In Evidence-based Family Practice, requesting a diagnostic test should be based on two issues. First is whether the test is accurate and thus will significantly help in clinical decision making. Second is whether the test is appropriate and acceptable for the patient. This involves careful discussion of risks and benefits based on the physician’s knowledge and experience and the patient’s values and preferences.
Diagnostic Tests, Routine

Systematic reviews and meta-analysis combine results and analysis of data from different primary studies (e.g. cross-sectional studies, case-control studies, cohort studies) conducted on similar or related research topics. They are secondary studies that guide clinical decision-making, delivery of care and policy development. This article aims to discuss how to conduct a systematic review and meta-analysis. The steps in conducting a systematic review and meta-analysis include: 1) Identify the purpose including formulating the research question and validating the purpose of the literature scan, 2) Formulate the objectives, 3) Literature search including selection of studies based on population, intervention, comparison and outcome, 4) Retrieval of full text articles, 5) Critical appraisal of articles, 6) Data extraction, 7) Data analysis and 8) Writing the final report. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is a useful guide in conducting and write systematic review and meta-analysis. While ethics approval is not usually required for systematic review and meta-analysis, authors of such study should still observe good practices including avoiding plagiarism, maintaining transparency and ensuring data accuracy.

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.
Outpatients ; Dyspnea ; Primary Health Care