JAMA Network Open最新文献

{"title":"Retention in Opioid Agonist Therapy Among First Nations People.","authors":"Alice Holton, Bisola Hamzat, Daniel McCormack, Sacha Bragg, Bernadette deGonzague, Graham Mecredy, Tonya Campbell, Tony Antoniou, Lorrilee McGregor, Jonathan Bertram, Tara Gomes","doi":"10.1001/jamanetworkopen.2025.18452","DOIUrl":"10.1001/jamanetworkopen.2025.18452","url":null,"abstract":"<p><strong>Importance: </strong>First Nations people are disproportionately impacted by the opioid crisis in Canada. While many First Nation communities have expanded access to treatment, there is a need to better understand the factors associated with early discontinuation of opioid agonist therapies (OAT).</p><p><strong>Objective: </strong>To investigate factors associated with OAT retention within the first year of treatment among First Nations people in Ontario, Canada.</p><p><strong>Design, setting, and participants: </strong>This was a population-based retrospective cohort study including all registered (status) First Nations people aged 15 years or older initiating OAT between January 2013 and March 2021. Data were analyzed between October 2022 and June 2024.</p><p><strong>Exposure: </strong>Methadone and buprenorphine-naloxone initiation.</p><p><strong>Main outcomes and measures: </strong>The main outcome was duration of OAT treatment, with discontinuation defined as a gap in therapy of more than 14 days. Cox proportional hazards models followed up individuals until the first occurrence of OAT discontinuation, death, end of 1-year follow-up, or switching between OAT treatments.</p><p><strong>Results: </strong>A total of 17 880 OAT initiations among 7476 individuals (median [IQR] age, 31 [26-38] years; 8966 [50.1%] female) were identified, including 9074 new episodes of buprenorphine-naloxone and 8806 new episodes of methadone. Time to treatment discontinuation was shorter among buprenorphine-naloxone episodes (median [IQR], 42 [5-321] days) compared with methadone episodes (median [IQR], 71 [10-544] days) (P < .001). Several factors were associated with buprenorphine-naloxone and methadone retention, including living in moderately sized urban areas (buprenorphine-naloxone: adjusted hazard ratio [aHR], 0.81; 95% CI, 0.70-0.95; methadone: aHR, 0.79; 95% CI, 0.70-0.90) and being recently dispensed non-OAT opioids (buprenorphine-naloxone: aHR, 0.86; 95% CI, 0.80-0.94; methadone: aHR, 0.86; 95% CI, 0.79-0.93). In contrast, factors associated with higher rates of discontinuation included recent opioid toxic events (buprenorphine-naloxone: aHR, 1.36; 95% CI, 1.20-1.54; methadone: aHR, 1.24; 95% CI, 1.11-1.38), and recent methadone treatment (buprenorphine-naloxone: aHR, 1.09; 95% CI, 1.01-1.18; methadone: aHR, 1.67; 95% CI, 1.57-1.78). Methadone discontinuation increased over time; however this pattern was not observed for buprenorphine-naloxone.</p><p><strong>Conclusions and relevance: </strong>This cohort study among First Nations people found low rates of OAT retention. Although retention was higher for methadone, it declined over time. These findings highlights important gaps in OAT provision for First Nations people that may be improved by investments into First Nations-led treatment programs that integrate traditional, land-based programs to better support people with opioid use disorder across Ontario.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2518452"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicians' Perceptions About Institutional Factors in Moral Distress Related to Potentially Nonbeneficial Treatments.","authors":"Teva D Brender, Julia K Axelrod, Sofia Weiss Goitiandia, Jason N Batten, Elizabeth W Dzeng","doi":"10.1001/jamanetworkopen.2025.16089","DOIUrl":"10.1001/jamanetworkopen.2025.16089","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Clinicians commonly experience moral distress related to potentially nonbeneficial life-sustaining treatments (LST). Hospitals' institutional culture (eg, shared beliefs, values, and practices), structures (eg, policies, practices, resource allocation), and societal-level factors (eg, national culture, local and national policies, medical hierarchies) may contribute to moral distress related to potentially nonbeneficial LST.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate clinicians' perspectives on how hospitals' institutional culture and structures might exacerbate, prevent, or mitigate the influence of societal factors contributing to moral distress related to potentially nonbeneficial LST.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This qualitative study used comparative ethnographic methods. Semistructured, in-depth interviews were conducted between February 2018 and June 2022 at 4 West Coast academic hospitals selected for their varying intensities of end-of-life care. Interview participants were hospital-based clinicians (eg, nurses, physicians), hospital leaders (eg, unit nursing and medical directors), and administrators with differing clinical backgrounds and professional responsibilities. Data were analyzed in 2 phases, from January 2019 to December 2022 and from June to September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Clinicians were asked about their hospitals' institutional culture and structures and their relationship to clinicians' experiences of moral distress related to potentially nonbeneficial LST in end-of-life care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 122 interviews were conducted (75 physicians [61%]; 22 nurses [18%]; 6 advanced practice clinicians [6%]; 68 [56%] women; mean [range] age, 42 [27-74] years). Respondents felt hospitals' institutional culture and structures could exacerbate moral distress. Respondents reported that a hospital culture of health care consumerism influenced clinicians', patients', and families' expectations for treatment intensity, contributing to morally distressing situations. Nurses and primary team physicians felt constrained by medical hierarchies, leading to perceptions of disempowerment and moral distress. Clinicians also reported that institutions lacked sufficient structures to support efforts to de-escalate potentially nonbeneficial treatments. However, respondents also reported that hospitals' institutional culture and structures could prevent or mitigate moral distress. Respondents felt policies empowering clinicians across the medical hierarchy to participate in decision-making reduced moral distress. They reported that institutional resources could manage conflicts and provide emotional support when moral distress occurs. Furthermore, respondents felt that clinician-driven quality improvement initiatives and supportive hospital leaders could address hospitals' institutional cultural and structural contributors t","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2516089"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Projected Trends in Metabolic Dysfunction-Associated Steatotic Liver Disease Mortality Through 2040.","authors":"Xinrong Zhang, Sovann Linden, Charles R Levesley, Xinyuan He, Zhanpeng Yang, Scott D Barnet, Ramsey Cheung, Fanpu Ji, Mindie H Nguyen","doi":"10.1001/jamanetworkopen.2025.16367","DOIUrl":"10.1001/jamanetworkopen.2025.16367","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Population-based data for metabolic dysfunction-associated steatotic liver disease (MASLD)-related mortality trends and forecasts in the United States are limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine MASLD-related mortality trends in the United States from 2006 to 2023 and forecast mortality rates up to 2040 overall and in subgroups by age, sex, race and ethnicity, and urbanization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used data from the National Vital Statistics System dataset. Data on deaths attributed to MASLD were obtained for adults aged 25 years and older from January 1, 2006, to December 31, 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Trends were evaluated by average annual percentage change (AAPC) in age-standardized mortality rates (ASMRs) per 100 000 persons, and mortality rates were forecasted to 2040 using projection models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 27 961 decedents aged 25 years and older with MASLD (15 251 [54.5%] aged ≥65 years; 15 450 [55.3%] female; 3373 [12.1%] Hispanic, 1480 [5.3%] non-Hispanic Black, and 21 936 [78.5%] non-Hispanic White) were documented from 2006 to 2023. ASMRs rose from 0.25 to 1.27 per 100 000 persons, with AAPCs increasing from 9.27% in 2006 to 2018 to 22.66% in 2018 to 2021, then decreasing to -1.23% from 2021 to 2023, leading to projected ASMRs of 2.24 per 100 000 persons in 2040. There were significant differences in the increases of ASMRs by age, with those aged 65 years or older having the steepest rise (AAPC, 15.34%; 95% CI, 14.40%-16.32%; P &lt; .001; 45-64 years: 8.76%; 95% CI, 7.29%-10.22%; P &lt; .001; 25-44 years: 2.65%; 95% CI, 0.49%-4.86%; P = .02) and a projected increase from 3.69 per 100 000 persons in 2024 to 7.12 per 100 000 persons in 2040. However, there was no significant difference in ASMRs by sex (AAPC among women: 11.24%; 95% CI, 10.09%-12.40%; P &lt; .001; AAPC among men: 11.04%; 95% CI, 9.56%-12.63%; P &lt; .001). ASMRs rose for all major racial ethnic groups, with the highest ASMR increase observed for non-Hispanic White individuals (AAPC, 11.12%; 95% CI, 9.48%-12.83%; P &lt; .001), followed by Hispanic (AAPC, 10.67%; 95% CI, 9.11%-12.26%; P &lt; .001), non-Hispanic Black (AAPC, 9.20%; 95% CI, 7.32%-11.11%; P &lt; .001), and non-Hispanic Asian (AAPC, 7.97%; 95% CI, 4.66%-11.75%; P &lt; .001) individuals, while the projected values for these 4 groups showed similar increasing trends to 2040. There were also significant differences in ASMRs by metropolitan categories overall, with the highest rise in nonmetropolitan areas (AAPC, 13.50%; 95% CI, 10.70%-16.32%; P &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cross-sectional study, MASLD-related mortality increased rapidly between 2006 and 2023 and was projected to rise over the next 20 years, with the largest disparities among those aged 65 years and older, among non-Hispanic White and Hispanic individuals, and among n","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2516367"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Neuroendocrine Neoplasms in the US.","authors":"Arvind Dasari, Katrine Wallace, Daniel M Halperin, Jessica Maxwell, Pamela Kunz, Simron Singh, Beth Chasen, James C Yao","doi":"10.1001/jamanetworkopen.2025.15798","DOIUrl":"10.1001/jamanetworkopen.2025.15798","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Neuroendocrine neoplasms (NENs) are increasing in incidence; prevalence and at the same time, practice patterns have also evolved, impacting classification and survival of these malignant neoplasms. However, updated epidemiological data are lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To define the epidemiological and survival trends of patients with NENs in the US.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program on NEN cases from 1975 to 2021. Analysis of project data was conducted between August 2023 and August 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Annual age-adjusted incidence between 1975 and 2021, limited duration prevalence, and overall survival (OS) rates. Recent trends in survival were evaluated from 2000 to 2021 for the entire cohort as well as specific subgroups including distant stage gastrointestinal neuroendocrine tumors (NETs) and pancreatic NETs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this analysis of 145 447 NEN cases (mean [SD] age, 61.4 [14.7] years; 76 057 female [52.4%]), the age-adjusted incidence rate increased 5.2-fold from 1975 (1.64 per 100 000 persons; 95% CI, 1.43-1.87 per 100 000 persons) to 2021 (8.52 per 100 000 persons; 95% CI, 8.33-8.70 per 100 000 persons) except for a dip in 2020 likely related to the COVID pandemic. This increase occurred across all sites, stages, and grades but was most marked for localized stage neoplasms (13-fold; 1975: 0.40 per 100 000 persons [95% CI, 0.30-0.52]; 2021: 5.04 per 100 000 persons [95% CI, 4.78-5.30]), well-differentiated neoplasms (53-fold; 1975: 0.04 per 100 000 persons [95% CI, 0.02-0.09]; 2021: 2.30 per 100 000 persons [95% CI, 2.13-2.48]), and neoplasms with the appendix (12-fold; 1975: 0.11 per 100 000 persons [95% CI, 0.09-0.22]; 2021: 1.68 per 100 000 persons [95% CI, 1.39-1.78]) or rectum (12-fold; 1975: 0.11 per 100 000 persons [95% CI, 0.06-0.18]; 2021: 1.32 per 100 000 persons [95% CI, 1.19-1.46]) as primary sites. Since 2000 (SEER 17 registry), the sites with the highest incidence rates included lung (1.49 per 100 000 persons) and gastroenteropancreatic (GEP) NENs (6.1 per 100 000 persons); within GEP NENs, small bowel (1.4 per 100 000 persons) and pancreas (1.3 per 100 000 persons) were the most common sites. The estimated 20-year limited duration prevalence of NENs in the US on January 1, 2021, was 243 896 cases. OS for all NENs improved from the 2000-2006 period to the 2014-2021 period (hazard ratio [HR], 1.42; 95% CI, 1.38-1.45). In addition, other factors associated with survival included age, stage, grade, and primary site of origin. The median OS for all NENs was 11.8 years, and for distant-stage, well-differentiated neuroendocrine tumors it was 6.7 years with 10-year OS ranging from 17 410 patients (15.4%) with rectum as primary site to 17 505 patients (51.7%) with small b","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2515798"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Household Firearm Access Among Adolescents-Opportunities for Firearm Injury Prevention.","authors":"Ali Rowhani-Rahbar","doi":"10.1001/jamanetworkopen.2025.14449","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.14449","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514449"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online Transdiagnostic Emotion Regulation Treatment for Adolescents With Mental Health Problems: A Randomized Clinical Trial.","authors":"Katja Sjöblom, Katri Frankenstein, Lars Klintwall, Jannike Nilbrink, Maria Zetterqvist, Hugo Hesser, Erik Hedman-Lagerlöf, James J Gross, Clara Hellner, Martin Bellander, Johan Bjureberg","doi":"10.1001/jamanetworkopen.2025.14871","DOIUrl":"10.1001/jamanetworkopen.2025.14871","url":null,"abstract":"<p><strong>Importance: </strong>Mental health problems are common during adolescence, but access to effective treatments is limited. Transdiagnostic treatments could address this treatment gap, but their feasibility, acceptability, and effectiveness remain unknown.</p><p><strong>Objective: </strong>To test the feasibility and acceptability of an online emotion regulation treatment for adolescents with mental health problems and investigate the preliminary effects on clinical outcomes and the target mechanism, emotion regulation.</p><p><strong>Design, setting, and participants: </strong>This single-blind randomized clinical trial was conducted between October 16, 2022, and July 28, 2023, in a primary care setting in Sweden. Participants in the intention-to-treat analysis were adolescents aged 12 to 17 years with mental health problems and their parents.</p><p><strong>Intervention: </strong>Participants were randomized 1:1 to 6 weeks of therapist-guided online transdiagnostic emotion regulation treatment or an active control condition consisting of 6 weeks of online supportive treatment.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were feasibility and acceptability measures, including consent rate, completion of assessments, adherence, credibility and expectancy ratings (Credibility/Expectancy Questionnaire), and treatment satisfaction (Client Satisfaction Questionnaire), immediately after treatment. Clinical outcomes, rated by blinded assessor, included global symptom severity and improvement, symptoms of depression and anxiety, global functioning, and emotion regulation.</p><p><strong>Results: </strong>A total of 30 adolescents (mean [SD] age, 14.2 [1.48] years; 28 females [93%]) were randomized to experimental treatment (n = 15) or active control treatment (n = 15). The consent rate (30 of 37 eligible participants [81%]) and rate of assessment completion immediately after treatment (28 [93%]) were high. Adherence, credibility, expectancy, and satisfaction in both groups were adequate. Participation in the experimental condition, but not the control condition, was associated with large within-group reductions in symptom severity (effect size, 1.30; 95% CI, 0.73-1.86) and symptoms of anxiety and depression (Cohen d, 1.07; 95% CI, 0.37-1.84), improved global functioning (Cohen d, 1.26; 95% CI, 0.66-1.85), and reductions in maladaptive cognitive coping (Cohen d, 1.10; 95% CI, 0.52-1.70) immediately after treatment.</p><p><strong>Conclusion and relevance: </strong>In this randomized clinical trial, a brief online transdiagnostic emotion regulation treatment targeting adolescents with mental health problems was found to be feasible, acceptable, and potentially efficacious in primary care and may increase treatment outreach and accessibility for this population.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05032547.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514871"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Artificial Intelligence for Gatekeeping in Referrals to Specialized Care.","authors":"Piter Oliveira Vergara, Jeronimo de Conto Oliveira, Rita Mattiello, Alfredo Montelongo, Rudi Roman, Natan Katz, Leandro Krug Wives, Dimitris Varvaki Rados","doi":"10.1001/jamanetworkopen.2025.13285","DOIUrl":"10.1001/jamanetworkopen.2025.13285","url":null,"abstract":"<p><strong>Importance: </strong>Integrating artificial intelligence (AI) technologies into gatekeeping holds significant potential, as it efficiently handles repetitive tasks and can process large amounts of information quickly.</p><p><strong>Objective: </strong>To develop and assess the accuracy of an AI model that enhances the gatekeeping process for referrals to specialized care.</p><p><strong>Design, setting, and participants: </strong>This diagnostic study comprised referrals from primary care to endocrinology, gastroenterology, proctology, rheumatology, and urology from a retrospective administrative database of patients in Brazil between June 2016 and April 2019. Analysis was performed between December 2022 and July 2024.</p><p><strong>Main outcomes and measures: </strong>The algorithm's development and testing comprised 2 stages. Multiple AI models were initially evaluated to train and test the algorithm for categorizing referrals as authorizing or requiring additional information. Subsequently, the model's performance was assessed against an independent set of referrals. Additionally, the current (human) evaluations of gatekeepers were evaluated against the standard. The reference standard was the consensus of 2 physicians with extensive experience. Accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC-ROC) were assessed.</p><p><strong>Results: </strong>The electronic system retrieved 45 039 eligible referrals for the development stage (mean [SD] patient age, 51.9 [15.8] years; 25 458 women [56.5%]). An algorithm utilizing word embeddings and a neural network proved the most effective. In the second phase, 1750 referrals (350 for each specialty) showed a 32% authorization rate according to the reference standard. The AI model achieved an overall accuracy of 0.716 (95% IC, 0.694-0.737), with a sensitivity of 0.542 (95% CI, 0.501 to 0.582) and specificity of 0.801 (95% CI, 0.777 to 0.822). Regarding individual specialties, rheumatology exhibited the highest accuracy (0.811; 95% IC, 0.767-0.849), while proctology had the lowest (0.649; 95% IC, 0.597-0.697). The overall AUC-ROC was 0.765 (95% IC, 0.742-0.788). When compared against the consensus standard, the AI model had higher accuracy and specificity and lower sensitivity than the current approach.</p><p><strong>Conclusions and relevance: </strong>In this diagnostic study of referral data, a novel AI model effectively distinguished between referrals that warranted immediate authorization and those that required further information with moderate accuracy; it had higher specificity and lower sensitivity than gatekeepers decisions. Implementing this AI model in the gatekeeping process should combine human judgment and AI support to optimize the referral process.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2513285"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectionality of Sexual Orientation, Race, and Ethnicity in Medical School Attrition.","authors":"Mytien Nguyen, Dowin Boatright, John Paul Sánchez, Alexandra M Hajduk, Shruthi Venkataraman, Meghan O'Connell, Allison Aviles, Pradeep Rajbhandari, Sarwat I Chaudhry","doi":"10.1001/jamanetworkopen.2025.14515","DOIUrl":"10.1001/jamanetworkopen.2025.14515","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514515"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oseltamivir Treatment vs Supportive Care for Seasonal Influenza Requiring Hospitalization.","authors":"Anthony D Bai, Siddhartha Srivastava, Thuwiba Al Baluki, Fahad Razak, Amol A Verma","doi":"10.1001/jamanetworkopen.2025.14508","DOIUrl":"10.1001/jamanetworkopen.2025.14508","url":null,"abstract":"<p><strong>Importance: </strong>Current guidelines recommend oseltamivir treatment for all patients hospitalized with influenza, but this guidance is based on suboptimal evidence.</p><p><strong>Objective: </strong>To evaluate outcomes associated with oseltamivir treatment when compared with supportive care for severe seasonal influenza requiring hospitalization.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study using target trial emulation included adult patients admitted to hospital with influenza from 30 hospitals in Ontario, Canada, from January 2015 to June 2023. Data were analyzed from November 2024 to March 2025.</p><p><strong>Exposure: </strong>Oseltamivir treatment on hospital day 0 or 1 vs supportive care without oseltamivir.</p><p><strong>Main outcome and measures: </strong>The primary outcome was in-hospital mortality. Secondary outcomes included time to being discharged alive and readmission within 30 days. Overlap weighting of propensity scores was used to balance covariates, and a competing risk model was used to compare time to being discharged alive.</p><p><strong>Results: </strong>Of 11 073 patients (mean [SD] age, 72.6 [16.8] years; 5793 female [52.3%]), there were 7632 patients (68.9%) and 3441 patients (31.1%) in the oseltamivir and supportive care groups, respectively. In hospital, 268 patients (3.5%) and 168 patients (4.9%) in the oseltamivir and supportive care groups died, respectively, with an adjusted risk difference of -1.8% (95% CI, -2.8% to -0.9%; P < .001). The oseltamivir treatment group was more likely to be discharged alive (adjusted subdistribution hazard ratio, 1.20; 95% CI, 1.15 to 1.25; P < .001). After discharge, 645 patients (8.5%) and 336 patients (9.8%) were readmitted in the oseltamivir and supportive care groups, respectively, with an adjusted risk difference of -1.5% (95% CI, -2.8% to -0.2%; P = .02).</p><p><strong>Conclusions and relevance: </strong>In this cohort study of patients hospitalized with influenza, oseltamivir treatment was associated with a lower in-hospital mortality risk, earlier discharge, and lower readmission rate, supporting evidence for the current guideline recommendation of oseltamivir treatment for severe influenza. Clinical trials are needed to definitively answer this question.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514508"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recombinant Zoster Vaccination and Risk of Postherpetic Neuralgia or Zoster Ophthalmicus.","authors":"Ousseny Zerbo, Joan Bartlett, Bruce Fireman, Kristin Goddard, Jonathan Duffy, Jason Glanz, Allison L Naleway, James G Donahue, Tara C Anderson, Nicola P Klein","doi":"10.1001/jamanetworkopen.2025.14615","DOIUrl":"10.1001/jamanetworkopen.2025.14615","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 6","pages":"e2514615"},"PeriodicalIF":10.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}