Pub Date : 2026-06-01Epub Date: 2026-04-27DOI: 10.1016/j.jnma.2026.03.009
Charles DeShazer
Artificial intelligence (AI) is rapidly entering clinical practice, yet the governance models needed to ensure its safe, ethical, and equitable use have not kept pace—particularly in community and safety-net settings. Existing frameworks, designed for large academic systems, are often impractical for frontline physicians, creating a dangerous gap between AI adoption and oversight.
This article reframes AI governance as a clinician-centered enabler rather than a compliance burden. We propose a pragmatic model built on clear accountability, defined use guardrails, basic safety and bias checks, transparency, and lightweight workflows—supported by a scalable hub-and-spoke approach leveraging trusted professional organizations.
Without intentional governance, AI risks amplifying disparities and eroding trust. Done well, it becomes a force multiplier—extending high-quality, equitable care into the communities that need it most. For community physicians, AI governance is not optional; it is essential to protecting patients, preserving clinical judgment, and ensuring that innovation advances equity rather than harm.
{"title":"The governance gap no one is solving","authors":"Charles DeShazer","doi":"10.1016/j.jnma.2026.03.009","DOIUrl":"10.1016/j.jnma.2026.03.009","url":null,"abstract":"<div><div>Artificial intelligence (AI) is rapidly entering clinical practice, yet the governance models needed to ensure its safe, ethical, and equitable use have not kept pace—particularly in community and safety-net settings. Existing frameworks, designed for large academic systems, are often impractical for frontline physicians, creating a dangerous gap between AI adoption and oversight.</div><div>This article reframes AI governance as a clinician-centered enabler rather than a compliance burden. We propose a pragmatic model built on clear accountability, defined use guardrails, basic safety and bias checks, transparency, and lightweight workflows—supported by a scalable hub-and-spoke approach leveraging trusted professional organizations.</div><div>Without intentional governance, AI risks amplifying disparities and eroding trust. Done well, it becomes a force multiplier—extending high-quality, equitable care into the communities that need it most. For community physicians, AI governance is not optional; it is essential to protecting patients, preserving clinical judgment, and ensuring that innovation advances equity rather than harm.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 458-462"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-02-10DOI: 10.1016/j.jnma.2026.02.003
Cherie Y. Zachary
{"title":"The application of artificial intelligence in asthma management: Advancing asthma care through the use of AI technologies","authors":"Cherie Y. Zachary","doi":"10.1016/j.jnma.2026.02.003","DOIUrl":"10.1016/j.jnma.2026.02.003","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 439-441"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-01-28DOI: 10.1016/j.jnma.2026.01.016
Chioma Amuzie , Lauren Hucko , Lauren C. Kiryakoza , Anne L. Kunkler , Audina M. Berrocal , Basil K. Williams Jr.
Purpose
To evaluate the association between neighborhood-level disadvantage, measured by the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI), and disease severity at presentation, treatment modality, and clinical outcomes in a cohort of Black patients with proliferative sickle cell retinopathy (PSR).
Methods
This retrospective cohort study included Black patients with PSR (Goldberg stages 3–5) seen at a metropolitan academic ophthalmology center from May 1, 2014, to December 31, 2022. Patient demographics, treatment patterns, and clinical outcomes were extracted from electronic medical records. Patient addresses were linked to SVI/ADI at the census tract level. Multiple linear regression analyses were conducted to assess associations between SVI/ADI and disease stage, treatment type (intravitreal injection [IVI], panretinal photocoagulation [PRP], pars plana vitrectomy [PPV]), and outcomes, including change in best-corrected visual acuity and post-treatment complications.
Results
The study included 110 eyes from Black patients with PSR. Neither SVI nor ADI was significantly associated with disease stage at presentation, initial treatment modality, or clinical outcomes (p > 0.05 for all models). PPV was the most common initial treatment (42 %), followed by PRP (36 %) and IVI (10 %). Patients undergoing PPV and IVI required significantly more follow-up visits (p = 0.032).
Conclusion
Neighborhood disadvantage, as measured by SVI/ADI, was not significantly associated with disease severity, treatment selection, or clinical outcomes in this cohort of Black patients with PSR. Patients undergoing PPV or IVI required significantly more follow-up visits (p = 0.032), highlighting the substantial management burden for these patients. While neighborhood disadvantage was not significantly associated with outcomes, larger studies are needed to further assess these relationships. Regardless of measured neighborhood disadvantage, the substantial follow-up burden associated with PSR management underscores the importance of addressing individual-level barriers and support systems in this high-risk population.
{"title":"Association of neighborhood indices on outcomes of patients with proliferative sickle retinopathy","authors":"Chioma Amuzie , Lauren Hucko , Lauren C. Kiryakoza , Anne L. Kunkler , Audina M. Berrocal , Basil K. Williams Jr.","doi":"10.1016/j.jnma.2026.01.016","DOIUrl":"10.1016/j.jnma.2026.01.016","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the association between neighborhood-level disadvantage, measured by the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI), and disease severity at presentation, treatment modality, and clinical outcomes in a cohort of Black patients with proliferative sickle cell retinopathy (PSR).</div></div><div><h3>Methods</h3><div>This retrospective cohort study included Black patients with PSR (Goldberg stages 3–5) seen at a metropolitan academic ophthalmology center from May 1, 2014, to December 31, 2022. Patient demographics, treatment patterns, and clinical outcomes were extracted from electronic medical records. Patient addresses were linked to SVI/ADI at the census tract level. Multiple linear regression analyses were conducted to assess associations between SVI/ADI and disease stage, treatment type (intravitreal injection [IVI], panretinal photocoagulation [PRP], pars plana vitrectomy [PPV]), and outcomes, including change in best-corrected visual acuity and post-treatment complications.</div></div><div><h3>Results</h3><div>The study included 110 eyes from Black patients with PSR. Neither SVI nor ADI was significantly associated with disease stage at presentation, initial treatment modality, or clinical outcomes (<em>p</em> > 0.05 for all models). PPV was the most common initial treatment (42 %), followed by PRP (36 %) and IVI (10 %). Patients undergoing PPV and IVI required significantly more follow-up visits (<em>p</em> = 0.032).</div></div><div><h3>Conclusion</h3><div>Neighborhood disadvantage, as measured by SVI/ADI, was not significantly associated with disease severity, treatment selection, or clinical outcomes in this cohort of Black patients with PSR. Patients undergoing PPV or IVI required significantly more follow-up visits (<em>p</em> = 0.032), highlighting the substantial management burden for these patients. While neighborhood disadvantage was not significantly associated with outcomes, larger studies are needed to further assess these relationships<em>.</em> Regardless of measured neighborhood disadvantage, the substantial follow-up burden associated with PSR management underscores the importance of addressing individual-level barriers and support systems in this high-risk population.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 391-399"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-03-26DOI: 10.1016/j.jnma.2026.03.004
Zihuang Zhang , Natalie Lim , Joe Abi-Rached , Benjamin Pickard , Aundria Parkman , Yitian Zha , Keith C. Ferdinand
Background
Transthyretin amyloid cardiomyopathy (ATTR-CM) remains substantially underdiagnosed among Black patient populations. When applied to non-invasive diagnostic and screening techniques, artificial intelligence (AI) can aid in the early detection of subtle patterns indicative of transthyretin amyloid cardiomyopathy (ATTR-CM), potentially before clinical symptoms appear. This systematic review examines the current landscape of AI-based diagnostic tools for ATTR-CM.
Methods
A comprehensive search was performed in PubMed, Embase, Cochrane Library, Scopus, and Web of Science. The search strategy targeted peer-reviewed, English-only articles published from January 1, 2015, to May 27, 2025, focusing on the application of artificial intelligence to electrocardiograms (ECG), echocardiograms, and cardiac magnetic resonance imaging (CMR) on ATTR-CM specifically. We include the studies that have diagnostic performance measures as their primary outcomes.
Results
713 studies were identified from databases, and 27 were included. Studies were categorized into three groups based on their primary AI-applied non-invasive diagnostic tools: ECG (n = 16), echocardiogram (n = 8), and CMR (n = 3), either as solo or combined interventions. Performance of AI-enhanced ECG yielded Area Under the Curves (AUCs) ranging from 0.82 to 0.97. AI-integrated echocardiography achieved AUCs between 0.87 and 0.97, while AI-CMR models resulted in AUCs up to 0.92. Multimodal approaches that integrated data from multiple sources also reported AUCs ranging up to 0.97.
Conclusion
The integration of AI into ECG, echocardiograms, and CMR have the potential to significantly improve the early detection and classification of ATTR-CM, preventing the progression to end-stage heart failure. Accessible AI-based screening tools could address health disparities by enabling earlier identification and treatment initiation for Black populations who face disproportionate disease burden of ATTR-CM and diagnostic delays.
{"title":"Addressing disparities in transthyretin amyloid cardiomyopathy: A systematic review of artificial intelligence in the early identification to improve patient outcomes","authors":"Zihuang Zhang , Natalie Lim , Joe Abi-Rached , Benjamin Pickard , Aundria Parkman , Yitian Zha , Keith C. Ferdinand","doi":"10.1016/j.jnma.2026.03.004","DOIUrl":"10.1016/j.jnma.2026.03.004","url":null,"abstract":"<div><h3>Background</h3><div>Transthyretin amyloid cardiomyopathy (ATTR-CM) remains substantially underdiagnosed among Black patient populations. When applied to non-invasive diagnostic and screening techniques, artificial intelligence (AI) can aid in the early detection of subtle patterns indicative of transthyretin amyloid cardiomyopathy (ATTR-CM), potentially before clinical symptoms appear. This systematic review examines the current landscape of AI-based diagnostic tools for ATTR-CM.</div></div><div><h3>Methods</h3><div>A comprehensive search was performed in PubMed, Embase, Cochrane Library, Scopus, and Web of Science. The search strategy targeted peer-reviewed, English-only articles published from January 1, 2015, to May 27, 2025, focusing on the application of artificial intelligence to electrocardiograms (ECG), echocardiograms, and cardiac magnetic resonance imaging (CMR) on ATTR-CM specifically. We include the studies that have diagnostic performance measures as their primary outcomes.</div></div><div><h3>Results</h3><div>713 studies were identified from databases, and 27 were included. Studies were categorized into three groups based on their primary AI-applied non-invasive diagnostic tools: ECG (n = 16), echocardiogram (n = 8), and CMR (n = 3), either as solo or combined interventions. Performance of AI-enhanced ECG yielded Area Under the Curves (AUCs) ranging from 0.82 to 0.97. AI-integrated echocardiography achieved AUCs between 0.87 and 0.97, while AI-CMR models resulted in AUCs up to 0.92. Multimodal approaches that integrated data from multiple sources also reported AUCs ranging up to 0.97.</div></div><div><h3>Conclusion</h3><div>The integration of AI into ECG, echocardiograms, and CMR have the potential to significantly improve the early detection and classification of ATTR-CM, preventing the progression to end-stage heart failure. Accessible AI-based screening tools could address health disparities by enabling earlier identification and treatment initiation for Black populations who face disproportionate disease burden of ATTR-CM and diagnostic delays.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 494-504"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-02-13DOI: 10.1016/j.jnma.2026.02.002
Athanasios Naum , Robert S. Gordon III , Anushka Deogaonkar , Maxwell Madani , Lucas Heilbroner , Kris Kokoneshi , Marie L. Borum
Background
Artificial intelligence (AI) is increasingly integrated into healthcare, offering opportunities to enhance clinical decision-making, efficiency, and patient outcomes.Despite rapid adoption, variability in AI use, confidence, and formal education acrosslevels of medical training and specialties remains poorly understood.
Objective
To evaluate patterns of AI usage, confidence, educational exposure, and perceptions of AI training across the medical hierarchy, with particular attention to differences between gastroenterology (GI) and internal medicine (IM) providers.
Methods
A descriptive, cross-sectional survey was conducted at an academic tertiary care medical center. A 25-item REDCap-based questionnaire assessed AI use, frequency, confidence, formal education, regulatory awareness, and attitudes toward AI curriculum integration among medical students, residents, fellows, and attending physicians. Descriptive statistics and chi-square tests were used for analysis, with significance defined as p < 0.05.
Results
Among 120 respondents, 83.5% reported AI use in clinical or educational activities, with 42.6% indicating daily use. Residents (92.3%) and medical students (87.8%) reported significantly higher AI use compared with attending physicians (61.5%). Overall, 73.7% of GI providers used AI; however, 47.3% reported low confidence, and none reported formal AI education. In contrast, 25% of IM providers had received structured AI training, and 56.1% were aware of HIPAA-compliant AI tools, compared with 15.8% of GI providers. All GI respondents (100%) supported the incorporation of formal AI education into medical curricula.
Conclusions
AI use is widespread across medical training levels, yet formal education, confidence, and regulatory awareness lag behind adoption, particularly among subspecialty providers such as gastroenterologists. These findings underscore the need for structured, specialty-specific AI education integrated throughout medical training to ensure safe, effective, and equitable use of AI in clinical practice.
{"title":"Artificial intelligence in clinical practice: Usage trends and educational implications across the medical hierarchy","authors":"Athanasios Naum , Robert S. Gordon III , Anushka Deogaonkar , Maxwell Madani , Lucas Heilbroner , Kris Kokoneshi , Marie L. Borum","doi":"10.1016/j.jnma.2026.02.002","DOIUrl":"10.1016/j.jnma.2026.02.002","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is increasingly integrated into healthcare, offering opportunities to enhance clinical decision-making, efficiency, and patient outcomes.Despite rapid adoption, variability in AI use, confidence, and formal education acrosslevels of medical training and specialties remains poorly understood.</div></div><div><h3>Objective</h3><div>To evaluate patterns of AI usage, confidence, educational exposure, and perceptions of AI training across the medical hierarchy, with particular attention to differences between gastroenterology (GI) and internal medicine (IM) providers.</div></div><div><h3>Methods</h3><div>A descriptive, cross-sectional survey was conducted at an academic tertiary care medical center. A 25-item REDCap-based questionnaire assessed AI use, frequency, confidence, formal education, regulatory awareness, and attitudes toward AI curriculum integration among medical students, residents, fellows, and attending physicians. Descriptive statistics and chi-square tests were used for analysis, with significance defined as p < 0.05.</div></div><div><h3>Results</h3><div>Among 120 respondents, 83.5% reported AI use in clinical or educational activities, with 42.6% indicating daily use. Residents (92.3%) and medical students (87.8%) reported significantly higher AI use compared with attending physicians (61.5%). Overall, 73.7% of GI providers used AI; however, 47.3% reported low confidence, and none reported formal AI education. In contrast, 25% of IM providers had received structured AI training, and 56.1% were aware of HIPAA-compliant AI tools, compared with 15.8% of GI providers. All GI respondents (100%) supported the incorporation of formal AI education into medical curricula.</div></div><div><h3>Conclusions</h3><div>AI use is widespread across medical training levels, yet formal education, confidence, and regulatory awareness lag behind adoption, particularly among subspecialty providers such as gastroenterologists. These findings underscore the need for structured, specialty-specific AI education integrated throughout medical training to ensure safe, effective, and equitable use of AI in clinical practice.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 387-390"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-05-01DOI: 10.1016/j.jnma.2026.03.010
Mateen Ahmad , Ayman Irshad , Sahaab Noor , Humna Irshad , Muhammad Aliyan Ahmed
Background
Hepatic cirrhosis and chronic kidney disease (CKD) often co-exist, exacerbating each other through shared inflammatory and hemodynamic pathways. Portal hypertension in cirrhosis impairs renal blood flow, increasing CKD risk. This study aims to highlight the annual trends and demographic differences in mortality due to hepatic cirrhosis and CKD in the US population from 1999–2020
Methods
Cirrhosis associated CKD-related mortality trends were analyzed from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) multiple-cause of death database. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Trends and annual percent changes (APCs) were assessed overall and stratified by sex, race/ethnicity, urbanization status, and census region.
Results
Between 1999 and 2020, 45,471 cirrhosis-associated CKD-related deaths occurred among adults in the U.S. The AAMR increased from 0.27 in 1999 to 1.14 in 2020 (APC, 6.84* [6.05 to 7.98], p < 0.000001) in the overall population. Over the study period, males averaged a considerably higher AAMR than females (overall AAMR: 0.83 vs 0.42, p < 0.001. Non-Hispanic (NH) American Indian or Alaskan Native had the highest AAMR (1.73), followed by Hispanics or Latinos (AAMR;1.2), NH Black or African Americans (AAMR; 0.89), NH Asian or Pacific Islander (AAMR; 0.48) and NH White (AAMR; 0.48) [p < 0.001]. West region had the highest AAMR (0.7), followed by South (AAMR; 0.6), Midwest (AAMR; 0.5), and Northeast (AAMR; 0.4). Moreover, metropolitan areas had a higher AAMR than non-metropolitan areas (AAMR: 0.6 vs 0.5, p < 0.001).
Conclusion
Cirrhosis-associated CKD mortality increased significantly from 1999 to 2020. The highest AAMRs were observed among men, the NH American Indian or Alaskan Native population, and individuals residing in the West region and metropolitan areas. Targeted interventions addressing both hepatic cirrhosis and CKD are essential, with a particular emphasis on high-burden population.
{"title":"Demographic and regional trends of mortality associated with hepatic cirrhosis and chronic kidney disease, in the United States, 1999-2020: A CDC WONDER database analysis","authors":"Mateen Ahmad , Ayman Irshad , Sahaab Noor , Humna Irshad , Muhammad Aliyan Ahmed","doi":"10.1016/j.jnma.2026.03.010","DOIUrl":"10.1016/j.jnma.2026.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Hepatic cirrhosis and chronic kidney disease (CKD) often co-exist, exacerbating each other through shared inflammatory and hemodynamic pathways. Portal hypertension in cirrhosis impairs renal blood flow, increasing CKD risk. This study aims to highlight the annual trends and demographic differences in mortality due to hepatic cirrhosis and CKD in the US population from 1999–2020</div></div><div><h3>Methods</h3><div>Cirrhosis associated CKD-related mortality trends were analyzed from 1999 to 2020 using the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) multiple-cause of death database. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Trends and annual percent changes (APCs) were assessed overall and stratified by sex, race/ethnicity, urbanization status, and census region.</div></div><div><h3>Results</h3><div>Between 1999 and 2020, 45,471 cirrhosis-associated CKD-related deaths occurred among adults in the U.S. The AAMR increased from 0.27 in 1999 to 1.14 in 2020 (APC, 6.84* [6.05 to 7.98], <em>p</em> < 0.000001) in the overall population. Over the study period, males averaged a considerably higher AAMR than females (overall AAMR: 0.83 vs 0.42, <em>p</em> < 0.001. Non-Hispanic (NH) American Indian or Alaskan Native had the highest AAMR (1.73), followed by Hispanics or Latinos (AAMR;1.2), NH Black or African Americans (AAMR; 0.89), NH Asian or Pacific Islander (AAMR; 0.48) and NH White (AAMR; 0.48) [<em>p</em> < 0.001]. West region had the highest AAMR (0.7), followed by South (AAMR; 0.6), Midwest (AAMR; 0.5), and Northeast (AAMR; 0.4). Moreover, metropolitan areas had a higher AAMR than non-metropolitan areas (AAMR: 0.6 vs 0.5, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Cirrhosis-associated CKD mortality increased significantly from 1999 to 2020. The highest AAMRs were observed among men, the NH American Indian or Alaskan Native population, and individuals residing in the West region and metropolitan areas. Targeted interventions addressing both hepatic cirrhosis and CKD are essential, with a particular emphasis on high-burden population.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 525-535"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-03-19DOI: 10.1016/j.jnma.2026.03.005
Shivam Patel , Anne Reisch , Bharat R. Narapareddy
Background
Neurocognitive disorders are classified within psychiatric nosology and may present with prominent behavioral, mood, or psychotic symptoms that resemble other psychiatric illnesses. This overlap can lead to diagnostic ambiguity, delayed recognition of neurodegeneration, and unnecessary or harmful treatments. Frontal variant Alzheimer’s disease (fvAD) is particularly prone to misdiagnosis because behavioral symptoms may precede memory impairment.
Objective
To describe three cases of fvAD initially diagnosed as other psychiatric illnesses and to highlight strategies for improving diagnostic accuracy on inpatient psychiatric units.
Methods
Three adults hospitalized for late-onset psychiatric syndromes refractory to standard treatment underwent systematic cognitive assessment, neuropsychological evaluation, and neuroimaging. Diagnoses were subsequently clarified as fvAD.
Results
All patients initially received antipsychotic medications; two developed extrapyramidal symptoms. Cognitive assessment, collateral history, neuropsychological testing, and FDG-PET/MRI demonstrated patterns consistent with fvAD, enabling diagnostic clarification, discontinuation of ineffective treatments, and engagement of appropriate dementia care.
Conclusion
Late-onset psychiatric syndromes resistant to treatment may represent early manifestations of neurocognitive disorders rather than other psychiatric conditions. Systematic assessment facilitates accurate diagnosis, reduces unnecessary interventions, and supports timely referral to multidisciplinary dementia care.
{"title":"Frontal variant Alzheimer’s disease presenting as late-onset psychiatric illness: A case series highlighting diagnostic challenges on inpatient psychiatric units","authors":"Shivam Patel , Anne Reisch , Bharat R. Narapareddy","doi":"10.1016/j.jnma.2026.03.005","DOIUrl":"10.1016/j.jnma.2026.03.005","url":null,"abstract":"<div><h3>Background</h3><div>Neurocognitive disorders are classified within psychiatric nosology and may present with prominent behavioral, mood, or psychotic symptoms that resemble other psychiatric illnesses. This overlap can lead to diagnostic ambiguity, delayed recognition of neurodegeneration, and unnecessary or harmful treatments. Frontal variant Alzheimer’s disease (fvAD) is particularly prone to misdiagnosis because behavioral symptoms may precede memory impairment.</div></div><div><h3>Objective</h3><div>To describe three cases of fvAD initially diagnosed as other psychiatric illnesses and to highlight strategies for improving diagnostic accuracy on inpatient psychiatric units.</div></div><div><h3>Methods</h3><div>Three adults hospitalized for late-onset psychiatric syndromes refractory to standard treatment underwent systematic cognitive assessment, neuropsychological evaluation, and neuroimaging. Diagnoses were subsequently clarified as fvAD.</div></div><div><h3>Results</h3><div>All patients initially received antipsychotic medications; two developed extrapyramidal symptoms. Cognitive assessment, collateral history, neuropsychological testing, and FDG-PET/MRI demonstrated patterns consistent with fvAD, enabling diagnostic clarification, discontinuation of ineffective treatments, and engagement of appropriate dementia care.</div></div><div><h3>Conclusion</h3><div>Late-onset psychiatric syndromes resistant to treatment may represent early manifestations of neurocognitive disorders rather than other psychiatric conditions. Systematic assessment facilitates accurate diagnosis, reduces unnecessary interventions, and supports timely referral to multidisciplinary dementia care.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 446-450"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-03-23DOI: 10.1016/j.jnma.2026.03.001
Kenneth F. Potter , Jacqueline Szilagyi , Laura Lahaye
Perioperative hypothermia is a significant concern in pediatric patients, contributing to various complications such as coagulopathy, neurologic dysfunction, infection, and prolonged recovery times. This article reviews the definition, measurement, and impact of hypothermia in children, with emphasis on the unique vulnerabilities of pediatric patients, including their immature thermoregulatory systems and differing age-related risks. We examine the challenges in temperature monitoring, highlighting the discrepancies between peripheral and central temperature measurements, as well as the consequences of temperature mismanagement. Strategies to prevent hypothermia, including prewarming, intraoperative warming, and continuous temperature monitoring are discussed, along with the associated challenges of equipment availability and patient-specific factors unique to the pediatric population. Further, this article addresses healthcare disparities as they pertain to the prevention and management of perioperative hypothermia. We advocate for the implementation of standardized protocols and further research to reduce disparities and improve outcomes. Ultimately, with proper resources and diligence, the effects of hypothermia can be effectively mitigated, ensuring safer perioperative care for all pediatric patients.
{"title":"Chill out: Hypothermia treatment in the pediatric patient population","authors":"Kenneth F. Potter , Jacqueline Szilagyi , Laura Lahaye","doi":"10.1016/j.jnma.2026.03.001","DOIUrl":"10.1016/j.jnma.2026.03.001","url":null,"abstract":"<div><div>Perioperative hypothermia is a significant concern in pediatric patients, contributing to various complications such as coagulopathy, neurologic dysfunction, infection, and prolonged recovery times. This article reviews the definition, measurement, and impact of hypothermia in children, with emphasis on the unique vulnerabilities of pediatric patients, including their immature thermoregulatory systems and differing age-related risks. We examine the challenges in temperature monitoring, highlighting the discrepancies between peripheral and central temperature measurements, as well as the consequences of temperature mismanagement. Strategies to prevent hypothermia, including prewarming, intraoperative warming, and continuous temperature monitoring are discussed, along with the associated challenges of equipment availability and patient-specific factors unique to the pediatric population. Further, this article addresses healthcare disparities as they pertain to the prevention and management of perioperative hypothermia. We advocate for the implementation of standardized protocols and further research to reduce disparities and improve outcomes. Ultimately, with proper resources and diligence, the effects of hypothermia can be effectively mitigated, ensuring safer perioperative care for all pediatric patients.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"118 3","pages":"Pages 559-563"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-06-01Epub Date: 2026-04-21DOI: 10.1016/j.jnma.2026.03.012
Muhammad Shaheer Bin Faheem , Own E Mohammad Najmi , Amna Farooq , Unsa Arif , Madho Mal , Ayesha Anwer , Usman Ahmad , Ammar Yahya , Mahad Ahmad
Background
Diseases of the gallbladder are one of the frequently encountered cases in clinical settings, and affect millions of adults worldwide. Gallbladder diseases are predominantly benign and encompass gallstones, polyps, adenomyomatosis, and acute cholecystitis, with gallstones representing the most common manifestation. We seek to evaluate disparities and analyze the mortality trends in Benign Gallbladder disease-related mortality among adults in the U.S. from 1999 to 2023.
Methods
Mortality data were obtained from death certificates in the CDC WONDER Multiple Cause of Death database for individuals aged ≥25 years with benign gallbladder disease from 1999 to 2023. AAMRs (age-adjusted mortality rates) were calculated, and standardized to 2000 U.S. population. APCs (annual percent changes) were derived through Joinpoint regression analysis. Data was stratified by multiple demographic and regional variables, including age group, sex, and urban-rural status.
Results
In total, 154,578 deaths were attributed to benign gallbladder diseases in the United States from 1999 to 2023. The 25-year analysis demonstrated an overall decline in the age-adjusted mortality rate (AAMR), from 3.4 per 100,000 to 1.9 (AAPC -2.7, p < 0.000001). Sex-stratified analyses showed persistently higher AAMRs among men compared with women (3.4 vs 2.4), with a significant temporal reduction observed in women (AAPC -0.70, p = 0.000966) but not in men (AAPC -0.3, p = 0.1346). Racial and ethnic stratification revealed the highest mortality burden among non-Hispanic American Indian or Alaska Native populations (AAMR 3.7; AAPC -1.3, p = 0.009652) and the lowest among non-Hispanic Asian or Pacific Islander populations (AAMR 2.4; AAPC -1.4, p = 0.005554). Geographically, the West region exhibited the highest regional mortality (AAMR 3.2; AAPC -0.52, p = 0.056539), while nonmetropolitan areas bore a greater burden than metropolitan areas (AAMR 3.4; AAPC -1.2, p = 0.000104). At the state level, New Mexico demonstrated the highest mortality (AAMR 4.1).
Conclusion
Despite overall declining mortality, significant demographic and geographic disparities persist, highlighting the need for targeted prevention strategies.
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Pub Date : 2026-06-01Epub Date: 2026-05-07DOI: 10.1016/j.jnma.2026.04.008
Cleavon Covington , Elisha Jackson , Zuleica Santiago Delgado , Deyanna Boston , Nicole M. Jackson , Joy Howell , Ashley Collazo , Kendall M. Campbell
Early career minoritized faculty face several academic challenges that negatively impact their success yet have demonstrated staying power and resilience in their institutional environments. Academic medicine has recognized pseudoleadership as a challenge for minoritized faculty. Using the framework provided by Coe et al., the authors define pseudoleadership across clinical, undergraduate medical education, research and graduate medical education leadership roles. They provide recommendations to decrease pseudoleadership to include prioritizing rank development for early career faculty over filling leadership positions, identifying and dismantling hidden curriculums, and employing a transdisciplinary approach to mentorship and sponsorship for leadership development.
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