Tag: nevin manimala

Wiad Lek. 2026;79(3):482-490. doi: 10.36740/WLek/218273.

ABSTRACT

OBJECTIVE: Aim: This research aims to assess the clinical and epidemiological profile of elderly patients reported to a tertiary care centre in Ajman, UAE.

PATIENTS AND METHODS: Materials and Methods: A retrospective cross-sectional review of electronic medical records was conducted for patients diagnosed with constipation between January 2020 and July 2025. Sociodemographic characteristics, anthropometric measures, functional status, lifestyle factors, comorbidities, gastrointestinal history, and treatment outcomes were extracted using a structured proforma. Descriptive statistics were applied.

RESULTS: Results: Eighty elderly patients were included, predominantly male (71.3%) and aged 60-69 years (78.8%). Abnormal BMI was present in 76.3%. Chronic symptoms were common, with 52.5% reporting constipation ≥3 months and 47.5% >6 months. Low fluid intake (66.3%), low dietary fiber intake (67.5%), and sedentary lifestyle (62.5%) were highly prevalent. Cardiometabolic comorbidities were frequent, including hypertension (68.8%), diabetes mellitus (65.0%), and hypercholesterolemia (63.7%). Only 38.8% achieved good therapeutic response, while 61.3% had poor or partial improvement.

CONCLUSION: Conclusions: Constipation in elderly patients at this tertiary center represents a persistent, multifactorial condition requiring comprehensive, individualized, and lifestyle-integrated management strategies to improve outcomes.

PMID:41962087 | DOI:10.36740/WLek/218273

Wiad Lek. 2026;79(3):474-481. doi: 10.36740/WLek/218412.

ABSTRACT

OBJECTIVE: Aim: To describe the clinico-epidemiological profile, metabolic risk factors, and treatment outcomes of patients with chronic liver disease (CLD) at a tertiary care center in Ajman, UAE.

PATIENTS AND METHODS: Materials and Methods: 149 individuals with confirmed CLD were included in a descriptive five-year retrospective study. Descriptive statistics (frequencies and percentages) were utilized for analyzing demographic data, lifestyle variables, metabolic comorbidities, and clinical outcomes.

RESULTS: Results: The male-to-female ratio in the cohort was 3.7:1, with a significant male preponderance (78.5%; n=117). In particular, most patients (91.3%) were under 60, with those under 40 making up the biggest group (46.3%; n=69). The Eastern Mediterranean Region was the place of origin for more than half of the participants (55.7%). In terms of lifestyle risk factors, 32.9% of respondents smoked, and 24.2% reported drinking alcohol (14.1% now, 10.1% previously). Although only 8.1% were classified as obese (BMI ≥30 kg/m²), 84.6% had abnormal BMI (overweight or obese). Fatty liver (41.6%), diabetes mellitus (38.9%), dyslipidaemia (37.6%), and hypertension (36.2%) were among the significant metabolic comorbidities. Nearly half (49.0%) of patients had incomplete or poor clinical outcomes to medications, whereas 51.0% had “good” results.

CONCLUSION: Conclusions: This tertiary-care cohort found a predominance of economically productive males who were affected by CLD, who also exhibited a high prevalence of metabolic risk factors. Origins of obesity and diabetes have highlighted the regional influence of metabolic (MAD) liver disease. To optimise the outcome of patients who have these diseases, there is an urgent need for early screening and comprehensive management of metabolic risk factors.

PMID:41962086 | DOI:10.36740/WLek/218412

Swiss Med Wkly. 2026 Feb 12;156:4892. doi: 10.57187/4892.

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: Polypharmacy is common among older adults and associated with potentially inappropriate medications and potential prescribing omissions, which together constitute potentially inappropriate prescriptions, contributing to adverse outcomes and increased healthcare costs. Longitudinal data on potentially inappropriate prescriptions and differences across living environments are limited. Our aim was to analyse patterns and determinants of potentially inappropriate prescriptions in multimorbid, older adults across different living environments and their trends over 12 months.

METHODS: We used data from the control group (n = 1045) of the multi-country OPERAM trial (December 2015 – October 2018), a cluster-randomised controlled trial including older adults aged ≥70 years with ≥3 chronic conditions and ≥5 medications, which tested a software intervention to improve prescribing in these patients. The control group received pharmaceutical care in accordance with usual care. STOPP/START criteria were applied to detect potentially inappropriate prescriptions at hospital admission, discharge, and at 2-, 6- and 12-month follow-up. The outcomes were a priori defined as the prevalence of potentially inappropriate prescriptions at hospital admission, differences in potentially inappropriate prescriptions between living settings (nursing home versus community-dwelling) and number of medications (polypharmacy [5-9 medications] versus hyperpolypharmacy [≥10 medications]), changes in potentially inappropriate prescriptions over the 12-month follow-up and factors associated with potentially inappropriate prescriptions. Analyses included descriptive statistics and multivariable regression.

RESULTS: At admission, 664 (63.5%) patients had ≥1 potentially inappropriate medication and 754 (72.1%) had ≥1 potential prescribing omission. Potentially inappropriate prescriptions at admission were most strongly associated with hyperpolypharmacy (potentially inappropriate medication: incidence rate ratio [IRR] 1.54, 95% CI 1.35-1.76) and cognitive impairment (potentially inappropriate medication: IRR 1.44, 95% CI 1.16-1.79), and were also significantly associated with female sex, number of comorbidities, fall history, nursing home residency and older age. Although overall prevalence remained stable over 12 months, substantial individual-level changes occurred, with many patients experiencing increases or decreases in the number of potentially inappropriate medications or potential prescribing omissions, alongside notable shifts in specific potentially inappropriate medications/potential prescribing omissions. An increasing number of potentially inappropriate prescriptions over time was mostly associated with hyperpolypharmacy (potential prescribing omission: OR 1.71, 95% CI 1.20-2.42 at 12 months) and nursing home residency (potentially inappropriate medication: OR 1.94, 95% CI 1.12-3.36 at 12 months), while significant associations were found for fall history and number of comorbidities.

CONCLUSION: Potentially inappropriate prescriptions remain highly prevalent in multimorbid, older adults and do not clearly improve over time. Frequent changes at patient level and dynamic shifts in specific potentially inappropriate medications/potential prescribing omissions over time underscore the need for individualised, continuous medication reviews addressing both over- and underprescribing. Factors associated with increasing potentially inappropriate prescriptions over time may serve as indicators of high-risk patients and highlight the need for targeted interventions and further research.

STUDY REGISTRATION: This study is based on data from the OPERAM trial, which was registered at ClinicalTrials.gov (NCT02986425).

PMID:41962085 | DOI:10.57187/4892

Swiss Med Wkly. 2026 Feb 26;156:4839. doi: 10.57187/4839.

ABSTRACT

BACKGROUND: Urban swimming, especially in the Aare River, is popular in Switzerland but carries risks, particularly for those unfamiliar with its currents and hazards. This study describes the epidemiology of river-related emergency department (ED) visits, focusing on injury patterns, patient demographics and presentation characteristics.

METHODS: A retrospective cross-sectional study at the University Hospital of Bern was conducted, analysing river-related ED visits from 2012 to 2024. Data on demographics, injury types, triage levels and outcomes were extracted from electronic medical records.

RESULTS: A total of 263 river-related ED visits were identified among a total of 541,561 ED visits over the study period (proportional incidence: 0.49 per 1000 ED consultations, 95% CI: 0.43-0.55). Most patients were male (62.7%), aged ≤35 years (65.4%) and Swiss nationals (65.4%). The most frequent injuries were trauma (63.1%), mainly affecting the lower extremities (30.8%) and head/face (16.3%), often due to collisions with submerged objects or bridge jumping. Drowning cases (12.2%) were less common, with seven fatalities (2.7%). Most incidents occurred in the summer between June and August (78.7%), with 37.3% on weekends. Suicide attempts (20.4% vs 3%) and boating-related incidents (11.2% vs 6.7%) were more common in females and jumping-related incidents more frequent in males (22.4% vs 11.2%), p <0.001. Hypothermia was significantly more often found in non-Swiss nationality ED visits (p = 0.002) and those of people aged >35 years (p <0.001). Compared to younger patients, those aged >35 years were significantly more likely to be triaged as life-threatening (22% vs 7.6%; p <0.001), report intentions other than swimming (notably more suicide attempts and accidents; p <0.001), and had higher rates of admission to an ICU or of transfer to a psychiatric clinic (p <0.001).

CONCLUSION: River-related ED visits are a recurring seasonal concern, primarily affecting young males. People with non-Swiss nationality and those engaging in high-risk activities are at higher risk. Adopting a multilingual approach could be a key objective of safety campaigns to more effectively reduce risks for non-Swiss swimmers and promote safer swimming practices in urban waters. Prevention efforts should continue to focus on public education, enhanced safety signage and improved emergency preparedness.

PMID:41962083 | DOI:10.57187/4839

Clin Nurse Spec. 2026 Mar-Apr 01;40(2):63-71. doi: 10.1097/NUR.0000000000000946. Epub 2026 Feb 4.

ABSTRACT

OBJECTIVES: To map the types and incidences of postoperative complications reported among frail adults (≥65 y) during intensive care treatment.

METHODS: A scoping review conducted following the Joanna Briggs Institute (JBI) methodological guidance and reported following the PRISMA-ScR guidelines. Sources of evidence included Medline (through PubMed), CINAHL (through EBSCO), and the Cochrane Library. Eligible studies enrolled postoperative patients aged 65 years or older who were identified as frail using validated assessment tools.Two reviewers performed 2-stage screening and standardized data charting. Outcomes were categorized by organ system, mortality, length of hospital and intensive care stay, and readmission.

RESULTS: Of 1345 titles, 8 observational studies were included. Reporting of postoperative complications in frail cohorts was heterogeneous. Described events included acute kidney injury, atrial fibrillation, pneumonia, delirium, and infectious complications. Mortality and lengths of stay were frequently reported but definitions and time points varied.

CONCLUSIONS: Evidence describing postoperative complications among frail older adults requiring intensive care remains limited and inconsistent. Standardized definitions and systematic reporting of complications in frail populations are needed to improve comparability and support evidence-based care planning for this vulnerable group.

PMID:41962076 | DOI:10.1097/NUR.0000000000000946

Swiss Med Wkly. 2026 Jan 31;156:4231. doi: 10.57187/4231.

ABSTRACT

STUDY AIMS: Robson’s Ten-Group Classification System (TGCS) was proposed to describe caesarean section rates by ten patient-centred risk-specific groups. The aim of the study was to describe Swiss caesarean section rates according to this classification, further stratifying it according to region and type of structure where delivery took place. We also aimed to compare our results to the standard caesarean section rates, recommended by the World Health Organization (WHO).

METHODS: An observational study including all women delivering in health facilities in Switzerland in the period 2014-2021. A total of 695,733 deliveries were included. Core variables used for classification were semi-automatically generated using routine data provided by the Swiss Federal Statistics Office. Caesarean section rates were reported according to the TGCS. Data were also stratified according to each of the 26 Swiss cantons, as well as to the typology of hospital where delivery took place.

RESULTS: The major relative contributors to the overall caesarean section rate were Group 2 (nulliparous, above 37 weeks, with induction) and Group 5 (women with previous caesarean section, above 37 weeks with a singleton pregnancy), respectively accounting for 20.7% and 30.1% of all caesarean sections. We also showed that the Swiss population was similar to the population considered in the WHO recommendation. Nonetheless, the caesarean section rate among our population exceeded that suggested by the WHO recommendations, being respectively of 44.4% vs 39.9% and 86.0% vs 74.4% for Groups 2 and 5. Large variations were detected in the caesarean section rate when looking at the different cantons, ranging from 29.8% to 59.6% for Group 2 and between 58.0% and 100.0% for Group 5.

CONCLUSION: Routine data collection allowed us to describe caesarean section rates throughout Switzerland according to the TGCS. The Swiss caesarean section rate was higher than the caesarean section rate recommended by the WHO, even though the population characteristics were comparable. Substantial differences were found when stratifying caesarean section rates according to the canton, as well as to the type of structure where delivery took place.

PMID:41962064 | DOI:10.57187/4231

JMIR Cancer. 2026 Apr 10;12:e84042. doi: 10.2196/84042.

ABSTRACT

BACKGROUND: Small cell lung cancer (SCLC) is a challenging disease to treat due to rapid progression, development of chemoresistance, and discrepancies in outcomes between real-world data and clinical trials. There is a lack of comprehensive analyses in other studies with regard to intermediate events and the treatment process, such as treatment decisions, progression of disease, and the occurrence of adverse events (AEs) over time.

OBJECTIVE: The aim of this study was to apply advanced statistical methods to a longitudinal SCLC dataset in order to identify factors of importance for the risk of AEs and for survival.

METHODS: Treatment pathways of 421 patients with SCLC collected from Karolinska University Hospital, located in Stockholm, Sweden, between 2016 and 2022, were analyzed with data-driven modeling. The analysis focused on the impact of dose adjustment on AEs, including neutropenia, by estimating odds ratios (ORs) using Bayesian mixed effects modeling. Covariates’ effects on Eastern Cooperative Oncology Group performance status (ECOG PS) deterioration and early discontinuation of chemotherapy with cause-specific hazard ratios (csHR) were explored using competitive risk models. This approach was applied to patient cohorts receiving combinatorial first-line platinum/etoposide and second-line platinum/etoposide or platinum/irinotecan.

RESULTS: At the end of the first-line treatment, most patients exhibited tumor regression (n=167). Patients with neutropenia had longer overall survival (hazard ratio 0.70, 95% CI 0.53-0.92). Higher etoposide dose levels were associated with subsequent occurrences of AEs (OR 5.97, 95% CI 1.41-30.5) and neutropenia (OR 3.55, 95% CI 1.03-13.3). Dose adjustment did not affect overall survival if the patient completed the 4-dose regimen treatment. With regard to second-line therapy, fewer patients completed 4 treatment cycles, and the most common reason for early discontinuation was tumor progression (n=72, 58%). Male patients (n=118) experienced fewer AEs and better first-line treatment response compared to females (csHR 0.51, 95% CI 0.25-0.90). High-risk patients (defined as ECOG PS 2-3 or age >75 years) with early discontinuation of therapy had survival outcomes similar to those who did not receive any therapy.

CONCLUSIONS: Our results indicate that first-line therapies may benefit from more individualized dosing strategies. It would also be beneficial to assess the risk-benefit of treating specific subgroups, including patients receiving second-line therapy. Real-world data proved beneficial for studying therapy response and risk-benefit of treating patient groups that are underrepresented in clinical trials.

PMID:41962051 | DOI:10.2196/84042

Swiss Med Wkly. 2026 Mar 31;156:4539. doi: 10.57187/4539.

ABSTRACT

BACKGROUND: Initiatives like “Choosing Wisely” promote efficient and high-quality healthcare by reducing overuse. The interdisciplinary copAIN project aims to reduce resource utilisation in medical ward patients by providing specific guidelines to internal medicine residents.

METHODS: This study was conducted in the Cantonal Hospital Aarau, a 500-bed tertiary care and academic facility.After implementing the copAIN project for medical inpatients on 1 June 2023, we conducted an interrupted time-series (ITS) cohort study and analysed it using a mixed-effects regression model for comparison. Neurological patients not involved in copAIN served as the control group. The primary outcome was resource utilisation defined by the measurement frequency of five vital signs and laboratory orders. The secondary, safety outcome was in-hospital mortality.

RESULTS: Of 51,396 admissions between 1 September 2022 and 31 May 2024, 8344 cases were eligible for analysis. While there were no differences in measurement frequencies in the control group, we found a significant reduction in the intervention group for the frequency of measurements of blood pressure (0.28 measures per day per length of stay [dLOS]), heart rate (0.26 measures per dLOS), oxygen saturation (0.28 measures per dLOS) and temperature (0.27 measures per dLOS). However, this effect was temporary, and adjusted analyses showed no significant difference between pre- and post-intervention periods. There was no change in mortality between study periods in both groups.

CONCLUSION: An intervention focusing on the reduction of routine parameters within the hospital settingresulted in a temporary decrease in resource use without increasing in-hospital mortality. This data supports recent initiatives aimed at improving resource efficiency in medicine without compromising quality. The absence of a sustained impact highlights the need for ongoing strategies to maintain and reinforce improvements.

PMID:41962046 | DOI:10.57187/4539

JMIR Form Res. 2026 Apr 10;10:e85484. doi: 10.2196/85484.

ABSTRACT

BACKGROUND: Physical inactivity remains a public health concern, with 42% (around 1 in 2) of women and 34% (around 1 in 3) of men in the United Kingdom, for example, failing to meet moderate-to-vigorous physical activity guidelines. To promote physical activity (PA) at scale, smartphone-based mHealth (mobile health) software apps offer a promising solution.

OBJECTIVE: This study aims to evaluate the feasibility of implementing an mHealth app offering very small (“micro”) financial incentives for PA in Leeds, United Kingdom.

METHODS: A 5-week single-arm proof-of-concept study was conducted with rolling recruitment among Caterpillar Health app users between September 12 and December 12, 2022 (Obesity-Related Behavioral Intervention Trial model, phase IIa). Users earned microincentives in the form of “points,” redeemable for consumer rewards (eg, movie tickets and gym passes), for meeting personalized daily step goals (US $0.13 per goal achieved; set using data from a 5-day baseline) and completing educational quizzes (US $0.33 per quiz). Descriptive statistics assessed feasibility outcomes (ie, reach, recruitment, retention, engagement, and acceptability) and preliminary effectiveness. Paired-samples t tests (P<.05) examined changes in weekly mean daily step count (from baseline) and step goal achievement over 5 weeks.

RESULTS: Of 285 app downloads, 46 users consented to participate (recruitment rate: 16.1%). Participants (mean age: 39.9, SD 11.1 y; 71.1%, 33/46 woman) had a baseline step count of 5598 (SD 2664) steps/day. A total of 25 participants remained engaged (ie, completed at least 1 quiz) at study week 5 (retention rate: 54.3%). Acceptability was high, with 75% of respondents (12/16) indicating they would recommend the app. Weekly mean daily step count did not significantly increase from baseline (mean difference 317, SD 2273, P=.53). Weekly daily step goal achievement rate (%) decreased from study week 1 to 5 (-23.23, SD 22.85, P=.02).

CONCLUSIONS: Despite lower-than-expected recruitment and no statistically significant PA increase, relatively high engagement and acceptability suggest future pilot testing (Obesity-Related Behavioral Intervention Trial model, phase IIb) of a refined intervention (eg, wider selection of loyalty reward partners) and modified study protocol (eg, simplified consent process) is warranted.

PMID:41962040 | DOI:10.2196/85484

Traffic Inj Prev. 2026 Apr 10:1-22. doi: 10.1080/15389588.2026.2636773. Online ahead of print.

ABSTRACT

OBJECTIVE: Since 1979, traffic fatalities dropped 16.0% in the U.S. compared to 77.4 ± 5.9% for 14 other countries. The gap to other countries has grown and has been statistically significant since 1996. This study describes reasons for the gap in traffic fatality reductions in the U.S.

METHODS: NHTSA’s research, programs and activities were analyzed to identify causes for the lack of traffic fatality reductions in the U.S. This includes policy decisions, selection of research projects, meaningfulness of NCAP and other tests, and errors in field accident data on serious injury and death.

RESULTS: There were three primary and nine secondary reasons identified. NHTSA has: 1) not set targets focusing activities on fatality reductions, 2) not pursued research with measurable reductions in fatalities, 3) no meaningful engagement with industry, IIHS and others on research, NCAP, and safety priorities, 4) not conducted critical analysis of projects, programs and research, 5) inherent problems managing research, regulations, investigations, and enforcement under one leadership, 6) not verified assumptions for field accident data collection, 7) not used correct sampling frequencies or case weights in NASS-CDS and CISS, 8) not terminated testing that does not measurably reduce fatalities, 9) not followed-up on useful research, 10) not pursued crash tests with relevance to traffic fatalities and wrongheaded focus on MAIS 2 injuries, 11) not required timely engineering reports on internal and external projects, and 12) inaccessible archives of many reports and findings.

Fatalities in the U.S. would have increased the past 25 years if safety technologies had not been voluntarily introduced by automotive manufacturers, including ESC (electronic stability control), AEB (automatic emergency braking) and high retention seats. NHTSA’s budget has increased 459% over 25 years, a 14.4% increase each year. NHTSA has little to show for the extremely large budget, except “we could do better with more money.”

CONCLUSION: NHTSA must set priorities and targets for research, programs, and activities that reduce traffic deaths. They must change their leadership, because the Agency has failed its core mission to reduce traffic deaths the past 25+ years. NHTSA focuses on new car technologies in crash tests with no relevance to fatal accidents. Most fatalities are in 10+ year old vehicles, where risky driver behavior is the main cause with no seatbelt use, alcohol-drug use, and aggressive, risk-taking speeding. NHTSA must prioritize risky driver behavior and align State activities to reduce traffic fatalities.

PMID:41962029 | DOI:10.1080/15389588.2026.2636773