Background Around 10% of adults suffer from clinically significant breathlessness. High quality and actionable patient education materials (PEMs) and patient decision aids (PDAs) have an important role for shared decision making and patient self-management. Objective To systematically assess the effectiveness of patient education materials (PEMs) and patient decision aids (PDAs) on clinical outcomes. Secondly, to assess the quality of PEMs and PDAs for breathlessness that are accessible online. Methods A systematic review of PEM or PDA intervention for breathlessness published between 1 January 2010 and November 2020 was conducted. An environmental scan and quality assessment of publicly available PEMs and PDAs was also conducted. Results Out of 2985 records, five studies were eligible for inclusion in this systematic review. Results of two randomised controlled trials suggest potential effectiveness of PEMs to improve patient reported outcomes and reduce healthcare utilization. In the environmental scan, 88 materials were included. Minimum reading age for most was high (Grade 10) and PEMs scored an average of 87% for understandability and 67% for actionability. Based on the DISCERN tool only 10 were classified as high quality. Conclusion There is a paucity of evidence on the effectiveness of PEMs and PDAs for improvement in breathlessness. There is a need to develop higher quality PEMs for breathlessness.
Background Previous reports on the prevalence of chronic kidney disease (CKD) in Asia have suggested important sex disparities but have been inconsistent in nature. We sought to synthesise available sex-disaggregated CKD prevalence data in Asia to quantify sex disparities in the region. Methods We systematically searched MEDLINE and EMBASE for observational studies involving ≥500 adults that reported sex-disaggregated CKD prevalence data in any of the 26 countries in East, Southeast, or South Asia. For each study, we calculated the female:male prevalence ratio (PR), with a ratio >1 indicating a higher female prevalence. For each country, log-transformed PRs were pooled using random effects meta-analysis. These were then combined using a fixed effect model, weighting by population size, to estimate a pooled PR for each of East, Southeast, and South Asia, and Asia overall. Results Sex-disaggregated data were available from 171 cohorts, spanning 15 countries, and comprising 2,550,169 females and 2,595,299 males. Most studies (75.4%) came from East Asia (China, Taiwan, Japan, and South Korea). Across Asia, CKD prevalence was higher in females (pooled prevalence 13.0% [95% CI 11.3-14.9%]) compared with males (pooled prevalence 12.1% [10.3-14.1%]), with a pooled PR of 1.07 (0.99-1.17). Substantial heterogeneity was observed between countries. The pooled PRs for East, Southeast, and South Asia were 1.11 (1.02-1.21), 1.09 (0.88-1.36,) and 1.03 (0.87-1.22), respectively. Conclusions Current evidence suggests considerable between-country and -region heterogeneity in the female:male PR of CKD. However, there remains a large part of the region where data on sex-specific CKD prevalence are absent or limited. Country-level assessment of the differential burden of CKD in females and males is needed to define locally relevant policies that address the needs of both sexes.
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