Raise the Line

In the United States, nearly 70% of people say they want to die at home, yet the majority still die in medical settings, often after receiving care that may not match their goals and values. Closing that gap between preference and reality is at the heart of the work being done by End Well, a nonprofit dedicated to transforming how we think about, plan for, and experience the end of life. "The gap isn't about people wanting the wrong things. It's that our culture and our incentives aren't aligned with helping those wishes actually happen at the end of life,” says Dr. Shoshana Ungerleider, End Well’s founder and president. 

As Dr. Ungerleider explains to Raise the Line host Michael Carrese, End Well sponsors an annual symposium and year-round activities to bring together clinicians, patients, caregivers, and innovators to improve that alignment. Key steps include earlier integration of palliative care, allowing providers time for listening and goal setting with patients, and normalizing conversations about what matters most to people.

This compelling conversation on reframing end of life care also covers how to bring wonder, joy, and hope into end-of-life conversations, and End Well’s work to change how death is portrayed in the media.

Mentioned in this episode:
End Well

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While Elsevier’s most recent Clinician of the Future Report shows increasing adoption of artificial intelligence tools among physicians and nurses, and optimism that they will improve quality of care in the future, a majority raised concerns about trust and reliability. To increase the level of trust, 60% said transparent citations of evidence-based and peer-reviewed research will be key.

How to provide that transparency is our focus today as Raise the Line host Lindsey Smith welcomes Elsevier colleagues Rhett Alden and Raman Kaur to guide us through the complexities involved, including the concept of traceability and what role it plays in how AI tools such as Elsevier’s ClinicalKey AI are built and deployed. 

“Traceability changes the confidence that a clinician has in an AI tool so that they aren’t trusting the AI, they’re trusting the underlying evidence they’re consuming from the AI-assisted platform,” says Raman, who brings years of experience as a primary care practitioner to her work. 

It's also important, Rhett adds, to provide additional information, pulled from both the clinician's query and the patient's medical record, to inform clinical thinking. “ClinicalKey AI can be more than a response engine by establishing a larger context to provide a more precise answer for that individual patient.”

In this thought-provoking discussion, these experts also provide insights on:

Mitigating bias in AI results;

Using AI responsibly with sustainability in mind;

What type of clinician will benefit most from AI

Mentioned in this episode:

ClinicalKey AI

Clinician of the Future Report

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It’s been one year since the U.S. Centers for Disease Control and Prevention, in an unprecedented move, dismissed all the members of its Advisory Committee on Immunization Practices (ACIP), kicking off what would turn out to be a very concerning and busy year for infectious disease specialists.  We’re going to recap this turbulent period – which includes a resurgence of measles, an unusually rough flu season, the emergence of a new COVID strain and outbreaks of hantavirus and Ebola – with Dr. William Schaffner, one of the country’s most frequently quoted medical experts on infectious disease, vaccination, and public health.

As a member of ACIP for decades, Dr. Schaffner brings unique insight into the dismantling of the committee and the distrust of vaccines that lies at the root of the changes. As he explains to Raise the Line host Lindsey Smith, while many vaccine critics are beyond reach, there are those he describes as vaccine hesitant that may be persuadable if the right approach is taken. “Beyond providing facts, we have to listen to them and respond to their concerns and make them feel comfortable. Information is fundamental, but behavior change only comes with a change in attitude.”

Tune in for a wealth of wisdom and context that includes observations on:

What’s complicating containment of the Ebola outbreak;

Challenges in public health communication in the current social media environment;

What grade health authorities should get on their response to the hantavirus outbreak.

Mentioned in this episode:
Vanderbilt University School of Medicine

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"Do nothing for us without us." According to today’s guest Robyn Bussey, that operating principle is the basis for effective community health work. "You don't go into a community and dictate. You go and listen and trust and be a partner," she adds. As you’ll learn in this enlightening conversation, Bussey is following that approach in her current work as Just Health Director at the Partnership for Southern Equity, an Atlanta-based nonprofit advancing racial equity and shared prosperity across the South. 

On this episode of Raise the Line from Elsevier, Bussey provides illuminating  examples of community-rooted work in South Fulton County and rural Georgia, and explains why community health workers may be the most underutilized asset in addressing health disparities.

This wide-ranging interview with host Michael Carrese also explores:

Bussey’s candid perspective on what happened to the surge of interest in health equity that occurred during COVID;

Why life expectancy gains in many Southern states have lagged behind the rest of the country;

Her advice to students and early-career clinicians about where they're needed most.

 

Mentioned in this episode:  Partnership for Southern Equity

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As concerns escalate about the deadly Ebola virus outbreak in Africa, we bring you the unique insights of Dr. Peter Piot, a renowned microbiologist who co-discovered the virus 50 years ago during the first recorded outbreak of the disease. His on-the-ground account of that crisis was provided to us in April before the current outbreak was declared, but it contains valuable historical perspective and shares lessons learned that he carried forward in his consequential career.  “What I saw from the beginning is the most important thing is to listen to people and that you need to act fast to save lives, before you have the evidence you would like to have.”   

He followed his contributions on Ebola by diving into the fight against HIV/AIDS, eventually reshaping global response in leadership roles at the World Health Organization and United Nations. As he shares with host Lindsey Smith, the learnings in that case were more pragmatic than scientific. “We had to redefine HIV/AIDS not as a medical problem but as an economic and security problem in order to get it on the political agenda.” 

Tune in for a fascinating episode that takes you from the gritty frontlines of public health crises to the battles for funding and attention in the halls of power as Dr. Piot shares what it actually takes to move the world to respond effectively to health threats.

Mentioned in this episode:

London School of Hygiene & Tropical Medicine

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