Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review

Objective To review systematically the evidence of effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses

The Impact of the COVID-19 Pandemic on Diabetes Self-Management in Saudi Arabia

The COVID-19 pandemic disrupted healthcare worldwide, potentially impacting disease management. The objective of this study was to assess the self-management behaviors of Saudi patients with diabetes during and after the COVID pandemic period using the Arabic version of the Diabetes Self-Management Questionnaire (DSMQ). A cross-sectional study was conducted in patients aged ≥18 years diagnosed with type 2 diabetes mellitus who had at least one ambulatory clinic visit in each of the specified time frames (Pre-COVID-19: 1 January 2019–21 March 2020; COVID-19 Time frame: 22 March 2020 to 30 April 2021) utilizing the DSMQ questionnaire, with an additional three questions specifically related to their diabetes care during the COVID pandemic. A total of 341 patients participated in the study. The study results revealed that the surveyed patients showed moderately high self-care activities post-COVID-19. Total DSMQ scores were significantly higher in patients aged >60 years versus younger groups (p p p < 0.05). Overall, DSMQ scores were higher than the pre-pandemic Saudi population and Turkish post-pandemic findings. DSMQ results suggest that, while COVID-19 negatively impacted some self-management domains, the Saudi patients surveyed in this study upheld relatively good diabetes control during the pandemic. Further research is warranted on specific barriers to optimize diabetes care during public health crises

Potentially Inappropriate Medications among Elderly with Frailty in a Tertiary Care Academic Medical Centre in Saudi Arabia

This study aims to assess the prevalence of potentially inappropriate medications (PIMs) and to analyze the relationship between the PIMs and frailty among inpatient older adults aged 65 and above in Saudi Arabia. A retrospective cross-sectional study design was utilized during the period between April 2021 and April 2022 of all patients aged 65 years and above admitted in a public tertiary hospital in Saudi Arabia. Data on the number of medications and the use of PIMs were assessed using Beers&rsquo; criteria while the frailty status was assessed using the &ldquo;FRAIL Scale&rdquo;. Of the 358 patient files that were reviewed, 52.2% were males, 60.9% were aged 65&ndash;74 years, and 82% were married. The prevalence of robust, prefrail, and frail patients was 5%, 36.9%, and 58.1%, respectively. According to the 2019 Beers criteria, a total of 45.8% (n = 164) participants identified as using PIMs. Compared to the non-PIMs group, the PIMs group demonstrated significant differences in the number of medications (p &lt; 0.001), the number of comorbidities (p &lt; 0.05), and the frailty score (p &lt; 0.001). The strongest predictor of PIM use was a number of comorbidities, recording an odds ratio of 2.86, (95% CI 1.21&ndash;6.77, p &lt; 0.05). Our results show that the use of PIM was significantly associated with frail older adults with multiple comorbidities and in patients with polypharmacy. A clear assessment and evaluation tool may improve the quality of drug treatment in the older adult population, particularly in frail patients

A systematic review of recent clinical practice guidelines on the diagnosis, assessment and management of hypertension.

BACKGROUND: Despite the availability of clinical practice guidelines (CPGs), optimal hypertension control is not achieved in many parts of the world; one of the challenges is the volume of guidelines on this topic and their variable quality. To systematically review the quality, methodology, and consistency of recommendations of recently-developed national CPGs on the diagnosis, assessment and the management of hypertension. METHODOLOGY/PRINCIPAL FINDINGS: MEDLINE, EMBASE, guidelines' websites and Google were searched for CPGs written in English on the general management of hypertension in any clinical setting published between January 2006 and September 2011. Four raters independently appraised each CPG using the AGREE-II instrument and 2 reviewers independently extracted the data. Conflicts were resolved by discussion or the involvement of an additional reviewer. Eleven CPGs were identified. The overall quality ranged from 2.5 to 6 out of 7 on the AGREE-II tool. The highest scores were for "clarity of presentation" (44.4%-88.9%) and the lowest were for "rigour of development" (8.3%-30% for 9 CGPs). None of them clearly reported being newly developed or adapted. Only one reported having a patient representative in its development team. Systematic reviews were not consistently used and only 2 up-to-date Cochrane reviews were cited. Two CPGs graded some recommendations and related that to levels (but not quality) of evidence. The CPGs' recommendations on assessment and non-pharmacological management were fairly consistent. Guidelines varied in the selection of first-line treatment, adjustment of therapy and drug combinations. Important specific aspects of care (e.g. resistant hypertension) were ignored by 6/11 CPGs. The CPGs varied in methodological quality, suggesting that their implementation might not result in less variation of care or in better health-related outcomes. CONCLUSIONS/SIGNIFICANCE: More efforts are needed to promote the realistic approach of localization or local adaptation of existing high-quality CPGs to the national context

Preconception care for diabetic women for improving maternal and fetal outcomes : a systematic review and meta-analysis

Background Preexisting diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. Despite improvement in the access and quality of antenatal care recent population based studies demonstrating increased congenital abnormalities and perinatal mortality in diabetic mothers as compared to the background population. This systematic review was carried out to evaluate the effectiveness and safety of preconception care in improving maternal and fetal outcomes for women with preexisting diabetes mellitus. Methods We searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINAHL up to December 2009, without language restriction, for any preconception care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women of reproductive age group with type I or type II diabetes. Study design were trials (randomized and non-randomized), cohort and case-control studies. Of the 1612 title scanned 44 full papers were retrieved of those 24 were included in this review. Twelve cohort studies at low and medium risk of bias, with 2502 women, were included in the meta-analysis. Results Meta-analysis suggested that preconception care is effective in reducing congenital malformation, RR 0.25 (95% CI 0.15-0.42), NNT17 (95% CI 14-24), preterm delivery, RR 0.70 (95% CI 0.55-0.90), NNT = 8 (95% CI 5-23) and perinatal mortality RR 0.35 (95% CI 0.15-0.82), NNT = 32 (95% CI 19-109). Preconception care lowers HbA1c in the first trimester of pregnancy by an average of 2.43% (95% CI 2.27-2.58). Women who received preconception care booked earlier for antenatal care by an average of 1.32 weeks (95% CI 1.23-1.40). Conclusion Preconception care is effective in reducing diabetes related congenital malformations, preterm delivery and maternal hyperglycemia in the first trimester of pregnancy

Quality of the 11 Hypertension Clinical Practice Guidelines for the six domains of the AGREE-II Instrument (D1–D6) and the Overall Impression of the 4 Assessors.

<p>D1 : Scope & purpose, D2: Stakeholder involvement, D3: Rigor of involvement, D4: Clarity of presentation, D5: Applicability, D6: editorial independence.</p><p>All the 23 items of the AGREE-II instrument are rated on a 7-point scale where a score of 1 is given when there is no information that is relevant to the item or if the concept is very poorly reported; a score of 7 is given if the quality of reporting is exceptional and where the full criteria and considerations articulated in the AGREE-II User's Manual have been met; and a score between 2 and 6 is assigned when the reporting of the AGREE II item does not meet the full criteria or considerations. Scores increase as more criteria are met and considerations addressed. In other words, the higher the score, the better the quality of the CPG item.</p><p>SOA: South Africa; IND: India; POL: Poland; MAL: Malaysia; EUR: Europe; JAP: Japan; LAT: Latin America; AUS: Australia; CAN: Canada; SAU: Saudi Arabia and NICE: UK's National Institute for Health and Clinical Excellence).</p>*<p>Although the scoring is done in integers, the numbers in this column represent the averages of the scoring done by 4 assessors.</p>**<p>Risk of bias: +++ high, ++ intermediate, + low.</p>***<p>This is based on the subjective assessment made individually by each of the 4 assessors in response to: “Do you recommend this CPG for use?”</p

Recommendations from Clinical Practice Guidelines About Diagnosis and Assessment of Patients with Hypertension.

<p>NR: Not reported, √: Recommended, ×: Not Recommended; SOA: South Africa; IND: India; POL: Poland; MAL: Malaysia; EUR: Europe; JAP: Japan; LAT: Latin America; AUS: Australia; CAN: Canada; SAU: Saudi Arabia and NICE (The UK's National Institute for Health and Clinical Excellence).</p>$<p>not endorsed by NICE. ABI: ankle-brachial index ECD: Echo Carotid Doppler, RAU: Renal artery duplex ultrasound.</p

Domain Scores (%) for the 11 Clinical Practice Guidelines Using the AGREE-II Instrument.

<p>SOA: South Africa; IND: India; POL: Poland; MAL: Malaysia; EUR: Europe; JAP: Japan; LAT: Latin America; AUS: Australia; CAN: Canada; SAU: Saudi Arabia and NICE: UK's National Institute for Health and Clinical Excellence.</p