Prevalence of depression among physicians: A comprehensive meta-analysis

Depression among medical personnel is recognized worldwide as a serious problem, yet quantitative syntheses of prevalence studies are rare. We proceeded quantify and understand prevalence variation among physicians at the global levels. For this meta-analysis, we searched 6 databases, including: PsycINFO, Web of Science, PubMed, ProQuest using a comprehensive search strategy to identify prevalence of the physicians’ depression studies in the literature, published from inception of 1979. Studies reporting estimates of depression prevalence in physicians were included in the analyses. Studies quality was assessed with a prevalence risk of bias tool. Meta-regression was used to explore heterogeneity of the moderators we included in the analysis. Of the 3,156 studies initially identified, 33 were eligible for inclusion. These studies were geographically diverse (15 countries). The pooled prevalence rate for overall elder abuse was .243 (CI [.188; .306]; p<.001). Meta-analysis of studies that included overall abuse revealed heterogeneity. Significant associations were found between overall prevalence estimates and region, but not for sampling allocation and severity of depression. In this meta-analysis, the summary estimate of the prevalence of depression among physicians is 24.3%, ranging from 2% to 65.3 % depending on the region from the studies. Further research is needed to identify effective strategies for preventing and treating depression among physicians.

COVID Feel Good – A Self-Help Virtual Therapeutic Experience for Overcoming the Psychological Distress of the COVID-19 Pandemic: Results from a European Multicentric Trial

The primary aim of the present study was to investigate the efficacy of a self-help virtual therapeutic experience (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown across different countries. For this purpose, we focused on participants recruited from June 2020 to May 2021 in the context of a European multicenter project including four university/academic sites. Primary outcome measures were depression, anxiety and stress symptoms, perceived stress levels and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. To assess the efficacy of the intervention in a multicentric context, we evaluated the strength of evidence supporting the COVID Feel Good computing a single summary estimate of the effect across the different countries. Using separate linear mixed-effect models, the most consistent result across the different countries was an improvement of the perceived stress level after the participation in the COVID Feel Good intervention. By pooling the results of the models using a random-effect meta-analysis, we found that COVID Feel Good intervention was associated a decrease in the perceived general distress [mean standardized effect size for general distress in the treatment groups compared to the control conditions was 0.52 (p = 0.007, 95% CI: 0.14, 0.89] and with an increase the perceived social connection [mean standardized effect size for social connection using COVID Feel Good compared to the control conditions was -0.50 (p = &lt; 0.001, 95% CI: -0.76, -0.25)]. Globally findings suggest the efficacy of the proposed protocol and contribute the growing literature supporting the use of digital psychological interventions to reduce the psychological stress among general population during the COVID-19 crisis.

Efficacy of tracheal tube introducers and stylets for endotracheal intubation in the prehospital setting: a systematic review and meta-analysis

Purpose Tracheal tube introducers and stylets remain some of the most widely used devices for aiding practitioners in performing endotracheal intubation (ETI). The purpose of this systematic review is to evaluate the efficacy of tracheal tube introducers and stylets for ETI in the prehospital setting. Methods A literature search was conducted on the 2nd of March 2021 across PubMed, Embase (Ovid) and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify relevant studies. Included studies had their data extracted and both a quality assessment and statistical analysis were performed. Results The summary estimate of prehospital studies with video technology showed a statistically significant increase in first pass ETI success in favour of bougies (RR 1.15, CI 1.10–1.21, p < 0.0001). The summary estimates of prehospital studies without video technology and simulation studies with and without video technology showed no statistical difference between methods for first pass or overall ETI success. Some of the highest success rates were recorded by devices that incorporated video technology. Stylets lead to a shorter time to ETI while bougies were easier to use. Neither device was associated with a higher rate of ETI complications than the other. Conclusion Both tracheal tube introducers and stylets function as efficacious aids to intubation in the prehospital environment. Where video technology is available, bougies could offer a statistically significant advantage in terms of first pass ETI success. Where video technology is unavailable, a combination of clinical scenario, practitioner expertise and personal preference might ultimately guide the choice of device.

Cognitive, Language, and Behavioral Outcomes in Children With Autism Spectrum Disorders Exposed to Early Comprehensive Treatment Models: A Meta-Analysis and Meta-Regression

Background: Early comprehensive treatment models (CTMs) have been developed as effective treatments for children with autism spectrum disorder (ASD). Numerous studies have suggested that CTMs can improve short-term outcomes, but little is known about precise outcome information in childhood. The current meta-analysis reviewed studies reporting broader outcomes in children with ASD who had ever participated in a CTM and examined the predictors of developmental gains.Methods: We searched eight databases up to June 13, 2019, for relevant trials and natural experiments. Longitudinal studies were selected if they investigated the outcomes of CTMs. Two meta-analyses were undertaken to provide a summary estimate of change in treatment outcomes and to evaluate the effect of CTMs; one used the standardized mean change between the pretest and posttest, and the other was a classical meta-analysis. Stratified and random-effects meta-regression analyses were performed to search for outcome differences among studies.Results: Eighteen intervention studies (involving 495 children with ASD) met all the inclusion criteria: 12 used early intensive behavioral intervention (EIBI), and two used the Early Start Denver Model (ESDM). Outcomes were categorized into three parts: cognitive, language and behavioral (e.g., adaptive functioning and symptomatology). Overall, most children with ASD who had ever participated in an early CTM made gains in many areas of functioning, especially in terms of symptom- and language-related outcomes. Stratified analyses indicated that the ESDM displayed the largest effect on IQ improvement (ES = 1.37, 95% CI: 0.95 to 1.80), while EIBI was more effective for symptom reduction (ES = −1.27, 95% CI: −1.96 to −0.58). Further, meta-regression suggested that interventions with parent involvement, higher intensity, and longer treatment hours yielded greater improvements in IQ and social adaptive functioning, respectively.Conclusion: The results demonstrate a positive association between CTMs and better prognosis in childhood, especially regarding symptoms, and language. However, most extant research involves small, non-randomized studies, preventing definitive conclusions from being drawn. Clearly, the outcomes of children with ASD are still far from normal, especially with respect to adaptive functioning, and the four mediating variables pertaining to treatment elements can affect their gains, including approach, implementer, intensity, and total treatment hours.Systematic Review Registration: [www.crd.york.ac.uk/PROSPERO], identifier [CRD42019146859].

Reliability of Cobb’s Angle in a Measurement of Kyphosis – A Meta–Analysis

This study aimed at analyzing the literature systematically on the reliability of Cobb’s angle in measurement of kyphosis. Cobb’s angle is the most widely used measurement to quantify spinal deformity. Kyphosis is the spinal disorder in which an excessive outwards of the spine results in an abnormal rounding of the upper back. Cobb’s angle used as standard measurement to determine and trackthe progression of scoliosis andkyphosis. Hence the purpose of the meta-analysis is to analyze the reliability of Cobb’s angle in a measurement of kyphosis Systematic searches in PubMed, Science direct, Google scholar, Cochrane library, Research Gate for systematic review was done. Research article and review article were selected within the published 1999 – 2020. The study design is Meta-analysis study of Analytical type. Study quality was done by PEDro Scale The study duration is about 4 months. A Meta-analysis was conducted by using Medical software to obtain a summary estimate of the standardized mean difference and 95% confidence limit. 100 articles taken for review in which finally 35 articles were summarized. Almost all the study shows that there was a highly significant difference on measurement of kyphosis using COBB’S angle. Outcome of measurement has excellent reliability with the small range of standard error of measurement. Cobb’s measurement had excellent reliability when used to measure kyphosis. The findings confirm the significance and the ease of using this method.

Diagnostic Accuracy of CBCT for Detection of Second Canal of Permanent Teeth: A Systematic Review and Meta-Analysis

Introduction. Missed canal is one of the common reasons for nonsurgical endodontic retreatments. The missed canals were frequently associated with periapical pathology. The aim of this systematic review was to find the diagnostic accuracy of CBCT for detection of the second canal of the root canal system of permanent teeth. Materials and Methods. The articles were selected from seven electronic databases according to selection criteria. All eligible studies were judged by the reviewers. The selected studies were checked with the QUADAS-2 tool for risk of bias and applicability concerns. Finally, 12 studies were selected for qualitative and quantitative analyses. The summary estimates of sensitivities and specificities and SROC curves were calculated and drawn by RevMan 5.3 and MetaDTA software. Results. Summary estimates of CBCT for detection of second canal anatomy in permanent teeth were 94% sensitivity and 93.1% specificity. 96.6% sensitivity of MB2 was followed by 88.8% sensitivity of maxillary and mandibular premolars and 81% that of mandibular molars. The specificity of 97.6% for premolars was trialed by 85% specificity of mandibular molars and MB2. For permanent mandibular canines, 67% sensitivity and 100% specificity were estimated. CBCT showed more agreement with detecting the second canal with micro-CT, estimating 100% sensitivity and 95.6% specificity. The highest prevalence of the second canal comprised the highest sensitivity of 99.1% and lowest specificity of 77.5%. After the exclusion of case-control studies, a 3% drop of sensitivity from the summary estimate was observed. Multiple spectrum of the second canal had 8.6% higher sensitivity and 4.4% lower specificity than single spectrum. Conclusion. CBCT is informative for detecting the second canal. Clinicians should keep in mind that the accuracy can vary in different types of teeth, with the prevalence of second canal across different populations, and with the spectrum of second canal anatomy in spite of the reviewers having postulated overestimation of the findings.

A comprehensive literature review and meta-analysis on prevalence of BRCAm, HRRm and HRD+ across tumor types.

10589 Background: Poly (ADP-ribose) polymerase inhibitor (PARPi) may have broad application in the treatment of cancer patients with mutations in BRCA (BRCAm) or other homologous recombination repair genes (HRRm) or with homologous recombination deficiency positive (HRD+). A literature review and meta-analysis were conducted to evaluate the prevalence of BRCAm, HRRm, and HRD+ across tumor types. Methods: Comprehensive searches for eligible studies in Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane reviews were performed in May 2020 to capture studies published in English, within 10 years for manuscripts and 3 years for abstracts across geographic regions. A weighted summary estimate was calculated for BRCAm. A summary estimate with corresponding 95% CI was calculated using random-effects models for HRD+ and HRRm. Results: A total of 342 eligible studies with at least 100 samples were included in the review of BRCA1/2m prevalence, containing a total of over 469,000 samples across 24 tumor types. The most frequent indications examined in the included studies were breast (study number n = 144), ovarian (53), prostate (17) and pancreatic (11) cancers. The prevalence of germline BRCA1m (gBRCA1m) and gBRCA2m was 5% and 4% for breast, 12% and 5% for ovarian, 1% and 3% for prostate, and 1% and 4% for pancreatic cancer, respectively. The prevalence of somatic BRCA1m (sBRCA1m) and somatic BRCA2m (sBRCA2m) was 3% and 3% for breast, 7% and 5% for ovarian, 3% and 5% for prostate, and 1% and 3% for pancreatic cancer, respectively. Few studies evaluated endometrial, lung and colon cancers, the prevalence of gBRCA1m or gBRCA2m was generally less than 1%, and the prevalence of sBRCA1m and sBRCA2 ranged 1 to 3%. Seven publications were identified where HRD+ was defined by either BRCAm or genomic instability score (GIS) ≥ 42 across breast, ovarian and pancreatic cancers. The overall HRD+ prevalence was 56% (95%CI: 48, 64), with similar prevalence observed across the 3 tumor types and was 50% (34, 66) for the 3 studies only counting GIS≥ 42. 194 studies across 26 tumor types were identified that examined HRRm as mutations in one or more HRR genes other than BRCA1/2m. The definitions of HRRm varied substantially across the studies, and ATM (2.8%), CHEK2 (1.6%), and PALB2 (1.6%) accounted for most of the observed mutations among HRR genes. Conclusions: Prevalence of BRCAm, HRRm and HRD+ varied by cancer type. This comprehensive meta-analysis enriches the knowledge in this field and demonstrates the need to standardize the measurement of HRRm and HRD.Understanding the prevalence of these biomarkers could have important clinical implications.

A comprehensive literature review and meta-analysis on prognostic value of BRCAm, HRRm and HRD+ across tumor types.

3125 Background: Poly (ADP-ribose) polymerase inhibitor (PARPi) may have broad application in the treatment of cancer patients with mutations of BRCA (BRCAm) or other homologous recombination repair genes (HRRm) or HR deficiency positive (HRD+). A literature review and meta-analysis were conducted to evaluate the clinical prognostic outcomes by total BRCAm, HRRm, and HRD+ status across tumor types among patients treated with non-PARPi treatment. Methods: Comprehensive searches for eligible studies in Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane reviews were performed in May 2020 to capture studies published in English within 10 years for manuscripts and 3 years for abstracts across geographic regions. A summary estimate with corresponding 95% CI was calculated using random-effects models due to varying effects sizes across studies. Results: A total of 135 eligible studies were included. Breast cancer (BC) patients with either BRCA1m or BRCA2m (BRCA1/2m) had a similar overall survival (OS) to those with wild-type BRCA1 and BRCA2 (BRCA1/2wt) across 18 studies reporting data on BRCA1m and BRCA2m. The pooled estimates of hazard ratio (HR) was 1.0 (95% CI: 0.8-1.3) overall and was 1.0 (0.7-1.5) for triple-negative BC (TNBC, 7 studies). Similarly, the HR was 1.1 (0.9-1.3) across all 10 studies reporting BRCA1m data and 1.1 (0.8-1.3) across all 7 studies reporting BRCA2m data. Ovarian cancer (OC) patients with BRCA1/2m had a significantly longer OS than those with BRCA1/2wt across 24 studies reporting BRCA1m and BRCA2m, with a HR of 0.7 (0.6-0.8). The HR was 0.6 (0.4, 0.8) across 4 studies on stage III-IV ovarian cancer. The HR was 0.8 (0.6-1.1) across 13 studies reporting BRCA1m and 0.5 (0.3-0.9) across 8 studies reporting BRCA2m. Less OS data were reported for other tumors, 6 studies for BRCA2m in prostate cancer with a HR of 1.9 (1.1-3.2) and 2 studies for BRCA1/2m in pancreatic cancer with a HR of 1.5 (0.8-3.1). Only 4 studies reported HRD+ by either BRCAm or genomic instability score (GIS) ≥ 42 and OS by HRD status; 3 on TNBC and 1 on high-grade serous ovarian cancer. The HR was 0.67 (0.43-1.02) for OS with HRD+ vs. HRD-. A total of 15 studies reported the association between HRRm and OS of cancers (5 on prostate, 4 on pancreas, 3 on ovary, 2 on breast and 1 on urothelial cancer), in which one or more HRR genes were examined. The HR was 1.0 (0.7-1.4) comparing patients with HRRm to those with HRRwt across tumor types. Due to the limited study number and inconsistent methodology/definitions of HRRm and HRD+, these results should be interpreted with caution. Conclusions: The effects of BRCA1/2m on OS in patients treated with chemotherapy varies by cancer type with no effect in BC and a positive association in OC. More study is required in other cancer types. There was no significant association found between HRD+ or HRRm with OS. These findings could help inform evidence-based treatment decisions.

Neurological manifestations and complications of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis

Background The spectrum of neurological involvement in COVID-19 is not thoroughly understood. To the best of our knowledge, no systematic review with meta-analysis and a sub-group comparison between severe and non-severe cases has been published. The aim of this study is to assess the frequency of neurological manifestations and complications, identify the neurodiagnostic findings, and compare these aspects between severe and non-severe COVID-19 cases. Methods A systematic search of PubMed, Scopus, EBSCO, Web of Science, and Google Scholar databases was conducted for studies published between the 1st of January 2020 and 22nd of April 2020. In addition, we scanned the bibliography of included studies to identify other potentially eligible studies. The criteria for eligibility included studies published in English language (or translated to English), those involving patients with COVID-19 of all age groups, and reporting neurological findings. Data were extracted from eligible studies. Meta-analyses were conducted using comprehensive meta-analysis software. Random-effects model was used to calculate the pooled percentages and means with their 95% confidence intervals (CIs). Sensitivity analysis was performed to assess the effect of individual studies on the summary estimate. A subgroup analysis was conducted according to severity. The main outcomes of the study were to identify the frequency and nature of neurological manifestations and complications, and the neuro-diagnostic findings in COVID-19 patients. Results 44 articles were included with a pooled sample size of 13,480 patients. The mean age was 50.3 years and 53% were males. The most common neurological manifestations were: Myalgia (22.2, 95% CI, 17.2 to 28.1%), taste impairment (19.6, 95% CI, 3.8 to 60.1%), smell impairment (18.3, 95% CI, 15.4 to 76.2%), headache (12.1, 95% CI, 9.1 to 15.8%), dizziness (11.3, 95% CI, 8.5 to 15.0%), and encephalopathy (9.4, 95% CI, 2.8 to 26.6%). Nearly 2.5% (95% CI, 1 to 6.1%) of patients had acute cerebrovascular diseases (CVD). Myalgia, elevated CK and LDH, and acute CVD were significantly more common in severe cases. Moreover, 20 case reports were assessed qualitatively, and their data presented separately. Conclusions Neurological involvement is common in COVID-19 patients. Early recognition and vigilance of such involvement might impact their overall outcomes.

Accuracy and precision of the spinal instability neoplastic score (SINS) for predicting vertebral compression fractures after radiotherapy in spinal metastases: a meta-analysis

Radiotherapy has played an important role in the treatment of spinal metastases. One of the major complications of radiotherapy is vertebral compression fracture (VCF). Although the spinal instability neoplastic score (SINS) was developed for evaluating spinal instability in patients with spinal metastases, it is also commonly used to predict VCF after radiotherapy in patients with spinal metastases. However, its accuracy for predicting radiotherapy-induced VCF and precision remain controversial. The aim of this study was to clarify the diagnostic value of the SINS to predict radiotherapy-induced VCF and to make recommendations for improving its diagnostic power. We searched core databases and identified 246 studies. Fourteen studies were analyzed, including 7 studies (with 1269 segments) for accuracy and 7 studies (with 280 patients) for precision. For accuracy, the area under the summary receiver operating characteristic curve was 0.776. When a SINS cut-off value of 7 was used, as was done in the included studies, the pooled sensitivity was 0.790 and the pooled specificity was 0.546. For precision, the summary estimate of interobserver agreement was the highest dividing 2 categories based on a cut-off value of 7, and the value was 0.788. The body collapse showed moderate relationship and precision with the VCF. The lytic tumor of bone lesion showed high accuracy and fair reliability, while location had excellent reliability, but low accuracy. The SINS system can be used to predict the occurrence of VCF after radiotherapy in spinal metastases with moderate accuracy and substantial reliability. Increasing the cut-off value and revising the domains may improve the diagnostic performance to predict the VCF of the SINS.