Literature Review

Proposed framework for setting practical and ethical boundaries in medicineJAMA Internal Medicine; Sarah C. Hull, MD, MBE; Nancy R. Angoff, MD, MPH, MEd; 2/25At a national conference session addressing challenges for women in cardiology, one of us (S.C.H.) was struck by a junior attending physician’s account of her struggle to establish boundaries, expressing her desire to be helpful and collaborative as well as her reticence to decline requests lest she appear unkind. Reflecting on my own experience, I realized that women are often socialized to avoid saying no for fear of disappointing others or appearing selfish, but this socialization has not served us well. Indeed, this is a common refrain we have heard from young women entering the medical profession. Our anecdotal experience matches data suggesting that, compared with men, women are more likely to be asked and less likely to decline low-promotability task requests.

Pursuing equity with artificial intelligence in health careJAMA Health Forum; Kevin B. Johnson, MD, MS; Ivor B. Horn, MD, MPH; Eric Horvitz, MD, PhD; 1/25The National Academy of Medicine defines equitable AI as “applications accompanied by proof of appropriate steps to ensure fair and unbiased development and access to AI-associated benefits and risk mitigation measures.” Health care–providing organizations deploying AI must take responsibility for monitoring and achieving equitable performance. There is much to learn as we face the challenge of understanding how AI applications affect long-standing inequities and discovering the best ways to harness AI to address them. By embedding equity considerations at every stage of AI development and deployment, the US can start to take meaningful steps toward using AI’s growing capabilities to tackle pressing problems in health care. 

Risk factors for and health status of socially isolated adultsJAMA Network Open; Tarun Ramesh, BS; Kushal Kadakia, MSc; Marcela Horvitz-Lennon, MD, MPH; Joshua Breslau, PhD, ScD; Hao Yu, PhD; 1/25In 2023, the Surgeon General issued an advisory on the epidemic of loneliness and social isolation, calling for more research and policy interventions to address these challenges. The overall prevalence of social isolation in our study was 3%, which is lower than other determinants of health, such as smoking, poverty, and inadequate health insurance. Our results indicate 3 broad and likely interrelated populations at risk for social isolation, including racial and ethnic minority groups, those with financial insecurity (ie, unemployed, uninsured, lower income), and those with chronic health conditions, with depression being a large factor. We also found that the socially isolated adults reported worse health status compared with those without social isolation.

Measures to prevent and control COVID-19 in skilled nursing facilities-A scoping reviewJAMA Health Forum; Benjamin E. Canter, OTD; Agne Ulyte, MD; Brian E. McGarry, PhD; Michael L. Barnett, MD, MS; 1/25Skilled nursing facilities (SNFs) experienced high mortality during the COVID-19 pandemic, leading them to adopt preventive measures to counteract viral spread. This scoping review identified 16 preventive measures, both nonpharmacologic (eg, staffing, visitor restrictions) and pharmacologic (eg, vaccines, antivirals) interventions. Nonpharmacologic measures were widely implemented but lacked evidence for effectiveness, whereas vaccinations and antivirals showed substantial benefits but were underutilized; up-to-date vaccination status was suboptimal in residents and staff and only a minority of infected residents received antiviral treatment.

Long-term health care use among children surviving multiple organ dysfunctionJAMA Network Open; Robert Ohman, MD, MPH; Jerry J. Zimmerman, MD, PhD; 1/25Mortality outcomes of pediatric critical illness have improved over the last several decades, while concurrently the population of patients with technology dependency and complex chronic morbidities has continued to grow and the incidence of MOD [multiple organ dysfunction] has simultaneously increased. In the setting of declining critical illness mortality, pediatric outcomes research has broadened its scope to assess metrics beyond mortality, describing the trajectory of recovery from critical illness with measures of patient quality of life; physical, cognitive, and functional status; and family psychological and economic well-being. As the authors point out, assessment of the larger financial impact of this higher health care utilization on families themselves would be valuable future knowledge, as high health care utilization, appointments, and recurrent hospitalizations may detract from families’ ability to work, care for their other children, and attend to their own medical needs. Targeted support for families of survivors of MOD may be necessary to minimize these secondary impacts and to optimize outcomes for this vulnerable population of patients.

Brain biomarkers for pain sensitivityJAMA Neurology; Prasad Shirvalkar, MD, PhD; Christopher J. Rozell, PhD; 1/25Identifying objective biomarkers that track individual pain severity has been dubbed “the holy grail” of pain neuroscience. Chronic pain affects up to one-fifth of US adults, and its complexity is attributed to a confluence of physical, emotional, and cognitive factors that contribute to suffering and disability. The epidemic of chronic pain initially contributed to the rise of the opioid epidemic and continues to plague nearly all fields of clinical medicine. Identifying and validating biomarkers to predict individual risk for chronic pain facilitate a precision medicine approach to pain medicine. Despite the unknown provenance of the proposed biomarkers, the results of the present study have the potential to aid in the practical development of personalized pain management strategies.

Reimagining care and research for Amyotrophic Lateral SclerosisJAMA Neurology; Suma Babu, MBBS, MPH; Joshua M. Sharfstein, MD; Eva L. Feldman, MD, PhD; 1/25Amyotrophic lateral sclerosis (ALS) is a fatal neurological disease involving progressive motor neuron degeneration. In 2022, US Congress and the National Institutes of Health (NIH) commissioned the National Academies of Science, Engineering and Medicine (NASEM) to identify priorities to make ALS a livable disease within a decade. After extensive deliberations and input from the public, researchers, and persons with lived experience, the committee released its report, Living With ALS. To accelerate progress in patient care and therapeutics, one of the report’s major recommendations was for the National Institute of Neurological Disorders and Stroke (NINDS) to fund a clinical trials network dedicated to ALS that is distributed across diverse geographic regions and integrated within a novel hub-and-spoke system of care and research for ALS. The hubs are ALS Centers of Excellence that provide patient care and research, both basic and clinical, while the spokes represent a large number of community and regional ALS clinics that provide care and link to hubs for research. By integrating ALS clinical trials within this structure, we have the potential to transform ALS care, drive innovation in ALS therapeutic development, and pave the way for breakthroughs in other neurodegenerative diseases. 

Factors influencing the self-reported palliative care practices of acute care nursesWestern Journal of Nursing Research; Keshia Kotula, Catherine Dingley, Du Feng, Lori Candela, Megan Pfitzinger Lippe; 1/25 Provision of palliative care in acute care settings is significantly lacking despite evidence that early integration leads to better patient/family-related outcomes and improved healthcare cost and efficiency. A descriptive, cross-sectional design was used to examine the effects of personal and environmental factors on nurses’ palliative care practices in the acute care setting. Personal factors, especially self-efficacy and attitudes toward care of the dying, are the most significant influencing factors to the frequency of acute care nurses’ palliative care practices.

Underused palliative care could aid stroke survivorsJAMA; Samantha Anderer; 1/25Every year in the US, 800,000 people experience strokes, and although most survive, current treatment plans fail to adequately address their physical, emotional, psychosocial, and spiritual distress, according to a new scientific statement from the American Heart Association. Palliative care could aid in the quality of life for both patients and their families by helping during all stages of poststroke care, including adapting to functional changes, navigating complex health care systems, and preparing for death when necessary. Although all affected individuals could benefit from palliative care, the statement noted that it is most underused in Black and Hispanic populations, which tend to have a higher incidence of stroke, worse functional outcomes, and a lower likelihood of receiving acute stroke treatments.

Access tops list of Americans' healthcare concerns: 4 survey findings Becker's Clinical Leadership; by Erica Carbajal; 2/5/25A quarter of Americans rank healthcare access and affordability as the top public health priority they want government leaders to focus on, according to poll findings from Gallup and Emory University's Rollins School of Public Health. ... Four key findings:

Care for patients with a history of immigrationJAMA; Margaret Wheeler, MS, MD; Juan Raul Gutierrez, MD; Alicia Fernandez, MD; 1/25Home to 20% of the world’s immigrants, the US is the leading destination for people leaving their birth countries, and the US Census estimates that almost 14% of the US population in 2022 was born outside the US. ... The 2023 US Preventive Services Task Force Guideline on screening for latent tuberculosis recommends screening for tuberculosis in patients from Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia because in 2020, 71% of cases of active tuberculosis in the US occurred among individuals from these areas. Assessment of clinically relevant premigration factors involves consideration of the epidemiology of disease, health care practices, and sociopolitical and environmental exposures in an immigrant’s country of origin. These factors can alter risk assessment in differential diagnoses; for example, neurocysticercosis should be considered in the differential diagnosis of seizures in a patient from Central America.

The National Donor Family Council: History, activities, achievements, and legaciesOmega-Journal of Death and Dying; Margaret B Coolican, Charles A Corr; 1/25The National Donor Family Council (NDFC) functioned under the sponsorship of the National Kidney Foundation from 1992-2014. Giving voice to the needs and views of donor families, the NDFC had an important impact on the support for those families. This article records significant points in the advocacy of donor families, summarizes the history of the NDFC, highlights the various activities and achievements of the NDFC, and offers some impressions of its legacies.

Flaws in the Medicare Advantage Star RatingsJAMA Health Forum; David J. Meyers, PhD, MPH; Amal N. Trivedi, MD; Andrew M. Ryan, PhD; 1/25The objective of the star ratings is to help beneficiaries select better plans, and to reward plans that deliver high-quality care. In June 2024, a US district court judge ruled that the Centers for Medicare and Medicaid Services (CMS) inappropriately calculated Medicare Advantage (MA) Star ratings due to not implementing a previously announced statistical adjustment. First, it is not clear if the star ratings are actually capturing a higher quality, as several measures in the star rating are reported by the plans themselves and plans often overstate their performance. Second, over 80% of contracts by enrollment are rated 4 stars or higher, which is the threshold needed to earn bonus payments, and a single star rating is assigned to each contract even when contracts may cover many different states and regions. Third, while bonus payments for star ratings are costly, plans eligible for enhanced bonuses have not shown greater improvement in measures related to clinical quality or administrative effectiveness. Taken together, the current star ratings are neither useful for all beneficiaries to make their plan decisions, nor do they appear to be capturing quality or catalyzing improvement.