Efficacy of Interventions to Reduce Resident Physician Burnout: A Systematic Review

ABSTRACT Background Studies report high burnout prevalence among resident physicians, with little consensus on methods to effectively reduce it. Objective This systematic literature review explores the efficacy of interventions in reducing resident burnout. Methods PubMed, Embase, and Web of Science were searched using these key words: burnout and resident, intern, or residency. We excluded review articles, editorials, letters, and non–English-language articles. We abstracted data on study characteristics, population, interventions, and outcomes. When appropriate, data were pooled using random effects meta-analysis to account for between-study heterogeneity. Study quality was assessed using Newcastle-Ottawa Scale (cohort studies) and Jadad scale (randomized control trials [RCTs]). Results Of 1294 retrieved articles, 19 (6 RCTs, 13 cohort studies) enrolling 2030 residents and examining 12 interventions met criteria, with 9 studying the 2003 and 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour restrictions. Work hour reductions were associated with score decrease (mean difference, −2.73; 95% confidence interval (CI) −4.12 to −1.34; P < .001) and lower odds ratio (OR) for residents reporting emotional exhaustion (42%; OR = 0.58; 95% CI 0.43–0.77; P < .001); a small, significant decrease in depersonalization score (−1.73; 95% CI −3.00 to −0.46; P = .008); and no effect on mean personal accomplishment score (0.93; 95% CI −0.19–2.06; P = .10) or for residents with high levels of personal accomplishment (OR = 1.01; 95% CI 0.67–1.54; P = .95). Among interventions, self-care workshops showed decreases in depersonalization scores, and a meditation intervention reduced emotional exhaustion. Conclusions The ACGME work hour limits were associated with improvement in emotional exhaustion and burnout.

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Relationship between Maternal Central Obesity and the Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Cohort Studies

Journal of Diabetes Research ◽

10.1155/2020/6303820 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Da Yao ◽

Qing Chang ◽

Qi-Jun Wu ◽

Shan-Yan Gao ◽

Huan Zhao ◽

...

Keyword(s):

Cohort Studies ◽

Central Obesity ◽

English Language ◽

Meta Analysis ◽

Random Effect ◽

Subcutaneous Fat ◽

Fat Distribution ◽

Summary Estimate ◽

Study Characteristics ◽

Design And Methods

Objective. Nowadays, body mass index (BMI) is used to evaluate the risk stratification of obesity-related pregnancy complications in clinics. However, BMI cannot reflect fat distribution or the proportion of adipose to nonadipose tissue. The objective of this study is to evaluate the association of maternal first or second trimester central obesity with the risk of GDM. Research Design and Methods. We searched in PubMed, Embase, and Web of Science for English-language medical literature published up to 12 May 2019. Cohort studies were only included in the search. Abdominal subcutaneous fat thickness, waist circumference, waist-hip ratio or body fat distribution were elected as measures of maternal central obesity, and all diagnostic criteria for GDM were accepted. The random effect meta-analysis was performed to evaluate the relationship between central obesity and the risk of GDM. Results. A total of 11 cohort studies with an overall sample size of 27,675 women and 2,226 patients with GDM were included in the analysis. The summary estimate of GDM risk in the central obesity pregnant women was 2.76 (95% confidence interval [CI]: 2.35–3.26) using the adjusted odds ratio (OR). The degree of heterogeneity among the studies was low (I2=14.4, P=0.307). The subgroup analyses showed that heterogeneity was affected by selected study characteristics (methods of exposure and trimesters). After adjusting for potential confounds, the OR of adjusted BMI was significant (OR=3.07, 95% CI: 2.35–4.00). Conclusions. Our findings indicate that the risk of GDM was positively associated with maternal central obesity.

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Postoperative Bleeding Associated with Ibuprofen Use after Tonsillectomy: A Meta-analysis

Otolaryngology ◽

10.1177/0194599819852328 ◽

2019 ◽

Vol 161 (5) ◽

pp. 734-741 ◽

Cited By ~ 11

Author(s):

William Stokes ◽

Robert T. Swanson ◽

Jane Schubart ◽

Michele M. Carr

Keyword(s):

Clinical Trials ◽

Cohort Studies ◽

Retrospective Cohort ◽

English Language ◽

Meta Analysis ◽

Postoperative Bleeding ◽

Perioperative Period ◽

Level Of Evidence ◽

Study Heterogeneity ◽

Retrospective Cohort Studies

Objective To better quantify the risk of ibuprofen-associated posttonsillectomy hemorrhage (PTH). Data Sources PUBMED/MEDLINE, Web of Science, and Cochrane Clinical Trials Database. Review Method Literature searches were performed for English-language publications containing the terms tonsillectomy, ibuprofen, and tonsillectomy from database inception to May 2017. Human clinical trials, prospective cohort studies, and retrospective cohort studies related to tonsillectomy, ibuprofen use, and posttonsillectomy hemorrhage among pediatric patients were selected. Electronic searches revealed 151 studies, of which 12 were deemed eligible for analysis. Studies were weighted according to level of evidence and risk of bias. Results Pooling of results across all studies showed a statistically significant increase in PTH among the patients taking ibuprofen (odds ratio, 1.38; 95% confidence interval, 1.11-1.72). The I 2 statistic of 20.8% demonstrates overall low study heterogeneity and good comparability of the results. Conclusion Our meta-analysis of available cohort studies and randomized controlled trials (RCTs) shows possible increased tendency to PTH with the use of ibuprofen. This has not been demonstrated in other studies and systematic reviews because their analyses were limited by use of multiple nonsteroidal anti-inflammatory drugs and inclusion of studies limited to the perioperative period and low sample size. However, the current analysis is limited due to inclusion of many retrospective cohort studies with unclear follow-up and no blinding. Further RCTs will be required to investigate this trend toward increased PTH.

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Hydroxychloroquine prophylaxis for preeclampsia, hypertension and prematurity in pregnant patients with systemic lupus erythematosus: A meta-analysis

Lupus ◽

10.1177/09612033211007199 ◽

2021 ◽

pp. 096120332110071

Author(s):

Jiaoniu Duan ◽

Dan Ma ◽

Xiaoting Wen ◽

Qianyu Guo ◽

Jinfang Gao ◽

...

Keyword(s):

Lupus Erythematosus ◽

English Language ◽

Gestational Hypertension ◽

Meta Analysis ◽

Fetal Outcomes ◽

Pregnancy Hypertension ◽

Cochrane Database ◽

Newcastle Ottawa Scale ◽

Prospective Cohorts ◽

Ottawa Scale

Objectives This meta-analysis aimed to evaluate the effectiveness of HCQ in improving the maternal and fetal outcomes in pregnancies with SLE. Methods A literature search was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane database for relevant English language articles, and Wanfang, CNKI and VIP for Chinese articles, from the databases’ inception to April 30, 2020. These studies compared the maternal and/or fetal outcomes between pregnant patients with SLE who were administered HCQ during pregnancy (HCQ+ group) and those who were not administered HCQ (HCQ− group). Two investigators extracted the data and assessed the quality using the Newcastle-Ottawa Scale (NOS) and GRADE criteria independently. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. All statistical analyses were conducted using the Stata 12.0 software. Results Nine studies involving 1132 pregnancies were included in the study (3 case controls, 2 prospective cohorts, 4 retrospective cohorts). Preeclampsia, gestational hypertension, and prematurity were significantly lower in the HCQ+ group than in the HCQ− group (OR 0.35, 95% CI 0.21–0.59), (OR 0.41, 95% CI 0.19–0.89) and (OR 0.55, 95% CI 0.36–0.86), respectively. There were no significant differences in the rates of HELLP Syndrome (OR 0.88, 95% CI 0.19–3.96), gestational diabetes (OR 2.3, 95% CI 0.44–12.12), thrombotic events (OR 0.26, 95% CI 0.05–1.51), spontaneous abortion (OR 1.77, 95% CI 0.96–3.26), premature rupture of membranes (OR 0.58, 95% CI 0.24–1.39), oligohydramnios (OR 0.90, 95% CI 0.38–2.14), live birth (OR 1.22, 95% CI 0.60–2.47), stillbirth (OR 1.00, 95% CI 0.50–2.00), congenital malformation (OR 0.53, 95% CI 0.14–2.04), low birth weight (OR 0.77, 95% CI 0.43–1.39), intrauterine distress (OR 1.07, 95% CI 0.41–2.76,), intrauterine growth restriction (OR 0.57, 95% CI 0.06–5.43), or five-minute APGAR score <7 (OR 0.72, 95% CI 0.20–2.58) between the two groups. Conclusions HCQ treatment during pregnancy could reduce the risk of preeclampsia, pregnancy hypertension and prematurity in SLE patients. The certainty of evidence is high but majority of the studies included are retrospective studies and not randomized controlled trials. Therefore, the multidisciplinary management of pregnant patients with SLE should promote HCQ use, irrespective of disease activity or severity.

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Association Between Prediabetes and Retinopathy: A Meta-Analysis

Hormone and Metabolic Research ◽

10.1055/a-1678-7092 ◽

2021 ◽

Vol 53 (12) ◽

pp. 801-809

Author(s):

Ji Jin ◽

Peirong Lu

Keyword(s):

Meta Analysis ◽

Microvascular Complications ◽

Random Effect ◽

Random Effect Model ◽

Community Dwelling ◽

Current Evidence ◽

Cross Sectional ◽

Increased Risk ◽

Study Heterogeneity ◽

Study Characteristics

AbstractDiabetes confers an increased risk of microvascular complications, including retinopathy. However, whether prediabetes is also related to retinopathy has not been comprehensively examined. We performed a meta-analysis to evaluate the relationship between prediabetes and retinopathy. This meta-analysis included relevant observational studies from Medline, Embase, and Web of Science databases. A random-effect model after incorporation of the intra-study heterogeneity was selected to pool the results. Subgroup analyses were applied to evaluate the influences of study characteristics on relationship. Nine cross-sectional studies including 14 751 community dwelling adult participants were included; 3847 (26.1%) of them were prediabetic. Results showed that prediabetes was associated with a higher prevalence of retinopathy compared to normoglycemia [odds ratio (OR): 1.55, 95% confidence interval (CI): 1.10–2.20, p=0.01, I2=34%]. Sensitivity analysis by excluding one study at a time showed consistent result (OR: 1.35 to 1.73, p all<0.05). Subgroup analysis showed study characteristics such as definition of prediabetes, country of study, sample size, mean age of participants, or univariate or multivariate analyses may not significantly affect the association (p for subgroup difference all>0.05). Current evidence suggests that patients with prediabetes may be associated with higher prevalence of retinopathy as compared to those with normoglycemia. Although prospective cohort studies are needed to validate these findings, results of our meta-analysis highlighted the importance of early prevention of retinopathy in patients with prediabetes.

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Depressed mood and anxiety as risk factors for hypertensive disorders of pregnancy: a systematic review and meta-analysis

Psychological Medicine ◽

10.1017/s0033291720003062 ◽

2020 ◽

Vol 50 (13) ◽

pp. 2128-2140 ◽

Cited By ~ 1

Author(s):

Matthew Shay ◽

Anna L. MacKinnon ◽

Amy Metcalfe ◽

Gerald Giesbrecht ◽

Tavis Campbell ◽

...

Keyword(s):

English Language ◽

Meta Analysis ◽

Hypertensive Disorders Of Pregnancy ◽

Case Control Studies ◽

Pregnancy Anxiety ◽

Relative Risks ◽

Hypertensive Disorders ◽

Study Characteristics ◽

Anxious Group ◽

In Pregnancy

AbstractBackgroundPsychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP.MethodsA comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to ‘pregnancy’, ‘anxiety’, ‘depression’, and ‘hypertensive disorders’. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP.ResultsIn total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25–1.54].ConclusionsWhen measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07–1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.

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Association between red blood cell transfusions and development of non-Hodgkin lymphoma: a meta-analysis of observational studies

Blood ◽

10.1182/blood-2010-03-276683 ◽

2010 ◽

Vol 116 (16) ◽

pp. 2897-2907 ◽

Cited By ~ 46

Author(s):

Jorge J. Castillo ◽

Samir Dalia ◽

Sheila K. Pascual

Keyword(s):

Cohort Studies ◽

Hodgkin Lymphoma ◽

Observational Studies ◽

Meta Analysis ◽

Case Control ◽

Lymphocytic Leukemia ◽

Blood Transfusions ◽

Non Hodgkin Lymphoma ◽

Newcastle Ottawa Scale ◽

Trim And Fill

AbstractThe incidence of non-Hodgkin lymphoma (NHL) has increased steadily for the past few decades. Previous studies have suggested an association between blood transfusions and NHL. The main objective of this study was to evaluate this relationship with a meta-analysis of observational studies. A literature search was undertaken, looking for case-control and cohort studies evaluating the risk of developing NHL in persons who received allogeneic blood transfusions; 14 studies were included. Outcome was calculated and reported as relative risk (RR). Heterogeneity was assessed with Cochrane Q and I2 statistics. Dissemination bias was evaluated by funnel plot visualization and trim-and-fill analysis. Quality assessment was performed with the Newcastle-Ottawa scale. Our analysis showed a RR of developing NHL of 1.05 (95% CI, 0.89-1.25; P = .42) and 1.34 (95% CI, 1.15-1.55; P < .01) in case-control and cohort studies, respectively. When pooling all studies, RR was 1.2 (95% CI, 1.07-1.35; P < .01). In subset analysis, RR of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) was 1.66 (95% CI, 1.08-2.56; P = .02). The RR of NHL was elevated in both men and women and in persons receiving transfusions either before or after 1992. Blood transfusions appear to increase the risk of developing NHL; however, the risk of CLL/SLL appears higher than for other NHL subtypes.

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Identification of Risk Factors for Falls in Multiple Sclerosis: A Systematic Review and Meta-Analysis

Physical Therapy ◽

10.2522/ptj.20120231 ◽

2013 ◽

Vol 93 (4) ◽

pp. 504-513 ◽

Cited By ~ 116

Author(s):

Hilary J. Gunn ◽

Paul Newell ◽

Bernhard Haas ◽

Jonathan F. Marsden ◽

Jennifer A. Freeman

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Fall Risk ◽

English Language ◽

Data Extraction ◽

Meta Analysis ◽

Eligibility Criteria ◽

Factors Associated ◽

Newcastle Ottawa Scale ◽

Risk Factors For Falls

Background Falls are a significant issue in people with multiple sclerosis (MS), with research demonstrating fall rates of more than 50%. Purpose The purpose of this study was to evaluate the risk factors associated with falling in people with MS. Data Sources Mixed search methods were used, including computer-based and manual searches. Additionally, hand searches of reference lists and conference abstracts were performed. All literature published from the source's earliest date to January 2012 was included; only full-text English-language sources (or those where a translation was available) were included. Study Selection Eligibility criteria specified articles evaluating any aspect of fall risk in adults with a confirmed MS diagnosis, where the incidence of falling as determined by prospective or retrospective participant report was included. Data Extraction Data were extracted independently by 2 reviewers using a written protocol and standardized extraction documentation. Detailed assessment of each article was independently undertaken by both reviewers, including assessment of study quality using an adaptation of the Newcastle Ottawa Scale plus extraction of key data (participant characteristics, fall incidence, and outcomes). Data Synthesis The final review comprised 8 articles with a total of 1,929 participants; 1,037 (53.75%) were classified as fallers. Eighteen different risk factors were assessed within the included studies. Meta-analysis demonstrated an increase in fall risk associated with impairments of balance and cognition, progressive MS, and use of a mobility aid. Narrative review of the qualitative articles and those factors where meta-analysis was not possible also was undertaken. Limitations Variation in assessment, analysis, and reporting methods allowed meta-analysis for only 4 factors. Conclusion There is limited evidence of the factors associated with fall risk in people with MS. Further methodologically robust studies are needed.

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Traumatic Injury and Multiple Sclerosis: A Systematic Review and Meta-Analysis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100013688 ◽

2013 ◽

Vol 40 (2) ◽

pp. 168-176 ◽

Cited By ~ 9

Author(s):

Sharon A. Warren ◽

Susan Armijo Olivo ◽

Jorge Fuentes Contreras ◽

Karen V. L. Turpin ◽

Douglas P. Gross ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Confidence Interval ◽

Cohort Studies ◽

Odds Ratio ◽

Meta Analysis ◽

Traumatic Injury ◽

Case Control ◽

Case Control Studies ◽

Newcastle Ottawa Scale

A systematic review/meta-analysis of literature addressing a possible association between traumatic injury and onset of multiple sclerosis was conducted. Medline, Embase, Cochrane DSR, Ovid HealthStar, CINAHL, ISI Web of Science and Scopus were searched for analytical studies from 1950 to 2011. Two investigators independently reviewed articles for inclusion, assessing their quality using the Newcastle-Ottawa Scale. Of the 13 case-control studies included, 8 were moderate quality and 5 low; of the 3 cohort studies 2 were high and 1 moderate. Meta-analysis including moderate and low quality case-control studies produced a modest but significant odds ratio: 1.41 (95% confidence interval: 1.03, 1.93). However, when low quality studies were excluded, the resulting odds ratio was non-significant. Cohort studies produced a non-significant standardized incidence ratio of 1.00 (95% confidence interval: 0.86, 1.16). These findings support the conclusion that there is no association between traumatic injury and multiple sclerosis onset; more high quality cohort studies would help to confirm this observation.

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The Comorbid Relationship Between Migraine and Asthma: A Systematic Review and Meta-Analysis of Population-Based Studies

Frontiers in Medicine ◽

10.3389/fmed.2020.609528 ◽

2021 ◽

Vol 7 ◽

Author(s):

Long Wang ◽

Zi-Ru Deng ◽

Mei-Dan Zu ◽

Juan Zhang ◽

Yu Wang

Keyword(s):

Cohort Studies ◽

Potential Risk ◽

Meta Analysis ◽

Population Based ◽

Pooled Analysis ◽

Sensitivity Analyses ◽

Risk Indicator ◽

Cross Sectional ◽

Full Text Review ◽

Newcastle Ottawa Scale

Objective: Recent studies have indicated a pathophysiologic link between migraine and asthma. This meta-analysis aimed to comprehensively estimate the risk ratio for migraine in asthma as well as that of asthma in migraine based on available evidence.Method: We systematically searched the electronic databases including PubMed, Web of Science, and SCOPUS for population-based studies that measured either the odds or the risk of asthma in subjects with migraine as well as that of migraine in subjects with asthma. The titles and abstracts were screened by two independent reviewers to identify eligible studies, and this was followed by full-text review of the included studies. Newcastle–Ottawa Scale (NOS) was used to assess the risk of bias of included literature. A meta-analysis was conducted with Review Manager 5.3 Software to calculate the odds ratio (OR) for case-control and cross-sectional studies and either relative ratio (RR) or hazard ratio (HR) for cohort studies, and the source of heterogeneity was assessed. Subgroup and sensitivity analyses were conducted, and the I2 test were used to assess the source of heterogeneity. The funnel plot, Galbraith plot, and Egger's test were used to evaluate publication bias.Results: Fifteen published studies covering a total of 1,188,780 individuals were identified. Pooled analysis indicated that migraine was associated with increased odds (OR = 1.54; 95% CI: 1.34~1.77) and risk for asthma (HR = 1.42; 95% CI: 1.26~1.60), and asthma associated with increased odds (OR = 1.45; 95% CI: 1.22~1.72) and risk for migraine (HR = 1.47; 95% CI: 1.41~1.52).Conclusion: Migraine is a potential risk indicator for asthma, and vice versa, asthma is a potential risk indicator for migraine. However, future prospective cohort studies are warranted to provide more evidence concerning the detailed association between migraine and asthma.

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Processed and Unprocessed Red Meat Consumption and Risk for Type 2 Diabetes Mellitus: An Updated Meta-Analysis of Cohort Studies

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010788 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10788

Author(s):

Rui Zhang ◽

Jialin Fu ◽

Justin B. Moore ◽

Lee Stoner ◽

Rui Li

Keyword(s):

Diabetes Mellitus ◽

Cohort Studies ◽

Fixed Effects ◽

English Language ◽

Meta Analysis ◽

Meat Consumption ◽

Type Ii Diabetes Mellitus ◽

Red Meat ◽

The Body ◽

Cochrane Library

Type II diabetes mellitus (T2DM) is a metabolic disorder that occurs in the body because of decreased insulin activity and/or insulin secretion. The incidence of T2DM has rapidly increased over recent decades. The relation between consumption of different types of red meats and risk of T2DM remains uncertain. This meta-analysis was conducted to quantitatively assess the associations of processed red meat (PRM) and unprocessed red meat (URM) consumption with T2DM. We searched PubMed, Embase, Web of Science and The Cochrane Library for English-language cohort studies published before January 2021. Summary relative risks (RR) with 95% confidence interval (CI) were estimated using fixed effects and random effects. Additionally, dose–response relationships were explored using meta-regression. Fifteen studies (N = 682,963 participants, cases = 50,675) were identified. Compared with the lowest intake group, high consumption of PRM and URM increased T2DM risk by 27% (95% CI 1.15–1.40) and 15% (95% CI 1.08–1.23), respectively. These relationships were consistently strongest for U.S-based studies, though the effects of sex are inconclusive. In conclusion, PRM and URM are both positively associated with T2DM incidence, and these relationships are strongest in the U.S. reduction of red meat consumption should be explored as a target for T2DM prevention initiatives.

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