BACKGROUND: Difficulty of sleeping is a predominant complaint among the elderly occurring in 12-25 percent of healthy seniors. Typical response of most physicians is to provide medications like benzodiazepines. Owing to the side effects of these drugs, alternatives to pharmacologic treatment such as music therapy abound. Music therapy is safe, affordable and may complement other non-pharmacologic interventions, yet there is paucity of evidence from controlled trials to support its efficacy.
OBJECTIVE: To determine the efficacy of music therapy in improving quality of sleep among elderly patients with primary insomnia as compared to 1) Zolpidem and 2) Sleep hygiene using the Pittsburgh Sleep Quality Index (PSQI).
METHODOLOGY: In a randomized controlled trial involving 78 male and female subjects aged 60-80 with primary insomnia seen at the Family Medicine Clinic, three interventions were employed: Treatment A (Music Therapy), Treatment B (Sleep Hygiene) and Treatment C (Zolpidem). To determine improvement in sleep quality, subjects answered the PSQI questionnaire at baseline and at 14 days after intervention. Comparison of the mean scores before and after intervention and the mean change in the Global PSQI and its sleep components was done to assess the efficacy of music therapy. An intention to treat analysis was done.
RESULTS: Of the 90 participants enrolled, 78 completed the treatment protocol (Sleep hygiene = 27, Zolpidem = 24 and Music therapy = 27). Twelve were lost to follow-up. Baseline characteristics showed no significant differences among the three interventions in terms of age, gender, marital status, education, concomitant illnesses and insomnia severity. After 14 days of intervention, significant improvement in sleep quality with regard to 4 important parameters (latency, duration, efficiency, overall sleep quality) was consistently found in all the three intervention groups (p <.05). A two week music therapy regimen increased sleep duration from 5.19 +/- 1.24 hours to 6.0 +/- 1.08 hours (p = .007). For all the three interventions, time to sleep onset significantly decreased from baseline (p = .000). Music therapy for two weeks significantly reduced the amount of sleep from 65.1 +/- 48.7 minutes to 32.7 +/- 12.9 minutes (p = .000). Overall subjective sleep quality rating improved across the three regimens (p < .05). For Music therapy, sleep quality rating improved from 1.48 +/- 0.72 to 0.71 +/- 0.46 post intervention (p = .000). Furthermore, music therapy is better than zolpidem in terms of subjective sleep quality (p = .017). Scores on the Global PSQI showed that there is no statistically significant difference between the Sleep hygiene and Zolpidem groups (p = .622), between the Sleep hygiene and Music therapy groups (p = .989) and between the Zolpidem and Music therapy groups (p = .540).
CONCLUSION: This controlled study conveys that music therapy is as efficacious as pharmacologic therapy and sleep hygiene in improving sleep quality. Instituting music therapy for 14 days improved sleep latency, duration, efficiency and overall sleep quality. It provided promising effect as a short term management alternative to primary insomnia. Its sustained effect has to be investigated.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Sleep Initiation And Maintenance Disorders ; Zolpidem ; Music Therapy ; Benzodiazepines ; Sleep Hygiene ; Sleep ; Pyridines

OBJECTIVE: To compare glucosamine sulfate with placebo in the management of osteoarthritis.
DESIGN: Therapeutic Controlled Trial-Single Blind.
SETTING: Out Patient Department of Quezon City General Hospital.
STUDY SUBJECTS: Patients aged 50 years old and above who satisfied the clinical criteria for idiopathic knee osteoarthritis.
INTERVENTIONS: Subjects were randomly assigned to receive either Glucosamine sulfate (Viartril-S) 500 mg/cap taken three times a day for four weeks or a piacebo taken three times also for four weeks upon admission to the study.
MEASUREMENTS: Thorough history taking was done giving particular attention on the knee pain plus the clinical criteria for idiopathic osteoarthritis of the knee. They were randomly assigned to receive either glucosamine sulfate 500 mg/cap or placebo. They were allowed to use their current analgesic for rescue analgesia and continue any form of alternative therapy currently being practiced. Scheduled follow-ups were done after 2 weeks and after 4 weeks from the start of the study period. Visual Analog Scale (VAS) was used to assess for global pain and Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index to assess for pain, stiffness and physical function during the study period. These were done on the first and second follow-up. Subject clinical progress was recorded on the same checklist or data collection forms based on the two scheduled follow-ups. Adverse events were also noted on each follow-up, though study subjects were instructed to have a check-up any day from the start of treatment for instances of occurrence of adverse reactions.
RESULTS: A total of 42 patients were screened for eligibility to the study. Six (14.28 percent) were excluded from the study, 4 (9.5 percent) did not fulfill the inclusion criteria and 2 (4.76 percent) declined to be included. From this, 36 (85.71 percent) subjects were enrolled in the study, 18 (50 percent) were placed in Group A (Glucosamine sulfate) and 18 (50 percent) were placed in Group B (Placebo). The prototype of the study subjects with knee osteoarthritis is belonging to age group 51-60 years (Group A = 72.2 percent; Group B = 83.3 percent). Both groups have 9 (50 percent) females and 9 (50 percent) males. Majority of the study subjects are overweight with a BM1 = 25-29.9 kg/m2, (Group A = 66.7 percent; Group B = 66.7 percent), with blue-collar jobs previously (Group A = 100 percent; Group B = 85.3 percent), presently unemployed or housewives (Group A = 77.8 percent; Group B = 66.7 percent) and reached high school (Group A = 88.9 percent; Group B = 50 percent). Most of the subjects in Group A have less than 1 year history of knee osteoarthritis, while in Group B, most of the subjects have history of knee osteoarthritis for 2 years. For both groups, 18 (100 percent) in Group A and 18 (100 percent) in Group B came for their scheduled follow-ups. A total of 36 participants completed the trial. After 4 weeks of the study period, subjects in Group A had a 40 percent decrease from the baseline on VAS scores in contrast to Group B which only has 17.15 percent decrease from the baseline score. The pain dimension on WOMAC in Group A had a decrease from baseline of 57.8 percent, while in Group B there was a decrease of only 12.41 percent from the baseline score. At 4 weeks after treatment, though not statistically significant, Group A had a greater decrease from its baseline stiffness and physical function scores (51 percent) and (58 percent), respectively than Group B (17.07 percent) and (8.4 percent), respectively. Both modes of treatment were well tolerated, with Group A having 22.2 percent occurrence of adverse effects and Group B having 27.8 percent. Adverse events experienced by the study subjects in Group A are cold, headache, constipation and diarrhea. While in Group B, two experienced colds and 1 developed abdominal pain. All adverse events for both groups occurred on the first day of treatment and lasted for only one day. No management was required for these adverse events because all were spontaneously resolved.
CONCLUSION: Despite the greater decrease of scores in VAS and WOMAC in group A, glucosamine sulfate use may not be cost-effective.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Osteoarthritis, Knee ; Glucosamine ; Constipation ; Analgesics ; Pain Management ; Knee Joint ; Abdominal Pain ; Headache ; Analgesia ; Diarrhea ; Overweight

OBJECTIVES: 1) To determine elderly patients' preference regarding home versus hospital as the site of treatment of their medical illnesses. 2) To formulate guidelines at the VMMC out patient department on home care.
DESIGN: Descriptive study (survey).
PARTICIPANTS: One hundred fifty elderly patients seen at the VMMC out patient department, 65-82 years of age, diagnosed with chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and pneumonia from September 2001 to July 2002.
INTERVENTION: Questionnaires consisting of a sequence of items were administered to the subjects seen at the out patient department, prompting participants to provide specific preference of care received in the home versus a hospital setting.
RESULTS: Of a total of 150 patients included in this study, 114 patients (76 percent) felt safer being treated in the hospital than at home. One hundred and twenty four patients (82.7 percent) reported that clinical recovery was faster in the hospital. One hundred patients (66.7 percent) believe that home treatment would consequently result in complications. One hundred and twenty four (82.7 percent) think that the promptness of an emergency response is delayed in the home.
CONCLUSION: This study shows that the elderly patients prefer the hospital rather than the home as the site of treatment of their medical illnesses.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Patient Preference ; Pulmonary Disease, Chronic Obstructive ; Pneumonia ; Home Care Services ; Heart Failure

Dialysis is one of the treatment options for ESRD. Several investigators have estimated that depression occurs in about 20 to 30 percent of dialysis patients. The treatment of End Stage Renal Disease (ESRD) successfully prolongs the survival of patients with kidney disease but requires that ESRD patients cope with frequent deleterious changes in their health and life situation and shortened survival. Several studies on coping up mechanisms of ESRD patients were collected and reviewed. Self-management of everyday life entailed achieving/maintaining "normalcy" in everyday roles and functioning. Meaning in life is an important motivator in the coping process. Understanding their own needs and accepting support from members of his family and health care community can help them have a quality life.

Human ; Male ; Middle Aged ; Depression ; Self Care ; Quality Of Life ; Adaptation, Psychological ; Depressive Disorder ; Motivation ; Kidney Diseases ; Kidney Failure, Chronic

In many instances, the differences between the two types of Diabetes may not always be easily perceived. What is seen in current practice is a combination of signs and symptoms that make diagnosis a bit more complex. This is an illustration of such. Clinical judgment alone may not be enough and laboratory findings will be extremely helpful. The clinician has to develop the skill in decision-making based on all the available data.

Human ; Female ; Adolescent ; Nutritional And Metabolic Diseases ; Glucose Metabolism Disorders ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetes Mellitus

This article discusses some methods by which the facilitator can evaluate effectiveness of small groups in promoting learning. The paper focuses on evaluation of the small group process using the sociogram and Bales' checklist. Additionally, it presents checklists for evaluating facilitation skills. Combination of the tools presented in this article and revision of the content of the checklists to make it more context-specific and attuned to the realities of your small group settings is suggested to maximize the evaluative potential of these tools.

Human ; Male ; Female ; Checklist ; Group Processes ; Learning ; Evaluation Studies As Topic

This clinical pathway is aimed at providing primary care physicians with a practical and evidence-based guide for evaluating signs and symptoms to diagnose Alzheimer's disease.
Human ; DEMENTIA ; CRITICAL PATHWAYS ; ALZHEIMER DISEASE

Sudden cardiac arrest is the leading cause of death in the world and early cardiopulmonary resuscitation (CPR) is the key to saving lives. The survival rate of all out-of-hospital cardiac arrest (OHCA) patients is poor and is estimated to be below 5% worldwide. The actual efficacy of out-of-hospital CPR in the Philippines is still unknown. In this pioneering OHCA CPR reporting, we hope to identify gaps in our emergency medical service (EMS) system as well as to modify and optimize management strategies. Methods: A descriptive study in Manila during the year 2010-2011 by the EMS of Manila Doctors Hospital was done on adult patients who experienced a sudden OHCA. Patient variables, cardiac arrest variables, such as etiology, initial rhythm, and outcome variables, such as immediate return of spontaneous circulation (ROSC) and short-term survival rate after the out-of-hospital CPR were studied. End-points of the study were death or survival to discharge from the hospital. Results: Cardiac etiology was seen in 78.94% of the cases. The initial rhythm upon cardiac arrest was classified as ventricular fibrillation (VF) in 15.79%, pulseless ventricular tachycardia (VT) in 10.53%, pulseless electrical activity (PEA) in 26.31%, or asystole in 47.37% of cases. Return of spontaneous circulation was achieved at 36.84%. The male gender correlated with a higher survival rate of 66.67%. A lethal outcome following OHCA was observed on the field in 63.16% of patients and during the hospital stay in 57.14%. Discussion: Results rendered were not significantly different from neighboring countries. The factors influencing the outcome of out-of-hospital CPR are cardiac etiology of arrest, VT/VF as the initial rhythm of arrest and male sex. The establishment of national OHCA database would significantly improve the quality of medical management.
Human ; EMERGENCY MEDICINE ; HEART ARREST ; CARDIOPULMONARY RESUSCITATION

Background: The journal in its many years of publication has seen changes in its cover design, themes, authorship, and major discussion points. A review can tell us about its focus, and many other factors which make it relevant and able to deliver the needs of its readers. Objective: To determine the contents of the Filipino Family Physician journal involving seven publication years and analyzed them on certain parameters which concern the editorial board and the writers/readers. Method: Content analysis using twenty issues, encompassing seven publication years of the journal was done based on the following parameters: authorship, number of authors, research design, statistics employed, total number of pages, number of references or citations, institutional affiliation, themes or issues addressed, tools and instruments used. Issues analyzed: 2005/2006, 2007, 2008, 2010, 2009-2011. But for 2005, 2006 and 2009, 2011; only 2 issues per publication year were analyzed. Results: No. of pages = 824 for 116 articles contained in 20 issues (4 issues/year), 7.1 pages per article with an average of 23.2 articles published per year or 5.8 articles per issue of the journal. There were 177 authors who wrote for the journal in 20 issues, averaging 35.4 authors who wrote per year's issues. Fifty percent of the authors were residents, 23% mixed, and 15% by consultants. Sixty percent by single authorship and 17% by 3 or more. Sixty percent used descriptive design (cross-sectional, case-control, cohort) and 10% each were case reports and randomized controlled studies. Eighty-six percent used foreign citations with 96% non-Asian sources and only 14% citied Philippine authors. Forty six percent of all the articles were written from university-based health institutions, and 21% by non-training institutions or local chapters. On themes - 15% were on non-communicable diseases of which 10% were on diabetes mellitus and hypertension, 13% each were on behavioral medicine & counseling, and medical education and bioethics. Least written were on nutrition, pharmacoadherence, medical informatics, and economics. Conclusion: Most of the articles published were of single authorship commonly written by a resident/fellow, sometimes with a consultant co-author, usually using the descriptive design, and standardized instruments with good statistical tools or packages commonly citing foreign authors. The articles written were as varied and wide as the fields of interest in Family and Community Medicine and general practice. Subject matter usually about non-communicable diseases like diabetes mellitus and hypertension and behavioral medicine. The authors usually come from training institutions or university-based health facilities.
RESEARCH DESIGN ; JOURNAL ARTICLE ;

To engage and empower the community (Barangay 727, San Andres, Malate, Manila) through a Comprehensive Community Health Program called "Sama-sama sa Malusog na Barangay" (United for a Healthy Community), aimed at capacity building in community health delivery and planning.
Human ; CAPACITY BUILDING ; COMMUNITY HEALTH SERVICES ; DELIVERY OF HEALTH CARE