Literature Review

US FDA approval of pediatric artificial intelligence and machine learning–enabled medical devicesJAMA Pediatrics; Ryan C. L. Brewster, MD; Matthew Nagy, MD, MPH; Susmitha Wunnava, PhD; Florence T. Bourgeois, MD, MPH; 12/24Despite rapid growth in the availability of AI/ML [artificial intelligence and machine learning]-enabled devices in recent years, only a small number have been authorized for pediatric use. The current regulatory framework may expose children to off-label use, differential performance of algorithms, and safety risks. Additionally, the lack of standardized reporting of pediatric device characteristics precludes informed decision-making by health care clinicians on appropriate device use. Pediatric AI/ML-enabled devices should be validated using representative datasets and should include complete and standard documentation on pediatric testing and authorization. Such changes will require cooperation across regulatory and industry stakeholders with a commitment to safe, equitable, and effective AI/ML development for children. 

Developing evidence-based health policy for dementia careJAMA Health Forum; Katherine Baicker, PhD; Kosali Simon, PhD; 12/24The rising prevalence of Alzheimer disease and related dementias (ADRD) represents a profound challenge to health care and long-term care systems. Promising diagnostic tools, medicines, and interventions for ADRD are on the horizon, but these medical advances will come with substantial costs. By 2050, the annual cost of care for patients with ADRD is projected to reach $1.5 trillion in the US, with 75% covered by Medicaid and Medicare. In addition to payment policy, the decision-making environment (what, when, and how information is presented and the way that different choices are framed) for both patients and clinicians will determine the quality and value of care delivered and how that varies across patient populations. With a rapidly aging population and rising prevalence of ADRD, the need for these efforts is urgent.

Heatwaves and neurodegenerative diseaseJAMA Neurology; Indu Subramanian, MD; Ali Saad, MD; 12/24In 2012, the Global Climate and Health Alliance drafted the Doha Declaration, a call to prioritize global policies that protect health from the effects of climate change. The number of people affected by heat waves increased by around 125 million between 2000 and 2016, and global ambient temperature is expected to increase 0.9 °F (0.5 °C) per year over the next 30 years. Heat stress is an underappreciated mechanism by which climate change impacts the health of people with neurodegenerative diseases. Given the high risk of heat-related complications in people living with neurodegenerative disease, it is critical to strengthen our evidence base to understand these risks and develop targeted solutions. 

Quality of hospices used by Medicare Advantage and traditional fee-for-service beneficiariesJAMA Network Open; Lindsay L. Y. White, PhD, MPH; Chuxuan Sun, MPA; Norma B. Coe, PhD; 12/24In this cross-sectional study including 4 215 648 decedents and 2 211 826 hospice enrollees, regular Medicare Advantage and fee-for-service beneficiaries enrolled in hospices of similar quality. However, beneficiaries in Medicare Advantage special needs plans were significantly more likely than fee-for-service beneficiaries to use hospices of inferior quality, with referral networks playing an important role in hospice quality choice. These results suggest that policymakers should consider incentivizing referrals to high-quality hospices and approaches to educating beneficiaries on identifying high-quality hospice care. 

Characteristics of patients enrolled in hospice presenting to the emergency department American Journal of Emergency Medicine; by Kayla P Carpenter, Fernanda Bellolio, Cory Ingram, Aaron B Klassen, Sarayna S McGuire, Alisha A Morgan, Aidan F Mullan, Alexander D Ginsburg; 12/9/24, online ahead of print Emergency Departments (EDs) frequently care for patients with life-limiting illnesses, with nearly 1 in 5 patients enrolled in hospice presenting to an ED during their hospice enrollment. This study investigates the reasons patients enrolled in hospice seek care in the ED, the interventions they receive, and their outcomes. ... Patients enrolled in hospice most frequently presented to the ED for trauma [36%; with 15% for pain, 12% for catheter/tube malfunction]. Most received laboratory studies and imaging. Nearly half of patients were admitted to the hospital and short-term mortality was high, particularly for patients enrolled in hospice for needs for ED care? Ie.,

The patient portal messaging crisisJAMA Neurology; Carrie K. Grouse, MD; Gregory J. Esper, MD, MBA; 12/24The patient portal has improved patient access to medical records and facilitated direct communication between patients and their health care teams, improving patient satisfaction, enhancing health care utilization, and increasing treatment adherence. Work associated with portal messaging has fallen primarily on physicians, requiring time outside clinical work hours to respond. Appointment access limitations have driven more asynchronous care delivery, resulting in more complex and time-consuming messages. This trend is causing higher levels of physician burnout, and female physicians are disproportionately affected. Burnout associated with excessive after-hours work in EHRs [electronic health records] is now noted among neurologists.

Promoting the resilience of health care information systems—The day hospitals stood stillJAMA Health Forum; Daniel B. Kramer, MD, MPH; Kevin Fu, PhD; 11/24On Friday, July 19, 2024, health care workers woke to emails declaring systemwide information technology (IT) emergencies. Because Crowdstrike had access to the most sensitive core parts of the Windows operating system, the automated process caused an immediate global outage of computer systems using the Crowdstrike Falcon product, which is embedded in many computer systems at health care organizations. Rather than accept this event as inherent to a complex, digitized, and wired health care ecosystem, we urge the US Congress, health care regulators, and the public to insist on proactive preventive methods to avoid future IT catastrophic events rather than simply waiting for the next disruptive crisis requiring an emergent response.

International comparison of underlying disease among recipients of medical assistance in dyingJAMA Internal Medicine; Brandon Heidinger, BSc; Colleen Webber, PhD; Kenneth Chambaere, PhD; Eliana Close, PhD; Luc Deliens, PhD; Bregje Onwuteaka-Philipsen, PhD; Thaddeus Pope, JD, PhD; Agnes van der Heide, MD, PhD; Ben White, DPhil, LLB, (Hons); James Downar, MD, MHSc; 12/24In 2023, 282 million individuals lived in jurisdictions allowing medical assistance in dying (MAID). But regardless of jurisdiction, cancer and amyotrophic lateral sclerosis (ALS) consistently account for up to 80% of MAID cases, despite accounting for fewer than 30% of all deaths. This observation is consistent with the idea that MAID is driven heavily by illness-related factors common to people with those illnesses and inconsistent with the idea that MAID is driven substantially by factors that are external to the individual and that vary by jurisdiction, such as eligibility criteria, culture, social assistance, or palliative care service availability. The overall incidence of MAID increased over time (per 1 calendar year ... )

Allostatic load, educational attainment, and risk of cancer mortality among US menJAMA Network Open; Cynthia Li, BS, MD; Sydney P. Howard, DrPH, MS; Charles R. Rogers, PhD, MPH, MS, MCHES; Sydney Andrzejak, MS; Keon L. Gilbert, DrPH; Keith J. Watts, PhD, MSW; Malcolm S. Bevel, PhD, MSPH; Myles D. Moody, PhD, MA; Marvin E. Langston, PhD; Judah V. Doty, MS; Adetunji T. Toriola, MD, PhD, MPH; Darwin Conwell, MD, MSc; Justin X. Moore, PhD, MPH; 12/24Social determinants of health, such as income, occupation, and education, can influence cancer disparities in men. Men with limited access to education and income are more likely to have high allostatic load (AL), a measure of cumulative physiologic stress on the body over time. Chronic stress triggers prolonged neuroendocrine responses, resulting in elevated proinflammatory cytokines, catecholamines, and other proteins. This overactivation can lead to physiologic dysregulation and can promote cancer development. The findings indicate that men with lower educational attainment and high AL face up to a 4-fold increased risk of cancer mortality and nearly 70% increased risk of cancer mortality when accounting possible confounders. 

[Germany] Challenges of regional hospice and palliative care networks: A group discussion study with coordinators and network expertsPalliative Medicine; Sven Schwabe, Hanna Aa Röwer, Christoph Buck, Eileen Doctor, Nils Schneider, Franziska A Herbst; 12/24Within hospice and palliative care, professionals from various disciplines collaborate to deliver comprehensive care to terminal patients and their relatives. Regional hospice and palliative care networks face numerous challenges relating to: (1) establishment and development, (2) infrastructure, (3) moderation, (4) public relations and information exchange, (5) education and training and (6) the development of regional care services and practices. Sustainable infrastructure, competent network governance and adequate resources for network members are essential for the success of regional hospice and palliative care networks. To improve networking, funding conditions should be simplified, the involvement of network partners should be improved and network coordinators should receive training in network management.

Families value flexibility and compassion in end-of-life care for children with cancer Hematology Advisor; by Megan Garlapow, PhD; 12/12/24 Bereaved families of children who died of cancer expressed a strong desire for high-quality end-of-life care that balanced comfort with continued treatment efforts, particularly chemotherapy, according to results from a study published in Cancer. Families did not perceive a conflict between comfort care and the pursuit of chemotherapy, seeking both as integral parts of their child’s final days. Despite variations in race and location, there was no clear preference for home or hospital deaths, ... Instead, decisions surrounding the location of death were often driven by the child’s preferences, medical needs, the impact on other family members, and prior experiences with death. ... Family decision-making was centered on maintaining hope, avoiding harm, and doing what was best for their child and themselves, with religious beliefs playing a significant role.

[Denmark] Opioids and dementia in the Danish populationJAMA Network Open; Nelsan Pourhadi, MD; Janet Janbek, PhD; Christiane Gasse, Dr rer medic; Thomas Munk Laursen, PhD; Gunhild Waldemar, DMSc; Christina Jensen-Dahm, PhD; 11/24This study found that opioid use of less than 90 TSDs [total standardized doses] was not significantly associated with increased dementia risk. Above 90 TSDs of opioid use was associated with an elevated dementia risk before age 90 years, which persisted in individuals with chronic noncancer pain and in individuals solely exposed to weak opioids. Further research should ascertain whether the findings denote causality between opioids and dementia risk.

[China] Psychological resilience and frailty progression in older adultsJAMA Network Open; Bo Ye, PhD; Yunxia Li, MPH; Zhijun Bao, PhD; Junling Gao, PhD; 11/24In this cohort study of community-dwelling older adults, a longitudinal association between PR [psychological frailty] and frailty progression was found. The results suggest that monitoring changes in PR can help forecast future frailty trajectories, particularly highlighting the need to support individuals facing declines in resilience. Targeted interventions that prioritize enhancing PR have potential to prevent and ameliorate frailty.