Use of epidemiological analyses in Clinical Practice Guideline development focused on the diabetic patients treated with insulin.

The prevalence of diabetes is on the rise worldwide especially in developed countries. The aim of glucose management in all types of diabetes is to minimize chronic and acute complications associated with diabetes. All patients with type 1 diabetes mellitus (T1DM) require insulin. Main areas of technology advances in diabetes are continuous subcutaneous insulin infusion (CSII) and also continuous glucose monitoring systems for the management of patients with both types of diabetes. It is very important to analyse the epidemiological situation within each country before and during the clinical practice guidelines (CPGs) development and implementation. The analyses will allow us to monitor the effect of the CPG after its implementation.The aim of this short communication is to analyse the epidemiology of prevalence and incidence of diabetes mellitus and use of CSII to inform development of CPGs in the Czech Republic.The analysis is developed based on the data managed by Institute of Health Information and Statistics of the Czech Republic. We used the National Register of Reimbursed Health Services 2015-2017 as primary source, and the annual report type A (Ministry of Health) 1-01: for Diabetology (A MH 004) 2007-2017 was used as validation source. The presented data are related to the year 2016 because we were able to validate them based on the data from 2015 to 2017 for this cohort of patients.The number of patients with T1DM is increasing in the Czech Republic with no significant sex difference. Life expectancy is about 11 years lower in the T1DM population. The majority of the patients are in older age; however, these are not treated with CSII compared with the younger population. From 61 533 patients with T1DM, 81% were reported with acute and chronic complications in 2016. Only 5011 of these patients were reported as using CSII.

Effectiveness of surgery for adults with hallux valgus deformity: a systematic review.

BACKGROUND: Hallux valgus (HV) is a common foot deformity. In severe stages of this condition, surgery is often necessary. Currently, there is no systematic review comparing the effectiveness of surgery over conservative treatment. OBJECTIVES: The objective of this review was to establish the effectiveness of surgery compared to conservatory management for adults with HV. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The current review included adults (18 years or over) with HV deformity, excluding adults with neurological problems causing foot deformities, for example, cerebral palsy, neuropathy, stroke and multiple sclerosis. TYPES OF INTERVENTIONS: The review included any type of HV surgery compared to no surgery, conservative treatment or different types of HV surgeries. OUTCOMES: The primary outcome was gait measurement, and secondary outcomes included quality of life, patient satisfaction, pain assessed using any validated assessment tool and adverse events. TYPES OF STUDIES: The review included randomized controlled trials. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 16 databases without language and date limitations. METHODOLOGICAL QUALITY: Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments developed by the Joanna Briggs Institute (JBI). DATA EXTRACTION: Data were extracted from papers included in the review using the standardized data extraction tool developed by the JBI. DATA SYNTHESIS: Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Effect sizes expressed as risk ratio (for categorical data) and mean differences (MD) or standardized MD (for continuous data) and their 95% confidence intervals were calculated for analysis. Where statistical pooling was not possible, the findings have been presented in narrative form. RESULTS: Searching identified 2412 citations. After removal of duplicates, paper retrieval and critical appraisal, 25 studies were included in the review. The included trials were of medium-to-poor quality.Twenty-four trials compared the effectiveness of different types of surgeries. Meta-analysis revealed no difference in level of pain between distal chevron-type osteotomy and other surgical procedures (standard mean difference [SMD] 0.02, 95% confidence interval [CI] -0.24 to 0.28). One single trial reported that distal chevron osteotomy is more effective than Lindgren osteotomy in terms of walking speed (MD -0.24, 95% CI -0.43 to -0.05).One medium quality trial assessed the effectiveness of HV surgery compared to conservative or no treatment. This trial showed that surgery, specifically distal chevron osteotomy of the first metatarsal, is a more effective procedure for pain compared to conservative treatment (MD -15.00, 95% CI -22.79 to -7.21) and also no treatment in the first year (MD -18.00, 95% CI -25.62 to -10.38). CONCLUSION: The current systematic review showed that differences between various types of surgical procedures, specifically osteotomies of the first metatarsal on clinical outcomes, are minimal. There is evidence from one study, that surgery, specifically distal chevron osteotomy of the first metatarsal is a more effective procedure than conservative or no treatment in reducing pain in the first year following surgery. However, this systematic review has identified that there is a lack of high-quality studies comparing similar types of HV treatments that assess the same outcomes.

The personal active aging strategies of older adults in Europe: a systematic review of qualitative evidence.

BACKGROUND: There is a consensus that the aging population is beginning to impact on many facets of our life. They have more medical problems and the potential to "drain" the focus of the medical community, as well as national budgets with their accompanying medical bills. Personal strategies related to active aging will help us to better understand and identify how older adults in Europe prepare themselves for the natural process of aging and what are their personal approaches to active aging. OBJECTIVES: The objective of this review was to synthesize the best available evidence regarding the older adult's perspective on the personal strategies related to active aging among older adults in Europe. INCLUSION CRITERIA TYPES OF PARTICIPANTS: This review considered studies that included older adults (age over 55 years) who live in Europe. PHENOMENA OF INTEREST: This review considered studies that investigated older adults' perspectives on (any) personal strategies related to active aging. CONTEXT: Europe (considering "some similarity" in health care systems and retirement policies). TYPES OF STUDIES: This review considered any qualitative designs. SEARCH STRATEGY: A three-step search strategy was used to identify published and unpublished studies. The extensive search process was conducted in October 2014 and considered published and unpublished studies from the inception of databases until October 2014. Studies published in any language which had an abstract in English, Czech and Slovak languages were considered for inclusion in this review. METHODOLOGICAL QUALITY: Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION: Data were extracted from the papers included in the review by two independent reviewers using the standardized JBI-QARI data extraction tool. DATA SYNTHESIS: Data synthesis was performed using the meta-aggregation approach of meta-synthesis recommended by the Joanna Briggs Institute. RESULTS: Fourteen studies were included in this systematic review. From these 14 studies, 42 findings were extracted; findings were synthesized into four categories: (1) positive approach to life, (2) mental, social and physical activities, (3) adaptation, and (4) financial independence. Categories were synthesized into two synthesized findings: (1) if older adults adapt to changing situations and choose a positive attitude, they can find an active way to live and also a mission and meaning in their lives, (2) if older adults learn new activities, participate in exercise, keep balanced relationships and manage their financial resources, they will stay mentally, socially and physically active, and also financially responsible. CONCLUSIONS: If older Europeans learn new activities, participate in exercise, keep balanced relationships and manage their financial resources, they will stay mentally, socially and physically active, and also financially responsible.

The effectiveness of inpatient physical therapy compared to outpatient physical therapy in older adults after total hip replacement in the post-discharge period: a systematic review.

BACKGROUND: Total hip replacement is the most effective and safest method for treating severe degenerative, traumatic and other diseases of the hip joint. Total hip replacement can reliably relieve pain and improve function in the majority of patients for a period of 15 to 20 years or more postoperatively. Physical therapy follows each total hip replacement surgery. Physical therapy protocols after total hip replacement in the post-discharge period vary widely in terms of setting (inpatient, outpatient), content (the particular set of exercises used), and frequency (e.g. daily versus twice a week). In current literature, there is no systematic review which has compared the effectiveness of inpatient and outpatient physical therapy in patients after total hip replacement in the post-discharge period. OBJECTIVES: The objective of this systematic review was to compare the effectiveness of inpatient physical therapy with outpatient physical therapy on the quality of life and gait measures in older adults after total hip replacement in the post-discharge period. INCLUSION CRITERIA: This review considered studies that include older adults (over 65 years) who have had total hip replacement and are in the post-discharge period. Adults with bilateral or multiple simultaneous surgeries and also patients who have had hemiarthroplasty of the hip joint were excluded.This review considered studies that included any type of physical therapy delivered in inpatient settings provided by professionals with education in physical therapy. Inpatient physical therapy delivered at any frequency and over any duration was included.This review considered studies that included as a comparator any type of physical therapy delivered in outpatient settings provided by professionals with education in physical therapy or no physical therapy.This review considered studies that included the following primary and secondary outcomes. The primary outcome was quality of life, assessed by any validated assessment tool. The secondary outcome was measures of gait assessed by any valid methods.This review considered both experimental and observational study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies for inclusion. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 12 databases. Studies published in all languages and any date were considered for inclusion in this review. METHODOLOGICAL QUALITY: Assessment of methodological quality was not conducted as no studies were identified that met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS: Data extraction and synthesis was not performed because no studies were included in this systematic review. RESULTS: During to the three-step search strategy 4330 papers were identified. The primary and secondary reviewer independently retrieved 42 potentially relevant papers according to the inclusion criteria by title and abstract screening. Following assessment of full text all of the retrieved papers were excluded based on the inclusion criteria. CONCLUSIONS: There is no scientific evidence comparing the effectiveness of inpatient physical therapy with outpatient physical therapy in older patients after total hip replacement in the post-discharge period. IMPLICATIONS FOR RESEARCH: This systematic review has identified gaps in the literature for comparing the effectiveness of inpatient physical therapy with and outpatient physical therapy on the quality of life and gait measures in older adults after total hip replacement in the post-discharge period. Prospective randomized double blind multicenter controlled trials are needed to answer this important clinical question.