Scottish Intercollegiate Guidelines Network Research Articles

Systematic Review of Behavioral Therapy to Improve Swallowing Functions of Patients With Parkinson's Disease.

Decreased swallowing function is a common and main cause of malnutrition and aspiration pneumonia in patients with Parkinson's disease. The aims of this systematic review were to summarize and qualitatively analyze the studies that have been published on behavioral therapies for improving swallowing functions in patients with Parkinson's disease. Studies published from January 2000 to December 2015 were identified via electronic database searches using Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and 8 Korean databases. Two reviewers independently evaluated the studies using inclusion criteria. Nine studies were included, of which 6 evaluated rehabilitation technique studies and 3 evaluated compensatory strategies. The 9 studies were evaluated qualitatively using a methodology checklist of the Scottish Intercollegiate Guideline Network, according to which all of the studies had acceptable quality. The available data on the effects of rehabilitation techniques and compensatory strategies remain insufficient. Further randomized controlled studies should be done to investigate the effect of behavioral therapy on improving swallowing functions in patients with Parkinson's disease.

Effect of Mobile Health on Obese Adults: A Systematic Review and Meta-Analysis.

ObjectivesThis study was conducted to examine the effects of mobile health (mHealth), using mobile phones as an intervention for weight loss in obese adults.MethodsAn electronic search was carried out using multiple databases. A meta-analysis of selected studies was performed. The effects of mHealth were analyzed using changes in body weight and body mass index (BMI).ResultsWe identified 20 randomized controlled trials (RCTs) involving 2,318 participants who fit our inclusion criteria. The meta-analysis showed that body weight was reduced with a weighted mean difference (WMD) of −2.35 kg (95% confidence interval [CI], −2.84 to −1.87). An examination of the impact of duration of intervention showed that weight loss was greater after 6 months of mHealth (WMD = −2.66 kg) than between three and four months (WMD = −2.25 kg); it was maintained for up to 9 months (WMD = −2.62 kg). At 12 months, weight loss was reduced to a WMD of −1.23 kg. BMI decreased with a WMD of −0.77 kg/m2 (95% CI, −1.01 to −0.52). BMI changes were not statistically significant at 3 months (WMD = −1.10 kg/m2), but they were statistically significant at 6 months (WMD = −0.67 kg/m2).ConclusionsThe use of mHealth for obese adults showed a modest short-term effect on body weight and BMI. Although the weight loss associated with mHealth did not meet the recommendation of the Scottish Intercollegiate Guideline Network, which considers a reduction of approximately 5 to 10 kg of the initial body weight as a successful intervention. Well-designed RCTs are needed to reveal the effects of mHealth interventions.

An Integrative Review of Job Stress and Mental Health Intervention Programs for Experienced Nurses

Purpose: The purpose of this study was to review intervention programs for experienced nurses’ job stress and mental health. Methods: Searches of literature were conducted through four electronic databases (RISS, KISS, PubMed, and CINAHL), focusing on the recent 5-year publications in English or Korean. Thirteen studies were selected for the final analysis and Scottish Intercollegiate Guidelines Network checklist was used to assess methodological rigor and quality. Results: Randomized controlled trials were used in five studies and quasi-experimental designs in eight studies. Cognitive-Behavioral Therapy (CBT) and group approach were the most frequent types of interventions in six and nine studies respectively. On average, the intervention was required for eight weeks and 60~120 minutes per session. After evaluating the effects of CBT, complementary alternative therapy, informative training, simulation training and stimuli control, most of the tested interventions reduced experienced nurses’ job stress and improved mental health, but informative training did not. Conclusion: Despite the obvious importance of experienced nurses in quality of nursing care, it has not been well studied due to limited numbers of studies with less rigorous design. Study findings provide a basis for developing intervention programs to reduce job stress and improve mental health for experienced nurses.

Clinical Practice Guideline for Assessment and Prevention of Falls in Adult People

Purpose Falls are one of the most frequent health events in medical institutions, however, they can be predicted and prevented. The Quality Improvement Nurse Society clinical practice guideline Steering Committee developed the Clinical Practice Guideline for the assessment and prevention of falls in adult people. The purpose of this study was to assess the risk factors for falls in adults aged 19 years and older, to present an evidence for preventing falls, formulate a recommendations, and indicators for applying the recommendations. Methods This clinical practice guideline was developed using a 23-step adaptation method according to the Handbook for clinical practice guideline developer (version 1.0) by National Evidence-based Healthcare Collaborating Agency. Evidence levels and recommendation ratings were established in accordance to SIGN 2011 (The Scottish Intercollegiate Guidelines Network). Results The final 15 recommendations from four domains were derived from experts’ advice; 1) assessment of risk factor for falls in adult 2) preventing falls and reducing the risks of falls or falls-related injury 3) management and reassessment after a person falls 4) leadership and culture. Conclusion This clinical practice guideline can be used as a basis for evaluation and prevention of fall risk factors for adults, to formulate recommendations for fall risk assessment and fall prevention, and to present monitoring indicators for applying the recommendations. Key words: Clinical practice guideline ㆍ Falls ㆍ Assessment ㆍ Prevention ㆍ Adult

Recommendations for the management of secondary hypogammaglobulinaemia due to B cell targeted therapies in autoimmune rheumatic diseases.

The association of B cell targeted therapies with development of hypogammaglobulinaemia and infection is increasingly recognized. Our aim was to develop consensus recommendations for immunoglobulin replacement therapy for management of hypogammaglobulinaemia following B cell targeted therapies in autoimmune rheumatic diseases. A modified Delphi exercise involved a 17-member Taskforce committee, consisting of immunologists, rheumatologists, nephrologists, haematologists, a gastroenterologist, an immunology specialist nurse and a patient representative. The first round identified the most pertinent topics to address in the recommendations. A search string was agreed upon for the identification of publications in PubMed focusing on these areas, for a systematic literature review. Original data was presented from this review to the Taskforce committee. Recommendations from the British Society for Rheumatology, the UK Department of Health, EULAR, the ACR, and the American Academy of Allergy, Asthma, and Immunology were also reviewed. The evidence was discussed in a face-to-face meeting to formulate recommendation statements. The levels of evidence and statements were graded according to Scottish Intercollegiate Guidelines Network methodology. Three overarching principles, eight recommendation statements and a research agenda were formulated. The Taskforce committee voted on these statements, achieving 82-100% agreement for each recommendation. The strength of the recommendations was restricted by the low quality of the available evidence, with no randomized controlled trial data. The recommendations cover risk factors, monitoring, referral for hypogammaglobulinaemia; indications, dosage and discontinuation of immunoglobulin replacement therapy. These are the first recommendations specifically formulated for B cell targeted therapies related to hypogammaglobulinaemia in autoimmune rheumatic diseases. The recommendations are to aid health-care professionals with clinical decision making for patients with hypogammaglobulinaemia.

El movimiento anti-vacunas como problema de salud pública: una revisión integrativa de la literatura

Aim: To analyze current literature about the situation of anti-vaccine movement groups and their current social presence, and to better understand the reasons why people decide not to vaccinate their childen. Methodology: A screening of articles was carried out, from November 2015 to May 2016, through an integrative review. The sources of data consulted were: PubMed, Scielo, Scopus, Cochrane Library Plus and CINAHL. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN). Results: A total of 587 articles was found, and 22 were selected, finally. The reasons for rejection of vaccines vary from philosophical reasons or fear of overloading the immune system to fear of side effects or a mistaken perception of low risk of disease. Conclusions: Vaccination should be understood as a fundamental right of each child, also knowing that with good information, communication and health relationship-parent / patient, great results can be obtained.

Reversal of mivacurium-induced neuromuscular blockade with a cholinesterase inhibitor: A systematic review.

Mivacurium is a short-acting non-depolarizing muscle relaxant, which is hydrolyzed by butyrylcholinesterase. The neuromuscular block (NMB) can be antagonized with cholinesterase inhibitors (CHEI), but the short duration of action of mivacurium questions the need. This systematic review evaluated if the use of CHEIs (neostigmine, pyridostigmine or edrophonium) facilitates reversal of mivacurium-induced NMB. Randomized controlled trials and crossover-studies comparing spontaneous recovery with CHEI reversal in patients with mivacurium-induced NMB, assessed with quantitative neuromuscular monitoring, were included. Mean time from injection of the CHEI or allowing of spontaneous recovery to an endpoint representing full recovery was used as outcome. First response to train-of-four nerve stimulation (T1 ) described the level of NMB for administration of the CHEI. Moderate NMB refers to T1 ≥5% and deeper NMB refers to T1 <5%. Systematic critical appraisal was performed using the Scottish Intercollegiate Guidelines Network guidelines. Overall quality assessment was done using the Grading of Recommendations Assessment, Development and Evaluation approach. Sixteen studies with data from 546 patients were included. Low quality of evidence was found that neostigmine and edrophonium administered at moderate NMB accelerated recovery with up to approximately 5.5-6.5 and 6.5-9.0minutes, respectively. At deeper NMB only edrophonium accelerated recovery. The effect of neostigmine was not clarified at deeper mivacurium-induced NMB. No studies with reversal by pyridostigmine were identified. Low quality of evidence supports that neostigmine and edrophonium accelerate the recovery of mivacurium-induced NMB with 5-6.5 and 6-9.0minutes respectively, when administered at moderate NMB. At deeper NMB only edrophonium accelerated the recovery.

Asthma phenotypes and their impact on treatment

Patients with asthma can have varying characteristics, and therefore they need different treatments. Knowing asthma phenotypes can aid practice nurses to better understand how to best manage their patients' condition, as Aleksandra Gawlik-Lipinski describes Asthma is characterised by the presence of a wheeze, a cough, breathlessness, tightness in the chest and various levels of airway obstruction ( Chapman et al, 2014 , British Thoracic Society and Scottish Intercollegiate Guidelines Network, 2016 ). There is diversity among asthma patients and it was in the final decade of twentieth century that asthma was categorised into phenotypes ( Wenzel, 2012a ). A phenotype is an observable manifestation of the interaction between an individual's genotype and their environment ( Marieb and Hoehn, 2012 ). Traditionally, phenotypes are based on clinical, molecular and individual characteristics, designed to recognise different treatment requirements among asthma patients and deliver targeted therapy ( Chung et al, 2014 ). Apart from inhaled corticosteroids, eosinophilic, early- and late-onset asthma phenotypes benefit from leukotriene receptor antagonists (LTRAs) and monoclonal anti-immunoglobin E therapy; obesity-related, non-eosinophilic phenotype from weight management; and allergic bronchopulmonary mycoses from antifungal treatment ( Haldar et al, 2008 ; Moore et al, 2010 ; Wenzel, 2012b ). The treatments of early-onset, non-eosinophilic phenotype with LTRAs ( Bacci et al, 2006 ; Paggiaro and Bacci, 2011 ) and the neutrophilic phenotype solely with macrolide antibiotics ( Wenzel, 2012b ) continue to be debated.

Impact of the SIGN head injury guidelines and NHS 4-hour emergency target on hospital admissions for head injury in Scotland: an interrupted times series

ObjectivesHead injury is a common reason for emergency department (ED) attendance. Around 1% of patients have life-threatening injuries, while 80% of patients are discharged. National guidelines (Scottish Intercollegiate Guidelines Network...

Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: a systematic review and meta-analysis of cohort studies

BackgroundIn 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers.MethodsCohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger’s test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309).ResultsEleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I2 = 99.7; P = 0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR = 0.56, 95% CI = 0.37 to 0.84), abdominal injuries (RR = 0.87; 95% CI = 0.78 to 0.98) and, spinal injuries (RR = 0.56, 95% CI = 0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR = 0.49; 95% CI = 0.22 to 1.08), neck injuries (RR = 0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR = 1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR = 0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers.ConclusionIn sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type.

Care of Women with Obesity in Pregnancy

Care of Women with Obesity in Pregnancy

Assessing the Quality of Global Clinical Practice Guidelines on Gout Using AGREE II Instrument.

The aim of this study was to assess the quality of global clinical practice guidelines (CPGs) on gout. We systematically searched MEDLINE, CBM (Chinese Biomedical Literature database), GIN (Guidelines International Network), NICE (National Institute for Health and Clinical Excellence), NGC (National Guideline Clearinghouse), WHO (World Health Organization), SIGN (Scottish Intercollegiate Guidelines Network), DynaMed, UpToDate, and Best Practice databases from their inception until January 2017 to identify and select CPGs related to gout. Two reviewers independently assessed the eligible gout CPGs using the AGREE II instrument. We evaluated 15 CPGs published between 2007 and 2017, produced by 13 different developers. Quality of evidence and strength of recommendations were presented in 14 (93%) and 13 (87%) CPGs, respectively. The mean scores (±SD) for each AGREE II domain were as follows: (i) scope and purpose: 75% (±17%), (ii) stakeholder involvement: 39% (±19%), (iii) rigor of development: 43% (±17%), (iv) clarity and presentation: 82% (±14%), (v) applicability: 31% (±12%), and (vi) editorial independence: 23% (±29%). The quality of gout CPGs was suboptimal, and various incompatible grading systems of quality of evidence and strength of recommendations were used. The use of a standardized international grading system is essential to ensure high methodological quality of gout CPGs. Tools such as AGREE II could substantially improve the development and update of future gout CPGs.

Assessing antibiotic stewardship using the surgical site infection prevention bundle.

Antibiotic prophylaxis is crucial in head and neck surgery to prevent infection from clean contaminated wounds. Scottish Intercollegiate Guidelines Network (SIGN) guidance, the gold standard of practice, recommends that administration of broad spectrum antibiotics is discontinued after 24 hours post-operation. A three-audit cycle quality improvement project was conducted to assess clinical practice against SIGN guidance at a large London teaching hospital. Three change initiatives were implemented to improve antibiotic stewardship. First, an update of Trust guidelines with an associated poster campaign to educate staff and improve awareness. Second, introduction of a specific 'prophylactic antibiotics in head and neck surgery' bundle on the electronic hospital-wide prescribing system. Third, an update to an antibiotic prescribing guide (Microguide). Over a 3-year study period the number of patients receiving antibiotics beyond 24 hours declined significantly (88% in 2015, 76% in 2016, 25% in 2018), demonstrating improved compliance with SIGN guidelines overall. Despite this, staff documentation of indications for extended antibiotic use remains suboptimal (58% in 2016 and 44% in 2018) as does the number of specimens sent for microbiological analysis (52% in 2016 and 0% in 2018). Appropriate prophylactic antibiotic prescribing can improve morbidity and mortality rates in head and neck cancer patients. Three change initiatives have been demonstrated which can help to improve prescribing compliance in line with SIGN guidance. Ongoing auditing is required to maintain the longevity of improvements made and encourage staff documentation of indications for extended antibiotic use and microbiology specimen analysis.

A Systematic Review and Meta-Analysis Comparing the Short- and Long-Term Outcomes for Laparoscopic and Open Liver Resections for Hepatocellular Carcinoma: Updated Results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017

The laparoscopic approach to liver resection has experienced exponential growth in recent years; however, its application is still under debate and objective, evidence-based guidelines for its safe future progression are needed. The aim of this study was to perform a systematic review and meta-analysis comparing the short- and long-term outcomes of laparoscopic and open liver resections for hepatocellular carcinoma (HCC). To identify all the comparative manuscripts reporting on laparoscopic and open liver resection for HCC, all published English-language studies with more than 10 cases were screened. In addition to the primary meta-analysis, four specific subgroup analyses were performed on patients with Child-Pugh A cirrhosis, resections for solitary tumors, and those undergoing minor and major resections. The quality of the studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and the Newcastle-Ottawa Scale. From the initial 361 manuscripts, 28 were included in the meta-analysis. Five of these 28 manuscripts were specific to patients with Child-Pugh A cirrhosis (321 cases), 11 focused on solitary tumors (1003 cases), 16 focused on minor resections (1286 cases), and 3 focused on major resections (164 cases). Three manuscripts compared 1079 cases but could not be assigned to any of the above subanalyses. In general terms, short-term outcomes were favorable when using a laparoscopic approach, especially in minor resections. The only advantage seen with an open approach was reduced operative time during major liver resections. No differences in long-term outcomes were observed between the approaches. Laparoscopic liver resection for HCC is feasible and offers improved short-term outcomes, with comparable long-term outcomes as the open approach.

ADHD in children and youth: Part 1-Etiology, diagnosis, and comorbidity.

Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Three position statements have been developed by the Canadian Paediatric Society, following systematic literature reviews. Statement objectives are to: 1) Summarize the current clinical evidence regarding ADHD,2) Establish a standard for ADHD care, and3) Assist Canadian clinicians in making well-informed, evidence-based decisions to enhance care of children and youth with this condition. Specific topics reviewed in Part 1, which focuses on diagnosis, include: prevalence, genetics, pathophysiology, differential diagnosis and comorbid psychiatric disorders and developmental disorders. In addition to database searches, the most recent guidelines of the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the National Institute for Health and Clinical Excellence, the Scottish Intercollegiate Guidelines Network, and the Eunethydis European ADHD Guidelines Group, were reviewed. Because ADHD is a heterogeneous disorder, comprehensive medical assessment for ADHD should always include a complete history, a physical examination, and a thorough consideration of differential diagnosis and related comorbidities. Specific recommendations for information gathering, testing, and referral are offered.

Global emergency care clinical practice guidelines: A landscape analysis.

IntroductionAn adaptive guideline development method, as opposed to a de novo guideline development, is dependent on access to existing high-quality up-to-date clinical practice guidelines (CPGs). We described the characteristics and quality of CPGs relevant to prehospital care worldwide, in order to strengthen guideline development in low-resource settings for emergency care.MethodsWe conducted a descriptive study of a database of international CPGs relevant to emergency care produced by the African Federation for Emergency Medicine (AFEM) CPG project in 2016. Guideline quality was assessed with the AGREE II tool, independently and in duplicate. End-user documents such as protocols, care pathways, and algorithms were excluded. Data were imported, managed, and analysed in STATA 14 and R.ResultsIn total, 276 guidelines were included. Less than 2% of CPGs originated from low- and middle income-countries (LMICs); only 15% (n = 38) of guidelines were prehospital specific, and there were no CPGs directly applicable to prehospital care in LMICs. Most guidelines used de novo methods (58%, n = 150) and were produced by professional societies or associations (63%, n = 164), with the minority developed by international bodies (3%, n = 7). National bodies, such as the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN), produced higher quality guidelines when compared to international guidelines, professional societies, and clinician/academic-produced guidelines. Guideline quality varied across topics, subpopulations and producers. Resource-constrained guideline developers that cannot afford de novo guideline development have access to an expanding pool of high-quality prehospital guidelines to translate to their local setting.DiscussionAlthough some high-quality CPGs exist relevant to emergency care, none directly address the needs of prehospital care in LMICs, especially in Africa. Strengthening guideline development capacity, including adaptive guideline development methods that use existing high-quality CPGs, is a priority.

Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: a systematic review

Escherichia coli bacteraemia rates in the UK have risen; rates are highest among older adults. Previous urinary tract infections (UTIs) and catheterization are risk factors. To examine effectiveness of behavioural interventions to reduce E.coli bacteraemia and/or symptomatic UTIs for older adults. Sixteen databases, grey literature, and reference lists were searched. Titles and/or abstracts were scanned and selected papers were read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading. Twenty-one studies were reviewed, and all lacked methodological quality. Six multi-faceted hospital interventions including education, with audit and feedback or reminders reduced UTIs but only three supplied statements of significance. One study reported decreasing catheter-associated UTI (CAUTI) by 88% (F (1,20)=7.25). Another study reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (χ2=254). A third study reported fewer UTIs per patient week (risk ratio=0.39). Two hospital studies of online training and catheter insertion and care simulations decreased CAUTIs from 33 to 14 and from 10.40 to 0. Increasing nursing staff, community continence nurses, and catheter removal reminder stickers reduced infection. There were no studies examining prevention of E.coli bacteraemias. The heterogeneity of studies means that one effective intervention cannot be recommended. We suggest that feedback should be considered because it facilitated reductions in UTI when used alone or in multi-faceted interventions including education, audit or catheter removal protocols. Multi-faceted education is likely to be effective. Catheter removal protocols, increased staffing, and patient education require further evaluation.

Nutritional screening in hospitalized pediatric patients: systematic review

malnutrition in the pediatric population has been associated with a great number of physiological problems and complications, which lead to a longer period of hospitalization, a higher risk of infections, a rise in mortality rate, and hence, a rise in assistance expenses. to collect available evidence on tools of nutritional screening frequently used in pediatrics that allow identifying, preventing and intervening hospital malnutrition, as well as providing guidelines regarding the appropriate application instant. a systematic review of literature was carried out in accordance with the PRISMA Declaration (Preferred Reporting Items in Systematic Reviews and Meta-Analyses) and in the main databases, search in ClinicalTrials and gray literature in Open Gray and TRIP Database. Then, the articles were selected and classified depending on the type of study. The quality assessment was done in accordance with the Scottish Intercollegiate Guidelines Network (SIGN) checklists. one hundred and ten articles were identified, following the parameters of the PRISMA declaration. Twenty-one articles were analyzed and evaluated through the SIGN methodology; 19 met the high quality criteria and were included in the present review. Six nutritional screening tools in pediatrics were identified, STRONGkids being the tool referred by 63% of the studies for the detection of malnutrition risk. the present systematic review allowed us to conclude that STRONGkids is the best screening tool for hospitalized children since it is practical, quick, easy to use and it reliably predicts the risk of malnutrition. However, further studies are required to validate the use of this in the Colombian context.

Characteristics of diabetic foot disease and risk factors in Benghazi, Libya

Introduction: Diabetic foot ulcer and amputation are associated with an increased incidence of morbidity and mortality. Diabetic foot ulcer can be prevented by screening for risk factors and proper interventions. Objectives: We aimed to determine the risk of diabetic foot ulcer and amputation among patients with type 2 diabetes at Benghazi Medical Center diabetic clinic. Patients and Methods: A cross-sectional study of diabetic foot status and risk factors in diabetic patients attending a specialist diabetes clinic in Benghazi, Libya. Results: Eighty-seven (84.5%) patients wear inappropriate shoes, 37 (35.9%) had Tinea pedis, 26 (25.2%) had foot deformity, 13 (12.6%) patients had bilateral hallux valgus deformity, 8 (7.8%) patients had clawing of feet, 2 (1.9%) patients had Charcot joint, and one patient (0.97%) had amputated toes. Dorsalis pedis and posterior tibial arteries pulsations were not palpable in six (5.8%) patients, there was a loss of protective sensation among 20 (19.4%) patients, vibration sense was absent in 15 (14.6%) patients, and joint position sense was lost in five (4.9%) patients. According to Scottish Intercollegiate Guideline Network system, 59 (57.3%) patients were in the low-risk category, 18 (17.5%) were in the moderate-risk, 22 (21.4%) were in the high-risk, and 4 (3.9%) were in the active disease categories. Conclusions: We conclude that the prevalence of diabetic foot risk factors is high among the studied group.

Speech and language characteristics in individuals with nonsyndromic submucous cleft palate-A systematic review.

Up to 80% of individuals with unrepaired submucous cleft palate (SMCP) experience speech difficulties secondary to velopharyngeal insufficiency. Language delays are reported in the broader cleft lip and/or palate population, suggesting that individuals with SMCP may also be at risk. However, contemporary understanding of this population remains limited as there has been no systematic examination of the literature. This review aims to systematically review and document the speech and language characteristics of individuals with nonsyndromic SMCP and, in addition, to identify factors reported to impact speech and language outcomes. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five databases were comprehensively searched using keywords and indexed headings. Included studies had to report speech or language outcomes of individuals with nonsyndromic SMCP. Risk of bias and methodological design quality were examined using tools from the Scottish Intercollegiate Guidelines Network. Relevant data were extracted for analysis. Eighteen studies met inclusion criteria, yielding 598 participants. Study results showed that individuals with unrepaired nonsyndromic SMCP may have speech difficulties secondary to velopharyngeal insufficiency including increased nasal resonance and palatalized or glottal articulation. Lower age at primary surgical repair led to better postsurgical speech outcomes. There is a paucity of literature outlining motor or phonological aspects of speech and receptive or expressive language abilities of this population. Individuals with nonsyndromic SMCP present with speech difficulties similar to those experienced by individuals with overt cleft palate. Health care professionals should be aware of possible presenting symptoms and consider early SMCP diagnoses where appropriate. Further research is needed to specify the broader communication profile in this population.