Whole-Body MRI at Initial Presentation of Chronic Recurrent Multifocal Osteomyelitis, Juvenile Idiopathic Arthritis, Their Overlapping Syndrome, and Non-Specific Arthropathy.

(1) Background: Whole-body magnetic resonance imaging (WB-MRI) is central to defining total inflammatory burden in juveniles with arthritis. Our aim was to determine and compare the initial distribution of lesions in the WB-MRI in patients with chronic recurrent multifocal osteomyelitis (CRMO), juvenile idiopathic arthritis (JIA), their overlapping syndrome (OS), and with Non-specific Arthropathy (NA). (2) Methods: This retrospective single center study was performed on an Avanto 1.5-T MRI scanner with a dedicated multichannel surface coil system. A total of 173 pediatric patients were included with the following final diagnoses: CRMO (15.0%), JIA (29.5%), OS (4.6%), and NA (50.9%). (3) Results: Bone marrow edema (BME) was the most common abnormality, being seen in 100% patients with CRMO, 88% with OS, 55% with JIA, and 11% with NA. The bones of the lower extremities were the most affected in all compared entities. Effusion was seen in 62.5% children with OS, and in 52.9% with JIA, and in CRMO and NA, the exudate was sporadic. Enthesitis was found in 7.8% of patients with JIA and 3.8% with CRMO, and myositis was seen in 12.5% of patients with OS and in 3.9% with JIA. (4) Conclusions: The most frequent indication for WB-MRI in our center was JIA. The most common pathology in all rheumatic entities was BME, followed by effusion mainly seen in in OS and JIA. Enthesitis and myositis were less common; no case was observed in NA.

Is the association between pulse wave velocity and bone mineral density the same for men and women? - A systematic review and meta-analysis.

BACKGROUND: Brachial aortic Pulse Wave Velocity (baPWV) and bone mineral density (BMD) are important indicators of cardiovascular health and bone strength, respectively. However, the gender-specific association between baPWV and BMD remains unclear. The aim of our study is to evaluate the relationship between baPWV and BMD in men and women populations METHODS: A comprehensive search was conducted in electronic databases for relevant studies published between the 1th and 30rd of April 2023. Studies reporting the correlation between baPWV and BMD in both males and females were considered. A random-effects model was used to calculate pooled correlation coefficients (r). RESULTS: Relevant data for both genders were found in six articles. In all publications included in the meta-analysis, the total number of studied individuals was 3800, with 2054 women and 1746 men. Pooled correlation coefficient was -0,24 (95 % CI: -0.34; -0.15) in women population, and -0.12 (95 %CI: -0.16, -0.06) in men. CONCLUSIONS: Based on the published data, we found that baPWV is negatively correlated with bone density in women. However, in men we do not find such a relationship. These findings suggest the importance of considering gender-specific factors when assessing the cardiovascular and bone health relationship.

Relationship between Cervical Instability in the Course of Rheumatoid Arthritis and Pelvic Parameters of Sagittal Balance.

BACKGROUND: The aim of the study is to search for a relationship between cervical instability in the course of rheumatoid arthritis (RA) and pelvic parameters of sagittal balance and lumbar lordosis (LL). METHODS: The study included 47 patients with rheumatoid arthritis with instability of the cervical segment, who were referred for a consultation to assess indications for surgical treatment. The patients underwent a radiological functional examination of the cervical region and postural examination of the entire spine. The basic parameters of the lumbar section and pelvis of these patients were compared with the population values. Then, using statistical methods, the correlation between radiological parameters of various types of instability and lumbar lordosis (LL), pelvic parameters (PI, SS, PT), as well as the patient's age and duration of the disease was assessed. RESULTS: A statistical correlation was found between the instability in the cervical spine C2-C3 level and the value of the PT and PI angles. A statistically significant correlation was discovered between C1-C2 instability and younger patient age. There was no significant difference in the values of the pelvic parameters and lumbar lordosis in patients with rheumatoid arthritis compared to the population values. CONCLUSIONS: Preliminary results suggest that there is a relationship between selected pelvic parameters and the development of instability in patients with rheumatoid arthritis. This may be important in planning treatment and assessing disease progression. Further studies on a larger group of patients are needed, as well as studies evaluating the correlation between other sagittal balance parameters and cervical instability in patients with RA.

Ultrasound and MRI of the foot in children and adolescents newly diagnosed with juvenile idiopathic arthritis.

Aim: To evaluate the spectrum of inflammatory features in foot joints which may be detected on routinely performed ultrasound (US) and magnetic resonance imaging (MRI) in children newly diagnosed with juvenile idiopathic arthritis (JIA). Material and methods: Two groups of children hospitalized in a reference center for rheumatology, newly diagnosed with JIA and suspected of foot involvement in the course of JIA were included in this retrospective study. In the first group of 47 patients aged 1-18 years, the imaging was restricted to US. The second group of 22 patients aged 5-18 years underwent only non-contrast MRI of the foot. Results: The most frequent pathologies seen on US included effusion and synovial thickening in the first metatarsophalangeal joint (MTP1), followed by the tibiotalar joint. Synovial hyperemia on color Doppler US images was present most frequently in the Chopart and midtarsal joints (64%; 7/11 cases), followed by the tibiotalar joint (45%; 5/11), and MTP2-5 joint synovitis (40%; 4/10). Grade 3 hyperemia was present only in four cases; grades 1 and 2 were detected in the majority of cases. On MRI, bone marrow edema was the most frequent pathology, found mostly in the calcaneus (45%; 10/22 cases), while alterations of the forefoot were rare. No cases of bursitis, enthesitis, cysts, erosions or ankylosis were diagnosed in either of the analyzed groups. Conclusions: Routine US of the foot is recommended for early detection of its involvement in JIA in daily clinical practice. Although MRI can identify features of various JIA stages, it is particularly useful for the detection of bone marrow alterations.

Relationship between the Central and Regional Pulse Wave Velocity in the Assessment of Arterial Stiffness Depending on Gender in the Geriatric Population.

Artery stiffness is a risk factor for cardiovascular disease (CVD). The measurement of pulse wave velocity (PWV) between the carotid artery and the femoral artery (cfPWV) is considered the gold standard in the assessment of arterial stiffness. A relationship between cfPWV and regional PWV has not been established. The aim of this study was to evaluate the influence of gender on arterial stiffness measured centrally and regionally in the geriatric population. The central PWV was assessed by a SphygmoCor XCEL, and the regional PWV was assessed by a new device through the photoplethysmographic measurement of multi-site arterial pulse wave velocity (MPPT). The study group included 118 patients (35 males and 83 females; mean age 77.2 ± 8.1 years). Men were characterized by statistically significantly higher values of cfPWV than women (cfPWV 10.52 m/s vs. 9.36 m/s; p = 0.001). In the measurement of regional PWV values using MPPT, no such relationship was found. Gender groups did not statistically differ in the distribution of atherosclerosis risk factors. cfPWV appears to be more accurate than regional PWV in assessing arterial stiffness in the geriatric population.

Hand and Wrist Involvement in Seropositive Rheumatoid Arthritis, Seronegative Rheumatoid Arthritis, and Psoriatic Arthritis-The Value of Classic Radiography.

The hand and wrist are among the most common anatomical areas involved in rheumatic diseases, especially seropositive and seronegative rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The purpose of this study was to identify the most differentiating radiographic characteristics of PsA, seropositive RA, and seronegative RA, particularly in the early stages. A retrospective analysis of radiographic hand findings was performed on 180 seropositive RA patients (29 males, 151 females, mean age at the point of acquisition of the analyzed radiograph of 53.4 y/o, SD 12.6), 154 PsA patients (45 males, 109 females, age median of 48.1 y/o, SD 12.4), and 36 seronegative RA patients (4 males, 32 females, age median of 53.1 y/o, SD 17.1) acquired during the period 2005-2020. Posterior-anterior and Nørgaard views were analyzed in all patients. The radiographs were evaluated for three radiographic findings: type of symmetry (asymmetric/bilateral/changes in corresponding joint compartments/'mirror-image' symmetry), anatomic location (e.g., wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP), distal interphalangeal (DIP) joints), and type of lesions (e.g., juxta-articular osteoporosis, bone cysts, erosions, proliferative bone changes). The study showed that symmetric distribution of lesions defined as 'lesions present in corresponding compartments' was more suggestive of seropositive or seronegative RA than PsA. Lesions affecting the PIP joints, wrist, or styloid process of the radius; juxta-articular osteoporosis, joint space narrowing, joint subluxations, or dislocations were more common in patients with seropositive RA than in those with PsA, whereas DIP joints' involvement and proliferative bone changes were more likely to suggest PsA than seropositive RA. Lesions in PIP, MCP, and wrist joints, as well as erosions, advanced bone damage, joint subluxations, dislocations, and joint space narrowing, were more common in seropositive RA patients than in seronegative RA patients. The ulnar styloid was more commonly affected in seronegative RA patients than in PsA patients. The study confirmed that types of bone lesions and their distribution in the hands and wrists can be useful in differentiating seropositive RA from PsA and suggests that seronegative RA varies in radiological presentation from seropositive RA and PsA.

Cardiomyopathy Associated with Right Ventricular Apical Pacing-Systematic Review and Meta-Analysis.

AIMS: Bradyarrhythmias are potentially life-threatening medical conditions. The most widespread treatment for slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular leads were located in the apex of the right ventricle. Right ventricular apical pacing (RVAP) was thought to have a deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials to determine the effects of right ventricular apical pacing on left ventricular ejection fraction (LVEF). METHODS: we systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of RVAP on LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model. RESULTS: 14 randomized controlled trials (RCTs) comprising 885 patients were included. In our meta-analysis, RVAP was associated with statistically significant left ventricular systolic function impairment as measured by LVEF. The mean difference between LVEF at baseline and after intervention amounted to 3.35% (95% CI: 1.80-4.91). CONCLUSION: our meta-analysis confirms that right ventricular apical pacing is associated with progressive deterioration of left ventricular systolic function.

Alcohol Policies Affect Drinking Patterns-A Potentially New and Harmful Drinking Pattern in Consumers of Small Vodka Bottles (SVB) in Poland.

Drinking alcohol has a vast and diverse impact on many aspects of people's lives around the world. It is a major public health concern and is subject to numerous legal regulations and limitations. So far, little attention has been paid to if and how the volume of alcohol containers may affect drinking patterns. The widespread availability in recent years in Poland of small vodka bottles in various flavors and sizes was the rationale behind investigating whether the phenomenon may affect drinking patterns in any way. This was a 12-month cross-sectional survey study that started in January 2020. It included a total of 217 inpatients and outpatients that met the ICD-10 alcohol dependence criteria. The respondents were asked about their drinking habits and the use of small vodka bottles. It was found that respondents who regularly use small vodka bottles were much more likely to start their drinking early in the morning. The widespread availability and selection of small vodka bottles may encourage and facilitate drinking that starts early in the morning. It also makes it easier to maintain and control intoxication throughout the whole day, which could be considered another drinking pattern different from the other well-established ones, such as binge or continuous drinking. However, the design of this study makes it impossible to draw firm conclusions and further research is necessary.

The Relationship between Searches for COVID-19 Vaccines and Dynamics of Vaccinated People in Poland: An Infodemiological Study.

BACKGROUND: Google Trends has turned out to be an appropriate tool for evaluating correlations and prognostic modelling regarding infectious diseases. The possibility of selecting a vaccine against COVID-19 has increased social interest in particular vaccines. The objective of this study was to show dependencies between the frequency of searches for COVID-19 vaccinations and the number of vaccinated people in Poland, along with epidemiological data. METHODS: Data were collected regarding Google searches for COVID-19 vaccines, the number of people in Poland vaccinated against COVID-19, the number of new cases, and the number of deaths due to COVID-19. Data were filtered from 27 December 2020 to 1 September 2021. RESULTS: The number of new vaccinations smoothed per million correlated most strongly with searches for the word 'Pfizer' in Google Trends (Kendall's tau = 0.46, p < 0.001). The number of new deaths correlated most strongly with the search phrase 'AstraZeneca' (Kendall's tau = 0.46, p < 0.001). The number of new cases per million correlated most strongly with searches for 'AstraZeneca' (Kendall's tau = 0.49, p < 0.001). The maximum daily number of searches ranged between 110 and 130. A significant interest in COVID-19 vaccines was observed from February to June 2021, i.e., in the period of a considerable increase in the number of new cases and new deaths due to COVID-19. CONCLUSIONS: A significant increase in interest in COVID-19 vaccines was observed from February to June 2021, i.e., in the period of gradually extended access to vaccinations, as well as a considerable increase in the number of new cases and new deaths due to COVID-19. The use of Google Trends with relevant keywords and a comparison with the course of the COVID-19 pandemic facilitates evaluation of the relationship between the frequency and types of searches for COVID-19 vaccines and epidemiological data.

Lost in Communication: Do Family Physicians Provide Patients with Information on Preventing Diet-Related Diseases?

Diet-related diseases remain leading causes of death in most developed countries around the world. The aim of the study was to compare opinions of patients and family physicians on receiving and providing recommendations about physical activity, diet and use of medication. Methods: The questionnaire study was conducted among patients of 36 primary health care clinics in Poland between September 2018 and February 2019. Patients and physicians were interviewed separately by trained researchers. Data from 509 patients and 167 family doctors were analyzed. Results: The median age of patients was 44 years (interquartile range: 29-55) and 70% were women. The majority of physicians were women (59%) and the median age was 37 years (IQR: 31-50). There was a significant difference between physicians' declarations on providing recommendations on diet (92% vs. 39%) and activity (90% vs. 37%) versus patients' declarations on receiving them. Conclusions: The results indicate that there is significant room for improvement in providing patients with proper recommendations on diet and physical activity by their family physicians. Primary care physicians should put more emphasis on clear communication of recommendations on diet and physical activity.

Type and reliability of information about coronavirus most frequently shared by social media users.

Objective: To identify, investigate and categorize the most frequently shared content related to COVID-19 by social media users. Methods: The BuzzSumo analytic tool was used to identify the most frequently shared content about COVID-19 between July and August 2020. They were then analyzed and classified into eight main categories according to their topic. Results: Among 120 articles that were shared 6,189,187 times in total during the analyzed period, the most popular were those that referred to methods for decreasing COVID-19 spread and characteristics. No myths or misinformation were found in the most frequently shared articles. The most popular content included humorous yet educational videos. Conclusions: The most frequently shared content by social media users is reliable and refers to prevention in the first place. As humorous videos about prevention attracted the most attention, it seems an attractive and potentially effective strategy to foster online preventive behaviors during the pandemic. Lay Summary: The most popular articles that were shared more than 6 million times in total during the analyzed period of time referred methods for decreasing COVID-19 spread and COVID-19 characteristics. The Internet and social media provide countless opportunities and audiences to deliver accurate knowledge and recommendations on COVID-19 and may contribute to fostering preventive and responsible behaviors.

Online Information of COVID-19: Visibility and Characterization of Highest Positioned Websites by Google between March and April 2020-A Cross-Country Analysis.

BACKGROUND: The WHO has used the term "infodemic" to describe the vast amount of false and true information that was making it difficult for people to find reliable information when they needed it. The infodemic spreads faster than COVID-19 itself. The main objective of the study was to characterize and analyze content about COVID-19 returned by Google during the pandemic and compare it between countries. METHODS: The study was conducted between 30 March and 27 April 2020. The information was searched through local Google websites using the "COVID-19", "Coronavirus", "SARS-CoV-2" and "fake news" keywords. The search was conducted in Australia, France, Germany, Italy, Poland, Singapore, Spain, UK and the USA. The total number of the analyzed webpages was 685. RESULTS: The most frequent types were News websites 47% (324/685) and Governmental 19% (131/685) while the least were Health portals 2% (17/685) and Scientific journals 5% (35/635), p < 0.001. United States and Australia had the highest share of Governmental websites. There was a positive correlation between the amount of preventive information and a number of SARS-CoV-2 infections in countries. The higher the number of tests performed, the higher was the amount of information about prevention available online. CONCLUSIONS: Online information is usually available on news and government websites and refers to prevention. There were differences between countries in types of information available online. The highest positioned (the first 20) websites for COVID-19, Coronavirus and SARS-CoV-2 keywords returned by Google include true information.

Ankle Magnetic Resonance Imaging in Juvenile Idiopathic Arthritis Versus Non-Juvenile Idiopathic Arthritis Patients with Arthralgia.

This retrospective case-control study aimed to evaluate whether Magnetic Resonance Imaging (MRI) enables differentiation of ankle arthritis in Juvenile Idiopathic Afrthritis JIA from ankle arthralgia of unknown aetiology in patients clinically suspected of JIA. Forty-four children, at ages 5-16, who underwent MRI of the ankle from January 2016 to March 2021 for clinically suspected active ankle arthritis in the course of JIA were included. MRI findings in both groups-patients with the final diagnosis of JIA and without final diagnosis of JIA-were compared and scored. The sum of the scores of 22 ankle lesions in an individual patient (active, destructive and developmental), so-called the MRI summarized score, was calculated and tested in terms of the most optimal diagnosis of JIA. Interobserver agreement was calculated. Inflammatory features were seen on MRI in 38 out of all the included patients (86%). The most common lesions in both groups were effusion in the tibio-talar joint (68% in JIA and 64% in the arthralgia group) and effusion in subtalar joint (64% in JIA vs. 59% in the arthralgia group). In general, more lesions were identified in the JIA group than in non-JIA. However, only tenosynovitis was significantly more common in the JIA vs. non-JIA group (p = 0.031). The MRI summarized score did not allow for discrimination between ankle arthritis in JIA from non-JIA patients; the best levels of sensitivity (32%), specificity (91%), positive predictive value PPV (78%) and negative predictive value NPV (57%) were achieved only at the cut-off point of 10.

Improving Colon Cancer Prevention in Poland. A Long Way Off.

The aim of this study was to analyse knowledge on colon cancer prevention among patients of primary care and identify their sources of information. The questionnaire study was conducted among patients of 36 primary healthcare clinics in Poland between September 2018 and February 2019. Patients were interviewed separately by trained researchers. Over 39% of the primary health patients declared that their knowledge about colon cancer prevention is unsatisfactory. Information about colon cancer prevention varied according to sex, age and BMI. Men declared lower level of knowledge than women: 46% of men thought it was unsatisfactory compared with 36% of women (p = 0.003). Preventive recommendations were more often provided to patients over 60 years old (p < 0.01). Overweight and obese patients were more likely to receive recommendations on diet (p < 0.001) and physical activity (p < 0.001) than patients with normal weight. The most common source of information on colon cancer prevention was Internet (68%) and medical doctors (60%). There is a need for developing colon cancer prevention policy. Crucial aspect includes educational programs aimed at improving patient's knowledge and involving medical staff. The policymakers should pay greater attention to cancer prevention policies and medical staff involved in prevention to quality of communication to make sure patients thoroughly understand information they are provided.

Association Between Physician Burnout and Self-reported Errors: Meta-analysis.

OBJECTIVES: Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians. METHODS: This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studies were hand searched. Data were extracted from published reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I2), publication bias (Begg-Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval. RESULTS: Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19-3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I2 = 67% (36%-83%). CONCLUSIONS: The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations.

MRI Findings in Hip in Juvenile Idiopathic Arthritis.

The aim of this study was to evaluate if magnetic resonance imaging allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology in juveniles clinically suspected for hip arthritis. This was a retrospective observational study which included 97 children with clinically suspected hip arthritis. Each hip was assessed and scored in MRI for signs of active and destructive inflammatory lesions and developmental lesions. MRI findings between JIA-confirmed patients and without final diagnosis of JIA were compared and the MRI summarized score was calculated, as the sum of scorings of all 24 hip lesions in an individual patient (i.a., effusion, synovitis, bone marrow edema, enthesitis). MRI showed at least one lesion in the majority of patients (95 patients; 98%). Effusion was the most common feature, followed by bone marrow oedema and synovitis. All lesions were more common in patients with a final diagnosis of JIA, especially synovitis and enthesitis (p = 0.037 and p = 0.047). The MRI summarized score was significantly higher in the JIA group than the non-JIA group: 3 (2-5) vs. 2 (2-2), respectively, p = 0.002. Using a cut-off score of 6, the MRI summarized score showed 25% sensitivity and 100% specificity indicating a good ability in discriminating hip arthritis during JIA from non-JIA patients. MRI allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology with good specificity, thus, may be helpful in confirming the diagnosis of JIA.

Assessment of Clinical Usefulness of Resting Electrocardiogram (PH-ECG Score) in Monitoring the Efficacy of Balloon Pulmonary Angioplasty (BPA) in Patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH).

BACKGROUND: Balloon pulmonary angioplasty (BPA) is a form of therapy for chronic thromboembolic pulmonary hypertension (CTEPH). The study objective is to assess the clinical usefulness of resting ECG (PH-ECG score) in monitoring the efficacy of BPA in CTEPH patients. METHODS AND RESULTS: Ninety-four (n = 94) CTEPH patients were included in the analysis. A standard 12-lead-ECG was performed before the first BPA session and after completion of treatment. The whole analysed population (n = 94) was divided into the following two groups: derivation cohort (n = 41) and validation cohort (n = 53). The derivation cohort was divided into the following two subgroups: patients with mean pulmonary artery pressure (mPAP) after the completion of therapy < 25 mmHg (n = 21) and patients with mPAP after the completion of therapy ≥ 25 mmHg (n = 20). In the first subgroup, four (R-wave V1 + S-wave V5/V6 > 10.5 mm, QRS-wave axis > 110 degrees, R-wave V1 > S-wave V1, SIQIII pattern) of the six ECG parameters of overload of the right cardiac chambers showed statistically significant differences (p < 0.005). That was followed by a determination of the sensitivity and specificity, positive (PPV) and negative predictive value (NPV), and ROC curve (AUC 0.9; 95% CI: 0.792-1.000) for the variable that was a sum of the above four ECG parameters (PH-ECG score). The absence of all of the four ECG parameters at rest (PH-ECG score = 0) well reflected patients with mPAP < 25 mmHg (sensitivity, 100%; specificity, 80%; PPV, 84%; NPV, 100%). In the validation cohort with mPAP < 25 mmHg and PH-ECG score = 0, sensitivity, specificity, PPV, and NPV were 86%, 77%, 73%, and 89%, respectively. CONCLUSIONS: Resting ECG trace is clinically useful in the monitoring of therapeutical effects of BPA in CTEPH patients.

Impact of continuous glucose monitoring on improving emotional well­being among adults with type 1 diabetes mellitus: a systematic review and meta­analysis.

INTRODUCTION: Real-time continuous glucose monitoring (CGM) has changed the way people with type 1 diabetes mellitus (T1DM) and health care providers perceive diabetes management and glucose control. OBJECTIVES: The purpose of this meta-analysis was to compare the emotional well-being of adults with T1DM who used CGM and those using conventional self-monitoring of blood glucose (SMBG). PATIENTS AND METHODS: The MEDLINE/PubMed, Cochrane Library / Embase, CINAHL, Scopus, Web of Science, and ProQuest databases were searched for relevant publications. Primary outcome measures were health-related quality of life, glycemic control, and fear of hypoglycemia. Randomized controlled trials and survey studies focused on the quality of life and fear of hypoglycemia among adult patients using CGM and SMBG were included in the analysis. RESULTS: The meta-analysis included 11 studies involving a total of 1228 patients with T1DM. Analysis of the Worry subscale of the Hypoglycemia Fear Survey indicated a reduction of hypoglycemia fear in CGM users compared with SMBG users (Cohen d = ­0.24; 95% CI, ­0.41 to ­0.07; mean difference, ­3.15; 95% CI, ­5.48 to ­0.82). Outcome analysis of studies including the Diabetes Treatment Satisfaction Questionnaire showed Cohen d of 0.23 (95% CI, ­0.18 to 0.63). The overall value of Cohen d equaled ­0.24 (95% CI, ­0.57 to 0.09), indicating a lack of effect of CGM use on improving HbA1c levels; however, after one of the studies was excluded from calculations, the reduction of HbA1c levels was significantly higher in CGM users (Cohen d = ­0.33; 95% CI, ­0.66 to 0.00; P = 0.047). CONCLUSIONS: This is the first quantitative meta-analysis of studies involving adult patients exclusively with T1DM, providing further evidence for the ability of CGM systems to reduce fear of hypoglycemia and improve quality of life. Continuous glucose monitoring systems have advantage over SMBG in adults with T1DM and improve HbA1c levels.

Burnout, well­being, and self­reported medical errors among physicians.

INTRODUCTION: In recent years, healthcare systems around the world have been subject to profound changes driven by advances in technology, new regulations as well as demographic and societal trends. This volatile and stressful environment has had its consequences for healthcare organizations and their employees. The resulting phenomena of burnout or lowered well­being may affect key aspects of healthcare delivery on individual, organizational, and financial levels. OBJECTIVES: The objective of this paper was to investigate the level of burnout and well­being in a group of Polish physicians, its impact on errors, and associations with other factors. PATIENTS AND METHODS: This was a cross­sectional survey using a self­administered questionnaire with 65 questions and validated tools such as the Maslach Burnout Inventory and the World Health Organization-5 Well­being Index (WHO­5). Correlations between variables were investigated using Spearman rank correlation analysis. Univariable and multivariable logistic regression models were used to evaluate predictors of burnout and errors. The study included residents and physicians of various specialties. RESULTS: A total of 125 residents and physicians, mostly internists and cardiologists, participated in the study, out of which 84 (67%) were found to be burned out. The median WHO­5 score was 40 points. Two­thirds of all physicians admitted to making an error in the last 3 months, which was strongly  associated with burnout. CONCLUSIONS: The level of burnout among respondents was high and had numerous negative consequences that may affect the entire healthcare system. The results suggest there is an urgent need to address the problem of burnout among physicians.