Tag: pubmed

Pain. 2026 Jun 5. doi: 10.1097/j.pain.0000000000004028. Online ahead of print.

ABSTRACT

Abbreviated psychotherapies for chronic pain improve access to care by reducing length of treatment and reaching patients outside of chronic pain clinics, such as primary care. However, the evidence for these approaches is limited. We conducted a randomized controlled trial of brief cognitive behavioral therapy for chronic pain (ie, 6, 30-minute sessions of psychoeducation, behavioral and cognitive skills, and relapse prevention delivered individually) with 184 primary care patients with moderate to severe chronic musculoskeletal pain from a Veterans Health Administration medical center. Mean age of the sample was 59 years (SD = 13.3), 84.8% were male, and 77.2% were White. Following baseline, patients were randomized to either brief cognitive behavioral therapy for chronic pain plus usual pain care or usual pain care alone. Assessments were conducted at baseline plus 6 weeks (mid-treatment), 12 weeks (treatment completion), and 24 weeks (3 month post-treatment follow-up) to gather information regarding pain interference (primary outcome), pain intensity, mental health symptoms, quality of life, and social role participation. Results indicated that relative to usual pain care alone, participants who also received behavioral treatment showed statistically greater improvement in pain interference at each time point. Clinically significant improvement in pain interference was reached by mid-treatment with continued improvement at treatment completion and 3-month follow-up among the behavioral treatment group but not the usual pain care group. Behavioral treatment was also associated with improved physical quality of life and sleep quality. This significantly abbreviated behavioral treatment designed for scalability can lead to rapid and sustained improvements in pain outcomes.

PMID:42263268 | DOI:10.1097/j.pain.0000000000004028

JMIR Mhealth Uhealth. 2026 Jun 9;14:e93877. doi: 10.2196/93877.

ABSTRACT

BACKGROUND: Falls among older adults are a growing and costly public health problem that often leads to mobility decline and loss of independence. Although clinical frameworks such as the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative recommend multifactor screening (gait, balance, strength, fear of falling, and fall history), most wearable fall risk assessment systems rely on a small set of risk factors (typically gait), which creates a gap between clinical practice and automated wearable assessment.

OBJECTIVE: This study aims to evaluate the importance of STEADI-based fall risk factors and provide design guidance for clinically compatible wearable fall risk assessment systems.

METHODS: We created a dataset of 24 older adults (10 low fall risk and 14 high fall risk) from a publicly available plantar pressure dataset of 48 participants by retaining only those with consistent fall risk labels based on both the Berg Balance Scale and the Timed Up and Go test. A total of 18 features were extracted to quantify gait, strength, balance, fear of falling, and fall history. Random forest (RF) models were trained with leave-one-subject-out cross-validation to assess fall risk. Importance of STEADI-based factors was assessed by two methods: (1) estimating Shapley Additive Explanations values based on a single RF model trained on all features; and (2) training 5 separate RF models, each on 1 STEADI factor category, and comparing their fall risk classification accuracies.

RESULTS: In this secondary analysis, the RF model trained on all features achieved a subject-level accuracy of 87.53% (95% CI 75%-100%). Shapley Additive Explanations analysis identified the right foot flat phase ratio (fear of falling feature) as the highest-ranked feature, followed by maximum right forefoot ground reaction force (strength feature), whereas traditional gait features did not appear in the top 10. The 5 separate RF models trained on individual STEADI-based factor categories showed a similar trend in mean participant-level accuracy: fear of falling, 87.59% (95% CI 75%-100%); strength, 79.18% (95% CI 62.5%-95.83%); balance, 70.5% (95% CI 50%-87.5%); gait 70.81% (95% CI 54.17%-87.5%); and fall history 62.37% (95% CI 50%-75.1%). However, paired comparisons did not show statistically significant differences in accuracy between the gait model and the models trained on other factors.

CONCLUSIONS: These preliminary results show that commonly overlooked nongait factors are potentially as informative as gait, although clear superiority was not demonstrated in this dataset. The novel foot flat phase ratio ranked higher than all other evaluated features, which showed the value of domain knowledge-informed feature engineering. These preliminary findings indicate that nongait STEADI factors merit consideration in the design of wearable fall risk assessment systems.

PMID:42263263 | DOI:10.2196/93877

J Food Sci. 2026 Jun;91(6):e71189. doi: 10.1111/1750-3841.71189.

ABSTRACT

This study evaluated the growth of Bacillus cereus, Escherichia coli, and Salmonella Typhimurium in commercially available cocoa-flavored plant-based milk alternatives (PBMAs) under different temperatures and examined the influence of product composition on bacterial development. Bacterial populations were monitored over 12 h at 25°C for all strains and additionally at their optimal growth temperatures (30°C for B. cereus, 37°C for E. coli, and S. Typhimurium). The nutritional composition of the PBMAs was analyzed, and principal component analysis (PCA) was performed to identify key compositional factors. Results showed that the increase in E. coli and Salmonella Typhimurium population was significantly higher at 37°C than at 25°C on all cocoa-flavored PBMAs (p < 0.05), whereas for B. cereus, the differences between 25°C and 30°C were relatively small, with statistical significance observed only for Substrate A (p < 0.05). Growth was significantly influenced by bacterial species (MS = 10.49, p < 0.001), substrate composition (MS = 0.48, p < 0.001), and interaction of both these factors (MS = 0.29, p = 0.001). The formulated regression models based on environmental factor (temperature), PCA scores (reflecting substrate composition, particularly protein, fiber, fat, sodium, and energy balance, and for B. cereus also sodium, fiber, and pH-related properties), and time, accurately reproduced bacterial growth (R² = 0.857-0.898), highlighting the combined effects of these factors. By mapping new PBMA formulations onto the tested compositional space, it may also support contamination risk assessment and contribute to ensuring consumer safety. PRACTICAL APPLICATIONS: The findings highlight that cocoa-flavored plant-based milk alternatives can support the growth of microorganisms depending on their composition and storage temperature. Understanding how nutrients such as protein, fiber, fat, and sodium drive microbial proliferation enables manufacturers to optimize formulations for improved microbial safety. The regression models developed can support predictive assessments during product design. These insights can guide industry and regulators in establishing safer handling, storage, and formulation strategies for PBMAs.

PMID:42263222 | DOI:10.1111/1750-3841.71189

BJS Open. 2026 May 12;10(3):zrag063. doi: 10.1093/bjsopen/zrag063.

ABSTRACT

BACKGROUND: Tumour-positive margins after breast-conserving surgery (BCS) for breast cancer increase the risk of local recurrence and require additional therapy. Intraoperative imaging techniques in high-risk patients could improve margin determination. This study describes margin status after BCS in the Netherlands between 2009 and 2022, focusing on trends in surgical margin status and identifying subgroups at higher risk of tumour-positive margins.

METHODS: All patients undergoing BCS for non-metastatic breast cancer in the Netherlands from 2009 to 2022 were selected from the Netherlands Cancer Registry. Data included patient and tumour characteristics, treatment details, and surgical margin status. Descriptive statistics and trend analyses were performed. Univariate and multivariable analyses were performed to identify risk factors and patient subgroups at higher risk of margin involvement. Marginal effects analyses quantified tumour-positive margin risks.

RESULTS: In total, 109 475 women were included in the study. The mean tumour-positive margin rate was 10.8%. An extensively positive margin (> 4 mm involvement) occurred in 3.9% of patients, with a decreasing trend seen until 2013. Risk factors for a positive margin were invasive lobular carcinoma, multifocal disease, clinical tumour (cT) category 2 or 3, and neoadjuvant chemo- or hormonal systemic therapy without pathological complete response (pCR), with odds ratios (ORs) ranging from 1.56 to 2.96. One or more of these risk factors was present in 44 772 patients (40.9% of total cohort). The probability of positive margins increased with the number of risk factors, from 6.8% (no risk factors) to 49.1% (all four risk factors). Preoperative understaging (cT<pathological tumour) was also associated with an increased margin risk (OR 3.69). Two prediction tools were developed based on these outcomes (for total positive margins and for extensively positive margins only).

CONCLUSION: Over the past decade, tumour-positive margin rates in the Netherlands have remained stable at 10.8%. Patients with invasive lobular carcinoma, cT2/3 tumours, multifocal disease, or those receiving neoadjuvant chemotherapy or hormonal systemic therapy without pCR remain at substantially higher risk. There is room for improvement in these patient subgroups, highlighting the need for intraoperative imaging innovations to reduce positive margins.

PMID:42263217 | DOI:10.1093/bjsopen/zrag063

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