Translating Dysphagia Evidence into Practice While Avoiding Pitfalls: Assessing Bias Risk in Tracheostomy Literature.

Critically ill patients who require a tracheostomy often have dysphagia. Widespread practice guidelines have yet to be developed regarding the acute assessment and management of dysphagia in patients with tracheostomy. In order for clinicians to base their practice on the best available evidence, they must first assess the applicable literature and determine its quality. To inform guideline development, our objective was to assess literature quality concerning swallowing following tracheostomy in acute stages of critical illness in adults. Our systematic literature search (published previously) included eight databases, nine gray literature repositories and citation chasing. Using inclusion criteria determined a priori, two reviewers, blinded to each other, conducted an eligibility review of identified citations. Patients with chronic tracheostomy and etiologies including head and/or neck cancer diagnoses were excluded. Four teams of two reviewers each, blinded to each other, assessed quality of included studies using a modified Cochrane Risk of Bias tool (RoB). Disagreements were resolved by consensus. Data were summarized descriptively according to study design and RoB domain. Of 6,396 identified citations, 74 studies met our inclusion criteria. Of those, 71 were observational and three were randomized controlled trials. Across all studies, the majority (> 75%) had low bias risk with: participant blinding, outcome reporting, and operationally defined outcomes. Areas requiring improvement included assessor and study personnel blinding. Prior to translating the literature into practice guidelines, we recommend attention to study quality limitations and its potential impact on study outcomes. For future work, we suggest an iterative approach to knowledge translation

Plants of Sabkha Ecosystems of the Arabian Peninsula.

Sabkhas are unique ecosystems that are highly saline and where specially adapted plants are able to grow, flower, and fruit. In general, saline environments are poor in species – for the Arabian Peninsula about 120 taxa are recorded as halophytes which constitute about 4% of the total flora of the Arabian Peninsula. Key halophytes of Arabia are nearly always perennial; predominant life-forms are somewhat succulent, semiwoody dwarf shrubs belonging to the families Amaranthaceae, Zygophyllaceae, and Plumbaginaceae and hemicryptophytes belonging to the Poaceae, Cyperaceae, and Juncaceae; annuals are exceptions. Coastal species are either obligate halophytes or salt-tolerant genera from unspecialized families, such as Sporobolus and Aeluropus (Poaceae), or salt-secreting species such as Avicennia (Acanthaceae) and Limonium (Plumbaginaceae). The submerged coastal vegetation, e.g., seagrasses, is one of the most important vegetation types of the Gulf coast and is of great importance to marine fauna. The north-south distribution of coastal species is more distinct on the Red Sea coast, with the border lying near Jeddah, than on the Persian Gulf coast where there is a broad transitional zone between Qatar and northern Oman. The east-west distribution of coastal species is not as distinct. The eastern elements are either restricted to the coasts around the Arabian Gulf or are Irano-Turanian species extending into the Gulf region. Several vicariant species groups of halophytes are represented in the Arabian Peninsula. Halophytes have developed strategies for seed germination such as high germination levels and fast germination speed. These traits are found in the sabkha plants of the Arabian Peninsula. Some halophytes have been investigated for their potential for phytoremediation in their ability to survive weathered oil-contaminated soils. They have been found to have a set of micoorganisms around their root system that are related to the degradation of oil in contaminated soils. Sabkha ecosystems are being degraded and altered throughout the Gulf countries as they appear to be nonproductive. Over the last two decades, there has been a growing concern in protecting and restoring mangroves, and programs do to so have seen promising results. But, on the whole, coastal and inland sabkhas are neglected, and these unique ecosystems require urgent protection