OBJECTIVES: The study aimed to determine the biofilm microorganisms colonizing the indwelling urinary catheters, the antibiotic sensitivity pattern of the biofilm microorganisms isolated and the presence, if any, and the nature of the relationship of some clinical factors to the biofilm microorganism isolated and/or the antibiotic sensitivity pattern.

MATERIALS AND METHOD: Indwelling catheter tips of urology patients were collected and processed. Biofilm microorganisms were extracted from the catheters and subjected to culture studies. Analysis of its antibiotic resistance and sensitivity pattern was performed.

RESULTS: E. coli was the most common microorganism isolated in the biofilms of indwelling catheter. Imipenem and nitrofurantoin showed high sensitivity in all isolated biofilm microorganisms. The presence of co morbidity and the previous use of antibiotics were two factors found to be significantly associated with antibiotic sensitivity/resistance patterns.

CONCLUSION: In dealing with catheter related infections, one should consider local antibiotic sensitivity pattern of E. coli. Based on this study, nitrofurantoin or imipenem can be expected to be effective empiric treatment for catheter related urinary track infections.

Human ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Biofilms ; Escherichia coli ; Equipment and Supplies ; Catheters ; Urinary Catheters ; Catheters, Indwelling ; Drug Resistance, Microbial ; data collection ; Escherichia coli

OBJECTIVE: This study aimed to determine the knowledge, attitudes and beliefs of adult Filipino males consulting in the Philippine General Hospital on vasectomy, and the affect of marital status, length of marriage, number of children, level of education, economic status, religion and type of mass -media exposure on these attitude and beliefs.

MATERIALS AND METHODS: This is a descriptive cross-sectional study. A total of 1120 adult male patients were included in the study. Data were collected using a standardized, self-administered questionnaire. Percentages and means were calculated for all variables. Analysis was done using multiple regression models.

RESULTS: The mean age of the participants was 50.7 years (SD 16.5) and the mean number of children was 2.5 (SD 2.2). Of the whole sample, 363 (32.4%) have used or are currently using one from of contraception. Among the 518 (46.2%) of men who knew about vasectomy as a form of contraception, 451(87.1%) knew that vasectomy involves ligation of the vas deferens. Higher educational status, previous or current use of contraceptive and not being a Roman Catholic were shown to be statistically significantly associated with knowing about vasectomy as a form of contraception. Only knowledge about the safety of vasectomy was shown to influence men's willingness to undergo the procedure.

CONCLUSION: Improved awareness of the safety and reversibility of vasectomy may lead to increased acceptance of the procedure amongst Filipino men. Physicians play an important role in the dissemination of information about contraception, alongside the mass media, and should make efforts to ensure that adequate and accurate information is made available.

Human ; Male ; Vasectomy ; Psychology ; Contraception ; Sterilization, Reproductive ; Health Knowledge, Attitudes, Practice ; Attitude to Health ; Culture ; Information Dissemination ; Awareness ; Safety

OBJECTIVES: Malnutrition is common among cancer patients. The aim of this study was to determine the nutritional status of preoperative cancer patients upon admission at a tertiary hospital in the Philippines. It also aimed to identify common symptoms with adverse impact on nutrition and to correlate the nutritional status to the length of hospital stay and development of post-operative complications.

METHODS: A hospital-based prospective cohort study design was conducted among pre-operative adult cancer patients admitted from September to December 2010. Nutritional status assessment was done using the Scored Patient-Generated Subjective Global Assessment (PG-SGA) tool and correlation to their symptoms, length of hospital stay, and post-operative complications were determined using analysis of variance (ANOVA) and Chi-Square tests.

RESULT: A total of 103 patients were included for the study amongst whom prevalence of malnutrition was 83%. Symptoms that were significantly associated with severity of malnutrition were early satiety, lack of appetite and alteration in taste perception. Poor nutritional status was associated with increased mean length of hospital stay: 7.5, 14.1 and 15.1 days for well-nourished, moderately malnourished and severely malnourished, respectively (p=0.048).

CONCLUSION: Using the Scored PG-SGA tool, this study observed a correlation between severity of nutritional status and increased length of hospital stay among cancer patients. Presence of nutritional impact symptoms such as lack of appetite, early satiety, and alteration of taste perception correlated with the degree of malnutrition on admission.

RECOMMENDATIONS: Formal objective assessment of the nutritional status of cancer patients should be done. Addressing the symptoms of lack of appetite, early satiety, and alteration of taste perception should be prioritized to prevent deterioration in nutrition.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Nutritional Status ; Appetite ; Taste Perception ; Nutrition Assessment ; Hospitalization ; Postoperative Care ; Protein-energy Malnutrition ; Neoplasms

INTRODUCTION: The operating room (OR) is one of the most cost-intensive units of any health care facility. Hence, OR effeciency has become a priority of many institutions. Delays in the OR lead to poor cost effectiveness and cause frustration both to patients and to OR staff.
OBJECTIVES: This study aims to describe the efficiency of the Philippine General Hospital Department of Surgery elective non-cardiac surgery operating room services using established parameters and identify causes of delays.
METHODS: A cross-sectional survey was conducted of randomly selected elective cases from October 2011 to January 2012. A framework of elements in the OR process and timing milestones were defined. These times were recorded during the OR process. Mean and median observed times for these elements were calculated and compared with target times based on previous research. Causes of delay were recorded.
RESULTS: Once anesthesia was started, target times for most parameters were met in the majority of cases. Delays were most notable between patient entry to the OR complex and start of anesthesia, particularly for first cases. Only 3.9% of cases started at or before the scheduled time; 49.7% of cases started more than one hour late. 54.3% of late starts were caused by surgeons not being in the OR complex on time. Errors in estimating case duration were commonplace: more than one third of cases took more than an hour longer or shorter than estimated. While the mean delay in start for first cases was nearly one hour, the mean delay for second and third cases was nearly two hours.
CONCLUSION: The majority of cases start late. The most common cause of delay is the surgeon's tardiness. Considerable discrepancy between the predicted and actual case duration was also observed.

Human ; Operating Rooms ; Cost-benefit Analysis ; Frustration ; Anesthesiology ; Anesthesia ; Efficiency ; Surgeons ; Hospital Departments

Nosocomial infections significantly contribute to a patient’s morbidity and mortality, increasing healthcare costs. While previous research has assessed the effect of oral hygiene on the prevention of nosocomial infections and postoperative complications, few guidelines exist that offer evidence-based recommendations on pre- or peri-operative oral hygiene in the surgical setting. The Philippine Surgical Infection Society set out to develop a set of guidelines that provide evidencebased recommendations on oral hygiene for improving surgical outcomes for adoption in the Philippines. Six clinical questions defined the scope of the guidelines. A systematic review was performed to provide the evidence base to develop the recommendations. A consensus meeting participated by 15 representatives from 13 specialty surgical societies and societies concerned with infection control was conducted using the modified Delphi technique to finalize the set of recommendations. A consensus guideline with sixteen recommendations on the use of oral hygiene to improve surgical outcomes is presented for adoption and implementation.

OBJECTIVE: To describe the clinicopathologic profile, management, and outcomes of patients with esophagogastric junction (EGJ) adenocarcinoma in the local setting. METHODS: Data was obtained from patients who had curative surgery for EGJ adenocarcinoma from 2004–2013 in the Philippine General Hospital. We used student's T-tests, analysis of variance, chi-squared and Fisher’s exact tests for comparisons and Cohen’s kappa index for correlation. A P value of less than or equal to 0.05 was considered significant. RESULTS: We included 88 patients (81.2% male) with mean age of 55.2 years. Eight percent were clinical Siewert type I; 23.9% were type II; 15.9% were type III; and majority (52.3%) were unknown type. Surgical approach and resection differed across the Siewert types (P<0.000). Thoracoabdominal approach (72.7%) and distal esophagectomy with total gastrectomy (77.3%) were the most common procedures. Many had at least pathologic T3 (80.6%), N2 (54.5%), and stage III (68.2%) disease. Neoadjuvant and adjuvant chemotherapy was given in 1.2% (1/82) and 48.6% (18/37), respectively. In-hospital morbidity was 40%; mortality was 4.5%; 1-year disease-free survival rate was 69.4%; and overall survival rate was 76.5%. Correlation was fair between preoperative and pathologic Siewert type (P=0.003) and poor between clinical and pathologic stage (P=0.115). Patients with recurrence had higher pathologic lymph nodes (P=0.029) and more advanced stage (P=0.022). CONCLUSION EGJ adenocarcinomas were locally advanced and had poor outcomes. Surgery should be individualized and multimodality approach considered.

Objective. This study aimed to assess compliance with current best practice guidelines on the use of antibiotics in the Department of Surgery in the Philippine General Hospital and to determine the impact of the dissemination of an institution-based guideline on compliance and on patient outcomes. Methods. Two antibiotic use surveys were performed 4 weeks before and 4 weeks after the implementation and dissemination of the PGH Surgical Antibiotic Use Guidelines in the Department of Surgery. The medical records of eligible patients were reviewed regarding patient and case characteristics, details on the administration of antibiotics and the collection of specimen for culture studies. Data relating to the occurrence of surgical site infection within 30 days of the operation was extracted. Compliance with antibiotic use guidelines was assessed for each case. The compliance rates in the pre- and post-intervention periods were compared. Results. The study included a total of 477 patients, 213 in the pre-implementation and 264 in the post-implementation period. Compared with the pre-intervention period, rates of compliance with guidelines improved for all parameters in the post-implementation period except for correct dosing. The greatest improvement was seen in the selection of the recommended drug, and proper duration. There was modest improvement in the timing of the preoperative drug administration. There was poor compliance with recommendations for appropriate specimen collection for culture studies, with marked improvement in collection in the pediatric group post-intervention. Overall, the in-hospital SSI rate was reduced from 6.8% to 1.1%, while there was little change in the 30-day SSI rate, post-intervention. Conclusion. A simple intervention to raise awareness of institutional guidelines on antibiotic use in the surgical setting lead to a modest improvement on overall compliance, although rates of total compliance with all relevant guidance on antibiotic use, choice, dose, timing and duration remained low. The impact on surgical site infection rates based on such compliance was modest.
Anti-Bacterial Agents