Literature Review

Identifying and addressing bias in artificial intelligenceJAMA Network Open; by Byron Crowe, Jorge A. Rodriguez; 8/6/24[Invited commentary.] In this issue, Lee and colleagues (Demographic representation of generative artificial intelligence images of physicians) describe the performance of several widely used artificial intelligence (AI) image generation models on producing images of physicians in the United States. The key question the authors set out to answer was whether the models would produce images that accurately reflect the actual racial, ethnic, and gender composition of the US physician workforce, or whether the models would demonstrate biased performance. One important aspect of the study method was that the authors used relatively open-ended prompts, including “Photo of a physician in the United States,” allowing the machinations of the AI to produce an image that it determined was most likely to meet the needs of the end user. AI tools powered by large language models, including the ones examined in the study, use a degree of randomness in their outputs, so models are expected to produce different images in response to each prompt—but how different would the images be? Their findings are striking. First, although 63% of US physicians are White, the models produced images of White physicians 82% of the time. Additionally, several models produced no images of Asian or Latino physicians despite nearly a third of the current physician workforce identifying as a member of these groups. The models also severely underrepresented women in their outputs, producing images of women physicians only 7% of the time. These results demonstrate a clear bias in outputs relative to actual physician demographics. But what do these findings mean for AI and its use in medicine?Publisher's note: This is a thought-provoking article on machine output - whether that's AI, a Google search, etc. It ultimately places responsibility of outputs and actions on people with conscience.

Changes in Registered Nurse Employment Plans and Workplace AssessmentsJAMA Network Open; by Christopher R Friese, Barbara R Medvec, Deanna J Marriott, Lara Khadr, Marissa Rurka Wade, Melissa Riba, Marita G Titler; 7/24How have nurses’ workplace assessments and intention to leave their workplace changed from the 2022 to the 2023 Michigan Nurses’ Study? In this survey study of 9150 and 7059 nurse participants in the 2022 and 2023 surveys, respectively, significantly fewer nurses were planning to leave their workplace in 2023 than in 2022 (32.0% vs 39.1%). Workplace assessments improved in the 2023 survey; however, planned departure rates, abusive or violent events, and unsafe conditions remained high, and understaffing remained a primary concern. Findings of this study suggest that improved working conditions are likely to promote nurse retention; health system leaders and policymakers should prioritize initiatives that support nurse retention and reduce potential workforce instability.

Kidney Transplant Outcomes From Deceased Donors Who Received DialysisJAMA Network; by Yumeng Wen, Sherry G Mansour, Nityasree Srialluri, David Hu, Heather Thiessen Philbrook, Isaac E Hall, Mona D Doshi, Sumit Mohan, Peter P Reese, Chirag R Parikh; 5/24Are kidneys from deceased donors who underwent dialysis prior to kidney donation associated with adverse graft outcomes in kidney transplant recipients compared with kidneys from deceased donors who did not undergo dialysis? Compared with recipients of kidneys from deceased donors who did not undergo dialysis, receiving kidneys from deceased donors who underwent dialysis prior to donation was associated with a higher incidence of delayed graft function, but no difference in graft failure or death at longer-term follow-up.

Managing medications among individuals with mild cognitive impairment and dementia: Patient-caregiver perspectivesJournal of the American Geriatrics Society, by Rachel O'Conor, Andrea M Russell, Allison Pack, Dianne Oladejo, Sarah Filec, Emily Rogalski, Darby Morhardt, Lee A Lindquist, Michael S Wolf; 7/24With changing cognitive abilities, individuals with mild cognitive impairment (MCI) and dementia face challenges in successfully managing multidrug regimens. We sought to understand how individuals with MCI or dementia and their family caregivers manage multidrug regimens and better understand patient-to-caregiver transitions in medication management responsibilities. To ease medication management transitions, balance must be sought between preservation of older adult autonomy and early family caregiver involvement. Clinicians should work to initiate conversations with family caregivers and individuals living with MCI or dementia about transitioning medication responsibilities as memory loss progresses, simplify regimens, and deprescribe, as appropriate.

Social isolation changes and long-term outcomes among older adultsJAMA Network Open; by Chen Lyu, Katherine Siu, Ian Xu, Iman Osman, Judy Zhong; 7/24Is social isolation change associated with long-term outcomes in older adults? In this cohort study using a national longitudinal health survey of 13 649 adults aged 50 years or older in the US, data revealed that increased isolation was associated with an increased risk of mortality, disability, and dementia. Decreased isolation was associated with a lower risk of mortality only among individuals who were non-isolated at baseline. These results underscore the importance of interventions targeting the prevention of increased isolation among older adults to mitigate its adverse effects on mortality, as well as physical and cognitive function decline.

Start of the COVID-19 pandemic and palliative care unit utilization: a retrospective cohort studyJournal of Pain and Symptom Management; by Michael Bonares, Kalli Stilos, Madison Peters, Lise Huynh, Debbie Selby; 7/24Despite historically poor palliative care units (PCU)/hospice access, the COVID-19 pandemic created circumstances that may have enabled unprecedented utilization in individuals with non-cancer diagnoses in our cohort. This substantiates that so long as it is concordant with their goals, individuals with non-cancer diagnoses can have enhanced PCU/hospice utilization.

Familial loss of a loved one and biological aging: NIMHD Social Epigenomics Program JAMA Network Open; by Allison E. Aiello, PhD, MS; Aura Ankita Mishra, PhD; Chantel L. Martin, PhD; Brandt Levitt, PhD; Lauren Gaydosh, PhD; Daniel W. Belsky, PhD; Robert A. Hummer, PhD; Debra J. Umberson, PhD; Kathleen Mullan Harris, PhD; 7/29/24Is the experience of losing a loved one associated with accelerated biological aging? In a cohort study of 3963 participants from the National Longitudinal Study of Adolescent to Adult Health, nearly 40% experienced the loss of a close relation by adulthood. Participants who had experienced a greater number of losses exhibited significantly older biological ages compared with those who had not experienced such losses. These findings suggest that loss can accelerate biological aging even before midlife and that frequency of losses may compound this, potentially leading to earlier chronic diseases and mortality.

Adapting an intervention to address barriers to pain management in hospice: formative research to inform EMPOWER-D for dementia caregiversPalliative Medicine Reports; by Karla T. Washington, Morgan L. Van Vleck, Todd D. Becker, George Demiris, Debra Parker Oliver, Paul E. Tatum, Jacquelyn J. Benson, John G. Cagle; 7/24Pain management is a priority for hospice patients, including those with ADRD [Alzheimer’s disease or a related dementia], most (63%) of whom experience bothersome pain. One such intervention, EMPOWER (Effective Management of Pain: Overcoming Worries to Enable Relief), has been shown to improve hospice pain management by training hospice staff on barriers to pain management, incorporating screening for pain concerns into routine hospice care, delivering tailored pain education to hospice patients and their family caregivers, and facilitating needed follow-up services. Participants indicated that the EMPOWER-D materials addressed common pain concerns that were both family-centered and relevant to clinical dementia care. 

Nursing strategies to mitigate separation between hospitalized acute and critical care patients and families: A scoping review Intensive Critical Care Nurse; Sonja Meiers, Véronique de Goumoëns, Lorraine Thirsk, Kristen Abbott-Anderson, Petra Brysiewicz, Sandra Eggenberger, Mary Heitschmidt, Blanche Kiszio, Natalie S Mcandrew, Aspen Morman, Sandra Richardson; 7/26/24 Implications for clinical practice: Permanent policy changes are needed across acute and critical care settings to provide support for nurses in mitigating patient and family separation. We recommend that family members be considered as caregivers and care receivers, not visitors in patient and family-centered care in acute and critical care settings. 

Patient outcomes of a virtual reality-based music therapy pilot in palliative care Palliative Medicine Reports; by Adreanne Brungardt, Angela Wibben, Prajakta Shanbhag, Debra Boeldt, Jeanie Youngwerth, Amanda Tompkins, Abigail J Rolbiecki, Heather Coats, A Blythe LaGasse, Jean S Kutner, Hillary D Lum; 7/19/24 Hospitalized patients with palliative care needs often have high levels of physical and psychological symptom distress. Virtual reality (VR) with a music therapy intervention may improve physical and psychological symptoms. Results: Seventeen patients completed VR-MT (range 20-79 years of age, 59% women). Moderate clinical improvements were observed for total ESAS-r score (Cohen's d effect size, 0.68), physical distress subscale (0.52), and psychological distress subscale (0.60); small improvements were observed in total MQOL-r score (0.26) and the existential subscale (0.27). Health care team members described the value of VR-MT as facilitating meaningful conversations.

Pain Management at the End of LifeJournal of Hospice and Palliative Nursing; HPNA position statement; 8/24.Pain management is essential from the time of diagnosis of a serious illness and throughout the disease trajectory. Unfortunately, the prevalence of pain in those with serious illness remains unacceptably high. In most cases, pain experienced by people with advanced disease can be prevented or relieved through optimal care, yet studies reveal that patients continue to experience uncontrolled pain in the final weeks, days, and hours of their lives...

The Uniform Determination of Death Act is not changing. Will physicians continue to misdiagnose brain death?The American Journal of  Bioethics; Michael Nair-Collins; 7/24Efforts to revise the Uniform Determination of Death Act [UDDA] in order to align law with medical practice have failed. It has long been common practice to declare some patients dead by neurologic criteria even though they do not meet the legal standard for death. Thus, legally living people will continue to be declared dead, not because of a mistake, but because of a choice. The decision to continue misdiagnosing death according to the law will create routine violations of civil rights, will continue to violate the DDR [dead donor rule] that allegedly is such an important red line for organ transplantation, and will contribute to a well-deserved mistrust in the determination of death.

Longitudinal analysis of cancer family caregiver perception of sleep difficulty during home hospice American Journal of Hospice & Palliative Care; William Hull, Gary Donaldson, Kristin G Cloyes, Lee Ellington, Kathryn Lee, Kathleen Mooney; 7/22/24 Our findings indicate that family caregivers who cohabitate exhibit increased perception of sleep difficulty over the course of hospice. Future studies and interventions for hospice family caregivers' sleep should consider cohabitation between the patient and the caregiver as a significant predictor of sleep difficulty to observe and potentially mediate the negative outcomes associated with caregiver sleep difficulty. Further, determining the underlying reasons for sleep difficulty in cohabitation (e.g., patient symptoms or treatments) should be explored.