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.

The effect of mHealth on vaccine uptake, coverage, and acceptance among children, adolescents and adults: A meta-analysis

Background@#This meta-analysis was conducted to synthesize the evidence on the effectiveness of mhealth for vaccination uptake, coverage, and acceptance among children, adolescents, and adults.@*Methods@#Database search was conducted in PubMed, Medline, and Cochrane Library. Studies were included if the following were met: 1) RCTs or CCTs, and 2) with comparison of mHealth on usual care. Studies were excluded if mHealth was not assessed and the data were insufficient to calculate pooled results. The effectiveness was evaluated using Odds ratio with 95% confidence interval in RevMan 5.3.@*Results@#A total of 17 studies were included in the analysis. The pooled analysis showed that mHealth can improve vaccine uptake (OR 1.83, p=0.0005), coverage (OR 1.49, p=0.03), up-to-date vaccination (OR 2.37, p=0.0007), and completion of full vaccine series (OR 1.81, p=0.0002). Subgroup analyses showed that vaccine uptake is significantly improved when text messaging is used as a reminder system (OR 1.73, p<0.001) and when mHealth is employed for children’s vaccines (OR of 2.77, p=0.007). Majority of the pooled studies showed significant heterogeneity. Statistical synthesis on vaccine acceptance was not feasible, but existing studies report positive effects of mHealth on this outcome.@*Conclusion@#mHealth can improve vaccine uptake, coverage, up-to-date vaccination, and completion of the full vaccine series. Additional unpublished and rigorous studies may be considered in a future research to fully assess its effectiveness.