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

The objectives if my presentation are: 1. To present a family which has been coping against Human Immunodeficiency Virus. 2. To identify and discuss the various Family Resiliency Factors which made this family respond positively in the midst of this catastrophic disease. 3. To discuss the family physician's role and intervention in a resilient family. 4. To formulate a family wellness plan.
Human ; ACQUIRED IMMUNODEFICIENCY SYNDROME ;

Conclusion: The many aspects of the diabetic foot make it an interesting and challenging concern not only for diabetologists but for all primary care physicians as well. The evaluation, diagnosis, and management of such infections are vital to the well-being of the diabetic patient. Optimal wound care techniques and appropriate technologies are imperative. Education, a multi-disciplinary approach and active participation of all stakeholders are essential elements in the prevention and successful management of this multifaceted disease.
DIABETES

Background: Inequalities in socioeconomic conditions and their effects on people's lives determine their risk of illness and the actions taken to prevent or treat illness when it occurs. Objective: This study aimed to determine effects of financial capacity on accessibility of health care. Methodology: Survey questionnaires were distributed at the FMC -OPD follow-up clinic. The study population included patients with chronic diseases. Descriptive statistics and Fisher's exact test were utilized for analysis. Results: Ninety-four respondents completed the questionnaires. Their mean age is 52, composed of 64.9% female and 34.1% male; two-thirds of them are married and live within NCR. They live with others, ranging 4-6 family members. Around 81 percent are unemployed; those with work are in the service industry. Almost 43% (40%) are with family income within Php2,000-5,000; around 20 percent earn either below Php2/000 or above Php5,000. Of the total income, 61 percent is allotted to food, non-food needs are about 20 percent, and health is about 9.5 percent. Among the socio-demographic characteristics, only family income showed significant association with the patient's decision to consult/ acquire medications and compliance with diagnostic work-up/ with P-values of 0.02, 0.02 and 0.05 respectively. For those with money on-hand concerns, 28.7% would not consult if they have Php 500, they would consult with certainty. Moreover, 53.2% would intermittently take their medications and 28.7 percent would borrow money just to be able to buy medicines. On the contrary, 54.3 percent would borrow money just to do the laboratory exams and 18.1 percent would not comply with all exams requested. Conclusion: Most of the respondents are non-earning and depend on their family's income for health support. To be able to consult, financial capacity threshold is Php201-300 but at >Php500, there is certainty to consult. More than half have poor compliance with medications, but also, would borrow money just to do diagnostic work-up. It seems that the respondents are more willing to spend and know the disease, rather than comply with treatment.
HEALTH CARE

Background: Pulmonary Tuberculosis has been a major health problem despite major efforts for its control. Quality assurance tools such as the clinical pathway may aid in promoting quality health care delivery to meet standards of care for PTB. Objectives: This study was conducted to determine the effectiveness of providing clinical pathway checklist for PTB in improving the appropriateness of care as compared to those without checklist and the issues with its use among residents at the Family Medicine Clinic of the Department of Family and Community Medicine at UP-PGH. Methodology: The Family Medicine Clinic was the setting of the study and the DFCM resident rotators for August-September, 2009 were the subjects. PTB cases seen during the 42 clinic days were randomized into groups with PTB clinical pathway checklist and without checklist. Chart audit was done based on the clinical pathway for PTB. The mean percentage scores served as a measure of the appropriateness of care. These were compared among the two groups based on the following parameters: clinical evaluation, assessment, health counseling, medications and monitoring and the overall appropriateness of care. A focus group discussion was done to identify issues with the use of the clinical pathway checklist. Results: The clinical pathway checklist significantly improved the appropriateness of care in the following parameters, clinical evaluation (86.40 versus 75.54) at P value 0.004; health counseling (71.98 versus 56.22) at P value 0.007; monitoring and follow-up (62.2 versus 37.98) at P value <0.01 and in the overall appropriateness of care (78.24 versus 71.05) at P value 0.0002. The parameters of care in terms of laboratory evaluation and diagnosis for both groups, and clinical evaluation in the group with clinical pathway checklist were able to meet the set standard of 80 percent. Issues identified with the use of PTB clinical pathway checklist were physician characteristics, clinician time commitment, applicability to setting and financial resources. Conclusion: The PTB clinical pathway checklist was effective in improving the appropriateness of care in all parameters and was significant in terms of clinical evaluation, laboratory evaluation, health counseling, monitoring and follow-up and the overall appropriateness of care. Issues identified with the use of clinical pathway should be considered prior to pathway development and implementation.
PULMONARY TUBERCULOSIS

Conclusion: The patient followed up in good spirits. CBG was being monitored daily. Adherence to diet as well as lifestyle modification (stopped his alcohol intake and lessened meat intake) was remarkable. Laboratory results especially blood sugar control reached and exceeded target levels. The patient's proteinuria was fiurther evaluated. Twenty-four hour urine collection showed protein spillage but renal function was good. The plan is for continuous monitoring of this parameter. The patient's insulin (premixed 70/30) dose from an initial dose of 20-10 was adjusted until a maximum of 40-24 then reduced gradually. His present dose is 8-4.
HYPERGLYCEMIC

Presented a patient with abdominal enlargement, thorough medical history and physical examination are imperative to establish a diagnosis.
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