Tag: pubmed

Geriatr Nurs. 2026 Feb 7;69:103918. doi: 10.1016/j.gerinurse.2026.103918. Online ahead of print.

ABSTRACT

AIM: Ecchymosis occurs when blood leaks into subcutaneous tissue or capillaries rupture. In older patients, adequate pressure after venipuncture may prevent it, but the optimal duration is unclear. This study evaluated the effect of applying 20 N of direct pressure for 1, 3, or 5 minutes after blood collection on ecchymosis at 24, 48, and 72 hours in older patients using oral or subcutaneous anticoagulants.

METHODS: The study used a parallel-group, prospective, single-blind randomized controlled design. The study sample consisted of 164 patients hospitalized at the geriatric clinic of a city hospital. Ecchymosis development was assessed by making and recording observations at 24, 48 and 72 h after routine blood sampling. Opsite Flexigrid was used to measure the size of the ecchymosis.

RESULTS: The mean age of the patients was 76.26±8.01 years, 50 % were women, and 56.1 % used subcutaneous anticoagulants. A statistically significant difference was found between the groups in terms of the frequency and size of ecchymoses at 24, 48, and 72 h after blood collection (24th hour: χ²=30.792, p < 0.001; 48th hour: χ²=28.698, p = 0.001; 72nd hour: χ²=26.429, p = 0.002). The incidence of ecchymoses ≥1 cm² in the control group was 14 % at all time points, and this rate was significantly higher than in all other groups (p < 0.05).

CONCLUSION: In geriatric patients receiving oral or subcutaneous anticoagulants but without coagulopathy, applying pressure to the venipuncture site for 5 min after blood collection reduced the development of ecchymosis.

PMID:41655322 | DOI:10.1016/j.gerinurse.2026.103918

Clin Neurol Neurosurg. 2026 Feb 5;263:109340. doi: 10.1016/j.clineuro.2026.109340. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: This study aims to assess the composite impact of frailty, malnutrition, and anemia on postoperative outcomes for elderly subdural hemorrhage (SDH) patients.

METHODS: A retrospective cohort study was performed using the 2011-2023 NSQIP database. All patients > 65 years who underwent SDH evacuation were identified using CPT and ICD codes. The study population was divided based on RAI-rev frailty status, with frail patients being further subdivided based on anemia and Geriatric Nutritional Risk Index (GNRI) nutritional status. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of these health condition combinations with extended hospital length of stay (LOS), any 30-day adverse event (AE), non-routine discharge (NRD), and 30-day mortality.

RESULTS: Of 3136 elderly SDH patients, 610 (19.5 %) were Frail Alone (F), 712 (22.7 %) were Frail + Anemic (FA), 464 (14.8 %) were Frail + Malnourished (FM), 1226 (39.1 %) were FA + Malnourished (FAM), and 124 (4.0 %) were Not Frail (NF). RAI-rev was a risk factor for extended LOS (aOR: 1.03, 95 % CI: 1.01-1.06), AEs (aOR: 1.04, 95 % CI: 1.02-1.06), and mortality (aOR: 1.05, 95 % CI: 1.03-1.08). GNRI was a predictor of decreased odds of extended LOS (aOR: 0.98, 95 % CI: 0.97-0.99) and NRD (aOR: 0.98, 95 % CI: 0.97-1.00), whereas anemia only predicted AEs (aOR: 1.58, 95 % CI: 1.27-1.96). On ROC analysis, adding anemia and GNRI to RAI-rev was associated with statistically significant (p = 0.034) but modest improvements in discrimination for 30-day adverse events.

CONCLUSION: Our findings suggest that adding anemia and GNRI to RAI-rev is associated with a modest incremental improvement in discrimination for 30-day adverse events in elderly SDH patients.

PMID:41655319 | DOI:10.1016/j.clineuro.2026.109340

Clin Psychol Rev. 2026 Jan 27;124:102707. doi: 10.1016/j.cpr.2026.102707. Online ahead of print.

ABSTRACT

BACKGROUND: Borderline personality disorder (BPD) is often accompanied by interpersonal dysfunction. Psychotherapy can improve interpersonal functioning, but individual characteristics may moderate outcomes. This systematic review used individual participant data meta-analysis (IPD-MA) to examine such moderators.

METHOD: A literature search up to 26 November 2025 across 10 databases (including PubMed, Medline, Embase, PsychINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) investigating the effects of psychotherapy on interpersonal functioning in individuals with BPD compared to treatment as usual (TAU) or clinical management control interventions (CM). Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects on interpersonal functioning and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688).

RESULTS: Out of 23,735 identified records, 32 RCTs (2762 participants) met inclusion criteria. Individual participant data (IPD) were available for 17 trials (1431 participants). All trials were rated as having either high risk of bias or some concerns. Missing data were common, with 321 out of 1431 participants (23%) lost to follow-up. Meta-analyses of both aggregate data and IPD yielded comparable effect estimates, though statistical significance differed (IPD-MA: β = -0.21, CI: -0.45 to -0.02, SE = 0.12, p = 0.0778; 17 trials, 1071 participants). In unadjusted analyses, the presence of co-occurring anxiety disorder(s) (β = -0.40, 95% CI: -0.73 to -0.08) and a higher number of co-occurring disorders (β = -0.08, 95% CI: -0.15 to -0.01) were associated with larger treatment effects (not significant after alpha correction).

CONCLUSION: Psychotherapy appears to be effective for individuals with BPD. Although moderator effects did not remain statistically significant after alpha correction, unadjusted analyses suggested larger treatment effects in individuals with co-occurring anxiety and greater clinical complexity. Importantly, these findings indicate that such comorbidities may not be a contraindication for psychotherapy for BPD.

PMID:41655316 | DOI:10.1016/j.cpr.2026.102707

Clin Psychol Rev. 2026 Feb 4;124:102710. doi: 10.1016/j.cpr.2026.102710. Online ahead of print.

ABSTRACT

Problematic Pornography Use (PPU) is an increasingly recognized public health concern, with increasing evidence of its potential adverse consequences for individuals’ psychological well-being, interpersonal relationships, and daily functioning. Accurate assessment of PPU is therefore essential for effective screening, diagnosis, and intervention. However, the field is characterized by a proliferation of outcome measures (OMs) with diverse theoretical foundations, inconsistent definitions, and limited cross-population validation. This systematic review was pre-registered in the PROSPERO database (CRD420251008765) and followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Version 2.0 guidelines to identify, evaluate, and compare OMs used to assess PPU, as well as to offer recommendations for selecting appropriate OMs in research and clinical settings. A comprehensive search was conducted across four databases (MEDLINE, Web of Science, Embase, and PsycInfo) from database inception to February 28, 2025, with an additional supplementary search conducted on October 19, 2025. A total of 47 studies reporting on 24 OMs were included. While structural validity and internal consistency were frequently assessed, content validity, test-retest reliability, measurement error, and responsiveness were infrequently reported for most OMs. No single OM can be unequivocally recommended as the most appropriate instrument for assessing PPU in either clinical or research settings. Based on measurement property ratings and the overall quality of evidence, 19 OMs received Class-C recommendations, among which four OMs were considered the most promising (including the Problematic Pornography Use Scale, Problematic Pornography Consumption Scale [PPCS], PPCS-6, and Brief Pornography Screen). Overall, these promising Class-C OMs may tentatively serve as valid and reliable tools for assessing PPU in clinical and research contexts, thereby providing a valuable resource for improving PPU assessment and informing evidence-based practice. Nevertheless, further studies are warranted to comprehensively validate the measurement properties of existing OMs. In addition, the findings underscore the importance of theory-driven and methodologically rigorous validation studies, as well as stricter adherence to COSMIN standards, to enhance consistency and comparability across studies.

PMID:41655315 | DOI:10.1016/j.cpr.2026.102710

Aust J Gen Pract. 2026 Jan-Feb;55(1-2):66-71. doi: 10.31128/AJGP-06-25-7702.

ABSTRACT

BACKGROUND AND OBJECTIVES: Voluntary assisted dying (VAD) is lawful in all Australian states, and doctors are an integral part of the VAD process. There are limited reports so far on general practitioners’ (GPs’) experiences with VAD. This study explores GPs’ perspectives on the first year of VAD in Queensland and any factors that influence choices on whether to participate in VAD.

METHOD: This was a qualitative interview study of 12 GPs with no in-principle objection to VAD, undertaken 1 year after VAD became available in Queensland. RESULTS: Thematic analysis identified four themes: nature of GPs’ participation, various factors influencing participation, experience of GPs with VAD provision and the ongoing needs of GPs.

DISCUSSION: This study highlights how GPs are well suited to VAD provision with their generalist approach to care. However, there are ongoing structural and logistical barriers to GP participation, including the need for appropriate remuneration and further education on VAD to support GP knowledge.

PMID:41655293 | DOI:10.31128/AJGP-06-25-7702

J Foot Ankle Res. 2026 Mar;19(1):e70123. doi: 10.1002/jfa2.70123.

ABSTRACT

BACKGROUND: Foot ulceration is a debilitating and often disabling complication of diabetes mellitus, with negative prognostic associations in terms of morbidity and mortality. Percutaneous needle tenotomy (PNT) is increasingly recognized as a safe, minimally invasive procedure for treating tendon-related deformities, including mechanical forefoot ulceration. This study evaluated clinical outcomes of needle flexor tenotomies performed by a podiatrist versus an orthopaedic surgeon.

METHODS: This service evaluation reviewed consecutive adult patients with foot ulceration who received needle tenotomy by a senior podiatrist, excluding those who underwent alternative procedures/amputation. Orthopaedic surgeon conducted tenotomy was the comparison group.

RESULTS: Podiatrist: 30 patients underwent needle tenotomy (total-31 feet) (23 patients had diabetes). Orthopaedic surgeon: 10 patients underwent needle tenotomy (total-12 feet). Median age was 71.5 years (range: 39.0-92.0), with 8 males/2 females. (8 patients had diabetes). The podiatrist-led group was older and had higher HbA1c, greater proportion of smokers, larger ulcer size and longer ulcer duration pre-intervention (median 54 vs. 20 weeks and p = 0.002) than the orthopaedic surgeon-led group. Despite these differences in disease severity, time to ulcer resolution (median 4.7 vs. 2 weeks, p = 0.119) and the rate of complete healing (86.7% vs. 100% and p = 0.556) did not differ significantly between groups.

CONCLUSION: The lowest cost of the minor surgical foot procedure as a day case = £554 (€662) with this cost at least halved by conducting the procedure in a podiatry clinic. In conclusion, podiatrist-led percutaneous needle tenotomy is a safe and effective intervention for foot ulcers, achieving healing outcomes comparable to an orthopaedic surgeon. We hope that the procedure can be adopted more widely.

PMID:41655273 | DOI:10.1002/jfa2.70123

J Int Med Res. 2026 Feb;54(2):3000605261416668. doi: 10.1177/03000605261416668. Epub 2026 Feb 8.

ABSTRACT

BackgroundPostoperative pain following liver resection remains a clinical challenge, and the optimal analgesic strategy is still debated.ObjectiveTo determine whether a single intrathecal morphine injection provides superior analgesia and opioid-sparing effects compared with conventional systemic or regional techniques in adult patients undergoing liver surgery.MethodsPubMed, Embase, Web of Science citation index, and the Cochrane Library were searched from inception to August 2025 for randomized controlled trials comparing intrathecal morphine with alternative analgesic regimens in liver resection. The primary outcome was pain intensity at rest 24 h after surgery (standardized mean difference). Secondary outcomes included pain intensity at 48 and 72 h and cumulative opioid consumption within 24 h postoperatively. Random-effects meta-analyses and I² statistics were used to assess pooled effects and heterogeneity.ResultsEleven randomized controlled trials (n = 535) met the inclusion criteria. Intrathecal morphine reduced 24-h postoperative pain scores with a moderate effect (standardized mean difference = -0.64; 95% confidence interval: -0.84 to -0.44; p < 0.001; I² = 55%) and decreased 24-h opioid consumption by 11.6 mg morphine equivalents (95% confidence interval: -19.3 to -3.9 mg; p = 0.003; I² = 96%). Differences in pain intensity at 48 and 72 h were not statistically significant. Adverse-event profiles were comparable between groups.ConclusionA single dose of intrathecal morphine provides clinically meaningful early analgesia and opioid-sparing benefits after liver resection without increasing adverse events. Incorporating intrathecal morphine into multimodal analgesic protocols may accelerate recovery; however, further high-quality trials are warranted to refine dosing and identify optimal patient selection.

PMID:41655272 | DOI:10.1177/03000605261416668

J Int Med Res. 2026 Feb;54(2):3000605261417447. doi: 10.1177/03000605261417447. Epub 2026 Feb 8.

ABSTRACT

ObjectiveThis study aimed to evaluate the safety profile of progesterone by analyzing adverse event data from the Food and Drug Administration Adverse Event Reporting System (FAERS) between 2004 and 2024.Materials and methodsThis retrospective, observational pharmacovigilance study was based on data from the FAERS database. A total of 1827 adverse event reports associated with progesterone were retrieved. Disproportionality analysis methods, including the reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker, were used to evaluate the frequency, signal strength, and time-to-onset of adverse events.ResultsAmong 24,589,239 adverse event reports in the reporting system, 1827 were associated with progesterone, covering 22 system organ classes and 152 preferred terms. The most frequently reported preferred terms were maternal exposure during pregnancy (151 cases), spontaneous abortion (144 cases), and abnormal product odor (114 cases). The top three preferred terms showing the strongest signals were decidual cast (reporting odds ratio: 2825.23), chondrodermatitis nodularis chronica helicis (reporting odds ratio: 3897.61), and autoimmune dermatitis (reporting odds ratio: 1519.29). Most adverse events occurred within 30 to 180 days after exposure. Newly identified preferred terms associated with progesterone included acute eosinophilic pneumonia, meningioma, and autoimmune dermatitis.ConclusionsThis study identified notable safety concerns associated with progesterone use and detected several rare adverse events. These findings underscore the need for continued monitoring, updated prescribing guidelines, and further investigation into progesterone formulations and adverse event mechanisms.

PMID:41655271 | DOI:10.1177/03000605261417447

Diabetes Metab Res Rev. 2026 Feb;42(2):e70135. doi: 10.1002/dmrr.70135.

ABSTRACT

BACKGROUND AND AIM: Diabetic neuropathy (DN) is a recognised risk factor for fragility fractures. However, the mechanisms linking DN, bone health, and falling risk remain unclear. We aimed to assess bone health and risk of falls, with their contributing factors, in young elderly patients with type 2 diabetes (T2D) and mild-to-moderate DN.

METHODS: We enrolled 144 subjects with T2D, excluding those with severe DN (neuropathy disability score -NDS- ≥ 9) or fracture history. Clinical and biochemical data were collected, including surrogate markers of insulin resistance, such as the triglycerides/HDL (TG/HDL) ratio and triglycerides/glucose (TyG) index. Bone mineral density (BMD) and trabecular bone score (TBS) were evaluated using DXA scans. Falls were self-recorded prospectively over 4 years using diaries.

RESULTS: Subjects with DN (27%) had higher BMI (p = 0.036), fasting blood glucose (p = 0.04), serum triglycerides (p = 0.016), TG/HDL ratio (p = 0.012) and TyG index (p = 0.003) compared with those without DN. After adjustment for gender, age, BMI, HbA1c, TyG index and TG/HDL ratio, subjects with DN showed significantly lower BMD at the femoral neck (0.702 [0.638-0.850] g/cm² vs. 0.789 [0.717-0.860] g/cm², p = 0.015) and total femur (0.890 [0.820-1.055] g/cm² vs. 0.983 [0.889-1.076] g/cm², p = 0.027). No differences were observed in spine BMD or TBS. However, TBS was negatively correlated with the TG/HDL ratio (r = -0.215, p = 0.013) and visceral adipose tissue (r = -0.310, p < 0.001). After 4 years of follow-up, subjects with painful neuropathy at baseline had a higher rate of falls (p = 0.011).

CONCLUSION: DN is associated with decreased BMD and increased risk of falls. Among factors associated with DN, insulin resistance was also associated with decreased bone quality.

PMID:41655239 | DOI:10.1002/dmrr.70135

Cutan Ocul Toxicol. 2026 Feb 8:1-6. doi: 10.1080/15569527.2026.2626680. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to investigate the potential role of systemic inflammatory biomarkers associated with high-density lipoprotein cholesterol (HDL) in the pathogenesis of Xanthelasma Palpebrarum (XP).

METHODS: HDL, low-density lipoprotein cholesterol (LDL), total cholesterol (TC), triglyceride (TG), lymphocyte, neutrophil, monocyte, platelet and red cell distribution width-standard deviation (RDW-SD) values were obtained from peripheral blood samples of patients who underwent XP excision. Monocyte-to-high-density lipoprotein cholesterol ratio (MHR), lymphocyte-to-HDL cholesterol ratio (LHR), platelet-to-HDL cholesterol ratio (PHR), neutrophil-to-HDL cholesterol ratio (NHR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were calculated and statistically compared. Multivariate logistic regression and ROC analyses were performed to determine predictive values.

RESULTS: The study compared the XP group (63 patients) and the control group (54 healthy individuals), finding no significant differences in age and gender (p = 0.059 and p = 0.406, respectively). Neutrophil, lymphocyte, monocyte, and platelet counts, as well as MHR, LHR, PHR, NHR, and SII values, were significantly higher in the XP group (p < 0.001, p = 0.015, p = 0.042, p = 0.018, p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.016, respectively). HDL levels were significantly lower in the XP group (p < 0.001). Among all parameters, NHR had the highest predictive value with an area under the curve (AUC) of 0.81. NHR (Odds ratio: 1.07) was identified as a potential risk factor for XP.

CONCLUSION: This study highlights the potential role of systemic inflammation associated with HDL in the pathogenesis of XP by triggering oxidative stress mechanisms, lipid peroxidation, and tissue-level inflammatory damage, and emphasizes the need to investigate treatments that regulate inflammation in XP therapy.

PMID:41655202 | DOI:10.1080/15569527.2026.2626680