Background: Epidemics or pandemics, such as the current Coronavirus Disease 2019 (COVID-19) crisis, pose unique challenges to healthcare professionals (HCPs). Caring for patients during an epidemic/pandemic may impact negatively on the mental health of HCPs. There is a lack of evidence-based advice on what would be effective in mitigating this impact. Objectives: This rapid review synthesizes the evidence on the psychological impact of pandemics/epidemics on the mental health of HCPs, what factors predict this impact, and the evidence of prevention/intervention strategies to reduce this impact.Method: According to rapid review guidelines, systematic searches were carried out inEmbase.com, PubMed, APA PsycINFO-Ovid SP, and Web of Science (core collection). Searches were restricted to the years 2003 or later to ensure inclusion of the most recent epidemic/pandemics, such as Severe Acute Respiratory Syndrome (SARS). Papers written in French or English, published in peer-reviewed journals, and of quantitative design using validated measures of mental health outcomes were included. Of 1308 papers found, 50 were included. The full protocol for this rapid review was registered with Prospero (reg.no.CRD42020175985).Results: Results show that exposed HCPs working with patients during an epidemic/pandemic are at heightened risk of mental health problems in the short and longer term, particularly: psychological distress, insomnia, alcohol/drug misuse, and symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, burnout, anger, and higher perceived stress. These mental health problems are predicted by organizational, social, personal, and psychological factors and may interfere with the quality of patient care. Few evidence-based early interventions exist so far.Discussion: HCPs need to be provided with psychosocial support to protect their mental wellbeing if they are to continue to provide high quality patient care. Several recommendations relevant during and after an epidemic/pandemic, such as COVID-19, and in preparation for a future outbreak, are proposed.

Half of osteoporotic fractures occur in patients with normal/osteopenic bone density or at intermediate or low estimated risk. Muscle measures have been shown to contribute to fracture risk independently of bone mineral density. The objectives were to review the measurements of muscle health (muscle mass/quantity/quality, strength and function) and their association with incident fragility fractures and to summarize their use in clinical practice. This scoping review follows the PRISMA‐ScR guidelines for reporting. Our search strategy covered the three overreaching concepts of ‘fragility fractures’, ‘muscle health assessment’ and ‘risk’. We retrieved 14 745 references from Medline Ovid SP, EMBASE, Web of Science Core Collection and Google Scholar. We included original and prospective studies on community‐dwelling adults aged over 50 years that analysed an association between at least one muscle parameter and incident fragility fractures. We systematically extracted 17 items from each study, including methodology, general characteristics and results. Data were summarized in tables and graphically presented in adjusted forest plots. Sixty‐seven articles fulfilled the inclusion criteria. In total, we studied 60 muscle parameters or indexes and 322 fracture risk ratios over 2.8 million person‐years (MPY). The median (interquartile range) sample size was 1642 (921–5756), age 69.2 (63.5–73.6) years, follow‐up 10.0 (4.4–12.0) years and number of incident fragility fractures 166 (88–277). A lower muscle mass was positively/not/negatively associated with incident fragility fracture in 28 (2.0), 64 (2.5) and 10 (0.2 MPY) analyses. A lower muscle strength was positively/not/negatively associated with fractures in 53 (1.3), 57 (1.7 MPY) and 0 analyses. A lower muscle function was positively/not/negatively associated in 63 (1.9), 45 (1.0 MPY) and 0 analyses. An in‐depth analysis shows how each single muscle parameter was associated with each fragility fractures subtype. This review summarizes markers of muscle health and their association with fragility fractures. Measures of muscle strength and function appeared to perform better for fracture risk prediction. Of these, hand grip strength and gait speed are likely to be the most practical measures for inclusion in clinical practice, as in the evaluation of sarcopenia or in further fracture risk assessment scores. Measures of muscle mass did not appear to predict fragility fractures and might benefit from further research, on D3‐creatine dilution test, lean mass indexes and artificial intelligence methods.

Background: Microsurgical treatment options for lymphedema consist mainly of lympho-venous anastomosis (LVA) and vascularized lymph node transfers (VLNT). There are no standard measurements of the effectiveness of these interventions and reported outcomes vary among studies. Methods: A systematic review and meta-analysis was performed based on a structured search in Embase, Medline, PubMed, Cinahl, Cochrane and ProQuest in October 2020, with an update in February 2022. Firstly, a qualitative summary of the main reported outcomes was performed followed by a pooled meta-analysis of the three most frequently reported outcomes using a random effects model. Randomized controlled trials, prospective cohort, retrospective cohort, cross-sectional and case-control studies that documented outcomes following microsurgery in adult patients were included. Studies of other surgical treatments (liposuction, radical excision, lymphatic vessels transplantation) or without reported outcomes were excluded. The study protocol was registered on PROSPERO (ID: hidden per double blind review policy). No external funding was received for this review. Results: 150 studies including 6’496 patients were included in the systematic review. The qualitative analysis highlighted the three most frequently reported outcomes: change in circumference, change in volume and change in number of infectious episodes per year. The overall pooled change in excess circumference across 29 studies including 1002 patients was -35.6% [95% CI, -30.8 to -40.3]. The overall pooled change in excess volume across 12 studies including 587 patients was -32.7% [95% CI, -19.8 to -45.6] and the overall pooled change in number of cutaneous infections episode per year across 8 studies including 248 patients was -1.9 [95% CI, -1.4 to -2.3]. The vast majority of the studies included were case-series and cohorts which intrinsically expose to a risk of selection bias Conclusion: The current available evidence supports lymphovenous anastomosis and vascularized lymph nodes transfers as effective treatments to reduce the severity of secondary lymphedema. Standardization of staging method, outcomes measurements and reporting is paramount in future research in order to allow comparability across studies and pooling of results.

Aims: There is increasing evidence that plaque instability in the extracranial carotid artery may lead to an increased stroke risk independently of the degree of stenosis. We aimed to determine diagnostic accuracy of vulnerable and stable plaque using noninvasive imaging modalities when compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis. Methods and results: Medline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of noninvasive imaging modalities (CT, MRI, US) in the detection of 1) vulnerable/stable plaque, and 2) vulnerable/stable plaque characteristics, compared to histology. The quality of included studies was assessed by QUADAS-2 and univariate and bivariate random-effect meta-analyses were performed. We included 36 vulnerable and 5 stable plaque studies in the meta-analysis, and out of 211 plaque characteristics from remaining studies, we classified 169 as vulnerable and 42 as stable characteristics (28 CT, 120 MRI, 104 US characteristics). We found that MRI had high accuracy [90% (95% CI: 82–95%)] in the detection of vulnerable plaque, similar to CT [86% (95% CI: 76–92%); P > 0.05], whereas US showed less accuracy [80% (95% CI: 75–84%); P = 0.013]. CT showed high diagnostic accuracy in visualizing characteristics of vulnerable or stable plaques (89% and 90%) similar to MRI (86% and 89%; P > 0.05); however, US had lower accuracy (77%, P < 0.001 and 82%, P > 0.05). Conclusion: CT and MRI have a similar, high performance in detecting vulnerable carotid plaques, whereas US showed significantly less diagnostic accuracy. Moreover, MRI visualized all vulnerable plaque characteristics allowing for a better stroke risk assessment. Registration: PROSPERO ID CRD42022329690

Carotid plaque composition represents one of the main risk factors of future ischemic stroke. MRI provides excellent soft tissue contrast that can distinguish plaque characteristics. Our objective was to analyze the diagnostic accuracy of MRI imaging in the detection of carotid plaque characteristics compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis through a systematic review. After prospective registration in PROSPERO (ID CRD42022329690), Medline Ovid, Embase.com, Cochrane Library, and Web of Science Core were searched without any search limitation up to May 27, 2022 to identify eligible articles. Of the 8168 studies, 53 (37 × 1.5 T MRI, 17 × 3 T MRI) evaluated MRI accuracy in the detection of 13 specific carotid plaque characteristics in 169 comparisons. MRI demonstrated high diagnostic accuracy for detection of calcification (3 T MRI: mean sensitivity 92%/mean specificity 90%; 1.5 T MRI: mean sensitivity 81%/mean specificity 91%), fibrous cap (1.5 T: 89%/87%), unstable plaque (1.5 T: 89%/87%), intraplaque hemorrhage (1.5 T: 86%/88%), and lipid‐rich necrotic core (1.5 T: 89%/79%). MRI also proved to have a high level of tissue discrimination for the carotid plaque characteristics investigated, allowing potentially for a better risk assessment and follow‐up of patients who may benefit from more aggressive treatments. These results emphasize the role of MRI as the first‐line imaging modality for comprehensive assessment of carotid plaque morphology, particularly for unstable plaque.Evidence Level: 2Technical Efficacy: Stage 2

Malaria prevention methods for travelers to low or moderate malaria risk areas varies and remains controversial. Standby Emergency Treatment (SBET) for malaria is one possible strategy increasingly recommended since 1988 with little evidence on its effectiveness or how it is truly being used. A systematic review and meta-analysis were performed based on a structured search in Embase, Medline, PubMed, Cochrane, and Web of Science on September 7, 2018. The primary outcome was the overall prevalence of SBET use in travelers, and secondary outcomes were the proportion carrying SBET, the response to fever (use of SBET, health facility attendance, use of malaria rapid diagnostic test [mRDT]), adverse events to SBET, and the proportion using SBET incorrectly (incorrect dosage/duration). The pooled SBET use prevalence was analyzed using a random-effects model. A descriptive summary was done to present secondary outcomes. The study protocol was registered with PROSPERO CRD42018103703. 11 studies were eligible for inclusion among the 1027 titles identified by our search. The studies included 7/11 prospective cohort studies that recruited pre-travel clinic attendees in Europe, and 4/11 cross-sectional studies, of which 3 recruited travelers at airports before their return home from South-East-Asia and Africa, and 1 from an employee registry including long-term travelers. The overall pooled prevalence of SBET use among the 26’403 travelers was 2.5% (95%CI 1.1%-4.3%; range 0.4%-10.8%). There was significant variation in the proportion of travelers carrying SBET medication (40%-100%), the proportion of travelers with appropriate response to fever (23%-100%), adverse events (0%-33%) and incorrect dosage/duration of SBET (0%-100%). Adherence to the proposed recommendations for SBET use, notably the response to fever, was poor. If the use of SBET is to be pursued, modifications to the current SBET strategy should be considered, such as better selection of travelers at higher risk for malaria, and the potential addition of mRDTs.