Tag: pubmed

Hypertension. 2026 Jun 29. doi: 10.1161/HYPERTENSIONAHA.125.26521. Online ahead of print.

ABSTRACT

BACKGROUND: Adaptive optics retinal imaging (rtx1e, Imagine Eyes, Orsay, France) enables high-resolution visualization of the retinal microvasculature, providing insights into systemic vascular health. Currently, no studies exist describing changes in wall-to-lumen ratio (WLR) during pregnancy, neither during the physiological course of pregnancy nor in pregnancy-associated complications.

METHODS: This single-center, prospective study at the Leipzig University Hospital, Germany, examines changes in retinal microvasculature by employing adaptive optics to calculate the WLR of an arteriole within a few seconds. The study examined a well-phenotyped cohort of 460 primarily White healthy singleton pregnancies, with 543 measurements taken from the first to the third trimester. The WLR was automatically determined using the nnUNet deep learning model.

RESULTS: Step-down selection mixed-effects modeling identified gestational week, maternal age, mean arterial pressure, and parity as significant contributors to WLR, whereas body mass index did not improve model fit. In the final model, advancing gestational week (P<0.001), higher maternal age (0.012), and higher mean arterial pressure (<0.001) were independently associated with increased WLR, whereas multiparous women showed significantly lower WLR values compared with nulliparous women, with negligible multicollinearity (variance inflation factor ≈1).

CONCLUSIONS: We identify WLR as a sensitive marker for imaging microvascular remodeling, serving as an indicator of adaptation to physiological pregnancy. Normal pregnancy is associated with an instant change of the retinal microvasculature indicated by an increase of WLR. Further studies are required to investigate the postpartum course of WLR and establish whether these changes are reversible.

REGISTRATION: URL: https://www.drks.de; Unique identifier: DRKS00032530.

PMID:42366971 | DOI:10.1161/HYPERTENSIONAHA.125.26521

Infect Control Hosp Epidemiol. 2026 Jun 29:1-8. doi: 10.1017/ice.2026.10485. Online ahead of print.

ABSTRACT

OBJECTIVES: Timely detection of pathogen-related outbreaks in hospitals is important for preventing onward transmission and can be supported by automated outbreak detection systems (AODS). Many methods overlook in-hospital patient transfers and focus only on patient locations at the time of sampling. This study compares three approaches for incorporating patient transfers into AODS.

DESIGN: Two existing AODS frameworks, a local percentile-based system and a statistical modeling-based system were extended to include patient transfers: 1) grouping wards into communities based on frequent patient exchange, 2) including prior ward visits in the past 14 days, and 3) including both prior ward visits and time spent on wards. Alerts generated were reviewed for clinical relevance.

SETTING: Data from January 2014 to December 2021 from a University Medical Center in the Netherlands.

RESULTS: Using the percentile-based approach, the baseline scenario detected 99 possible outbreaks. Extension with ward community groupings, prior ward visits, and prior ward visits accounting for time spent in each ward increased this number with 16 (+15%), 42 (+42%), and 106 (+110%) possible outbreaks, respectively. Of the alerts generated by including individual patient transfer history, 35% were judged as requiring investigation. The trade-off between increased detection and relevance was less favorable for the other approaches. Similar findings were found for statistical modeling-based methods.

CONCLUSIONS: Inclusion of patient transfer data in AODS improved sensitivity, at the cost of increasing the alert burden. Therefore, ongoing refinement should further optimize the balance between accurate outbreak detection and a manageable alert burden.

PMID:42366951 | DOI:10.1017/ice.2026.10485

J Magn Reson Imaging. 2026 Jun 29. doi: 10.1002/jmri.70390. Online ahead of print.

ABSTRACT

BACKGROUND: In cardiac MRI, poor breath-holding may lead to suboptimal image quality. However, the effect of different breath-hold methods on image quality remains unknown.

PURPOSE: To explore the effect of respiratory training with different breath-holding methods and identify the optimal technique for reducing respiratory motion artifacts in cardiac MRI.

STUDY TYPE: Prospective.

POPULATION: A total of 93 patients undergoing cardiac MRI (64 men and 29 women; mean age of 48.9 ± 13.7 years).

FIELD STRENGTH/SEQUENCES: 3T, single-shot fast spin-echo sequence, fast imaging employing steady-state acquisition sequence, first-pass perfusion sequence (fast gradient echo), and late gadolinium enhancement sequence (phase-sensitive myocardial delayed enhancement).

ASSESSMENT: All patients undergoing cardiac MRI were divided into three groups: mouth-breathing, nasal-breathing, and nose-clip. Respiratory-gated monitoring diagrams, examination duration, and subjective and objective image quality assessments were compared.

STATISTICAL TESTS: One-way ANOVA, Chi-square test, Kruskal-Wallis H test, Kappa test. Statistical significance was set at p < 0.05.

RESULTS: Evaluation of the cardiac MRI respiratory-gated monitoring diagrams showed that the probability of good breath-holding in the nose-clip group was 96.7%, significantly higher than in the mouth-breathing (64.5%) and nasal-breathing groups (75.0%). There was no significant difference in examination duration among groups. Myocardial noise in the mouth-breathing group was significantly higher than those in the other two groups (24.2 [18.3, 32.5] vs. 15.8 [12.5, 23.9]/19.2 [13.7, 24.4]); blood pool noise was significantly higher than in the nasal-breathing group (34.6 [22.6, 42.9] vs. 24.9 [18.4, 33.8]). However, CNR did not significantly differ among the three groups (p = 0.07). Subjective image quality scores were higher in the nose-clip group than those in the other two groups (26 [86.7%] versus 16 [51.6%]/18 [56.3%]).

DATA CONCLUSION: Optimized respiratory training can enhance breath-holding performance and image quality in patients undergoing cardiac MRI. The use of a nose clip for assisted breath-holding was found to be the most effective method.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 2.

PMID:42366921 | DOI:10.1002/jmri.70390

Pain Pract. 2026 Jul;26(6):e70182. doi: 10.1111/papr.70182.

ABSTRACT

INTRODUCTION: Percutaneous vertebral augmentation is widely used to provide symptom relief for patients with painful vertebral compression fractures (VCFs), but adjacent fractures remain a known complication. This retrospective study evaluated the risk of adjacent vertebral fractures following different percutaneous vertebral augmentation techniques.

METHODS: A total of 985 encounters from 878 patients who underwent vertebroplasty, kyphoplasty, or bone tumor radiofrequency ablation (BT-RFA) with cement augmentation were included. The primary outcome was incidence of postprocedural adjacent fractures. Associations with demographic and clinical factors including age, sex, BMI, pathologic fractures, bone density, imaging guidance, and number of treated levels were assessed. Statistical analyses included a generalized linear mixed model and Cox proportional hazards models clustered by patient.

RESULTS: Adjacent fracture occurred in 17.8% of encounters. BT-RFA was associated with a significantly lower risk of adjacent fractures compared with kyphoplasty (HR: 0.54, 95% CI:0.36-0.81; p = 0.003) and vertebroplasty (HR: 0.40, 95% CI: 0.27-0.60; p < 0.0001). Multilevel vertebral augmentations increased fracture risk by 1.42-fold, while pathologic fractures lowered the odds of adjacent fracture. No significant associations were found for age, BMI, sex, cement extravasation, or bone density.

CONCLUSION: BT-RFA combined with cement augmentation significantly reduced the risk of adjacent fractures compared to kyphoplasty or vertebroplasty.

PMID:42366910 | DOI:10.1111/papr.70182

Pediatr Pulmonol. 2026 Jul;61(7):e71717. doi: 10.1002/ppul.71717.

ABSTRACT

BACKGROUND: Cystic fibrosis (CF) is a rare, multisystem genetic disease requiring early diagnosis and lifelong multidisciplinary follow-up. In many middle-income countries, including Colombia, national CF registries are absent, and epidemiological information largely relies on administrative health data. Although such data do not reflect true clinical prevalence, they enable systematic monitoring of service-based prevalence and diagnostic practice patterns, offering critical insights for health system planning.

METHODS: We conducted a nationwide, observational study using the Colombian Individual Registry of Provision of Health Services (RIPS) from 2015 to 2024. Children and adolescents aged 0-19 years with CF diagnoses (ICD-10 E84.0-E84.9) were identified. Annual crude and age-standardized administrative prevalence rates were estimated using national population projections. Diagnostic test utilization (spirometry, chest CT, pancreatic elastase, genetic testing) was quantified per 100 encounters. Temporal trends were analyzed using LOESS smoothing with 95% confidence intervals.

RESULTS: The age-standardized national administrative prevalence of CF-related healthcare encounters was 5.64 per 100,000. Administrative prevalence was highest in children aged 0-4 years and declined progressively with age. The contributory insurance regime showed the highest service-based prevalence, suggesting disparities in diagnostic access. Temporal patterns revealed a peak in 2018-2019 followed by a decline after 2020, coinciding with COVID-19-related disruptions in pediatric care. Diagnostic utilization was markedly low: spirometry was performed in fewer than 6 tests per 100 encounters annually, chest CT use was sporadic, and genetic testing was minimal before 2018, increasing slightly thereafter.

CONCLUSIONS: Administrative prevalence of CF in Colombia has remained stable over a decade but is accompanied by underutilization of essential diagnostic procedures and inequities across insurance groups. Strengthening diagnostic capacity, standardizing monitoring practices, and improving early detection are urgent priorities. This study provides a scalable framework for CF surveillance in countries lacking national registries.

PMID:42366899 | DOI:10.1002/ppul.71717

J Appl Behav Anal. 2026 Aug;59(3):e70071. doi: 10.1002/jaba.70071.

ABSTRACT

Treatment durability can be compromised when challenging behavior recurs following context changes (i.e., renewal), yet the temporal features of lapses have not been well described in large clinical samples. We examined latency to onset and persistence of renewal to inform clinical monitoring and planning following context changes. Using a retrospective consecutive case series of 98 patients receiving intensive outpatient treatment for challenging behavior, we analyzed 749 context changes involving person, setting, and task variables. Renewal emerged quickly (M = 1-2 sessions), with half beginning in the first postchange session. Persistence was often brief (49.74% resolved within one session), whereas 32.28% persisted for three or more sessions and 12.17% for five or more. Latency and persistence did not differ meaningfully across context-change types. Latency was not systematically associated with magnitude or persistence, whereas greater renewal magnitude predicted prolonged persistence. Results support extended monitoring and high-fidelity implementation following context changes.

PMID:42366898 | DOI:10.1002/jaba.70071

Nurs Crit Care. 2026 Jul;31(4):e70542. doi: 10.1111/nicc.70542.

ABSTRACT

BACKGROUND: Fatigue is highly prevalent among ICU survivors and is associated with adverse outcomes. However, its longitudinal trajectories and prognostic significance remain unclear.

AIM: To identify fatigue trajectories after critical illness, determine baseline predictors and examine their associations with long-term mortality and health-related quality of life (HRQoL).

STUDY DESIGN: This prospective multicentre cohort study was conducted in 10 ICUs across five tertiary hospitals in Fujian Province, China, from February 2022 to August 2023. Fatigue was assessed using the 14-item Fatigue Scale (FS-14) at ICU admission, ICU discharge, hospital discharge and 1 week, 2 weeks, 1 month and 6 months after discharge. The primary outcome was the 6-month fatigue trajectory group, identified using group-based trajectory modelling. Secondary outcomes were 6- and 12-month mortality and 6-month HRQoL. Multinomial logistic regression was used to examine baseline predictors of fatigue trajectory group. Inverse probability treatment weighting-adjusted Cox models were used for mortality, and weighted linear regression models were used for HRQoL.

RESULTS: Among 348 critically ill adults, three fatigue trajectories were identified: persistent fatigue (38.8%), recovered fatigue (43.1%) and no fatigue (18.1%). Recovered fatigue was associated with older age, prolonged mechanical ventilation, lower skeletal muscle index and higher Hospital Anxiety and Depression Scale scores. Compared with no fatigue, persistent fatigue was associated with lower physical HRQoL at 6 months (estimate -13.17, 95% CI: -19.85 to -6.495, p < 0.001), and higher 12-month mortality (hazard ratio, 6.75; 95% CI, 1.37-33.35; p = 0.019).

CONCLUSIONS: Fatigue trajectories after critical illness are heterogeneous. Persistent fatigue is linked to modifiable clinical factors and is associated with impaired HRQoL and increased long-term mortality.

RELEVANCE TO CLINICAL PRACTICE: Routine fatigue assessment should be embedded in ICU care to identify patients at risk for persistent fatigue, enabling personalised rehabilitation and self-management strategies that reduce symptom burden and promote long-term recovery.

PMID:42366878 | DOI:10.1111/nicc.70542

Nurs Open. 2026 Jul;13(7):e70666. doi: 10.1002/nop2.70666.

ABSTRACT

BACKGROUND: Decision-making readiness is essential for effective patient participation in treatment decisions, especially for lung cancer patients receiving chemotherapy who face repeated complicated treatment choices. However, existing research investigating their level of decision-making readiness and its associated influencing factors remains inadequate.

AIMS: This study aimed to investigate the level of decision-making readiness among hospitalized lung cancer patients undergoing chemotherapy, and further explore the influencing factors of their decision-making readiness.

MATERIALS AND METHODS: A cross-sectional observational design was adopted. A total of 452 hospitalized lung cancer patients receiving chemotherapy were recruited using convenience sampling. Data were collected via multiple questionnaires: the Chinese Version of the Preparation for Decision Making Scale, Decisional Conflict Scale, Patient Attitude Toward Treatment Decision-Making Scale, Decision Regret Scale, and a self-designed questionnaire covering sociodemographic and clinical characteristics. Descriptive statistics, correlation analysis, and hierarchical multiple linear regression were applied for data analysis.

RESULTS: The median score of participants’ decision-making readiness was 62.00 (56.00, 70.00), representing a moderate overall readiness level. Correlation analysis demonstrated that decision-making readiness was positively associated with patients’ willingness to participate in treatment decision-making and negatively associated with decisional conflict. Hierarchical regression revealed that demographic variables could explain 9.2% of the total variance of decision-making readiness, and the inclusion of decisional conflict and decision participation attitude raised the explanatory power to 31.1%. Economic status, residential location, decisional conflict and participation attitude were identified as significant predictive factors of decision-making readiness.

DISCUSSION: Lung cancer patients undergoing chemotherapy only possess moderate decision-making readiness. Compared with demographic characteristics, psychosocial factors (decisional conflict and decision participation attitude) exert a stronger impact on patients’ decision-making readiness. These findings also support the applicability of the Common Sense Model of Self-Regulation in the field of cancer treatment decision-making research.

CONCLUSION: Targeted nursing decision-support interventions are urgently needed to assess and elevate lung cancer patients’ decision-making readiness, which can further promote the practice of patient-centered treatment decision-making.

PMID:42366843 | DOI:10.1002/nop2.70666

J Med Virol. 2026 Jul;98(7):e71040. doi: 10.1002/jmv.71040.

ABSTRACT

This study estimates the incidence of symptomatic COVID-19 cases, both documented and undocumented, among U.S. Veterans across demographic groups from the beginning of the pandemic to the end of the public health emergency on May 11, 2023. By analyzing a cohort of Veterans alive as of March 1, 2020, we extended a mortality-based estimation approach to measure COVID-19 incidence. We relaxed the assumptions of a constant infection fatality rate (IFR) over time and across age groups and broadened the model from considering only excess respiratory deaths to including excess all-cause deaths. Descriptive analyses were performed to understand differential ascertainment biases among demographic groups. Resulting estimates suggested a significantly higher number of COVID-19 cases among Veterans than those documented in the electronic health record. We also identified varying biases among different demographic groups. These estimates offer a clearer view of COVID-19’s impact on Veterans, accounting for missed cases among those who sought care outside of the VA. Differences between documented and estimated cases were substantial. Policymakers should recognize that actual numbers are likely much higher than documented and that documented rates may not be directly comparable across populations or time periods.

PMID:42366842 | DOI:10.1002/jmv.71040

Health Technol Assess. 2026 Jun;30(53):1-34. doi: 10.3310/GJCB1006.

ABSTRACT

BACKGROUND: Fatigue is common in many long-term medical conditions. Interventions to date have largely been in single conditions.

OBJECTIVE: To conduct a mixed-methods evidence synthesis of the clinical and cost-effectiveness and acceptability of non-pharmacological interventions for fatigue in adults with long-term medical conditions.

METHODS: Randomised controlled trials, cost-effectiveness studies, or qualitative studies of non-pharmacological interventions for fatigue in long-term medical conditions where fatigue was either a criterion for inclusion, the primary target of the intervention, or the primary or coprimary outcome. Studies of post-infectious, post-traumatic, cancer-related or idiopathic fatigue were excluded.

INFORMATION SOURCES: Searches used the MEDical Literature Analysis and Retrieval System, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, and American Psychological Association PsycInfo^® (American Psychological Association, Washington, DC, USA) databases. We used systematic CLUSTER searching for qualitative studies and Epistemonikos for systematic reviews.

INVOLVEMENT OF PATIENTS: We held three rounds of five focus groups involving people with fatigue in long-term conditions to ensure that assumptions in, and reporting of, the research had validity with the patient population.

RISK OF BIAS: Risk-of-bias assessment of all studies included in the network meta-analysis was undertaken using an adapted version 2 of the Cochrane risk-of-bias tool for randomised controlled trials.

SYNTHESIS OF RESULTS: Clinical effectiveness evaluation used random effects network meta-analyses at three time points. The cost-effectiveness analysis involved a de novo analysis of interventions identified as clinically effective. The qualitative synthesis involved a thematic synthesis of primary studies of interventions and a mega-synthesis of reviews of patient experience of fatigue across different conditions. Focus groups were analysed by thematic analysis, and findings from all work packages were integrated in a final synthesis by the research team.

RESULTS: The clinical effectiveness review included 88 randomised controlled trials, involving 27 interventions, with 6636 participants included at end of treatment, 1849 in the short term and 2322 in the long term.

SYNTHESIS OF RESULTS: Compared to usual care at long-term follow-up, cognitive-behavioural therapy-based interventions and physical activity promotion showed statistically significant reductions in fatigue (standardised mean difference -0.4, 95% credible interval -0.63 to -0.21, 9 studies; and -0.52, -0.86 to -0.18, 2 studies), respectively. Effective interventions provided positive net monetary benefit versus usual care, particularly when delivered in a group format, when valuing a quality-adjusted life-year at £20,000. Individuals vary in their experience of fatigue in ways that are not simply due to their medical condition, indicating that interventions need to be adaptable to individuals’ experiences and capabilities.

DISCUSSION: The evidence base is relatively small, heterogeneous and includes studies at moderate to high risk of bias. More than half of the included trials were in multiple sclerosis.

INTERPRETATION: Interventions for fatigue that support people to increase physical activity or are based on cognitive-behavioural therapy are acceptable and effective in reducing fatigue in people with different long-term medical conditions, with the potential to be cost-effective. Based on the qualitative synthesis, we propose a three-stage component model for interventions.

FUTURE WORK: Future trials should focus on the feasibility and effectiveness of transdiagnostic fatigue services, fatigue interventions in multimorbidity, and investigations of emerging non-invasive stimulation interventions.

FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR154660.

PMID:42366788 | DOI:10.3310/GJCB1006