Psychological interventions using virtual reality for pain associated with medical procedures: a systematic review and meta-analysis.

BACKGROUND: Virtual reality (VR) may enhance the effectiveness of psychological interventions for acute pain. We conducted a meta-analysis to assess the efficacy and safety of VR-based interventions for pain associated with medical procedures. METHODS: We searched PubMed, EMBASE, the Cochrane Library, and PsycINFO until June 17th 2018. We identified randomized controlled trials (RCTs), comparing VR-based psychological interventions to usual care, for pain intensity (primary outcome) or affective and cognitive components of pain (secondary outcomes), assessed real-time or retrospectively. Two independent reviewers performed study selection and data extraction. Risk of bias was independently evaluated by three raters using the revised Cochrane Collaboration tool. A random-effects model using the Paule and Mandel estimator was used for pooling effect sizes. RESULTS: 27 RCTs (1452 patients) provided enough data for meta-analysis. Compared to usual care, VR-based interventions reduced pain intensity both real-time (9 RCTs, Hedges' g = 0.95, 95% CI 0.32-1.57) and retrospectively (22 RCTs, g = 0.87, 95% CI 0.54-1.21). Results were similar for cognitive (8 RCTs, g = 0.82, 95% CI 0.39-1.26) and affective pain components (14 RCTs, g = 0.55, 95% CI 0.34-0.77). There was marked heterogeneity, which remained similarly high in sensitivity analyses. Across domains, few trials were rated as low risk of bias and there was evidence of publication bias. Adverse events were rare. CONCLUSIONS: Though VR-based interventions reduced pain for patients undergoing medical procedures, inferring clinical effectiveness is precluded by the predominance of small trials, with substantial risk of bias, and by incomplete reporting.

Parental Risk and Protective Factors Associated with Bullying Victimization in Children and Adolescents: A Systematic Review and Meta-analysis.

The main objective of this meta-analysis was to investigate how modifiable parental factors are related to traditional and cyberbullying victimization in children and adolescents. A systematic literature search of modifiable parental factors associated with bullying victimization was conducted using PubMed, PsycINFO, Scopus, and Web of Science electronic databases. Meta-analyses were performed to assess the mean effect sizes of the associations between the broader categories of parental factors (risk and protective) and bullying victimization (traditional and cyber), as well as between specific parental factors and bullying victimization (traditional and cyber). The differential impact of maternal and paternal factors (risk and protective) was examined. Age and gender were tested as moderators. Out of the 13,171 records identified, 158 studies met the inclusion criteria. Larger evidence was found for the association between parental risk (i.e., authoritarian parenting, aversiveness, inter-parental conflict, over-involvement, permissive parenting, and withdrawal) and protective (i.e., authoritative parenting, autonomy granting, warmth, and monitoring) factors, respectively, and traditional bullying victimization, with parental warmth, aversiveness, and withdrawal being the only common related predictors for traditional and cyberbullying victimization. The effect sizes were generally small. Maternal and paternal factors showed similar patterns of association with both types of bullying victimization. Age had a moderating effect on the association between parental protective factors and cyberbullying victimization. Overall, the present findings suggest that parental factors are relevant in protecting or putting children at risk for bullying victimization, especially in the offline context.

Management of SARS-CoV-2 Prevention Methods in Dental Offices-A Cross-Sectional Study in Bucharest, Romania.

We compared the managing of prevention methods for SARS-CoV-2 infections in dental offices before and immediately after the COVID-19 pandemic. The purpose of this study was to find out the varieties of infection prevention methods used by dentists before and during the pandemic and compare them. We designed a digital transversal questionnaire with 15 closed questions that was sent to 150 dentists in Bucharest, Romania. We received n = 112 valid answers during July-August 2021 from dentists of all age groups (25-60 years), with a sex ratio of 0.36, which agreed to anonymously participate in this study. The results showed an increase in types and amount of personal protection equipment (i.e., ocular/facial protection, supplemental gown, and upgrading the FFP1 masks to FFP2 or FFP3). Ocular protection showed statistical significance by gender but not by age group. Vaccination rate against SARS-CoV-2 was at 80% of the participant dentists at the time of the survey and had statistical significance. However, vaccination status of the patients did not alter dentists' protection protocol.

The Einstein effect provides global evidence for scientific source credibility effects and the influence of religiosity.

People tend to evaluate information from reliable sources more favourably, but it is unclear exactly how perceivers' worldviews interact with this source credibility effect. In a large and diverse cross-cultural sample (N = 10,195 from 24 countries), we presented participants with obscure, meaningless statements attributed to either a spiritual guru or a scientist. We found a robust global source credibility effect for scientific authorities, which we dub 'the Einstein effect': across all 24 countries and all levels of religiosity, scientists held greater authority than spiritual gurus. In addition, individual religiosity predicted a weaker relative preference for the statement from the scientist compared with the spiritual guru, and was more strongly associated with credibility judgements for the guru than the scientist. Independent data on explicit trust ratings across 143 countries mirrored our experimental findings. These findings suggest that irrespective of one's religious worldview, across cultures science is a powerful and universal heuristic that signals the reliability of information.

A virtual reality-based intervention for surgical patients: study protocol of a randomized controlled trial.

BACKGROUND: Pain after surgery is normal, and treatments, including both pharmacological and psychological components, are fundamental for proper postoperative care. While several trials have investigated the analgesic effect of traditional non-pharmacological treatments, such as cognitive behavior therapies, the newer ways of delivering psychological interventions for pain after surgery are scarcely investigated. The aim of this randomized controlled trial (RCT) is to determine if delivering the psychological content through virtual reality (VR) along with the standard pharmacological treatment return better pain relief outcomes than standard care in adult patients following surgery. METHODS: This is a protocol of a parallel RCT conducted in one community hospital. In order to test the efficacy of VR environments for reducing pain intensity, in the following day after surgery, adults (18 to 65 years) will be randomly assigned to either (1) standard treatment after surgery (control group) or (2) VR based intervention along with standard treatment. It is intended that a minimum of 30 patients be recruited in each group. For estimating the intensity of pain, both self-report and physiological measures will be used. Repeated measures of pain outcomes will be taken before and after the intervention. Moreover, for allowing an in-depth investigation of the effect of VR environments, the primary outcome will be complemented with measures of the adverse effects, level of immersion, and level of presence in the VR environment.

Thyroseq v3, Afirma GSC, and microRNA Panels Versus Previous Molecular Tests in the Preoperative Diagnosis of Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis.

Background: Molecular tests are being used increasingly as an auxiliary diagnostic tool so as to avoid a diagnostic surgery approach for cytologically indeterminate thyroid nodules (ITNs). Previous test versions, Thyroseq v2 and Afirma Gene Expression Classifier (GEC), have proven shortcomings in malignancy detection performance. Objective: This study aimed to evaluate the diagnostic performance of the established Thyroseq v3, Afirma Gene Sequencing Classifier (GSC), and microRNA-based assays versus prior iterations in ITNs, in light of "rule-in" and "rule-out" concepts. It further analyzed the impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification and Bethesda cytological subtypes on the performance of molecular tests. Methods: Pubmed, Scopus, and Web of Science were the databases used for the present research, a process that lasted until September 2020. A random-effects bivariate model was used to estimate the summary sensitivity, specificity, positive (PLR) and negative likelihood ratios (NLR), and area under the curve (AUC) for each panel. The conducted sensitivity analyses addressed different Bethesda categories and NIFTP thresholds. Results: A total of 40 eligible studies were included with 7,831 ITNs from 7,565 patients. Thyroseq v3 showed the best overall performance (AUC 0.95; 95% confidence interval: 0.93-0.97), followed by Afirma GSC (AUC 0.90; 0.87-0.92) and Thyroseq v2 (AUC 0.88; 0.85-0.90). In terms of "rule-out" abilities Thyroseq v3 (NLR 0.02; 95%CI: 0.0-2.69) surpassed Afirma GEC (NLR 0.18; 95%CI: 0.10-0.33). Thyroseq v2 (PLR 3.5; 95%CI: 2.2-5.5) and Thyroseq v3 (PLR 2.8; 95%CI: 1.2-6.3) achieved superior "rule-in" properties compared to Afirma GSC (PLR 1.9; 95%CI: 1.3-2.8). Evidence for Thyroseq v3 seems to have higher quality, notwithstanding the paucity of studies. Both Afirma GEC and Thyroseq v2 performance have been affected by NIFTP reclassification. ThyGenNEXT/ThyraMIR and RosettaGX show prominent preliminary results. Conclusion: The newly emerged tests, Thyroseq v3 and Afirma GSC, designed for a "rule-in" purpose, have been proved to outperform in abilities to rule out malignancy, thus surpassing previous tests no longer available, Thyroseq 2 and Afirma GEC. However, Thyroseq v2 still ranks as the best rule-in molecular test. Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO, identifier CRD42020212531.

The Efficacy of Internet-Based Parenting Programs for Children and Adolescents with Behavior Problems: A Meta-Analysis of Randomized Clinical Trials.

Online parenting programs can increase the accessibility of mental health services. This meta-analysis investigated the effectiveness of online parenting interventions in reducing children and adolescents behavior problems (primary outcome) and improving parenting behavior, parent distress, and parenting efficacy (secondary outcomes). A systematic search was conducted on PubMed, PsycInfo, Web of Science, SCOPUS, and ProQuest on June 28th, 2019. The meta-analysis was prior registered in PROSPERO. In total, 2160 records were identified and 15 Randomized Controlled Trials (RCTs) were included (N = 1668) in the systematic review and meta-analysis. The quality of each study was assessed by two independent evaluators. When compared to waitlist, online parenting interventions are effective in reducing behavior problems with a small effect size (Hedges's g = 0.40). No significant differences were found between online and classical delivered parenting interventions in reducing behavior problems (g = - 0.07). Compared to waitlist, the interventions are effective in improving parenting behavior (g = 0.34), parent distress (g = 0.30), and parenting efficacy (g = 0.41). The results appear to be stable at follow-up measures. The factors responsible for the effectiveness of the interventions were explored through moderation analyses. Online parenting interventions are promising for improving both behavior problems and parent outcomes. Future studies should focus on methods to increase their effectiveness and measure the outcomes more objectively.

The Prognostic Value of MicroRNAs in Thyroid Cancers-A Systematic Review and Meta-Analysis.

Thyroid cancer (TC) includes various phenotypes, from indolent to highly aggressive cancer. The limitations of the current prognostication systems to predict the recurrence risk and the variability in expression of the genes involved in the thyroid carcinogenesis uncover the need for new prognostic biomarkers by taking into account potential epigenetic differences. We aimed to summarize the current knowledge regarding the prognostic impact of microRNAs (miRNAs) in TC. A literature search was conducted in PubMed, Embase, Scopus, and Web of Science databases. Both upregulated and downregulated miRNAs are significantly correlated with worse overall survival (hazard ratio (HR) = 5.94, 95% CI: 2.73-12.90, p < 0.001; HR = 0.51, 95% CI: 0.26-0.96, p = 0.048) disease/recurrence-free survival (HR = 1.58, 95% CI: 1.08-2.32, p = 0.003; HR = 0.37, 95%, CI: 0.24-0.60, p < 0.001). Sensitivity analysis revealed a significant association between the higher expression of miR-146b, miR-221, and miR-222 and the recurrence of papillary TC (OR = 9.11, 95% CI 3.00 to 27.52; p < 0.001; OR = 3.88, 95% CI 1.34 to 11.19, p < 0.001; OR = 6.56, 95% CI 2.75 to 15.64, p < 0.001). This research identified that miR-146b, miR-221, and miR-222 could serve as potential prognostic biomarkers in TC, particularly in PTC. Further studies are needed to strengthen these findings and sustain its clinical applicability.

Efficacy of cognitive bias modification interventions in anxiety and depressive disorders: a systematic review and network meta-analysis.

BACKGROUND: Cognitive bias modification (CBM) therapies, including attention bias modification, interpretation bias modification, or approach and avoidance training, are prototypical examples of mechanistically derived treatments, but their effectiveness is contentious. We aimed to assess the relative effectiveness of various CBM interventions for anxious and depressive symptomatology. METHODS: For this systematic review and network meta-analysis, we searched PubMed, PsycINFO, Embase, and Cochrane Central Register from database inception up until Feb 7, 2020. We included randomised controlled trials of CBM versus control conditions or other forms of CBM for adults aged 18 years and older with clinical or subclinical anxiety or depression measured with a diagnostic interview or a validated clinical scale. We excluded studies comparing CBM with a non-CBM active intervention. Two researchers independently selected studies and evaluated risk of bias with the Cochrane Collaboration tool. Primary outcomes encompassed anxiety and depressive symptoms measured with validated clinical scales. We computed standardised mean differences (SMDs) with a restricted maximum likelihood random effects model. This study is registered with PROSPERO, CRD42018086113. FINDINGS: From 2125 records we selected 85 trials, 65 (n=3897) on anxiety and 20 (n=1116) on depression. In a well connected network of anxiety trials, interpretation bias modification outperformed waitlist (SMD -0·55, 95% CI -0·91 to -0·19) and sham training (SMD -0·30, -0·50 to -0·10) for the primary outcome. Attention bias modification showed benefits only in post-hoc sensitivity analyses excluding post-traumatic stress disorder trials. Prediction intervals for all findings were large, including an SMD of 0. Networks of depression trials displayed evidence of inconsistency. Only four randomised controlled trials had low risk of bias on all six domains assessed. INTERPRETATION: CBM interventions showed consistent but small benefits; however heterogeneity and risk of bias undermine the reliability of these findings. Larger, definitive trials for interpretation bias modification for anxiety might be warranted, but insufficient evidence precludes conclusions for depression. FUNDING: Romanian Ministry of Research and Innovation, The National Council for Scientific Research-The Executive Agency for Higher Education, Research, Development and Innovation Funding.

Group B streptococcus colonization of Romanian women: phenotypic traits of isolates from vaginal swabs.

In the attempt to enrich the local contemporary laboratory data regarding the group B streptococcus (GBS) colonization, isolates obtained from the vaginal swab cultures were characterized for their serotype distribution and antibiotic susceptibility. The 100 GBS isolates analyzed were collected during a four-month period of year 2009 from women screened in ambulatory for vaginal carriage of GBS. The GBS isolates were classified based on their capsular polysaccharide structures using commercially available antisera. Susceptibility to penicillin, ampicillin, erithromycin, clindamycin, tetracycline, ofloxacin, and chloramphenicol was initially tested using antibiotic disk diffusion technique according to CLSI guidelines. Minimum inhibitory concentrations of erythromycin and tetracycline for the isolates with reduced susceptibility were evaluated according to the CLSI criteria and macrolide-lincosamide-streptogramin B (MLSB) resistance was investigated by a double-disk test with erythromycin and clindamycin disks. All the GBS isolates were serotypeable. Their distribution comprised six different serotypes of which serotypes II (26%), III (26%), and Ia (19%) prevailed and no serotype VI, VII, and VIII isolates were found. Overall, the GBS isolates were fully susceptible to penicillin and ampicillin, but the rates of susceptibility to the other antimicrobial agents tested were decreased, ranging from 87% for chloramphenicol to 5% for tetracycline. Reduced susceptibility to clindamycin and erythromycin was detected in 18% and 19% of isolates, respectively. For the latter, 84% displayed a constitutive MLSB phenotype, 11% had an inducible MLSB phenotype, and M phenotype was expressed by 5% of them. Erythromycin-resistant GBS isolates displayed concurrently resistance to at least one more antibiotic. In conclusion, according to our study the most frequent GBS serotypes isolated from the vaginal microflora were II and III, followed by serotype Ia. While the GBS isolates remain susceptible to beta-lactams, resistance to alternative antimicrobial drugs such as erythromycin and clindamycin seems to be an increasing concern for our region. Further phenotypic and genotypic studies are required to identify specific aspects of GBS strains colonizing or infecting the local population.

Papillitis in Neurosyphilis.

We present a case of a 47-year-old female patient, with papillitis in the right eye and anterior uveitis in both eyes, as a manifestation of untreated neurosyphilis.

New perspectives in retinal imaging - angio OCT.

In the last few years, structural and functional optical coherence tomography (OCT) technology has seen new and revolutionary developments. The most important of all is OCT angiography (Angio-OCT). Angio-OCT already plays an important role in clinical ophthalmology as a new, non invasive and dyeless diagnostic tool, which serves as an adjunct to, or even a replacement for fluorescein and indocyanine green (ICG) angiographies. Angio-OCT brings multiple technical and clinical improvements in the study of retinal diseases, glaucoma, and optic nerve disorders. It enables rapid, high-resolution, detailed images of large retinal vessels and capillary networks in seconds by using a strategy called "motion contrast", as opposed to revealing detailed images of large retinal vessels and capillary networks in seconds by using a strategy called "motion contrast" as opposed to the minutes required in conventional fluorescein angiography. These images are uniquely three-dimensional and allow an isolated study of individual capillary beds at different depths of the retina.

Chromovitrectomy.

The term "chromovitrectomy" has been coined to define the use of vital dyes in vitreoretinal surgery. The basic concept for the application of vital dyes during vitreoretinal surgery is to assist in highlighting preretinal membranes and tissues which are very thin and semitransparent and thus difficult to detect. Various dyes are currently being used in routine clinical procedures, however, the ideal staining agent has not yet been found. The vital dyes indocyanine green, infracyanine green, and brilliant blue stain the internal limiting membrane, trypan blue and triamcinolone acetonide help to visualize the epiretinal and vitreous membranes. New dyes with a better safety profile than the synthetic ones are important for optimizing the outcome of modern ophthalmic surgery and natural dyes, such as lutein, offer a potentially safer and more efficient method of identifying intraocular structures such as vitreous and ILM. Any dye, which is intravitreally injected has the potential to become toxic.

Prenatal diagnosis and perinatal outcome in congenital diaphragmatic hernia. Single tertiary center report.

PURPOSE: To evaluate the perinatal results for fetuses and neonates with left-sided congenital diaphragmatic hernia (CDH) and the role of the prenatal diagnosis in the pregnancy outcome. MATERIALS AND METHODS: We reviewed data from fetuses and neonates with left-sided CDH, managed from January 2009 and December 2013 in the University Clinic Hospital, Craiova, Romania. The following data were analyzed: the gestational age at the time of diagnosis, fetal karyotyping, presence of associated structural malformations, ultrasound (US) data (circumference and area of right lung, lung-to-head ratio - LHR, observed/expected LHR, hepatic herniation), the type of antenatal care, the pregnancy outcome, the place of birth and the conventional autopsy data, if performed. Perinatal outcomes were obtained by reviewing hospital documents. RESULTS: Twenty-one cases were identified. No fetal surgery was performed in our series. Mean gestational age at time of diagnosis was 29 weeks of amenorrhea (WA) (range, 16-37 WA). Associated structural malformations were noticed in nine (42.8%) cases, in which three fetuses had a normal karyotype and two had chromosomal abnormalities, and four fetuses were not investigated. Isolated congenital diaphragmatic hernia was confirmed in 12 (57.1%) cases. All early second trimester diagnosed cases were terminated. The overall mortality rate was 61.9%. Rates of fetal deaths, early neonatal deaths, late neonatal deaths, and survival were 28.5%, 19%, 14.2%, and 38%, respectively. The perinatal mortality rate was 19% in cases with isolated congenital diaphragmatic hernia. CONCLUSIONS: The overall and perinatal mortality rate in congenital diaphragmatic hernia was still high in our series. Early perinatal deaths are associated with early diagnosis and with the presence of other structural defects. The prevalence of chromosomal abnormalities in perinatal death could not be determined from these data. In isolated congenital diaphragmatic hernia, mortality is related to the presence of herniated liver and severe pulmonary hypoplasia, this being well correlated with antenatal ultrasound parameters used for the estimation of fetal lung volumes. The antenatal diagnosis allowed better counseling of the parents, description of associations and improving the neonatal care.