Nevin Manimala

Am J Audiol. 2026 Jun 9:1-10. doi: 10.1044/2026_AJA-25-00223. Online ahead of print.

ABSTRACT

BACKGROUND: Effect sizes quantify the magnitude of group differences, yet hearing aid research still relies on Cohen’s benchmarks (0.20, 0.50, 0.80). These cutoffs are not field specific and may misrepresent typical effects.

OBJECTIVE: The aims of this study were to characterize the distribution of effect sizes in adult hearing aid research and use these data to estimate sample sizes required to achieve varying levels of statistical power.

METHOD: A systematic search of PubMed, CINAHL, and Embase identified English-language randomized controlled trials (RCTs) involving adults with mild-to-severe hearing loss using commercially available air-conduction hearing devices. Eligible outcomes included standardized self-reports and behavioral measures. Absolute Hedges’s g values were calculated, with the 25th, 50th, and 75th percentiles representing small, medium, and large effects, respectively. A priori power analyses estimated required sample sizes.

RESULTS: From 15,066 records, 33 trials (4,471 participants) met the inclusion criteria; of these, 17 trials provided 63 effect sizes. Across all outcomes, the 25th, 50th, and 75th percentile values (Hedges’s g = 0.10, 0.22, and 0.48, respectively) were smaller than Cohen’s conventional thresholds (0.20, 0.50, and 0.80, respectively), indicating that Cohen’s standardized benchmarks may portray effects in hearing aid research as smaller than they typically are. Estimated sample sizes showed that few published studies met 80% power for a medium effect.

CONCLUSIONS: The empirical distribution of effect sizes in hearing aid RCTs is shifted toward smaller numerical values relative to Cohen’s conventional benchmarks. Therefore, using Cohen’s generic benchmarks makes an effect appear smaller than it is in the context of this field. We recommend using the effect sizes of 0.1, 0.2, and 0.5 for small, medium, and large effect sizes, respectively, when interpreting hearing aid trial results. Adoption of these empirically derived benchmarks will improve the accuracy of interpretation, guide more realistic sample size planning, and enhance the replicability of future trials.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.32559894.

PMID:42263203 | DOI:10.1044/2026_AJA-25-00223

JMIR Res Protoc. 2026 Jun 9;15:e87021. doi: 10.2196/87021.

ABSTRACT

BACKGROUND: Bereavement is a common and inevitable part of life. However, it is also difficult and disruptive. Prolonged grief disorder has recently been added to the International Classification of Diseases, 11th Revision, and the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Grief is a deeply cultural experience; however, most research about grief and grief intervention is conducted in Western, educated, industrialized, rich, and democratic (WEIRD) countries. Support for grief is often limited and difficult to access. We propose that ecological momentary interventions (EMIs) present an opportunity to widen access to grief support and develop culturally relevant interventions, given EMIs’ easy accessibility and opportunity to offer self-help support in people’s natural environments.

OBJECTIVE: This study aims to describe the development protocol of 2 EMIs for grief, one in China and one in Switzerland. he EMIs are intended for individuals seeking additional grief support without a diagnosis of prolonged grief disorder. The EMIs will be developed to be culturally relevant and appropriate for each country; therefore, contextual factors may prescribe slightly different protocols to fit the needs of each cultural group.

METHODS: Both interventions will be developed using a collaborative research approach. This means that the content for the app will be developed after consultation with grief experts, bereaved participants (potential end users), and the research team. After the initial content development, another round of feedback will be gathered to ensure acceptability.

RESULTS: Funding for both studies has been secured through a grant in 2024. The scoping phase for both WEIRD and non-WEIRD contexts has been completed. At the time of submission, both studies have started recruitment, and the Chinese study has conducted interviews with 17 bereaved participants. The next steps are to continue recruitment and data gathering, analyze the collected data, and extract important themes for intervention components, and then begin the app content development. Results are expected by the end of 2026 and will subsequently be prepared for publication.

CONCLUSIONS: The study presents 2 similar but nonidentical development protocols for EMIs for grief support in 2 countries, where one is a WEIRD country and the other is a non-WEIRD country. Similarities and differences in the developmental process across both countries are discussed, along with challenges associated with adapting grief interventions into an EMI format.

PMID:42263193 | DOI:10.2196/87021

Ann Indian Acad Neurol. 2026 Jun 5. doi: 10.4103/aian.aian_1225_25. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Migraine, a disabling neurological disorder, poses a significant global burden, especially among women of reproductive age. In India, inconsistent diagnoses and the underutilization of evidence-based therapies present substantial challenges. This study evaluated the knowledge, attitudes, and practices of general neurologists and headache experts in India regarding migraine diagnosis and treatment, identifying barriers and opportunities for improvement in clinical care.

METHODS: A cross-sectional online survey was conducted among 137 clinicians in India (125 general neurologists and 12 headache experts). The questionnaire assessed diagnostic approaches, preferences for pharmacological and non-pharmacological treatments, utilization of guidelines, and readiness to adopt novel therapies. Data were analyzed using descriptive statistics.

RESULTS: Headache experts reported a higher patient burden, with 9 (75.00%) seeing 25 or more headache patients per week, compared to 39 (31.2%) general neurologists. Migraines comprised over 50% of cases for 7 (58.33%) of the experts. The use of International Classification of Headache Disorders (3 rd edition) criteria was markedly higher among headache experts (91.67% vs. 38.71%), as was the Migraine Disability Assessment (66.67% vs. 24.20%). Nonsteroidal anti-inflammatory drugs and triptans were the most commonly prescribed therapies. Although triptans provided only moderate relief for most patients, newer agents, such as ditans, were rarely used (0-20%). Nonpharmacological interventions were widely adopted, with approximately 90% usage in both groups. Barriers included limited diagnostic standardization, therapeutic inertia, low familiarity with newer agents, and operational challenges such as time constraints.

CONCLUSIONS: Both general neurologists and headache experts acknowledge the burden of migraine and practice holistic management. However, gaps remain in standardized diagnosis, optimal triptan use, and the adoption of novel therapies. Enhancing clinician education, promoting validated diagnostic tools, developing expert consensus, and increasing community awareness are crucial to optimizing outcomes and reducing therapeutic inertia.

PMID:42262822 | DOI:10.4103/aian.aian_1225_25

Saudi J Kidney Dis Transpl. 2026 Jun 3. doi: 10.4103/sjkdt.sjkdt_118_26. Online ahead of print.

ABSTRACT

CONTEXT: Haemodialysis patients are especially vulnerable to blood-borne viral infections because of repeated exposure to invasive procedures and the dialysis care environment.

AIMS: This study aimed to determine the HBV-positive status of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus among haemodialysis patients and to identify factors associated with HBV seropositivity.

SETTINGS AND DESIGN: A cross-sectional analytical study was conducted among haemodialysis patients in Morocco.

METHODS AND MATERIAL: A total of 305 haemodialysis patients were included. Sociodemographic, clinical, and serological data were collected using a structured form. Serological status for HBV, HCV, and HIV was assessed by ELISA and confirmed using specific confirmatory assays. Statistical analysis used: Univariate and multivariable logistic regression analyses were performed to identify factors associated with HBV seropositivity. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated, and statistical significance was set at p < 0.05.

RESULTS: The overall seroprevalence was 2.62% for HBV, 0.33% for HCV, and 0.66% for HIV. Multivariable analysis showed that use of an arteriovenous fistula and complete HBV vaccination (3-4 doses) were significantly associated with lower odds of HBV infection (OR = 0.012, 95% CI: 0.010-0.286, p = 0.007; OR = 0.008, 95% CI: 0.000-0.511, p = 0.023, respectively). In contrast, longer haemodialysis duration was significantly associated with increased HBV seropositivity (OR = 1.036, 95% CI: 1.012-1.061, p = 0.004).

CONCLUSIONS: Despite the low prevalence of HBV, HCV, and HIV, prevention, surveillance, and strengthened vaccination strategies remain necessary in haemodialysis settings.

PMID:42262818 | DOI:10.4103/sjkdt.sjkdt_118_26

J Minim Access Surg. 2026 Jun 5. doi: 10.4103/jmas.jmas_49_26. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive surgery (MIS) has become an essential component of modern surgical practice due to improved patient outcomes. However, these procedures impose significant cognitive and physical demands on surgeons, which remain inadequately quantified. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a validated subjective tool used to assess workload during complex tasks, including surgery.

AIM: The aim of this study was to evaluate intra-operative surgeon workload during minimally invasive procedures across multiple surgical departments in a tertiary healthcare centre using NASA-TLX.

PATIENTS AND METHODS: This prospective observational study included surgeons performing elective minimally invasive procedures over a 3-month period at a tertiary care hospital. A total of 200 procedures performed by 27 surgeons across multiple departments were analysed. Emergency procedures, conversions to open surgery, combined procedures and abandoned surgeries were excluded. Surgeons completed the NASA-TLX questionnaire immediately after each procedure, assessing mental demand, physical demand, temporal demand, performance, effort and frustration. Workload scores were compared across procedure types and surgeon experience levels using appropriate statistical analyses, and effect sizes (η²) were calculated.

RESULTS: NASA-TLX scores demonstrated a moderate overall workload, with higher mental and physical demand. Significant differences were observed across procedures in mental demand ( P = 0.013, η² =0.07), physical demand ( P = 0.022, η² =0.06), temporal demand ( P < 0.001, η² =0.11) and frustration ( P < 0.001, η² =0.21). The mean global NASA-TLX score was 5.77 ± 1.3. Laparoscopic gastrointestinal and cholecystectomy procedures demonstrated higher workload scores. Surgeons with < 5 years’ experience reported greater temporal demand, while senior surgeons demonstrated higher mental demand, effort and frustration.

CONCLUSION: Surgeon workload during MIS varies with procedure type and experience level. NASA-TLX is a practical and effective tool for assessing intra-operative workload and may help optimise surgical training, ergonomics and operative planning.

PMID:42262815 | DOI:10.4103/jmas.jmas_49_26

J Minim Access Surg. 2026 Jun 5. doi: 10.4103/jmas.jmas_398_25. Online ahead of print.

ABSTRACT

INTRODUCTION: Recurrent pleural effusions (RPEs) significantly impair the quality of life and remain a therapeutic challenge. Video-assisted thoracoscopic surgery (VATS) pleurodesis is an established treatment, while the role of primary indwelling pleural catheter (IPC) implantation during surgery is not yet clearly defined. This study compared the outcomes of thoracoscopic treatment of RPEs with and without primary IPC implantation.

PATIENTS AND METHODS: In this retrospective bicentric study, 115 adult patients undergoing VATS for RPEs between January 2022 and December 2023 were analysed. Patients were treated at either Knappschaft Kliniken Lünen (KKL), where VATS pleurodesis without IPC was standard, or Helios University Hospital Wuppertal (WUP), where routine primary IPC implantation was performed. Demographic data, operative characteristics, post-operative chest drainage duration and length of hospital stay (LOS) were evaluated. Statistical analysis was performed using unpaired t -tests.

RESULTS: Operative duration did not differ significantly between groups. However, patients in the WUP group demonstrated a significantly shorter duration of post-operative chest drainage (3.4 ± 1.5 vs. 5.2 ± 2.1 days) and reduced LOS (5.8 ± 1.6 vs. 7.4 ± 2.4 days) compared with the KKL group. Post-operative complications were minor and comparable between groups, with no major complications observed.

CONCLUSION: Simultaneous IPC implantation during VATS pleurodesis for RPEs is associated with shorter chest drainage duration and hospital stay without increasing operative time or morbidity. This combined approach represents a safe and effective treatment option for selected patients. Prospective studies are warranted to confirm long-term benefits.

PMID:42262813 | DOI:10.4103/jmas.jmas_398_25

Indian J Pathol Microbiol. 2026 Jun 2. doi: 10.4103/ijpm.ijpm_366_25. Online ahead of print.

ABSTRACT

AIMS: Despite its importance in patient care, public awareness of histopathology and the role of histopathologists remain overshadowed. This study aimed to assess Jordanians’ public awareness of histopathology and identify areas of misconception or lack of understanding.

METHODS: A cross-sectional survey was conducted among adults (>18 years) in Jordan through a web-based questionnaire. The survey evaluated participants’ knowledge and perceptions of histopathology, including the nature of histopathologists’ work, their educational requirements, and their role in patient care. Descriptive statistics, Chi-square tests, and multivariate linear regression were used to analyze the data.

RESULTS: A total of 614 participants completed the survey, of which 41% did not recognize histopathology as a medical specialty. The majority identified pathologists as medical doctors whose main job is diagnosis of diseases among living patients, while some participants have misconceptions about associating histopathologists’ work with performing autopsies or laboratory tests. Underestimation of the duration of training required to become a certified histopathologist and misconceptions regarding the diagnostic decision-making on selected sample procedures were noticed. Female gender, educational level, and medical background were associated with higher knowledge scores.

CONCLUSION: Despite acceptable general knowledge, the observed misconceptions and lack of understanding regarding histopathology among the public necessitate interdisciplinary collaboration between pathologists and other healthcare professionals to increase the public awareness.

PMID:42262808 | DOI:10.4103/ijpm.ijpm_366_25

Saudi J Kidney Dis Transpl. 2026 Jun 3. doi: 10.4103/sjkdt.sjkdt_165_26. Online ahead of print.

ABSTRACT

CONTEXT: Tunneled cuffed catheters (TCCs) are vital haemodialysis access devices in chronic kidney disease (CKD), yet prone to significant dysfunction-related morbidity.

AIMS: To identify bedside patient-related predictors of TCC dysfunction and reduced patency in adult CKD patients undergoing haemodialysis at a single Indonesian center.

SETTINGS AND DESIGN: Single-center retrospective cohort study at Rasyida Kidney Hospital, Medan, Indonesia, covering TCC insertions from 2021 to 2024.

METHODS AND MATERIAL: Primary outcomes were catheter dysfunction and patency. Variables were extracted from medical records.

STATISTICAL ANALYSIS USED: Multivariable logistic regression identified predictors of dysfunction; Cox proportional hazards regression assessed reduced patency.

RESULTS: A total of 102 TCCs in 96 adult patients were included. Mean age was 62.7 ± 14.9 years and 62.7% were female. Dysfunction occurred in 30 catheters (29.4%) over a mean dwell time of 20.1 ± 13.1 months. Independent predictors of dysfunction were femoral insertion site (aOR 3.56, 95% CI 1.08-11.7, p = 0.036) and hypertension (aOR 3.34, 95% CI 1.01-11.1, p = 0.049). Cox regression confirmed femoral site (aHR 3.10, 95% CI 1.29-7.44, p = 0.011), hypertension (aHR 4.45, 95% CI 1.40-14.15, p = 0.011), and age ≥ 60 years (aHR 3.96, 95% CI 1.48-10.64, p = 0.006) as predictors of reduced patency.

CONCLUSIONS: Femoral insertion site and hypertension were strong independent predictors of TCC dysfunction and shortened patency. Age ≥ 60 years additionally predicted reduced patency. These simple bedside factors support practical risk stratification in low-resource haemodialysis settings.

PMID:42262802 | DOI:10.4103/sjkdt.sjkdt_165_26

J Minim Access Surg. 2026 Jun 2. doi: 10.4103/jmas.jmas_498_25. Online ahead of print.

ABSTRACT

INTRODUCTION: While minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) are applied, the relative impact of surgical approach versus procedure type on outcomes remains controversial in pulmonary hydatid cyst treatment.

PATIENTS AND METHODS: This retrospective study analysed 192 operations performed in 157 patients with pulmonary hydatid cysts between 2010 and 2023. Patients were stratified by surgical approach (VATS, video-assisted mini-thoracotomy and thoracotomy) and by procedure type (cystotomy, cystotomy + capitonnage, cystotomy + wedge and wedge). Demographic data, cyst characteristics, rupture status, concomitant hepatic hydatidosis, post-operative complications, length of stay and recurrence were evaluated. Statistical comparisons were made as appropriate.

RESULTS: The mean patient age was 38.9 ± 20.2 years; 94 were female (59.5%) and 63 were male (40.5%). Cysts treated with VATS were significantly smaller, likely reflecting selection bias towards thoracoscopic suitability, whereas larger cysts were more often managed with cystotomy + capitonnage. Surgical approach did not significantly affect post-operative complication rates or hospital stay ( P > 0.05). In contrast, procedure type strongly influenced outcomes: cystotomy was associated with prolonged air leak and longer hospitalisation, capitonnage reduced complications but slightly extended recovery, and wedge resections achieved the shortest stays with low morbidity. Overall morbidity, recurrence and hospitalisation duration were comparable between paediatric and adult groups.

CONCLUSIONS: In pulmonary hydatid cyst surgery, prognosis depends primarily on the procedure performed rather than the surgical approach. Parenchyma-preserving techniques – particularly capitonnage and appropriately selected wedge resections – reduce morbidity and accelerate recovery. Surgical planning should therefore prioritise the choice of procedure over the approach to optimise outcomes in pulmonary hydatid disease.

PMID:42262782 | DOI:10.4103/jmas.jmas_498_25

JAMA. 2025 Oct 13. doi: 10.1001/jama.2025.16876. Online ahead of print.

ABSTRACT

IMPORTANCE: Functional outcomes in patients with acute ischemic stroke due to large-vessel occlusion who undergo thrombectomy remain suboptimal, and the benefits of intra-arterial alteplase after thrombectomy remain uncertain.

OBJECTIVE: To investigate whether treatment with intra-arterial alteplase after successful endovascular reperfusion improves functional outcomes among patients with acute, anterior-circulation, large-vessel occlusion stroke.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized clinical trial recruited patients with anterior-circulation, large-vessel occlusion stroke within 24 hours of symptom onset who achieved successful reperfusion (expanded Thrombolysis in Cerebral Infarction scale score of ≥2b50) after thrombectomy. Guideline-based intravenous thrombolysis was allowed. Patients were randomized between August 1, 2023, and October 16, 2024, and the trial was conducted at 28 hospitals in China. Final follow-up occurred on January 7, 2025.

INTERVENTIONS: Intra-arterial alteplase treatment (n = 164) with 0.225 mg/kg (maximum dose of 20 mg) vs standard treatment (n = 160).

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days (score range, 0 [no symptoms] to 6 [death]; a score of 0 or 1 indicates an excellent outcome). The safety outcomes included symptomatic intracranial hemorrhage within 36 hours of randomization, all-cause mortality within 90 days, and any intracranial hemorrhage within 36 hours.

RESULTS: Of the 324 patients randomized (median age, 68 years [IQR, 58-75 years]; 99 were female [30.6%]), 1 patient in each group was lost to follow-up. The proportion of patients with a modified Rankin Scale score of 0 or 1 at 90 days was 44.8% (73/163) in the intra-arterial alteplase group vs 30.2% (48/159) in the standard treatment group (adjusted risk ratio [RR], 1.45 [95% CI, 1.08-1.96]; P = .01). The proportion of patients with symptomatic intracranial hemorrhage within 36 hours was 4.3% (7/164) in the intra-arterial alteplase group vs 5.0% (8/160) in the standard treatment group (adjusted RR, 0.85 [95% CI, 0.43-1.69]; P = .67). The proportion of patients with all-cause mortality within 90 days was 17.1% (28/164) in the intra-arterial alteplase group vs 11.3% (18/160) in the standard treatment group (adjusted hazard ratio, 1.60 [95% CI, 0.88-2.89]; P = .12). The proportion of patients with any intracranial hemorrhage within 36 hours was 32.9% (54/164) in the intra-arterial alteplase group vs 26.9% (43/160) in the standard treatment group (adjusted RR, 1.22 [95% CI, 0.92-1.63]; P = .17).

CONCLUSIONS AND RELEVANCE: Among patients with acute, anterior-circulation, large-vessel occlusion stroke who achieved successful endovascular reperfusion by mechanical thrombectomy, intra-arterial alteplase resulted in a higher likelihood of excellent outcomes at 90 days. The incidence of all-cause mortality and any intracranial hemorrhage was higher in patients who received intra-arterial alteplase, although these differences were not statistically significant.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05856851.

PMID:42262770 | DOI:10.1001/jama.2025.16876