Tag: pubmed

JAMA Netw Open. 2026 Jun 1;9(6):e2619644. doi: 10.1001/jamanetworkopen.2026.19644.

ABSTRACT

IMPORTANCE: Following the Dobbs v Jackson Women’s Health Organization decision, states with abortion bans have experienced increased maternal morbidity and mortality. However, the associations of these restrictions with abortion-adjacent care-medical care directly affected by or overlapping with abortion, such as management of early pregnancy loss (EPL), ectopic pregnancy, and other pregnancy complications-are not well described.

OBJECTIVE: To examine how state-level abortion bans are associated with abortion-adjacent clinical care among physicians from different medical specialties.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study was conducted between May 13, 2024, and May 23, 2025, using purposive and snowball sampling. Participants included physicians from emergency medicine, family medicine, and obstetrics and gynecology specialties practicing in 9 states with total abortion bans. Semistructured interviews were conducted via videoconference and analyzed using an inductive thematic approach with dual independent coding.

EXPOSURE: Medical practice in a state with an abortion ban.

MAIN OUTCOMES AND MEASURES: Participant-reported experiences with clinical decision-making, care delivery, counseling practices, and professional responsibilities in the context of abortion bans.

RESULTS: A total of 40 physicians (18 in obstetrics and gynecology, 8 in family medicine, and 14 in emergency medicine) across 9 states participated, 30 (75.0%) of whom were female. Mean (SD) length of time in practice was 7.9 (6.1) years. Six major themes emerged: (1) delays in care and deviations from standard practice for EPL, ectopic pregnancy, molar pregnancy, preterm prelabor rupture of membranes, and maternal comorbidities; (2) ambiguity and fear among physicians; (3) loss of patient autonomy and shared decision-making; (4) erosion of trust in the patient-physician relationship; (5) placement of physicians into new gatekeeping roles; and (6) increased health care system burdens. Physicians described requiring additional confirmatory testing, seeking institutional approval even for emergent life-saving interventions, and being forced to determine which patients were sick enough to receive medically indicated care.

CONCLUSIONS AND RELEVANCE: In this qualitative study of the consequences of abortion bans across multiple medical specialties, abortion bans were associated with disrupted clinical care far beyond what is traditionally categorized as abortion, with treatment delays that endanger patients, undermined patient autonomy and physician-patient trust, and with new gatekeeping roles for physicians. These restrictions shifted medical decision-making from clinical judgment and patient values toward legal risk mitigation, with potential long-term consequences including exacerbation of health care inequities and compromised ability to provide safe and effective care for pregnant patients.

PMID:42329649 | DOI:10.1001/jamanetworkopen.2026.19644

JAMA Intern Med. 2026 Jun 22. doi: 10.1001/jamainternmed.2026.2036. Online ahead of print.

ABSTRACT

IMPORTANCE: Antiplatelet medications are overprescribed in patients taking direct oral anticoagulants (DOACs), increasing their risk of major bleeding. The utility of potentially scalable antithrombotic stewardship approaches remains unknown.

OBJECTIVE: To evaluate a multicomponent antithrombotic stewardship initiative to reduce unnecessary antiplatelet use in patients prescribed DOACs.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study used retrospective multiperiod comparative interrupted-time-series analysis from July 2020 to July 2023 to compare intervention and control sites. Participants were adults prescribed DOACs in the ambulatory setting. The interventions occurred in 7 Veterans Health Administration (VHA) health systems, while 128 other VHA health systems served as controls. Data were analyzed from July 2023 to March 2026.

INTERVENTION: In stage 1, lasting 9 months, intervention sites implemented educational outreach to clinicians and patients and changes to the electronic health record system. In stage 2, lasting 16 months, a clinical pharmacist-facing electronic flag identifying patients receiving antiplatelet therapy was added to a widely used electronic dashboard.

MAIN OUTCOMES AND MEASURES: Monthly site-level percentage of patients prescribed antiplatelet medications. The summary measure was the difference in the semiannual change in the outcome for intervention compared with control sites, controlling for preintervention trends. Subgroup analyses were performed based on antiplatelet indication.

RESULTS: This study found that preintervention antiplatelet use in patients prescribed DOACs was 26.1% (95% CI, 26.0%-26.1%) in the 7 intervention sites (27 588 patients; 704 females [2.6%]) and 30.1% (95% CI, 30.0%-30.2%) in 128 control sites (253 085 patients; 6481 females [2.6%]). Antiplatelet use decreased faster by an absolute -0.58 (95% CI, -0.95 to -0.22) percentage points (pp) per 6 months for intervention compared with control sites after the 2 interventions had been implemented. The initial set of interventions was associated with an absolute -0.29 (95% CI, -0.61 to 0.04) pp change per 6 months and later augmentation with the electronic flag was associated with an absolute -0.29 (95% CI, -0.61 to 0.03) pp change per 6 months. The combined interventions were associated with the greatest reduction in the subgroup of patients with stable coronary artery disease (absolute -2.1 [95% CI, -3.0 to -1.2] pp per 6 months, equivalent to a -5.5% additional change compared with the baseline prevalence in this group), for whom antiplatelet deimplementation is likely appropriate.

CONCLUSIONS AND RELEVANCE: This study found that the combined interventions were associated with a clinically meaningful reduction in potentially harmful combination antithrombotic therapy. The initial educational outreach and changes to the electronic health record and later augmentation with the electronic flag had additive effects, highlighting the importance of multilevel interventions to speed adoption of evidence-based antithrombotic prescribing.

PMID:42329643 | DOI:10.1001/jamainternmed.2026.2036

Gen Dent. 2026 Jul-Aug;74(4):70-76.

ABSTRACT

Light transmission during photopolymerization is reduced by the intrinsic optical properties of ceramics, which vary with material and thickness. The higher translucency of lithium disilicate contrasts with the chemical inertness and opacity of third-generation zirconia materials, which often require dual-cure resin cements to ensure adequate polymerization. This study evaluated the influence of the thickness of lithium disilicate and monolithic zirconia ceramics on the bond strength of a universal resin cement following 24 hours and 6 months of water storage. High-translucency lithium disilicate and zirconia discs were milled in 2 thicknesses: 0.5 mm and 1.5 mm (n = 10). Cylinders of light-curing resin cement, 0.7 mm in diameter, were bonded following application of a universal adhesive system. Microshear bond strength testing and failure mode analysis were performed after 24 hours and 6 months of water storage in a temperature-controlled, light-protected environment. Mixed generalized linear models showed that the 1.5-mm zirconia group presented a higher mean bond strength (P < 0.05). The 1.5-mm zirconia group showed significantly higher mean bond strengths than the 1.5-mm lithium disilicate group at both evaluation times (P < 0.05). Both 0.5- and 1.5-mm-thick zirconia discs exhibited a statistically significant reduction in bond strength after 6 months of storage (P < 0.05), whereas lithium disilicate discs in both thicknesses maintained stable bond strengths over time (P > 0.05). The chi-square test revealed a significant association between premature failure and the material group, with no premature failures occurring in the 0.5-mm lithium disilicate group after either storage time. Although the bond strength of zirconia decreased over time, 1.5-mm-thick zirconia still attained a higher value than 1.5-mm-thick lithium disilicate at the 6-month timepoint. Lithium disilicate showed stable values at both thicknesses.

PMID:42329617

Gen Dent. 2026 Jul-Aug;74(4):65-68.

ABSTRACT

The aim of this in vitro study was to evaluate the surface roughness of microhybrid and nanohybrid composite resins subjected to polishing procedures immediately after curing or after 24 hours of immersion in distilled water. Two groups, comprising a total of 60 disc-shaped (10 × 2-mm) specimens, were prepared using microhybrid and nanohybrid composite resins (n = 30 per material) and further categorized into subgroups based on the polishing protocol. Specimens were fabricated by packing the appropriate composite resin into a cylindrical mold, compressing the material between transparent polyester film strips at both ends, and curing each side of the specimen with an LED light for 40 seconds. All specimens were finished immediately after polymerization using a 12-fluted tungsten carbide bur in a high-speed handpiece for 15 seconds under water cooling. The specimens in each material group were then divided into 2 subgroups (n = 15 each). One subgroup was polished immediately after finishing; the other was stored in distilled water at 37°C in a dark environment for 24 hours prior to polishing. Polishing was performed using a planar motion with 10 strokes at a low speed of 12,000 rpm, applying light pressure for 30 seconds. Surface roughness (R_a) was analyzed with a profilometer. Independent t tests were performed to compare the R_a data of the groups, and values of P < 0.05 were considered statistically significant. The R_a values of nanohybrid specimens were significantly lower than those of microhybrid specimens, regardless of whether polishing was performed immediately or delayed. Delayed polishing significantly reduced the R_a values of both materials. Nanohybrid composite resins demonstrated superior polishability and surface smoothness, making them a preferred choice for both immediate and delayed polishing.

PMID:42329616

Gen Dent. 2026 Jul-Aug;74(4):40-48.

ABSTRACT

This study examined the demographics, practice characteristics, service mix, and barriers faced by general and pediatric dentists in the provision of orthodontic care to the pediatric population, including children enrolled in Medicaid programs. A 31-item questionnaire was developed and distributed by email to 567 members of the Academy of Gp Orthodontics and the American Orthodontic Society. Analyses included descriptive and inferential statistical methods: chi-square, Kruskal-Wallis, and Student t tests; analysis of variance; and Spearman correlation. A value of (P < 0.05) was considered statistically significant. Thirty-four practitioners (6.0%), the majority male (58.8%), completed the survey. The mean (SD) age of respondents was 53.3 (11.8) years, and on average they had been practicing 23.3 (12.9) years. Respondents primarily practiced in suburban areas (47.1%), and most identified as general dentists (85.3%). Only 23.5% reported providing orthodontic services to children enrolled in Medicaid. The most common reasons for not participating in the program included low reimbursement rates, difficulty with billing, and patient noncompliance. Although time dedicated to orthodontic services varied, the majority (55.9%) allocated 10% to 25% of their practice time to such treatments. Most respondents (79.4%) referred cases to orthodontists, mainly Class III malocclusions (30.6%) and open bites (23.6%). General and pediatric dentists increase access to orthodontic services by evaluating patients, rendering care, and, when appropriate, referring patients to specialists. Respondents to this survey reported multiple barriers to providing orthodontic care, particularly for the Medicaid population. These findings underscore the need for reforms to address financial and administrative barriers to orthodontic care, particularly for underserved populations.

PMID:42329612

Gen Dent. 2026 Jul-Aug;74(4):34-38.

ABSTRACT

This in vitro study aimed to compare the effects of conventional and ultrasonic root canal preparation on the adhesion of glass fiber posts to root canal dentin. A total of 20 human maxillary central incisors were instrumented and then filled with gutta percha and sealant using the lateral condensation technique. The teeth were randomly divided into 2 equal groups (n = 10), gutta percha was removed, and canals were prepared using a different protocol for each group: in the conventional group, a Gates-Glidden drill, a Largo drill, and post bur kit were used; in the ultrasonic group, ultrasonic tips were operated in endo mode. Microcomputed tomography was used to confirm complete removal of the filling material, and fiber posts were cemented with self-adhesive resin cement. The apical ends of the roots were discarded, and the remaining portions were transversely sectioned into 3 segments, each 1.5 mm thick. The sections underwent push-out testing to determine bond strength, and the adhesion defects were examined with scanning electron microscopy and stereomicroscopy to determine the failure mode. Data normality was assessed using the Kolmogorov-Smirnov test, followed by analysis of variance with Tukey test for group comparisons and chi-square tests to evaluate any associations regarding failure mode. A 5% significance level was applied. Tukey tests revealed that the conventional group exhibited statistically significant lower push-out bond strengths than the ultrasonic preparation groups across all thirds; no statistically significant differences were noted among the cervical, middle, and apical thirds within the same group. There were no statistically significant differences in failure modes between the preparation groups, and adhesive failure was the most prevalent mode. The ultrasonic method effectively removed gutta percha from canals and enhanced the bond strength of fiber posts.

PMID:42329611

Gen Dent. 2026 Jul-Aug;74(4):21-26.

ABSTRACT

This study evaluated and compared the perceptions of general dentists, pediatric dentists, and orthodontists regarding the need for transverse maxillary expansion for Class I malocclusions with posterior crossbite. An electronic survey consisting of digitally manipulated intraoral images depicting 8 clinical scenarios was distributed to 10,000 general dentists, 8734 pediatric dentists, and 2400 orthodontists. A total of 566 practitioners responded (2.7% response rate): 85 general dentists, 339 pediatric dentists, and 142 orthodontists. For each case, participants assessed the need for expansion, type of expansion, and referral preferences. Statistical analyses included chi-square tests and multivariable logistic regression, which were adjusted for specialty, years of experience, and geographic region. Significant differences in perception were observed in 6 of the 8 cases (P < 0.05), primarily influenced by specialty training. Orthodontists demonstrated significantly higher odds of recommending expansion than general dentists, particularly in more complex presentations. Pediatric dentists more frequently opted for referral rather than treatment. Neither years of practice nor geographic region significantly influenced diagnostic decisions. Survey reliability demonstrated moderate to substantial agreement across repeated cases (κ = 0.424 to 0.677), and power analysis indicated sufficient sample size and effect sizes for most scenarios. These findings suggest that specialty training strongly influences the perceived need for transverse maxillary expansion, highlighting a potential need for enhanced orthodontic diagnostic education in dental and pediatric residency programs to promote consistency in the diagnosis and management of transverse discrepancies across dental specialties.

PMID:42329609

Ann Surg Oncol. 2026 Jun 22. doi: 10.1245/s10434-026-19996-1. Online ahead of print.

ABSTRACT

BACKGROUND: Esophageal cancer is associated with substantial morbidity and mortality worldwide and is frequently diagnosed at advanced stages, leading patients and their relatives to seek health-related information beyond traditional clinical encounters. In recent years, YouTube has become a popular source of medical information. Nevertheless, questions persist regarding the accuracy, credibility, and overall reliability of the content available on the platform.

METHODS: This cross-sectional study evaluated publicly available YouTube videos related to esophageal cancer. Data were collected on December 3, 2025, using a browser without a user login to minimize algorithm-driven bias. Viewer engagement metrics (views, likes, and comments), source categories, and country of origin were recorded for each video. Content quality and reliability were assessed using the DISCERN instrument, Journal of the American Medical Association (JAMA) benchmark criteria, and Global Quality Score (GQS). Non-parametric statistical analyses were used to compare quality outcomes across source categories and evaluate the correlations between the engagement metrics and quality scores.

RESULTS: A total of 78 videos met the inclusion criteria, most of which originated in the USA (83.3%). Health-related channels constituted the largest source category (35.9%), followed by patient experience-based videos (23.1%), and private institutions (20.5%). Viewer engagement metrics (views, likes, and comments) did not differ significantly among source types (p > 0.05). In contrast, the content quality varied substantially. Videos produced by public institutions achieved the highest DISCERN, JAMA, and GQS values, whereas patient-experience-based videos demonstrated significantly lower quality and reliability (p < 0.001). Engagement metrics were strongly intercorrelated but showed no association with quality scores.

CONCLUSION: YouTube videos related to esophageal cancer frequently exhibit moderate informational quality, and popularity metrics do not reflect content reliability. Source credibility plays a critical role in determining video quality, underscoring the need for greater involvement of healthcare professionals and public institutions in digital health content production.

PMID:42329563 | DOI:10.1245/s10434-026-19996-1

Oral Radiol. 2026 Jun 22. doi: 10.1007/s11282-026-00942-6. Online ahead of print.

ABSTRACT

OBJECTIVE: Pleomorphic adenoma (PA) is the most common benign parotid tumour. Magnetic resonance imaging (MRI) and fine-needle aspiration cytology (FNAC) are routinely used during preoperative work up. However, there is insufficient evidence to support the use of MRI alone to diagnose a PA. This paper aims to evaluate the diagnostic performance of MRI and FNAC in the diagnosis of PA and develop an MRI assessment tool to potentially reduce an invasive biopsy.

METHODS: A retrospective cohort study was conducted in 155 patients with histopathologically confirmed parotid tumours with preoperative MRI and/or FNAC between 2015 and 2020. Two experienced head and neck radiologists, both with over 20 years’ experience, blinded to final histopathology, evaluated 100 MRIs. Diagnostic values for detecting PA with MRI and FNAC were evaluated. An MRI assessment tool was developed based on clinical criteria and MRI characteristics typical for a PA.

RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value, (NPV) and diagnostic accuracy for predicting PA were 93%, 97%, 96%, 94% and 95% (Area under ROC curve (AUC) 0.95) for FNAC and 95%, 90%, 86%, 96% and 92% (AUC 0.93) for MRI respectively. There was no statistically significant difference between MRI and FNAC for diagnosing PA with regards to sensitivity (p = 0.628), specificity (p = 0.162) or overall accuracy (p = 0.361).

CONCLUSION: MRI is a noninvasive imaging technique that can predict PA with similar sensitivity, specificity and diagnostic accuracy compared with FNAC. The PA MRI assessment tool aims to assist in surgical management decisions, while potentially reducing the need for an invasive biopsy.

PMID:42329557 | DOI:10.1007/s11282-026-00942-6

Saudi Dent J. 2026 Jun 22;38(7):91. doi: 10.1007/s44445-026-00201-8.

ABSTRACT

Endodontically treated teeth often have compromised tooth structure, which increases their susceptibility to fracture. This in vitro study compared the fracture resistance of endodontically treated mandibular premolars restored using the sandwich technique, Nayyar core composite, and semi-direct composite onlay. Seventy-six extracted mandibular premolars were randomly allocated into four groups (n = 19): intact teeth (control), conventional sandwich technique, Nayyar core composite, and semi-direct composite onlay. All groups except the control teeth group underwent standardized root canal treatment and obturation, followed by composite restoration according to the group allocation. Specimens were loaded axially in a universal testing machine until fracture. Fracture resistance was recorded in kilonewtons (kN). Data were analyzed using one-way ANOVA and Dunnett T3 post-hoc tests (p < 0.05). Mean fracture resistance was highest in the intact control group (8.70 ± 4.09 kN), followed by the sandwich technique (7.50 ± 1.55 kN), Nayyar core composite (6.10 ± 1.61 kN), and semi-direct composite onlay (4.94 ± 3.16 kN). The overall difference among the groups was statistically significant (p = 0.001). Post-hoc analysis showed significant differences between the control and semi-direct onlay groups (p = 0.019) and between the sandwich technique and semi-direct onlay groups (p = 0.022). Within the limitations of this in vitro study, the sandwich technique demonstrated the highest fracture resistance when compared with Nayyar core composite restoration and semi-direct composite onlay in endodontically treated mandibular premolars with conservative access preparation and intact marginal ridges.

PMID:42329556 | DOI:10.1007/s44445-026-00201-8