Tag: pubmed

J Craniofac Surg. 2026 Mar 18. doi: 10.1097/SCS.0000000000012583. Online ahead of print.

ABSTRACT

OBJECTIVES: In the present study, we investigated the efficacy of nasal tip grafts for nasal tip shaping and for evaluating rhinoplasty outcome evaluation (ROE).

METHODS: Patients who underwent open rhinoplasty and received various grafts to improve tip support, including alar batten graft, alar rim graft, caudal septal extension graft, columellar strut, shield graft, tongue-in-groove, and tip-onlay graft, were included in this study (n=510). All follow-up items were recorded during the preoperative, early postoperative, and late postoperative periods. Rhinoplasty outcome evaluation scores, nasofrontal angle, and nasolabial angle were evaluated.

RESULTS: A statistically significant difference was observed between the mean preoperative and postoperative questionnaire scores in the graft groups (P<0.001). Shield graft, tongue-in-groove, and tip-onlay graft groups showed better results than many others. A statistically significant difference was observed between the preoperative and postoperative mean nasolabial angle values in the tongue-in-groove, shield graft, caudal septal extension graft, and columellar strut groups (P<0.001). In addition, a statistically significant difference was found between the preoperative and postoperative mean nasofrontal angle values across the graft groups (P<0.001), with significant changes observed in the tongue-in-groove, shield, caudal septal extension, and columellar strut groups. However, these changes in the nasofrontal angle are considered not directly related to the type of graft used but rather to the dorsal hump reduction performed in these patients.

CONCLUSION: These considerations underscore the limitation of attributing patient satisfaction solely to graft selection. They also highlight the importance of comprehensive preoperative counseling and multifactorial outcome assessment. Future studies using more controlled surgical variables or stratified analyses may help clarify the independent contribution of specific grafting techniques to both objective nasal angles and patient-perceived aesthetic success.

PMID:41849710 | DOI:10.1097/SCS.0000000000012583

J Craniofac Surg. 2026 Mar 18. doi: 10.1097/SCS.0000000000012580. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this paper is to investigate the feasibility and advantages of the gasket-seal technique using an autologous bone flap combined with artificial dura mater, following endoscopic transnasal resection of pituitary tumors.

METHODS: The clinical data of 144 patients who underwent endoscopic transnasal pituitary tumor resection surgery were collected from January 2020 to April 2024 at the Affiliated Hospital of Xuzhou Medical University. Thirty patients who underwent reconstruction with autologous bone flap combined with artificial dura mater using the Gasket-Seal technique were selected as experimental group A. The control group was divided into 2 subgroups, B and C: group B consisted of 47 patients with autologous bone flap combined with pedicled nasal septum mucosal flap, and group C consisted of 67 patients with autologous soft tissue (fat, fascia lata) combined with pedicled nasal septum mucosal flap. The operation time, intraoperative Kelly grading scale, incidence of postoperative complications, and postoperative nasal function scores of the 3 groups were compared. The Sinonasal Outcome Test-22 (SNOT-22) was used to evaluate the postoperative nasal function among the 3 groups.

RESULTS: The operation time of the patients in group A was 3.15 ± 0.68 hours. The operation times of groups B and C were 3.90 ± 0.77 hours and 3.61 ± 0.84 hours, respectively. The operation time was shortest in group A, which was the experimental group (P<0.05). No significant difference was observed in intraoperative Kelly grading among the 3 groups (P>0.05). There was no statistically significant difference in the incidence of postoperative complications among the 3 groups (P>0.05). The SNOT-22 score of patients in group A was 3.50 (range: 0.00-6.50) points. The SNOT-22 scores in groups B and C were 9.00 (range: 5.50-11.00) points and 10.00 (range: 8.00-13.00) points, respectively. The SNOT-22 score of patients in the experimental group was the lowest (P<0.05).

CONCLUSION: The gasket-seal reconstruction technique using an autogenous bone flap and artificial dura achieves close anatomic restoration of the sellar floor. This technique shortens the operation time, reduces nasal trauma, and protects olfactory function. It can be considered a viable option for clinical use.

PMID:41849709 | DOI:10.1097/SCS.0000000000012580

J Craniofac Surg. 2026 Mar 18. doi: 10.1097/SCS.0000000000012605. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative edema, ecchymosis, and delayed social recovery remain major concerns following implant-based rhinoplasty. Tranexamic acid (TXA) has been widely used to mitigate postoperative bleeding; however, the optimal route of administration in implant-based rhinoplasty remains controversial.

OBJECTIVE: This study aimed to compare the effects of different perioperative TXA administration strategies-local injection, topical application, and intravenous administration-on early postoperative recovery following implant-based rhinoplasty.

METHOD: This study included 82 patients undergoing primary implant-based rhinoplasty. Patients were allocated into 4 groups: no TXA (control), local TXA injection, topical TXA application via intraoperative soaked gauze, and intravenous TXA administration. Postoperative outcomes included edema and ecchymosis scores, pain scores, and time to social recovery. Assessments were performed on postoperative day (POD) 1, 3, 7, and 1 month. Group comparisons were performed using appropriate parametric or nonparametric statistical tests.

RESULT: Significant differences in early postoperative recovery were observed among groups. The topical TXA group demonstrated the lowest edema and ecchymosis scores on POD1 and POD3, followed by the local injection and intravenous TXA groups, while the control group consistently showed the poorest outcomes. By POD7, all TXA-treated groups showed improved recovery compared with controls; however, locally administered TXA remained superior to intravenous administration. At 1 month postoperatively, no clinically meaningful differences were observed among the 4 groups. Time to social recovery was shortest in the topical TXA group and longest in the control group.

CONCLUSION: Local administration of TXA, particularly topical intraoperative application, significantly improves early postoperative recovery following implant-based rhinoplasty. These benefits appear to be limited to the early postoperative period, with no impact on long-term outcomes. Topical TXA represents a simple and effective adjunct for enhanced recovery in aesthetic rhinoplasty.

PMID:41849708 | DOI:10.1097/SCS.0000000000012605

Clin Exp Dent Res. 2026 Apr;12(2):e70336. doi: 10.1002/cre2.70336.

ABSTRACT

OBJECTIVES: To evaluate the influence of operator access on surface roughness parameters and material loss following implantoplasty (IP).

MATERIAL AND METHODS: A total of 42 dental implants were utilized in this study, and three different implant designs. Two set-ups were used: a table-top, allowing unrestricted access, and a phantom-head, imposing limitations in access and better replicating the clinical situation. A combination of tungsten carbide burs and silicone polishers was used to perform IP on the implants. The total amount of time required for IP of each implant was measured for comparisons between modalities, and a 2D roughness profile analysis (R_a and R_z) was conducted using a contact stylus profilometer. The weight and the diameter of the implants were also measured before and after IP was performed.

RESULTS: A statistically significant difference was found between the R_a (p = 0.004) and R_z (p = 0.019) values of implants prepared under table-top conditions, being smoother, when compared to the ones prepared in the phantom head. The time required to perform IP was significantly different between the two different settings (p < 0.001) and between some implant types. The set-up in which IP was performed did not have a significant impact on the change in implant mass (p = 0.926) or in implant diameter (p = 0.721).

CONCLUSIONS: Implants treated with IP in the phantom-head set-up exhibited significantly greater surface roughness and required longer procedural time compared to those treated in the table-top model, but did not influence material loss.

PMID:41849691 | DOI:10.1002/cre2.70336

Pharm Stat. 2026 Mar-Apr;25(2):e70086. doi: 10.1002/pst.70086.

ABSTRACT

Well-controlled clinical trials employ careful processes to reduce bias, often blinding investigators and sponsors to prevent knowledge of study outcomes and potential operational bias. Quality assurance of outcomes is also ensured through designation of unblinded data managers and statisticians, so that complex adaptive designs with multiple interim analyses can be executed. Our approach addresses potential ad-hoc requests by the Data and Safety Monitoring Board (DSMB) for monitoring safety, efficacy, and ethical oversight. A novel approach utilizing current trial data is proposed to predict trial outcomes for blinded decision-makers without unblinding those that should stay blinded. Bayesian predictive power, a trial prediction method, is employed and illustrated on simulated data. This study presents an approach for presenting updated Bayesian predictive power in complex adaptive designs, exemplified by the Hyperbaric Oxygen Brain Injury Treatment (HOBIT) trial. Simulation examples motivated from the trial demonstrate the utility of Bayesian predictive power in predicting trial outcomes and sample size distribution, aiding in resource allocation and decision-making with different reports for blinded and unblinded teams. Bayesian predictive power calculations offer valuable insights into future trial behavior for both blinded and unblinded groups, aiding in guidance during trial conduction. The approach outlined in this short communication can be applied to various trial designs.

PMID:41849677 | DOI:10.1002/pst.70086

Eur J Public Health. 2026 Mar 14;36(2):ckag022. doi: 10.1093/eurpub/ckag022.

ABSTRACT

Multimorbidity places increasing pressure on healthcare systems, requiring effective tools to assess clinical complexity. Existing comorbidity indices are often setting-specific and lack generalizability. The Multisource Comorbidity Score (MCS), developed in Italy, has shown strong predictive value. This study aimed to externally validate MCS and to test recalibrated and context-adapted versions to enhance its performance in a different healthcare system. A longitudinal observational study included 198 753 residents aged ≥50 in the Barcelona-Esquerra health district, followed between 2016 and 2019. The original MCS was validated, and two adapted versions were tested: a recalibrated MCS with locally derived weights and an enhanced MCS incorporating primary care data. Predictive validity for 1-year mortality (primary outcome) and secondary outcomes (4-year mortality, hospitalizations, and healthcare use) was assessed using the Area Under the Receiver Operating Characteristic (AUROC) curve, survival analysis, and net reclassification improvement (NRI). All MCS versions showed good discrimination. AUROCs for 1-year mortality were 0.742 (original), 0.756 (recalibrated), and 0.771 (enhanced). Adapted versions achieved better risk reclassification and higher discrimination for long-term mortality. Higher MCS scores were associated with progressively lower survival probabilities and increased healthcare resource utilization. The MCS demonstrated satisfactory external validity in the validation context, with adapted versions offering modest improvements.

PMID:41849674 | DOI:10.1093/eurpub/ckag022

J Med Internet Res. 2026 Mar 18;28:e81879. doi: 10.2196/81879.

ABSTRACT

BACKGROUND: Telehealth use surged during the COVID-19 pandemic and has stabilized at levels substantially above prepandemic baselines. However, concerns persist that the digital divide may reproduce or widen disparities in access. Understanding the determinants of telehealth use-and particularly modality choice between video and audio-is essential for designing policies that promote equitable access in the post-public health emergency era.

OBJECTIVE: This study aims to identify determinants of telehealth use and modality among US adults in 2022 and quantify the relative contributions of digital, geographic, clinical, and socioeconomic domains.

METHODS: We conducted a cross-sectional secondary analysis of the sixth cycle of the Health Information National Trends Survey, administered in 2022 by the National Cancer Institute, a nationally representative, 2-stage stratified random probability survey of civilian, noninstitutionalized US adults aged 18 years or older. Sampled households were recruited via mailed invitations, and 1 adult per household was randomly selected using the next birthday method and invited to complete a self-administered questionnaire between February 2022 and November 2022 (N=6252). The primary analytic sample included respondents with nonmissing telehealth modality responses (n=6046, 59.4% female; mean age of 55.1 y). Individual-level data were linked to county-level American Community Survey socioeconomic indicators and broadband availability measures. The primary outcome was telehealth use, categorized as video (n=1641, 27.2%; 95% CI 25.5%-29.1%), audio-only (n=876, 12.1%; 95% CI 10.9%-13.4%), or none (n=3529, 60.7%; 95% CI 58.6%-62.7%). We estimated 4 binary contrasts using survey-weighted linear probability models with jackknife variance estimation, reporting absolute risk differences in percentage points (pp) with 95% CIs. We applied Shorrocks-Shapley decomposition to quantify each predictor domain’s contribution to explained variance.

RESULTS: Nationally, 39.3% (n=2517; 95% CI 37.3%-41.4%) reported any telehealth use in the past 12 months. In survey-weighted linear probability models (α=.05), significant predictors of any telehealth vs none included: male sex (-9.7 pp, 95% CI -14.0 to -5.4), disability status (+22.5 pp, 95% CI 16.1-28.8), and health app use (+18.4 pp, 95% CI 12.0-24.8). For video vs audio-only telehealth, insurance coverage increased video use (+21.2 pp, 95% CI 13.0-29.3), while basic cell phone only (vs smartphone) decreased video use (-20.1 pp, 95% CI -33.5 to -6.8). Shorrocks-Shapley decomposition revealed that digital access and eHealth behaviors explained 40.4% of variance in video vs audio choice and 33.4% of video vs none; geography explained 40.5% of audio vs none; digital factors (25.7%), geography (19.7%), and health status and needs (15.5%) all contributed substantially to any vs none.

CONCLUSIONS: Digital access and eHealth behaviors collectively explain more variance in modality choice than traditional sociodemographic factors. Telehealth uptake reflects a combination of digital factors, geography, and clinical need, whereas video modality specifically hinges on digital readiness. Interventions pairing sustained insurance coverage with targeted investments in device access, affordable high-speed connectivity, and digital literacy training are most likely to narrow persistent telehealth gaps.

PMID:41849671 | DOI:10.2196/81879

JMIR Form Res. 2026 Mar 18;10:e79694. doi: 10.2196/79694.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors are widely used in oncology but can cause immune-related adverse events (irAEs), which may be severe or life-threatening if not detected early. Electronic patient-reported outcome (ePRO) symptom monitoring systems may facilitate timely recognition and management of irAEs. Usability testing is a critical stage in ePRO system development, yet no published examples of formal usability and acceptance testing exist.

OBJECTIVE: This study aims to assess the usability and acceptance of a co-designed ePRO symptom monitoring prototype for irAEs embedded within the Epic electronic medical record.

METHODS: Testing was conducted at an Australian quaternary cancer center. Eligible participants were patients who had received or were receiving immune checkpoint inhibitors, their caregivers, or clinicians (oncologists and nurse specialists). Participants completed baseline digital literacy assessments (16-item Mobile Device Proficiency Questionnaire [MDPQ-16] and 12-item Computer Proficiency Questionnaire [CPQ-12]) before a structured testing session. Each session involved role-specific tasks using the patient-facing Health Hub or the clinician-facing Epic electronic medical record. Usability was assessed using the System Usability Scale (SUS). Acceptance was assessed using a customized Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Semistructured interviews were used to capture qualitative feedback.

RESULTS: A total of 30 participants (7 patients, 3 caregivers, 10 oncologists, and 10 nurse specialists) completed 10 testing sessions. Median MDPQ-16 and CPQ-12 scores were higher for clinicians compared to patients and caregivers. Median SUS scores indicated high usability-patients and caregivers: 77.5% (IQR 70.0%-86.3%), oncologists: 82.5% (IQR 80.0%-90.0%), and nurse specialists: 80.0% (IQR 75.6%-94.4%). Median UTAUT scores demonstrated strong user acceptance-patients or caregivers: 4.27 (IQR 4.09-4.58), oncologists: 4.33 (IQR 4-4.63), and nurse specialists: 4.23 (IQR 3.87-4.57). Health Hub usability themes highlighted overall ease of navigation and efficiency of reporting, but a need for clearer survey navigation, simplification of the actions page, and improved organization of trend graphs. For clinicians, themes included efficient side effect capture and intuitive system design, but a need to improve navigation to results, optimize data display, and facilitate team-based alert management. Health Hub acceptance themes highlighted patient empowerment to self-manage, enhanced patient-clinician communication, and reinforcement of existing care. However, concerns were raised about digital equity for vulnerable groups. Clinicians reported that the system streamlined side effect management between visits, aligned with existing Epic workflows, and could be tailored to personal preferences. Concerns remained regarding additional workload and medico-legal responsibilities associated with real-time alerts.

CONCLUSIONS: The ePRO prototype demonstrated high levels of usability and acceptance across patients, caregivers, and clinicians. Limitations around navigation and data visualization, alongside equity and workload concerns, will guide refinements prior to implementation. These findings emphasize the value of rigorous formative usability and acceptance testing to optimize ePRO systems prior to deployment in routine cancer care.

PMID:41849661 | DOI:10.2196/79694

JMIR Res Protoc. 2026 Mar 18;15:e76470. doi: 10.2196/76470.

ABSTRACT

BACKGROUND: Advances in antiretroviral therapy (ART) have significantly improved the life expectancy of people living with HIV. However, maintaining retention in care-defined as ongoing engagement with medical services from diagnosis through regular follow-up-is essential for optimal clinical outcomes. Loss to follow-up (LTFU), commonly defined as the absence of ART prescription refills or medical visits for more than 90 days, has been associated with increased mortality, treatment failure, and continued community transmission. Although multiple individual and structural factors have been linked to LTFU, evidence from the Mexican context remains limited.

OBJECTIVE: This protocol describes a prospective cohort study designed to identify factors associated with LTFU among recently diagnosed people living with HIV in Mexico.

METHODS: We conducted a prospective cohort study at a national tertiary care hospital in Guadalajara, Jalisco, Mexico. Eligible participants were adults (≥18 years) who had initiated ART within 6 months prior to enrollment. Data on sociodemographic, clinical, HIV-related, and psychosocial variables were obtained from electronic medical records, pharmacy dispensing logs, and validated questionnaires (Simplified Medication Adherence Questionnaire, Berger HIV Stigma Scale, and the Medical Outcomes Study HIV Health Survey). The primary outcome is LTFU, defined as ≥90 consecutive days without a medical visit or ART refill, ascertained through institutional records and national ART dispensation systems. Participants will be followed for 24 months. Planned analyses include descriptive statistics, Kaplan-Meier curves for time to LTFU, and multivariable Cox and logistic regression models to identify factors independently associated with disengagement from care.

RESULTS: Recruitment took place between December 2023 and March 2024, yielding 164 enrolled participants who completed all baseline assessments. The 24-month follow-up period for this cohort extends from April 2024 through March 2026, with primary analyses and dissemination of results planned for the second half of 2026. Baseline data indicate that the cohort is characterized by substantial socioeconomic vulnerability, a high prevalence of late presentation, and notable levels of perceived stigma and reduced health-related quality of life.

CONCLUSIONS: This protocol outlines a prospective cohort study to evaluate factors associated with LTFU among people living with HIV in a Mexican tertiary care setting. The baseline findings highlight substantial socioeconomic, clinical, and psychosocial vulnerabilities that may compromise long-term retention in care. The longitudinal follow-up of this cohort will provide context-specific evidence to inform targeted interventions aimed at improving engagement in care and reducing LTFU in similar populations.

PMID:41849639 | DOI:10.2196/76470

Cerebrovasc Dis Extra. 2026 Mar 18:1-18. doi: 10.1159/000551531. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The benefit of intravenous thrombolysis (IVT) before endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) with medium-large infarct core (MLIC) remains uncertain.

METHODS: We conducted a retrospective analysis of a prospective multicenter registry in Vietnam (August 2023-September 2024). We included patients with AIS-LVO in the anterior circulation within 4.5 hours of onset, an Alberta Stroke Program Early CT Score (ASPECTS) < 6, and a National Institutes of Health Stroke Scale (NIHSS) ≥ 6 at admission. The primary outcome was functional ambulation (defined as mRS 0-3) at 90 days of follow-up. Secondary outcomes were functional independence (mRS 0-2), mRS shift analysis, and rates of successful reperfusion (modified thrombolysis in cerebral infarction 2b-3). Safety outcomes were defined by symptomatic intracranial hemorrhage (ICH) according to SITS-MOST criteria and 90-day mortality. Outcomes between the bridging therapy and EVT alone groups were compared using propensity score-matched (PSM) analysis.

RESULTS: Of 403 MLIC patients undergoing EVT, 148 presented within 4.5 hours, 59 (39.9%) received bridging IVT. After PSM (n=72), with 36 in each group. The median age, proportion of males, baseline ASPECTS, and NIHSS scores were similar between the two groups. The bridging group achieved higher rates of functional ambulation (75% vs 41.7%, OR 4.2, 95% CI 1.54-11.46). Regarding safety, there was no statistically significant difference in symptomatic intracerebral hemorrhage (8.3% vs 11.1%, p = 1.0) or mortality (8.3% vs 19.4%, p = 0.17), though the confidence intervals were wide.

CONCLUSIONS: Our study suggests that bridging therapy in patients with acute medium-large ischemic core within 4.5 hours of onset results in better functional outcomes than EVT alone without increasing the sICH rate. Further studies are required to assess the safety and efficacy of bridging therapy.

PMID:41849637 | DOI:10.1159/000551531