Medicare’s fraud audits. They may feel pressure to discharge patients who threaten the organization’s finances, even though such discharges can remove important care. “Medicare is worried about fraud and abuse, not about people not getting enough care,” Berthelot said.

    Especially for diagnoses with uncertain prognoses — such as dementia — if a patient improves or even stabilizes, hospice physicians might discharge the patient because they can no longer certify a likelihood of death within six months.

    For some lucky reason, Mike’s aneurysm and sepsis held off. By early May, his wounds had healed, and his strength had improved enough that he returned to gardening, playing bridge, and whipping up his signature lattice-topped blueberry-cinnamon pies. While we appreciated the convenience of the nurse’s visits and the drug and medical supply delivery, we realized Mike no longer needed care, so we agreed with our agency’s decision to discharge him.

    For patients suffering from more debilitating diseases, discharges can be a “nightmare,” said Krista Harrison, a hospice researcher at the University of California-San Francisco. Discharges often happen quickly. Medicare requires that patients be given a minimum of two days’ notice.

    When Harrison’s stepfather, suffering from a neurodegenerative disease similar to Parkinson’s, was discharged because his health seemed to plateau, the family scrambled to replace and pay for hospice-provided equipment such as a hospital bed and oxygen supply, and they had to quickly find and hire aides to replace the hospice aides. “Just getting his prescriptions reestablished and filled was a big deal,” she said. Her stepfather died six weeks after discharge, she said.

    Do your homework to ensure appropriate care

    Arming yourself with information about your risks and rights can help you get the hospice care you need when you need it.

    • Know your diagnosis. Discharges are unlikely for most cancer patients. But patients with dementia, heart disease, and Parkinson’s often plateau. So they are disproportionately likely to be discharged, UCSF’s Harrison said.
    • Choose a highly rated hospice. Research shows for-profit hospice agencies are more likely to discharge patients than nonprofits. Medicare’s Care Compare site will alert you to which is which.
    • Keep your own records. Caregivers who can document, say, a patient’s growing need for eating assistance can help hospice staff approve continuing care, or build a stronger appeal, UCSF’s Harrison said.
    • Keep your family doctor more informed. Doctors “don’t have the financial interest” the hospice faces and could help you dispute a discharge, Berthelot advised.
    • Appeal quickly. Hospice agencies must provide information on appealing a discharge. But you must file the appeal (online or by phone) by noon on the day before the termination date, which may mean you have only a few hours if you’ve been given the minimum two days’ notice, said Wey-Wey Kwok, a senior attorney for the Center for Medicare Advocacy.
    • Reenroll. Patients can try reenrolling in hospice at any time. Another hospice agency may take you immediately. Or you can wait until the patient’s health declines and try reenrolling with your original hospice agency, the Hospice Foundation’s Tucci advised.

    That last option is our plan. For now, Mike and I are enjoying these unexpected bonus days. But whenever fate catches up with him, Mike said, he’s comforted to know he’ll get good care from the hospice’s staff. “They’ll try to improve the quality of what time I have left,” he said.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

  • Could GLP-1s help with alcohol use disorder? A Philly VA doctor is leading a national trial to find out.

    Could GLP-1s help with alcohol use disorder? A Philly VA doctor is leading a national trial to find out.

    A Philadelphia Veterans Affairs doctor is leading a national trial testing whether GLP-1 drugs could help patients with alcohol use disorder.

    The treatments, which work by mimicking a natural hormone in the body, have skyrocketed in popularity in recent years for diabetes and weight loss. People have also reported unexpected benefits for other conditions, from heart issues to kidney disease. GLP-1s may even help reduce cravings for addictive substances, including alcohol, opioids, and nicotine, early studies suggest.

    While some of the additional health effects have been well-studied, others, like alcohol use disorder, still need a robust trial to assess safety and efficacy.

    The upcoming trial will take place at 18 VA sites around the country, including Philadelphia, with the goal of recruiting 622 participants.

    “The driving force has been really the groundswell of anecdotal and observational data from folks,” said David Oslin, the psychiatrist leading the national trial.

    Recruitment for the trial starts this week and will likely take two years. Half of participants will be randomly selected to receive the treatment for six months, while the other half will receive a placebo with no active drug.

    Participants will not know whether they received the intervention — a study design that’s considered the gold standard for medical research.

    Alcohol use disorder affects roughly 28 million people nationwide. While there are many options to treat it — including psychosocial treatment, peer support groups, and medications — uptake is low.

    Fewer than 10% of people with alcohol use disorder receive any treatment in a given year. Oslin hopes GLP-1s, should they prove safe and effective, could improve that statistic.

    “The impact is potentially very big in the sense that this is a drug that people seem comfortable prescribing and using,” he said.

    He anticipates publishing the results in about three years.

    The Inquirer spoke with Oslin, who also serves as the chief of behavioral health at the Philadelphia VA, about the trial in an interview lightly edited for length and clarity.

    David Oslin serves as the chief of behavioral health at the Philadelphia VA Medical Center and a professor of psychiatry at the University of Pennsylvania. He is leading the national trial.Courtesy of the VA
    What inspired the trial?

    Anecdotally, folks that have been receiving the GLP-1s for something else — diabetes or weight loss — had noticed a decline in use of alcohol.

    There have subsequently been three small clinical trials in the U.S. that have been published. They wouldn’t be sufficient to define efficacy from an FDA perspective, but they’re certainly encouraging.

    Each of them have their own little pitfalls. One of them is small — 40 subjects — so we wouldn’t want to change clinical practice based on that. But they certainly point us in the direction that we need a large trial, and this trial was designed specifically with FDA requirements in mind.

    How is this trial different?

    Semaglutide is already FDA-approved. What you would want to be able to do is change the existing label to add the indication of alcohol use disorder.

    The FDA has a number of requirements for trials in this domain for alcohol use disorder. One is that the duration be a minimum of six months, and we are doing that. The other is that it be a sufficient sample size to test a hypothesis. For our trial, we are hoping to enroll 622 veterans over the course of the next couple of years. That would be sufficient to answer the question of, ‘Is there efficacy and is there safety?’

    What is the theory behind how GLP-1s could treat alcohol use disorder?

    We know that GLP-1s have three main effects on the body.

    One effect is to induce the pancreas to release more insulin. The second effect is that it slows down the stomach’s emptying when you eat. The third effect is on GLP-1 receptors in our brain. Those receptors actually respond to reward, and the natural effect of GLP-1s is to indicate that you’re full or that you don’t need any more to eat or drink.

    These medicines will have the effect of reducing your desire to want to drink more. They don’t take away your pleasure or your ability to enjoy life, but they will reduce excessive eating and excessive drinking — that’s the hypothesis that is driving the study.

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    Who can participate in the study?

    They have to be a veteran getting their healthcare through the VA. They have to be between 18 and 80. They have to be drinking sufficiently enough to meet criteria for moderate to severe alcohol use disorder. You also can’t be on insulin and can’t be taking another medication for diabetes.

    The 18 sites would take any veteran and screen them, and if they’re not appropriate for the trial, we would get them into the right care for their needs.

    How could having a GLP-1 as an option improve uptake?

    A lot of folks that have alcohol use disorder will not seek treatment in a specialty care setting. They don’t think of their symptoms as being that severe. So they’ll talk to their primary care doctor.

    We need treatments that primary care providers are comfortable delivering. The current medicines are not medicines that they often prescribe, so they’re not used to using them. Meanwhile, they’re prescribing GLP-1s for diabetes and weight loss, so they clearly are comfortable prescribing them.

    There’s a lot of potential here that this could become a front-line treatment for folks, and we could reach many more people to get them in treatment. We need to establish the safety and efficacy first.

    How big of an impact could that have?

    The early clinical trials show that the effect of the treatment is actually larger than our current treatments, which would be really great if that’s replicated. It really could shepherd in a new era of being able to treat more people than we’ve been able to treat in the past.

    Is there anything else you would like to share?

    We want to really make sure that these compounds are safe in this population. I know that you can get these compounds pretty much anywhere these days, and I would discourage people from doing that when we don’t know that they’re safe and efficacious.

    Alcohol use disorder is a devastating illness, and people should feel comfortable reaching out for help. Even if they can’t get into the study, the VA is here to assist them in that journey and try to find them a path to sobriety and a better life.

    Veterans who need support can contact the Veterans Crisis Line 24/7. You don’t need to be in immediate crisis or enrolled in VA care to reach out. Dial 988 and press 1, visit VeteransCrisisLine.net/Chat, or text 838255 to connect with trained responders who can help with next steps.

    Those interested in participating in the clinical trial in Philadelphia can call: 215-823-5800 extension 203404.

  • Inspira Medical Center Mullica Hill doubles the size of its maternity unit

    Inspira Medical Center Mullica Hill doubles the size of its maternity unit

    Inspira Medical Center Mullica Hill has doubled the size of its maternity unit to meet rising demand.

    The updated maternity unit, which opened this week, is part of Inspira’s $257 million expansion project at the Mullica Hill hospital that includes a new five-story tower for surgery, intensive care, education and residency programs, and additional parking.

    The maternity unit doubled its size, to a total of 36,000 square feet, and increased the number of beds to 38, up from 20. The extra space is intended to give families more privacy and improve patient flow from delivery to recovery.

    “Opening this expanded maternity unit is an important step forward for families across South Jersey and for the future of Inspira Medical Center Mullica Hill,” Lydia Stockman, executive vice president and chief clinical officer at Inspira Health, said in a statement.

    Inspira opened the Mullica Hill hospital in late 2019, and it has quickly become one of the system’s busiest hospitals in a growing South Jersey community.

    The hospital had 1,374 births last year.

    The new patient tower, expected to open in 2027, will add more beds and an observation unit to ease strain on the emergency department. It will also include a surgery unit, intensive care beds, and a neuro ICU.

  • Hospital staff aren’t explaining medication side effects to one in three Philly patients, survey says

    Hospital staff aren’t explaining medication side effects to one in three Philly patients, survey says

    Philadelphia-area patients say they are often being left in the dark about side effects that could result from new medications given during hospitalizations, even though hospitals are required to explain the potential risks.

    One in three patients at Philadelphia-area hospitals claimed that staff did not consistently explain possible side effects of medication, according to a leading patient satisfaction survey conducted annually by the Centers for Medicare and Medicaid Services.

    To gauge the patient experience, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey asks questions about the hospital environment and how staff treated them during their stay. These quality indicators are less tangible than closely watched rates of infections or falls but still can offer meaningful insight into hospital culture and help administrators identify gaps in care.

    The regional hospitals where large portions of patients surveyed reported not being told about medication side effects included three operated by the Virtua health system in New Jersey. About 40% of patients at Our Lady of Lourdes, Mount Holly, and Willingboro said staff had “never” or only “sometimes” explained side effects.

    “These survey results reinforce that it is not enough for patients to receive clear information most of the time,” Jen Khelil, executive vice president and chief clinical officer at Virtua, said in a statement.

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    “Our goal is for every patient to feel fully informed about new medications, including their potential side effects, every time,” Khelil said.

    Medication safety

    The most recent HCAHPS report, released in June, includes responses from about 2.3 million patients across the country, including nearly 32,000 from Philadelphia-area hospitals, between July 2024 and June 2025.

    The survey covers topics such as noise levels, room cleanliness, staff friendliness, and whether they would overall recommend the hospital.

    Among the questions: Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?

    Patients can answer “never,” “sometimes,” “usually,” or “always.” The survey results published by CMS combine “never” and “sometimes” answers.

    These multiple-choice answers are subjective. But generally speaking, doctors and nurses should strive to always explain side effects, said Jeffrey Millstein, an internist and regional medical director for Penn Primary Care who regularly writes about the doctor-patient relationship as an Inquirer contributor.

    Patients who do not fully understand potential side effects may disregard a dangerous complication as “normal.” Alternatively, a common, harmless side effect could be alarming to a patient who wasn’t educated about what to expect when taking a new medication, he said.

    “They need to know the real red flags, and to not discontinue their medicine for the wrong reason,” he said.

    In busy medical settings, staff may focus on other aspects of medication adherence, such as explaining what the medication does, instructions for when and how to take it, and whether it will negatively mix with a patient’s other medications. Side effects may be mentioned last, quickly, or by telling patients to refer to a manufacturer’s pamphlet with warnings.

    “That’s really useless,” Millstein said. “It doesn’t put anything in context.”

    Doctors and nurses should open a conversation about side effects by asking patients what they know about a drug, or what concerns they have, which can allow staff to dispel inaccurate information, he said.

    Philadelphia-area hospitals respond

    Across the Philadelphia region, three Penn Medicine hospitals scored the highest marks for explaining medication side effects.

    More than half of survey respondents who stayed at Chester County Hospital, Penn Presbyterian Medical Center, and Hospital of the University of Pennsylvania said staff “always” explained side effects. About a quarter of respondents said they had received such information “sometimes” or “never” during their stay at the Penn hospitals.

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    Lower Bucks Hospital and Roxborough Memorial Hospital — both owned by California-based Prime Healthcare Foundation — received the region’s lowest marks for explaining side effects.

    Forty-five percent of survey respondents said Lower Bucks staff had “never” or only “sometimes” explained side effects, while 34% said they had “always” received such information during their stay.

    Michelle Aliprantis, a spokesperson for Prime, said the 2024-2025 data in the CMS survey does not reflect more recent efforts at the hospitals to improve bedside medication education and postdischarge follow-up. The health system has also expanded pharmacy consultation to ensure patients understand medications.

    “We are always focused on continued improvement,” Aliprantis said in a statement.

    Virtua’s chief medical officer said the health system closely monitors results from the CMS survey, which includes responses from about 2,000 patients across the New Jersey hospital system.

    Administrators review feedback from a total of some 300,000 consumers a year from satisfaction surveys, Google ratings, and other ratings systems.

    Virtua has been working to improve consistency and patient communication.

    “We remain committed to listening, learning, and improving so that every patient receives clear, compassionate, and consistent communication,” she said.

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  • Tower Health reported $8.5 million in operating profit for fiscal 2026

    Tower Health reported an $8.5 million operating profit in the year that ended June 30, compared to a $20.6 million loss the year before.

    The fiscal 2026 profit will be Tower’s first in eight years, if the result holds in its audited financial.

    In the Berks County nonprofit’s preliminary financial report to bond investors Friday, Tower management called the result “an important milestone in Tower Health’s ongoing journey toward sustained financial strength.”

    Recent moves by Tower to become financially stable included creating a clinical alliance with Jefferson Health, with the goal of bringing more advanced care to Tower’s markets, and laying off 160 workers — or 22% of the workforce — at Pottstown Hospital.

    In addition to Pottstown, Tower owns Phoenixville Hospital and Reading Hospital in West Reading, and half of St. Christopher’s Hospital for Children in North Philadelphia in a joint venture with Drexel University.

    Here are more details:

    Revenue: Tower reported a 2% increase in revenue, to $2.07 billion from $2.03 billion. Reading Hospital in West Reading logged an 11% increase in revenue, while the combined revenue of Phoenixville and Pottstown Hospitals fell 8%.

    Patient volumes: Pottstown saw an 11% decrease in hospital admissions, likely because Tower closed the hospital’s intensive care unit at the beginning of the this year. Phoenixville had a small gain of 0.7% in admissions, while Reading was flat. Total surgeries across the system were flat.

    Notable: A year ago, Tower reported a preliminary operating profit of $5.9 million for fiscal 2025, thanks to a gain on the sale of the former Brandywine Hospital. That would have been the system’s first profit in seven years, but it turned into a $20.6 million loss in Tower’s audited financial statements. Auditors from KPMG decided that Tower needed to boost medical malpractice reserves and give up on collecting millions owed by patients.

    In an email to The Inquirer, Tower CEO Michael Stern expressed confidence this year’s audit will uphold the preliminary result, giving Tower its first profitable year since 2017.

  • I treat brain fog. Here are 6 surprising causes many people overlook. | Expert Opinion

    I treat brain fog. Here are 6 surprising causes many people overlook. | Expert Opinion

    Q: A lot of people are talking about brain fog, and the symptoms sound exactly like me. How do I know if I have it, and is there a treatment?

    A: You walk decisively into the living room and pause just past the doorway. Why are you here? What was it you came to look for again?

    Maybe you’re chatting with a friend and there’s a phrase at the tip of your tongue — you were about to say something clever, but now you can’t find the right words. You feel embarrassed and annoyed with yourself.

    Or perhaps it’s not just one precise moment in your day — maybe the entire world feels enveloped in a haze you’re struggling to make sense of.

    That’s how a lot of my patients describe brain fog, a term that’s not an official diagnosis but is showing up in the medical literature more and more. Much of the recent discourse has focused on long COVID, but brain fog has become an important part of the conversation in many conditions, including perimenopause and hypothyroidism. It’s become enough of a buzzword that I’ve also heard from people wondering whether it’s even “a thing.”

    “Brain fog is real,” said Adam Hampshire, a brain fog researcher and a professor of cognitive and computational neuroscience at King’s College London. “It’s affecting people’s decisions, and it’s affecting their life. It’s really important not to be dismissive where that’s the case.”

    For me and most clinicians treating it, brain fog becomes a condition to investigate when it starts to interfere with your daily activities. On the extreme end, it can hinder the ability to hold down a job or care for family.

    But brain fog itself isn’t the diagnosis — it’s a symptom, Hampshire said. It should be viewed as a starting point to investigate the underlying cause. In some cases, people perform just fine on cognitive tests, but the tests feel harder to do. That’s part of why brain fog research is complicated, and people can feel dismissed if their cognitive tests come back “normal.” Brain fog probably isn’t one cohesive condition but a shared pattern of symptoms with many roots.

    Brain fog is an underappreciated symptom associated with common conditions like depression, anxiety, low thyroid function, and even early dementia. These are often the first diagnoses I consider — they can be assessed, and, if present, treated accordingly.

    Here are six other surprising conditions associated with brain fog — and what the data shows may help.

    Gut inflammation

    It turns out brain fog, in many cases, traces back to the gut. At least half of people with common GI disorders experience it. That’s why neurogastroenterologists like myself who study the gut-brain connection have come to focus so closely on what I call “gut fog.”

    In those with celiac disease, the overwhelming majority — upward of 80% — experience brain fog in addition to such classic GI symptoms as bloating and diarrhea. For about one-quarter, brain fog is the only symptom. Gluten triggers small bowel inflammation that’s thought to spill over into the rest of the body, including the brain. In a small study of newly diagnosed patients with celiac disease, cognitive testing improved over a year on a gluten-free diet, and this correlated closely with how well the small bowel had healed.

    That close relationship between food and brain function isn’t limited to celiac disease: Ultra-processed foods are linked to lower attention scores and higher dementia risk even in the general population, probably through inflammatory pathways.

    This is why I advise most of my patients to eat an anti-inflammatory, Mediterranean-style diet that focuses on whole foods and fiber.

    Long COVID

    In 2024, a group of researchers from Ireland published a study of long COVID patients in Nature Neuroscience involving persistent changes to the blood-brain barrier, the rugged membrane that regulates what can pass from bloodstream to the brain.

    The clue had come from an unexpected place: a study that found rugby players and martial arts fighters with memory problems that lingered for months after a concussion, even with normal head CTs, who turned out to have disrupted blood-brain barriers. So, in 2020, when patients who had recovered from COVID started describing lingering “brain fog,” it sounded familiar.

    Using a special contrast dye injected into the bloodstream, the scientists compared a group of long COVID patients who reported brain fog with a group of long COVID patients who didn’t. In those without brain fog, the dye stayed where it should — outside the brain. But in the patients with brain fog? It leaked through, and their brain scans lit up.

    Other studies on brain fog in long COVID patients have shown changes to the electrical waves in the brain and signs of poor blood flow in certain areas.

    So what actually helps here? The honest answer: We’re still figuring that out, but there have been some promising studies. A randomized trial published in 2026 found that 10 weeks of cognitive rehabilitation, one-on-one video sessions that help patients build concrete strategies to meet their own goals, led to improvement in brain fog symptoms that lasted at least six months.

    Perimenopause and menopause

    Brain fog is one of the most common complaints of the menopause transition. Up to 60% of women experience some form of it — often trouble with finding words or remembering names or numbers. Data from the Study of Women’s Health Across the Nation suggests that for most women, these changes are mild and do not persist after perimenopause.

    The leading theory is related to the role of estrogen in the brain, specifically the regions governing memory and executive function. Women who experience hot flashes tend to perform worse on memory testing.

    Most high-quality randomized trials have not found a cognitive benefit from hormone replacement therapy for people going through natural menopause — even when hot flashes and overall quality of life improve.

    In general, the same important principles to protect the aging brain still apply: regular exercise, with resistance training being especially important for women during menopause; a Mediterranean-style diet; staying socially engaged; and minimizing alcohol intake.

    Sleep apnea

    People often equate sleep apnea with snoring, but that’s not necessarily the case: Up to 40% of women with sleep apnea don’t snore, don’t have nighttime choking episodes, and don’t have witnessed episodes during which they stop breathing.

    Brain fog, however, is a common complaint, and objective cognitive impairment affects over a third of people with sleep apnea. A four-year study of over 1,100 adults found that people with new or existing sleep apnea showed faster declines in attention, visual processing, and memory, with measurable changes in the brain’s white matter, compared with adults without sleep apnea.

    It’s estimated that 75% of women with sleep apnea remain undiagnosed. Early recognition is key because treatment with CPAP therapy can make a big difference.

    Vitamin B12 deficiency

    People who are at risk of vitamin B12 deficiency, such as adults older than 65, those who have had certain gastrointestinal surgeries, and vegans, may benefit from an evaluation if they experience brain fog.

    It’s worth noting: A study from 1988 in the New England Journal of Medicine found that 28% of patients with neuropsychiatric symptoms from a B12 deficiency had normal blood levels.

    But if you have risk factors for a deficiency, a different set of blood tests can help get to the bottom of it.

    This absolutely doesn’t mean we should all be rushing to get extra B12. If you don’t have a deficiency on a blood test and have no specific risk factors, further testing may not be warranted, and vitamin B12 supplementation can be a waste of money.

    Chronic pain

    Cognitive difficulties are so prevalent in fibromyalgia, a chronic pain condition, that patients have their own name for it: “fibro fog.”

    The prevailing hypothesis is that managing constant pain consumes brain bandwidth and resources that would otherwise go toward memory and attention. And because many people with chronic pain sleep poorly, their symptoms compound.

    Besides addressing sleep issues and other pain management strategies, moderate aerobic exercise has been shown to improve both cognitive performance and overall fibromyalgia symptoms.

    What I want my patients to know

    There are many other conditions linked to brain fog, including multiple sclerosis and fatigue.

    It’s important to discuss brain fog early with a physician in part because there are so many potential underlying causes — several of which we can treat effectively.

    Trisha Pasricha is a physician and scientist at Beth Israel Deaconess Medical Center and an assistant professor of medicine at Harvard Medical School. She is the author of “You’ve Been Pooping All Wrong.”