Tag: pubmed

Cureus. 2025 Nov 17;17(11):e97076. doi: 10.7759/cureus.97076. eCollection 2025 Nov.

ABSTRACT

Background Ankle fractures are common and place a substantial burden on services. Contemporary guidance generally permits weight-bearing as tolerated after stable fixation with early outpatient review. Recent randomised evidence suggests that beginning weight-bearing at around two weeks after open reduction and internal fixation (ORIF) can achieve at least comparable functional outcomes without increased complications and may be resource-efficient. Despite this, the adoption of early weight-bearing remains variable. We evaluated our centre’s timing to first weight-bearing and early safety in the year following the dissemination of new evidence. Methods We conducted a single-centre retrospective cohort study at a UK major trauma centre (September 2024-August 2025). Adults (≥18 years) undergoing ankle ORIF were included; exclusions were hindfoot nails, tibial plafond (pilon) fractures, open fractures, or missing follow-up. Data sources were the local trauma database, operative notes, discharge summaries, fracture-clinic letters, imaging, and general practitioner records. Variables included age, sex, length of inpatient stay (LOS), fracture pattern (unimalleolar/bimalleolar/trimalleolar), posterior malleolus fixation (yes/no), syndesmosis fixation (none/screw/suture-button), and discharge device (cast/boot). The primary outcome was time to first weight-bearing (bands: at 2 weeks, 2-6 weeks, >6 weeks; sub-bands 6-8 and >8 weeks). Safety within eight weeks comprised unplanned emergency department/clinic contact, re-operation, and radiographic loss of reduction. Analyses used descriptive statistics (mean/standard deviation (SD); median/interquartile range (IQR)); between-group comparisons employed Kruskal-Wallis or Mann-Whitney U for days to weight-bearing and chi-square for proportions >6 weeks (two-sided p<0.05). Continuous outcomes (LOS, days to first weight-bearing) were non-normally distributed (Shapiro-Wilk p<0.001); hence, non-parametric tests were used. Results Forty-two patients were included. The mean age was 51.1 years (SD 16.5), with a median age of 49.5 years (IQR 39.2-62.5). LOS had a mean of 7.0 days (SD 7.9) and a median of 3.5 days (IQR 1.0-13.0). Time to first weight-bearing: at 2 weeks 2/42 (4.8%), 2-6 weeks 9/42 (21.4%), >6 weeks 31/42 (73.8%) (including 6-8 weeks 21/42 (50.0%), >8 weeks 10/42 (23.8%)). Safety ≤8 weeks in the 6-week or longer group showed unplanned contact 1/42 (2.4%), re-operation 0/42, loss of reduction 0/42, and delayed union 2/42 (4.8%). Safety margins in the 2-week group did not show any complications (0/42 in all parameters). Days to first weight-bearing did not differ significantly by fracture pattern (p=0.066) or syndesmosis fixation (p=0.383); posterior malleolus fixation was associated with longer time (Mann-Whitney p=0.036). Proportions exceeding six weeks did not differ significantly across subgroups. Conclusions Early weight-bearing after ankle ORIF was seldom implemented locally, with most patients first weight-bearing at ≥6 weeks despite reassuring short-term safety. In light of the recent clinical guidance, a default “weight-bearing as tolerated from two weeks” pathway (with clearly defined exceptions), standardised discharge/clinic instructions, and planned re-audit may improve implementation without compromising safety.

PMID:41416288 | PMC:PMC12710795 | DOI:10.7759/cureus.97076

Cureus. 2025 Nov 16;17(11):e97018. doi: 10.7759/cureus.97018. eCollection 2025 Nov.

ABSTRACT

Background and objective The restoration of bowel continuity after temporary intestinal stoma formation is a routine general surgical procedure. However, stoma reversal is associated with significant postoperative morbidity and mortality. Surgeons may face challenges such as dense adhesions, iatrogenic bowel injury, or even procedure abandonment, as well as postoperative complications such as surgical site infection (SSI), anastomotic leak, intra-abdominal sepsis, and death. This study aimed to identify common complications and their risk factors to facilitate strategies for optimizing surgical outcomes. Specifically, it sought to determine the incidence and pattern of early (within 30 days) postoperative complications, grade their severity using the Clavien-Dindo classification, and analyze the risk factors associated with complications following intestinal stoma reversal. Methods A prospective observational study was conducted in the Department of General Surgery at a tertiary care medical college hospital. All consenting adult patients undergoing reversal of a temporary intestinal stoma were included. Demographic, clinical, and operative variables – including age, sex, comorbidities, stoma type, indication, local pathology, interval between stoma creation and closure, preoperative chemo- or radiotherapy, hemoglobin, serum albumin, surgical technique, and use of postoperative nutritional support – were recorded. Outcome measures included intraoperative technical difficulty, iatrogenic bowel injury, postoperative complications, SSI, anastomotic leak, and mortality. Statistical analysis was performed using the Chi-square or Fisher’s exact test for categorical data and the t-test for continuous data. A p-value <0.05 was considered statistically significant. Results Seventy patients undergoing stoma reversal were included. Technical difficulty and iatrogenic bowel injury occurred in 23 (32.8%) patients and were significantly associated with colostomy reversal (p=0.002) and end stoma reversal (p=0.0059). Postoperative complications occurred in 32 patients (45.7%). The most common complication was SSI in 26 (37.1%), followed by anastomotic leak in six (8.6% ), intra-abdominal abscess in four (5.7%), abdominal wall dehiscence in four (5.7%), and enterocutaneous fistula in three (4.2%). There were four deaths (5.7%), all due to sepsis following anastomotic leak in patients with comorbidities. Preoperative serum albumin <3.5 g/dL was significantly associated with mortality (p=0.0007), while postoperative nutritional support significantly reduced complications (p=0.001). Conclusions Stoma reversal is linked to considerable morbidity and mortality; hence, the decision to create a diverting stoma should be made judiciously. Ileostomy reversal is technically easier and safer than colostomy or Hartmann’s reversal and may be preferred when diversion is indicated. Delayed reversal beyond three months, optimization of comorbidities, correction of hypoalbuminemia (>3.5 g/dL), and postoperative nutritional support are recommended to minimize complications and improve outcomes.

PMID:41416276 | PMC:PMC12709135 | DOI:10.7759/cureus.97018

Cureus. 2025 Nov 17;17(11):e97061. doi: 10.7759/cureus.97061. eCollection 2025 Nov.

ABSTRACT

Background Terson syndrome (TS), an intraocular hemorrhage secondary to aneurysmal subarachnoid hemorrhage (aSAH), has a high incidence rate. Clinically, patients with aSAH often present with concomitant TS; however, owing to the difficulty in performing ophthalmic examinations in critically ill patients, many cases may be missed. This study aimed to develop and evaluate a CT-based diagnostic model incorporating posterior globe thickness to predict TS in patients with aSAH. Materials and methods This was a retrospective study on patients who underwent direct surgery or endovascular treatment for ruptured cerebral aneurysms at our institution between January 1, 2018, and August 31, 2025 (analyzed by eye). We extracted data from eyes definitively diagnosed with TS via ophthalmic examination. In addition to collecting epidemiological and clinical data, posterior globe thickness was measured for each eye. Statistical analyses included the Mann-Whitney U test, chi-square test, generalized estimating equation (GEE) logistic regression analysis, and receiver operating characteristic (ROC) analysis. Statistical significance was set at p < 0.05. Results A total of 177 patients (354 eyes) received aSAH treatment, of whom 26 individuals (52 eyes) underwent ophthalmic examination, and within this subgroup, 11 patients (17 eyes) were diagnosed with TS. In the univariate GEE logistic regression analysis, the presence of TS was significantly correlated with age (p=0.005), World Federation of Neurosurgical Societies (WFNS) grade (p=0.021), complaints of visual and visual field impairment (p=0.021), and posterior globe thickness (p=0.038). The multivariate GEE logistic regression analysis demonstrated that age and posterior globe thickness significantly influenced the risk of developing TS. In this final multivariate model, the odds of having TS decreased by a factor of 0.85 for every one-year increase in age (p=0.007), whereas the odds increased by a factor of 13.74 for every 1 mm increase in posterior globe thickness (p=0.027). ROC analysis, performed using this final multivariate model, yielded a calculation to determine the age-dependent cutoff for posterior globe thickness: Cutoff(mm)≈-1.295+0.0637×Age (years), which showed a sensitivity and specificity of 82.4% and 82.9%, respectively. Conclusion This study proposes a noninvasive prediction model for estimating TS based on CT measurements of posterior globe thickness. Serving as a practical triage tool, these findings suggest that incorporating age significantly enhances the diagnostic utility. To ensure broad generalizability and facilitate its application in clinical practice, prospective multicenter trials are necessary to validate these results.

PMID:41416274 | PMC:PMC12710446 | DOI:10.7759/cureus.97061

Psychiatry Res. 2025 Dec 11;356:116897. doi: 10.1016/j.psychres.2025.116897. Online ahead of print.

ABSTRACT

BACKGROUND: Poetry therapy whether using reading, writing, or discussing poems in a therapeutic context, is increasingly applied in mental and physical health care, yet its empirical support remains unclear. This systematic review and meta-analysis examined the effectiveness of poetry-based interventions across psychiatric and somatic outcomes.

METHODS: PubMed and Google Scholar were searched up to November 2023 for original studies evaluating poetry-based interventions on mental or physical health outcomes. Studies in English or French using individual or group poetry activities were eligible. Fifteen studies (randomized controlled, case-control, and pre-post designs) met inclusion criteria; those scoring ≥6 on the Newcastle-Ottawa Scale were included in the meta-analysis. Random-effects models were used to pool standardized mean differences for post-traumatic stress disorder (PTSD), major depressive disorder (MDD), anxiety, resilience, stress, and perceived pain. Heterogeneity, prediction intervals, and publication bias (Egger’s test) were assessed.

RESULTS: Poetry-based interventions were associated with large reductions in PTSD symptoms and significant improvements in depressive symptoms, anxiety, and stress, with effect sizes generally in the moderate-to-large range. In contrast, effects on resilience were statistically non-significant and highly imprecise, and no reliable benefit was found for perceived pain, where heterogeneity and evidence of small-study effects were substantial. Across outcomes, most trials were small, at risk of bias, and methodologically heterogeneous.

CONCLUSIONS: Poetry therapy shows promising benefits for trauma-related, depressive, anxiety, and stress outcomes, but the evidence base is limited by small samples, variable quality, and potential publication bias. High-quality, preregistered randomized controlled trials are needed before poetry-based interventions can be firmly recommended beyond an adjunctive role in routine psychiatric care.

PMID:41411711 | DOI:10.1016/j.psychres.2025.116897

JMIR Aging. 2025 Dec 18;8:e76489. doi: 10.2196/76489.

ABSTRACT

BACKGROUND: The health and economic burden of dementia has led the World Health Organization to recognize it as a public health priority. Although there currently does not exist a cure for dementia, there are multiple interventions aimed at preventing the risk of dementia and improving the quality of life of people with dementia. Voice assistants (VAs), particularly those using large language models (LLMs), have emerged as promising tools to deliver these interventions to older adults due to their accessible and natural interface.

OBJECTIVE: This pilot study aimed to evaluate the technical feasibility (ie, functional performance and usability) and user acceptance of the embodied rule-based and LLM VA GRACE, as well as the perceived strength of the collaborative relationship or working alliance, between GRACE and healthy older adults during the delivery of cognitive stimulation interventions.

METHODS: A pilot study was conducted with 21 healthy German-speaking adults aged 60 years and older. Participants interacted with GRACE in a laboratory setting for 10-15 minutes. The interaction involved a structured cognitive stimulation session using rule-based and LLM components. Data were collected using pre- and postinteraction questionnaires and semistructured interviews. Quantitative analysis included descriptive statistics and Wilcoxon signed rank tests. Qualitative data were analyzed thematically.

RESULTS: Participants rated GRACE positively, with statistically significant scores above neutral (P<.001 for perceived ease of use, usefulness, enjoyment, and working alliance; P=.009 for perceived control; and P=.009 for intention to continue interacting). Thematic analysis revealed that GRACE was perceived as easy to understand and unambiguous, friendly, and supportive, with intervention components viewed as enjoyable and appropriately challenging. Areas for improvement included personalization, response delays, and voice quality.

CONCLUSIONS: The results suggest that embodied rule-based and LLM VAs like GRACE are feasible and well-received tools for delivering cognitive interventions to older adults. Future iterations will incorporate feedback and extend testing to individuals at risk for dementia.

PMID:41411649 | DOI:10.2196/76489

JMIR Form Res. 2025 Dec 18;9:e77357. doi: 10.2196/77357.

ABSTRACT

BACKGROUND: Despite the transformative potential of artificial intelligence (AI)-based chatbots in medicine, their implementation is hindered by data privacy and security concerns. DeepSeek offers a conceivable solution through its capability for local offline operations. However, as of 2025, it remains unclear whether DeepSeek can achieve an accuracy comparable to that of conventional, cloud-based AI chatbots.

OBJECTIVE: This study aims to evaluate whether DeepSeek, an AI-based chatbot capable of offline operation, achieves answer accuracy on medical multiple-choice questions (MCQs) comparable to that of leading chatbots (ie, ChatGPT and Gemini) on German medical MCQs, thereby assessing its potential as a privacy-preserving alternative for clinical use.

METHODS: A total of 200 interdisciplinary MCQs from the German Progress Test Medicine were administered to ChatGPT (GPT-o3-mini), DeepSeek (DeepSeek-R1), and Gemini (Gemini 2.0 Flash). Accuracy was defined as the proportion of correctly solved questions. Overall differences among the 3 models were tested with the Cochran Q test, while pairwise comparisons were conducted using the McNemar test. Subgroup analyses were performed by medical domain (Fisher exact test) and question length (Wilcoxon rank-sum test). An a priori power analysis indicated a minimum sample size of 195 questions.

RESULTS: All 3 chatbots surpassed the conventional passing threshold of 60%, with accuracies of 96% (192/200) for DeepSeek, 94% (188/200) for Gemini, and 92.5% (185/200) for ChatGPT. The overall difference among models was not statistically significant (P=.10) nor were pairwise comparisons. However, incorrect responses were significantly associated with longer question length for DeepSeek (P=.049) and ChatGPT (P=.04) but not for Gemini. No significant differences in performance were observed across clinical versus preclinical domains or medical specialties (all P>.05).

CONCLUSIONS: Overall, DeepSeek demonstrates outstanding performance on German medical MCQs comparable to the widely used chatbots ChatGPT and Gemini. Similar to ChatGPT, DeepSeek’s performance declined with increasing question length, highlighting verbosity as a persistent challenge for large language models. While DeepSeek’s offline capability and lower operational costs are advantageous, its safe and reliable application in clinical contexts requires further investigation.

PMID:41411646 | DOI:10.2196/77357

JMIR Mhealth Uhealth. 2025 Dec 18;13:e75445. doi: 10.2196/75445.

ABSTRACT

BACKGROUND: Patients undergoing gastrectomy usually experience postgastrectomy syndrome and face difficulties adapting to a regular diet. Human health coaching via a mobile app has recently been applied to patients with chronic metabolic diseases, with significant improvements being observed in clinical outcomes.

OBJECTIVE: This study aimed to compare the quality of life and nutritional outcomes of human health coaching via a mobile app with those of conventional face-to-face counseling in postgastrectomy patients with gastric cancer.

METHODS: This was a prospective randomized controlled trial, and patients were enrolled between May 2020 and August 2022. The mobile coaching group received health coaching that provides personalized advice based on self-recorded health data via a mobile app from assigned coaches for 3 months after discharge, and the conventional counseling group underwent dietary consultations with a clinical dietitian 1 and 3 months postoperatively. The primary end point for sample size calculation was the eating restriction score on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module 1 month postoperatively. Secondary end points included changes in other subscales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and gastric cancer module, as well as nutritional outcomes assessed preoperatively and 1, 3, 6, and 12 months postoperatively.

RESULTS: Data from 88.9% (160/180) of enrolled patients were analyzed after excluding dropouts. In the mobile coaching group (n=76), 66% (n=50) of patients who used the mobile app for ≥8 weeks were classified as active users. No significant difference in eating restriction 1 month postoperatively was found between the mobile coaching and conventional counseling groups. However, the mobile coaching group reported less dyspnea during the entire period (P=.01), less eating restriction at 6 months (P=.045), and less negative body image 3 months postoperatively (P=.04) than the conventional counseling group (n=84). Exploratory subgroup analyses based on age, sex, and operation type indicated that younger patients (<60 years), female patients, and those who underwent distal gastrectomy had better quality of life from mobile coaching. In the mobile coaching group, exploratory subgroup analyses based on mobile activity showed that active users had a better global health status than inactive users (P=.005). However, no significant differences in body composition or nutritional parameters were observed between the mobile coaching and conventional counseling groups or between active and inactive users in the mobile coaching group.

CONCLUSIONS: Although this trial did not show a significant difference in eating restriction 1 month postoperatively, human coaching via a mobile app was associated with fewer symptoms in some scales compared to conventional counseling in postgastrectomy patients with gastric cancer. The intervention might help patients manage their symptoms and adapt to their diet.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04394585; https://clinicaltrials.gov/study/NCT04394585.

PMID:41411643 | DOI:10.2196/75445

JMIR Mhealth Uhealth. 2025 Dec 18;13:e69244. doi: 10.2196/69244.

ABSTRACT

BACKGROUND: Digital microinterventions have strong potential to improve the lives of adults diagnosed with cancer. However, little is known about which types of digital microinterventions are most desired and how contextual factors may influence those preferences. This potentially limits guidance for personalized and timely digital microintervention delivery.

OBJECTIVE: This study aims to identify time-varying and person-level predictors of relative digital microintervention interest among adult survivors of cancer.

METHODS: We enrolled US adults within 5 years of a cancer diagnosis in a 5-week observational study using ecological momentary assessment. Participants (N=407) were asked 3 times a day for 5 weeks which of 9 brief, mobile-delivered interventions, if any, they would have been interested in completing within the past hour. Intervention options were (1) reducing worry, (2) reducing negative thoughts, (3) problem solving, (4) increasing positive emotions, (5) connecting with values, (6) guided relaxation, (7) getting support from others, (8) setting goals, and (9) something else. Multinomial models were used to identify demographic (ie, age), cancer-related (ie, treatment status), and psychological (ie, depression symptom severity, anxiety symptom severity, history of major depressive diagnosis, history of anxiety disorder diagnosis, and psychotherapy status) predictors of individual differences in modal intervention preference. Multilevel logistic and multilevel multinomial models were used to identify momentary negative affect, positive affect, and pain predictors of relative intervention interest.

RESULTS: Participants indicated interest in completing a digital microintervention in 87% (20,429/23,472) of completed surveys. The most frequently selected intervention option was guided relaxation (8611/20,429, 42%). Neither cancer treatment status (χ²₉=6.5; P=.69) nor psychotherapy status (χ²₉=14.0; P=.12) differentiated between modal intervention preferences. Participants with greater anxiety (χ²₉=35.1; P<.001) and depression symptom severity (χ²₉=23.0; P=.006) were less likely to modally endorse guided relaxation compared to other intervention options like increasing positive emotions, reducing negative thoughts, and getting support from others. Higher momentary negative affect and pain and lower momentary positive affect each predicted a greater likelihood to endorse interest in completing an intervention (vs not completing an intervention; P<.05) and to endorse interest in completing multiple interventions (vs only one; P<.001). Finally, higher momentary negative affect generally predicted greater interest in completing an intervention other than guided relaxation, whereas higher momentary pain generally predicted greater relative interest in guided relaxation.

CONCLUSIONS: Adult survivors of cancer differ in their digital microintervention preferences between and within persons. Guided relaxation alone is less appealing to survivors of cancer when they are in greater emotional distress but may be more appealing in response to instances of increased pain.

PMID:41411642 | DOI:10.2196/69244

JCO Precis Oncol. 2025 Oct;9:e2500076. doi: 10.1200/PO-25-00076. Epub 2025 Dec 18.

ABSTRACT

PURPOSE: To investigate tumor mutation variations across different racial/ethnic groups to better understand implications for targeted cancer therapies.

METHODS: A retrospective analysis of 5,045 patients at University of New Mexico Comprehensive Cancer Center who underwent tumor genetic testing between January 2015 and April 2022 was conducted. Data were standardized from internal genetic tests, FoundationOne, and Guardant next-generation sequencing panels. Chi-square tests, one-way analysis of variance, and negative binomial regression estimated differences in mutation rates across race/ethnicity, adjusting for cancer type, age, testing year, and number of genes screened. Primary outcomes included tumor mutation rates and their variation across racial/ethnic groups. Specific focus was placed on mutation frequencies in common genes, and association between race/ethnicity and mutations detected, adjusted for covariates.

RESULTS: Among 5,045 patients-Hispanic/Latino (30%), American Indian (5.7%), Asian/Hawaiian Native (1.9%), Black (1.5%), non-Hispanic White (41%), and other/unknown (19.7%)-mutations were identified most commonly for Asian/Hawaiian Native individuals, with a rate of 0.068 mutations per gene screened (95% CI, 0.051 to 0.090), followed by White individuals (rate = 0.061, 95% CI, 0.051 to 0.072). Fewest mutations were identified for Black individuals, with a rate of 0.045 mutations per gene screened (95% CI, 0.033 to 0.061). Single-gene comparisons suggested BRAF mutations to be most prevalent in non-Hispanic Whites (5.8%, P = .015) while EGFR mutations were most common in Asian/Hawaiian Native patients (10.53%, P = .005).

CONCLUSION: This study highlights substantial heterogeneity in tumor mutations across racial/ethnic groups while emphasizing the need for wider understanding of genomics and tailored approaches in cancer treatment. Findings underscore the need for equitable genomic testing, tailored therapies, and inclusive cancer care. Further research is necessary to bridge existing disparities, ensuring comprehensive, personalized cancer treatment for all patients.

PMID:41411616 | DOI:10.1200/PO-25-00076

JCO Precis Oncol. 2025 Oct;9:e2500638. doi: 10.1200/PO-25-00638. Epub 2025 Dec 18.

ABSTRACT

PURPOSE: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of hepatocellular carcinoma (HCC), yet current screening strategies overlook the genetic complexity of MASLD. We hypothesized that capturing this complexity through a multitrait polygenic approach could improve HCC prevention.

METHODS: Using genome-wide association data for 10 MASLD-related traits in individuals of European ancestry, we constructed a meta-polygenic risk score (metaPRS) in the UK Biobank. We evaluated its performance in HCC prediction and its utility in stratified screening. Risk advancement period (RAP) analysis estimated how much earlier individuals in different genetic risk groups reach comparable risk levels.

RESULTS: The metaPRS that incorporated genome-wide variants achieved a C-statistic of 0.686 for HCC prediction, outperforming existing PRSs. Individuals in the top 20% of genetic risk had a 5.33-fold higher HCC risk than those in the bottom 20%. RAP analysis showed that high-risk individuals reached the HCC risk threshold 11.91 years earlier than the intermediate group, whereas low-risk individuals reached it 5.49 years later, suggesting a shift in recommended screening age from 65 to 43 years. Genetic stratification by the metaPRS also improved the predictive performance of noninvasive fibrosis scores (eg, Forns score). Combining high genetic risk with an elevated Forns score yielded a 10-year HCC risk of 2.68%, compared with 0.01% in the lowest-risk group-reducing the number needed to screen from 7,918 to 27.

CONCLUSION: The MASLD-related metaPRS supports effective population risk stratification and enables a layered HCC screening strategy combining genetic risk profiling with targeted clinical assessment.

PMID:41411614 | DOI:10.1200/PO-25-00638