Clinical practice guidelines for the diagnosis and management of Dyspnea in primary care and outpatient setting

Background@#Dyspnea also referred to as shortness of breath or breathlessness is defined as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Dyspnea is a symptom of the disease, rather than a disease itself. Its etiology can be designated as arising from four primary categories: respiratory, cardiac, neuromuscular, psychogenic, systemic illness, or a combination of these.@*Objective@#The general objective in developing this guideline is to improve the quality and outcomes of care to adult patients with dyspnea or shortness of breath in primary care and outpatient setting.@*Methods@#The ADAPTE process was utilized in the development of the initial guideline recommendations where the following steps were followed: 1) definition of clinical questions, 2) searching, screening and appraisal of guidelines, 3) decision and selection of evidence and 4) iterative drafting of guideline recommendation was done. The retrieved guidelines were systematically evaluated for their quality and validity using the Appraisal of Guidelines for Research & Evaluation (AGREE) II Instrument, which is a tool developed to assess the methodological quality of practice guidelines. If the adopted guideline did not have recommendations for our clinical question, we developed the recommendations de novo using the GRADE approach. We prioritized retrieving systematic reviews and meta-analysis articles that are relevant to our clinical questions. In the development of recommendations, the guideline development team prioritized the interventions that address the following outcomes i.e., decrease in severity of dyspnea, resolution of dyspnea, improved quality of life and decrease mortality. Data from the articles were extracted and the evidence was then summarized and appraised based on the type of study. The recommendations were then developed by the team as the initial draft that was subjected to external review and consensus panel discussion for finalization.

Correlation on the level of adherence to self-care activities and blood glucose control of adult patients with type 2 diabetes mellitus seen in the Outpatient Department of a tertiary hospital in Baguio City – A cross-sectional study

Introduction@#Type 2 Diabetes Mellitus (T2DM) remains one of the leading causes of mortality in the Philippines. Studies have reported that good adherence to self-care activities significantly aid in glycemic control. However, previous studies revealed a low adherence to diabetes self-care activities. Moreover, only few studies were done in the local setting assessing the level of adherence to self-care activities and correlating the two; hence, the immense need for the assessment of level of adherence to self-care activities among patients with T2DM.@*Objective@#This study aims to determine the level of adherence to self-care activities and correlate it with the glycemic control among T2DM patients seen in the outpatient department in a tertiary hospital in Baguio City.@*Methods@#This cross-sectional study was done using a survey questionnaire adapted from the Summary Diabetes Self-Care Activities Questionnaire version 2000. Glycemic control was determined using the latest valid HbA1c results. One hundred adult diabetic patients were included in the study. Participants were selected in the Family Medicine and Internal Medicine OPD Clinics through systematic random sampling method. Data collected were analyzed using descriptive and inferential statistics.@*Results@#Results revealed that majority of the sample population had undesirable self-care activity (69%), and poor glycemic control (69%). Statistical analysis revealed that proper adherence to either exercise (0.003) or compliance to medications (0.012) both have a significant relationship with glycemic control. Overall score (0.003) on one hand revealed a highly significant relationship with glycemic control.@*Conclusion@#Incorporating the different self-care activities namely diet, exercise, blood sugar testing, foot care, smoking cessation, and compliance to medication all together has a significant relationship with glycemic control among diabetic patients. Clinicians must emphasize proper adherence to self-care activities because of the high number of patients with undesirable self-care activities.