JAMA Network Open最新文献

{"title":"Reshaping Medical Education to Uplift First-Generation Medical Students.","authors":"Mytien Nguyen, Dowin Boatright, Hyacinth R C Mason","doi":"10.1001/jamanetworkopen.2025.9780","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.9780","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e259780"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971821","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":"Genetic Ancestry, Structural Racism, Social Determinants of Health, and Mortality Among Black Adults.","authors":"Leonard E Egede, Jennifer A Campbell, Rebekah J Walker","doi":"10.1001/jamanetworkopen.2025.10024","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.10024","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2510024"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002780","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":"Vehicle Age and Driver Assistance Technologies in Fatal Crashes Involving Teen and Middle-Aged Drivers.","authors":"Fangda Zhang, Christopher R M Rundus, Enas Alshaikh, Corinne Peek-Asa, Jingzhen Yang","doi":"10.1001/jamanetworkopen.2025.8942","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8942","url":null,"abstract":"<p><strong>Importance: </strong>Motor vehicle crashes are the leading cause of death for US teens. Newer vehicles and driver assistance technologies show promise in reducing crashes and injury severities; however, research on the age and technologies of vehicles driven by teens involved in fatal crashes is limited.</p><p><strong>Objective: </strong>To examine the differences in vehicle age and driver assistance technologies between vehicles driven by teen and middle-aged drivers involved in fatal crashes and to investigate the associations among vehicle age, driver assistance technologies, and driver death in these crashes.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used fatal crash data (2016-2021) obtained from the Fatality Analysis Reporting System. Data analysis was restricted to passenger vehicles. Participants included teen drivers (15-18 years old) and middle-aged drivers (31-55 years old). All analyses were performed between December 1, 2023, and July 25, 2024.</p><p><strong>Exposures: </strong>Exposures include the vehicle age (≤5, 6-15, or >15 years) and the number of driver assistance technologies installed (0 to 4).</p><p><strong>Main outcomes and measures: </strong>The main outcome was whether the driver died in fatal crashes. Multivariable logistic regressions examined the associations between vehicle age (or driver assistance technologies installed) and driver death in fatal crashes, adjusting for driver sex, restraint use, and crash year.</p><p><strong>Results: </strong>Among 81 145 drivers (49 838 male [61.4%]) involved in fatal crashes, there were 9809 teen drivers (mean [SD] age, 17.2 [0.9] years) and 71 336 middle-aged drivers (mean [SD] age, 41.7 [7.3] years). A higher proportion of teen drivers were operating vehicles older than 15 years compared with middle-aged drivers (2706 drivers [27.6%] vs 16 239 drivers [22.8%]). Driving vehicles aged 6 to 15 years (adjusted risk ratio [aRR], 1.19; 95% CI, 1.17-1.22) or older than 15 years (aRR, 1.31; 95% CI, 1.28-1.34) was associated with significantly higher odds of driver death in fatal crashes compared with driving vehicles 5 years old or newer, independently of driver age. Additionally, each installed driver assistance technology was associated with a 6% reduction (aRR, 0.94; 95% CI, 0.90-0.98) in the risk of driver death in fatal crashes.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that older vehicles and those with fewer driver assistance technologies are associated with increased risk of driver death in fatal crashes; thus, teens should drive the safest vehicles available, not older family cars. The findings underscore the urgent need to ensure teens drive safer vehicles to protect their lives.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258942"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12059974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003828","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":"Evaluation of an Ambient Artificial Intelligence Documentation Platform for Clinicians.","authors":"Cheryl D Stults, Sien Deng, Meghan C Martinez, Joseph Wilcox, Nina Szwerinski, Kevin H Chen, Stephanie Driscoll, Joanna Washburn, Veena G Jones","doi":"10.1001/jamanetworkopen.2025.8614","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2025.8614","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The increase of electronic health record (EHR) work negatively impacts clinician well-being. One potential solution is incorporating an ambient artificial intelligence (AI) documentation platform.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To understand clinician experience before and after implementing ambient AI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This quality improvement study was a pilot evaluation with before and after survey and EHR metrics conducted at a large health care organization in Northern and Central California. Clinicians were purposively sampled to be representative of region and specialty. Ambient AI was implemented in April 2024 with EHR data from 3 months before and after implementation. Data were analyzed from May to September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Ambient AI access.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Metrics of time were examined in notes per appointment, off-hour EHR activities (5:30 pm to 7:00 am on weekdays and nonscheduled weekends and holidays), documentation note length, progress note length, NASA Task Load Index (NASA-TLX) score, mini-Z burnout question, and overall experience. It was hypothesized that time in notes per appointment would decrease and clinical well-being would improve. Logistic regression and linear mixed-effect models were used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 100 clinicians (53 male [53.0%]; mean [SD] age, 48.9 [11.0] years), 58 clinicians (58.0%) were in primary care and 92 clinicians had EHR metrics. Among 57 clinicians who completed both preimplementation and postimplementation surveys, there was a decrease in burnout from 24 clinicians (42.1%) to 20 clinicians (35.1%), although this was not a significant difference (P = .12). Mean (SD) NASA-TLX scores all decreased after using ambient AI: mental demand of note writing (12.2 [4.0] to 6.3 [3.7]), hurried or rushed pace (13.2 [4.0] to 6.4 [4.2]), and effort to accomplish note writing (12.5 [4.1] to 7.4 [4.3]) (all P &lt; .001). Mean (SD) time in notes per appointment significantly decreased from 6.2 (4.0) to 5.3 (3.5) minutes (P &lt; .001), with a bigger decrease for female vs male clinicians (8.1 [3.9] to 6.7 [3.6] minutes vs 4.7 [3.5] to 4.2 [3.1] minutes; P = .001). More primary care clinicians (33 of 38 clinicians [85.8%]) reported that ambient AI improved overall satisfaction at work compared with clinicians in medical (4 of 11 clinicians [36.4%]) and surgical (4 of 8 clinicians [50.0%]) subspecialties (P &lt; .001). After adjusting for participant characteristics, model results suggested that mean scores for NASA-TLX decreased for mental demand (-6.12 [95% CI, -7.52 to -4.72]), hurried or rushed pace (-6.96 [95% CI, -8.42 to -5.50]), and effort to accomplish note writing (-5.57 [95% CI, -6.93 to -4.21]), while mean time in note taking decreased by less than 1 minute per appointment (0.91 minutes [95% CI, -1.20 to -0.62 minutes]) (all P &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e258614"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025443","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":"Error in Introduction.","authors":"","doi":"10.1001/jamanetworkopen.2025.15018","DOIUrl":"10.1001/jamanetworkopen.2025.15018","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2515018"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013180","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":"Long-Term Survival in Patients With Low-Risk Cervical Cancer After Simple, Modified, or Radical Hysterectomy.","authors":"Christopher M Tarney, Chunqiao Tian, Leslie M Randall, S Ahmed Hussain, Pouya Javadian, Sean P Cronin, Sara Drayer, John K Chan, Daniel S Kapp, Chad A Hamilton, Charles A Leath, Doris M Benbrook, Christina R Washington, Kathleen N Moore, Nicholas W Bateman, Thomas P Conrads, Neil T Phippen, G Larry Maxwell, Kathleen M Darcy","doi":"10.1001/jamanetworkopen.2025.10717","DOIUrl":"10.1001/jamanetworkopen.2025.10717","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Three-year pelvic recurrence rate in women with low-risk cervical carcinoma was not inferior following simple hysterectomy (SH) vs modified radical hysterectomy (MRH) or radical hysterectomy (RH) in the Simple Hysterectomy and Pelvic Node Assessment randomized clinical trial, but the survival analysis of the trial was underpowered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate long-term survival in low-risk cervical carcinoma following SH vs MRH or RH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study included women undergoing SH, MRH or RH in US Commission on Cancer-accredited facilities participating in the National Cancer Database who received a diagnosis between January 2010 and December 2017 of International Federation of Gynecology and Obstetrics 2009 stage IA2 or IB1 squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix (≤2 cm) and clinically negative lymph nodes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;SH, MRH, or RH following diagnosis of stage IA2 or IB1 squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Survival was the primary end point, evaluated with and without propensity score balancing. Survival rates, survival distributions, adjusted hazard ratio (aHR) of death, and restricted mean survival times (RMST) were analyzed as of September 2024. Two multivariable models were fitted. Model 1 included the hysterectomy type and 9 baseline factors (age, comorbidity score, race and ethnicity, insurance status, treatment facility, stage, histologic subtype, tumor grade, and surgical approach). Model 2 included the model 1 variables plus 4 additional clinical factors (surgical margin, LVSI, pathologic LN metastasis, and adjuvant treatment).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This cohort study evaluated 2636 women (mean [SD] age, 45.4 [11.4] years; median [IQR] follow-up, 85 [64-110] months), including 982 with SH, 300 with MRH, 927 with traditional RH, and 427 with unspecified MRH or RH. Survival was similar following SH vs MRH or RH (7 year survival rate, 93.9%; 95% CI, 91.9%-95.4% vs 95.3%; 95% CI, 94.0%-96.3%%; P = .07) and SH vs MRH vs RH (7 year survival rate, 93.9%; 95% CI, 91.9%-95.4% vs 94.2%; 95% CI, 90.1%-96.7% vs 95.4%; 95% CI, 93.6%-96.6%; P = .15). Risk of death following either SH vs MRH or RH, SH vs RH, or MRH vs RH remained similar after adjusting for baseline covariates alone or baseline covariates plus clinical factors. Survival remained similar within subsets by age, comorbidity score, race and ethnicity, facility type, stage, histologic subtype, tumor grade, surgical approach, and year of diagnosis. Adjusted survival remained similar in patients with SH vs MRH or RH after propensity score balancing for baseline covariates (aHR, 1.19; 95% CI, 0.86-1.65; P = .31) with similar 3-year (98.3%; 95% CI, 97.2%-99.0% vs 97.6%; 95% CI, 96.6%-98.2%), 5-year (95.9%; 95% CI, 94.3","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2510717"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077987","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":"An Intervention to Increase Advance Care Planning Among Older Adults With Advanced Cancer: A Randomized Clinical Trial.","authors":"Angelo E Volandes, Yuchiao Chang, Joshua R Lakin, Michael K Paasche-Orlow, Charlotta Lindvall, Seth N Zupanc, Diana Martins-Welch, Maria T Carney, Edith A Burns, Jennifer Itty, Kaitlin Emmert-Tangredi, Narda J Martin, Shreya Sanghani, Jon Tilburt, Kathryn I Pollak, Aretha Delight Davis, Cynthia Garde, Michael J Barry, Areej El-Jawahri, Lisa Quintiliani, Kate Sciacca, Julie Goldman, James A Tulsky","doi":"10.1001/jamanetworkopen.2025.9150","DOIUrl":"10.1001/jamanetworkopen.2025.9150","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Many older adults with advanced cancer never communicate goals of care or treatment preferences to their clinicians, raising the risk that care received will not match their values. Scalable models of care may help surmount this barrier.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To test whether a combined patient and clinician intervention increased the rate of advance care planning (ACP) documentation in large health care systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This stepped-wedge cluster randomized clinical trial using an open cohort design included patients aged 65 years or older with advanced cancer seen at oncology clinics in 3 health care systems located in the US South, Midwest, and Mid-Atlantic regions from April 1, 2020, to November 30, 2022. Data collection ended in 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;The intervention involved delivering brief evidence-based patient-facing video decision aids available in 25 languages as well as goals-of-care communication training to oncology clinicians. Patients in the control period received usual care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was ACP documentation, which included any electronic health record documentation of a goals-of-care conversation, palliative care, hospice, or limitation of life-sustaining treatments, identified via a validated natural language processing program. Analysis was performed on an intention-to-treat basis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-nine practices, comprising 13 800 unique eligible patients with a total of 29 357 repeated measurements, were included (mean [SD] age, 74.5 [6.6] years; 52.3% men [15 344 of 29 357 measurements]). The proportion of patients with ACP documentation was greater in the intervention phase compared with the usual care phase (adjusted rate difference, 6.8% [95% CI, 2.8%-10.8%]; P &lt; .001). ACP documentation in the intervention phase occurred among 3980 of 15 754 patients (25.3%) (goals-of-care conversation, 21.4% [3377 of 15 754]; palliative care, 9.6% [1517 of 15 754]; hospice, 5.4% [847 of 15 754]; and limitation of life-sustaining treatments, 7.2% [1128 of 15 754]). In comparison, ACP documentation in the usual care phase occurred among 2834 of 13 603 patients (20.8%) (goals-of-care conversation, 16.8% [2281 of 13 603]; palliative care, 9.5% [1287 of 13 603]; hospice, 5.3% [724 of 13 603]; and limitation of life-sustaining treatments, 8.4% [1149 of 13 603]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this stepped-wedge cluster randomized clinical trial for older adults with advanced cancer, a bundled evidence-based decision aid and communication training intervention increased the proportion of older patients with ACP documentation. This approach offers an innovative paradigm with a clinically meaningful increase in ACP documentation, a widely used quality metric that reflects high-quality patient-centered care delivery.&lt;/p&gt;&lt;p&gt;&lt;strong","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e259150"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967672","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":"Behavioral Health Flag Use by Race and Ethnicity in a Pediatric Emergency Department.","authors":"Danielle Foltz, Gia M Badolato, Theresa Ryan Schultz, Shilpa J Patel, Asha S Payne, Sephora Morrison, Meleah Boyle, Monika K Goyal","doi":"10.1001/jamanetworkopen.2025.9502","DOIUrl":"10.1001/jamanetworkopen.2025.9502","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Behavioral health flags are intended to serve as safety alerts for staff by identifying patients at risk of aggression but may also be prone to racial bias, leading to inequities in care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate racial and ethnic differences in the use of an aggression risk evaluation tool and being labeled as high aggression risk in the electronic health record among youths presenting to a pediatric emergency department.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study of electronic health record data was conducted at a single-center pediatric emergency department. Visits from patients aged 21 years or younger presenting with mental health-related concerns between January 2020 and December 2022 were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Patient race and ethnicity (Hispanic, non-Hispanic Black [hereafter, Black], non-Hispanic White [hereafter, White], or other, which includes individuals who identify as American Indian or Alaska Native, Asian, multiple races, or any other race).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcomes were (1) the use of an aggression risk evaluation tool by a psychiatric social worker, (2) being labeled with a high aggression risk behavioral health flag, or (3) being labeled with a high aggression risk behavioral health flag with a history of violent behavior documented with no other aggression risk behaviors documented. Separate logistic regression models were used to examine association of race and ethnicity with each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 5121 visits for mental health concerns. The majority of patients were female (3198 patients [62.5%]) and publicly insured (3161 patients [61.8%), with a mean (SD) age of 13.8 (2.7) years. With regard to race and ethnicity, 3061 patients (59.8%) were Black, 893 patients (17.4%) were Hispanic, 778 (15.2%) were White, and 389 (7.6%) belonged to other racial and ethnic groups. Most visits (4119 visits [80.4%]) had an aggression risk evaluation tool completed, and 627 (15.2%) were labeled with a high aggression risk behavioral health flag. There were no racial and ethnic differences in use of the aggression risk evaluation tool. Compared with White youths, Black youths were more likely to be labeled as high aggression risk (60 White youths [9.8%] vs 486 Black youths [19.8%]; adjusted odds ratio, 1.71; 95% CI 1.24-2.35). Among patients who had a history of violent behavior and no other aggression risk behaviors documented on the evaluation tool, Black patients had higher odds of being labeled as high aggression risk compared with White patients (72 Black patients [32.4%] vs 3 White patients [10.7%]; odds ratio, 4.00; 95% CI, 1.16-13.69).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this cross-sectional study, Black youths were more likely to be labeled with a high aggression risk behavioral health flag despite similar responses to a","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e259502"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013209","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":"Change in Optic Nerve Sheath Diameter and Cerebral Ventricular Shunt Failure in Children.","authors":"Adrienne L Davis, Mark Tessaro, Suzanne Schuh, Armaan K Malhotra, Maya Sumaida, Magali Gauthey, Onaiza Zahid, Sara Breitbart, Helen M Branson, Suzanne Laughlin, Brian W Hanak, Abhaya V Kulkarni","doi":"10.1001/jamanetworkopen.2025.11009","DOIUrl":"10.1001/jamanetworkopen.2025.11009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Ocular point-of-care ultrasonography (POCUS) may be a clinically useful method to evaluate shunt dysfunction for children with hydrocephalus presenting to the emergency department (ED).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether a change in the optic nerve sheath diameter (ONSD) from prior asymptomatic baseline was associated with shunt failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Participants in this prospective single-center observational cohort study at a tertiary care children's hospital were enrolled from January 5, 2018, to March 2, 2022. Children 18 years or younger with cerebrospinal fluid (CSF) shunts were consecutively recruited during routine asymptomatic visits in the outpatient neurosurgery clinic. The institution sees approximately 1000 children with shunts. Children with comorbid eye pathologic conditions known to increase the ONSD were excluded, as were those with shunt interventions between baseline and symptomatic ocular POCUS. Data analysis was completed in May 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Baseline ocular POCUS was performed on asymptomatic children with CSF shunts recruited in the outpatient neurosurgery clinic; a second ocular POCUS was performed if the patient subsequently presented to the ED with symptoms of shunt failure. Change in ONSD from prior asymptomatic baseline to symptomatic presentation was the main study exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Shunt failure was defined as intraoperative confirmation of inadequate CSF flow through the shunt system associated with identifiable shunt complications, including catheter or valve obstruction, shunt tubing fracture or disconnection, or proximal catheter migration out of the ventricle within 96 hours from presentation to the ED.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Seventy-six pairs of baseline and symptomatic ultrasonograms from 58 patients (mean [SD] age, 6.6 [4.7] years; 36 of 58 boys [62%]) were included. Twenty patients (35%) had 2 or more prior shunt revisions, and 29 (50%) had communicating hydrocephalus. The primary outcome of intraoperatively confirmed shunt failure was observed in 14 of 76 ED patient presentations (18%). The mean (SD) change in ONSD among patients with shunt failure was 0.89 (0.66) mm vs 0.16 (0.40) mm among patients without shunt failure (mean difference, 0.73 mm [95% CI, 0.47-0.99 mm]; P &lt; .001). The odds of full shunt failure were 1.4 times higher (95% CI, 1.21-1.78; P &lt; .001) for every 0.1-mm increase in ONSD. The area under the receiver operating characteristic curve was 0.86, with an optimal cutoff of 0.4 mm or more, yielding a sensitivity of 0.93, specificity of 0.73, positive predictive value of 0.43, and negative predictive value of 0.98, for a disease prevalence of 15%, with a positive likelihood ratio of 3.39 and negative likelihood ratio of 0.10.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this single-center, prospective cohort study","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2511009"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078198","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":"Race, Ethnicity, Sex, Sexual Orientation, and Discrimination in the Adolescent Brain Cognitive Development Study.","authors":"Zhenqiang Zhao, Jinjin Yan, Yijie Wang, Cindy H Liu, Lijuan Wang, Heining Cham, Tiffany Yip","doi":"10.1001/jamanetworkopen.2025.10799","DOIUrl":"10.1001/jamanetworkopen.2025.10799","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Children are disproportionately exposed to sexual orientation-based discrimination and ethnic or racial discrimination due to intersections of sexual orientation, ethnicity, race, and assigned sex at birth. Yet, there is sparse evidence in clinical settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate how social strata of sexual orientation, ethnicity, race, and assigned sex at birth intersect and are associated with experiences of sexual orientation-based discrimination and ethnic or racial discrimination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This survey study included data retrieved from children enrolled in the Adolescent Brain Cognitive Development Study between 2016 and 2020. Children were recruited from 21 study sites across 17 states. Eligible participants were between ages 9 and 11 years at recruitment. Baseline data (2016-2018), first-year follow-up data (2017-2019), and second-year follow-up data (2018-2020) were included. Analyses were conducted between June and October 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Logistic regressions were conducted to test the association between children's social strata indicated by intersections of sexual orientation, ethnicity, race, and assigned sex at birth and discrimination based on sexual orientation and ethnic or racial discrimination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 9854 children (mean [SD] age at baseline, 9.5 [0.5] years; 4582 girls [46.5%]; 202 Asian [2.0%], 1488 Black [15.1%], 2030 Latinx [20.6%], 906 multiple races [9.2%], 4921 White [49.9%]), White sexual minority girls reported the highest percentage of sexual orientation-based discrimination (113 of 312 [36.2%]). Ethnically or racially minoritized boys reported the highest percentage of ethnic or racial discrimination (41 of 174 [23.7%]). After accounting for covariates, ethnically or racially minoritized sexual minority girls were less likely to report sexual orientation-based discrimination compared with ethnically or racially minoritized heterosexual boys (odds ratio [OR], 0.60; 95% CI, 0.43-0.85). Ethnically or racially minoritized sexual minority boys (OR, 3.17; 95% CI, 1.71-5.88) and girls (OR, 2.09; 95% CI, 1.47-2.97) were more likely to report ethnic or racial discrimination compared with ethnically or racially minoritized heterosexual boys. Moreover, ethnically or racially minoritized sexual minority boys (OR, 3.39; 95% CI, 1.81-6.34) and girls (OR, 2.24; 95% CI, 1.56-3.21) were more likely to report ethnic or racial discrimination compared with ethnically or racially minoritized heterosexual girls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this survey study investigating experience of sexual orientation-based discrimination alongside ethnic or racial discrimination during late childhood, findings highlighted that intersections of sexual orientation, ethnicity, race, and assigned sex at birth contributed to disproportionate exposures to sexual orientati","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 5","pages":"e2510799"},"PeriodicalIF":10.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077950","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}