BACKGROUND: Diabetes mellitus is becoming prevalent in developing countries like the Philippines. Mass screening is not recommended and is not cost effective. Targeted screening is a more practical way to detect people with disease.
Overseas employment is one of the most common occupations in the country. Primary medical examination is done in pre-employment clinics with routine panel of diagnostics, urinalysis included. Fasting blood sugar(FBS) and oral glucose tolerance test (OGTT) are not part of the panel of pre-employment medical examination for overseas Filipino workers (OFW). They are mostly done when they are referred to endocrinology or diabetes clinics when suspicion arises or glucosuria is noted on urinalysis. However, there are patients who consulted endocrinology clinics but deny any symptoms of diabetes.                                                                                                                                                                
OBJECTIVE: The objective of this study is to determine the prevalence of diabetes among OFW by employing FBS and OGTT among those who had urinalysis and referred to endocrinology clinic.
RESULTS: Among the 192 OFWs with glucosuria, doing FBS detected 21 percent, 51 percent and 28 percent with diabetes mellitus (DM), impaired fasting glucose (IFG) and normal fasting glucose respectively. By doing OGTT among the OFW with normal FBS, 46 percent were reclassified as diabetic or have impaired glucose tolerance (IGT). OGTT among those with IFG also detected 71 percent with diabetes or IGT. Overall the patients with glucosuria have a DM prevalence that is more than ten times that of the general population done by the National Nutrition and Health Survey in 2003.
Among the 149 OFWs without glucosuria, FBS detected 36 percent, 54 percent, and 10 percent with DM, IFG and normal fasting sugar respectively. OGTT among those with normal FBS detected 67 percent of them to have diabetes or prediabetes. Doing the same among those with IFG reclassified 60 percent to have DM or IGT. Similarly the prevalence of DM is about ten times of the national survey.
CONCLUSION: Among OFW with or without glucosuria referred for suspicion of diabetes FBS confirmed many to have diabetes and pre-diabetes. This prevalence is doubled by employing OGTT as part of the screening test.

Human ; Male ; Female ; Middle Aged ; Adult ; Diabetes Mellitus ; Asymptomatic Diseases ; Blood Glucose ; Endocrinology ; Glucose Intolerance ; Glucose Tolerance Test ; Glycosuria ; Philippines ; Urinalysis

Among the serious complications associated with radioiodine therapy (RAI) for thyroid cancer, cerebral edema is uncommon and has been reported previously in cases of swelling of brain metastases. This case is of a patient with papillary thyroid carcinoma who complained of nausea and vomiting after RAI and was then found unconscious the next day. Laboratory results showed electrolyte imbalances including hyponatremia and cranial imaging only revealed cerebral edema, and she regained consciousness after sodium correction. The etiology of the cerebral edema here is likely multifactorial - due to hyponatremia from hypothyroidism, aggravated by vomiting, copious water intake and a low sodium diet.

Human ; Female ; Adult ; Brain ; Brain Edema ; Carcinoma ; Consciousness ; Diet, Sodium-restricted ; Electrolytes ; Hyponatremia ; Hypothyroidism ; Iodine Radioisotopes ; Nausea ; Sodium ; Thyroid Neoplasms ; Vomiting

Introduction: The Hearing for Life (HeLe) is a novel newborn hearing screening device initially designed according to specifications of clinicians of the Philippine National Ear Institute (PNEI). Unfortunately, targeted end-users, rural health workers, had difficulty using it. This research applied the user-centered design (UCD) methodology involving rural health workers in recommending design, content, and function requirements for HeLe. Objectives: This study aims to 1) describe how UCD was applied in a time-limited and resource-constrained environment, 2) assess the usability of the design prototypes, and 3) recommend design, content, and function requirements for HeLe. Methods: This research is a descriptive study using mixed methods. Six rural health units (RHU) involved in the HeLe research program were purposively selected for the study. There were 30 participants included, five health care workers per RHU. Applying the UCD method, the study had three phases: 1) user profiling (where participants accomplished a survey questionnaire, 2) inspiration phase (focus group discussions, workflow analysis, and interviews with a technical expert were conducted), and 3) ideation phase (designing and assessment of prototypes were done). Results: Participatory methods and structured procedures (i.e., card sorting, MoSCoW matrix prototyping, etc.) were applied to help determine and prioritize user requirements and elicit user feedback. These methods were chosen considering the time and resource constraints in the RHU. The prototype's System Usability Scale (SUS) score (81.94) was higher than the SUS score previously obtained (68) from the older version of the interface. Accuracy, durability, in-app instructions, feedback, and an easily understood interface were the most requested requirements for the telemedicine device. The need for the technology to be aligned with the RHU's workflow and available resources was highlighted in the focus group discussions. Conclusions The study documents practices and lessons learned in applying UCD methodology in design and development that have been demonstrated to improve usability of the device. The involvement of the users surfaced in the design, content, and functional requirements which can guide future iterations of HeLe and contribute to better understanding of ways to develop user-friendly telemedicine devices in the Philippines. This paper emphasizes that users should be involved in the entire process and not just recipients of the technology.
User-Centered Design ; Digital Technology ; Telemedicine

BACKGROUND: Medication errors are preventable events that can cause or lead to inappropriate drug use. Knowing the prevalence and types of errors can help us institute corrective measures and avoid adverse drug events.
OBJECTIVE: This study determined the prevalence of medication errors and its specific types in the four main service wards of a tertiary government training medical center.
METHODS: This is a retrospective, descriptive chart review study. From the master list of admissions, systematic sampling was done to retrieve the required number of charts. Relevant pages such as order sheets, nurses' notes, therapeutic sheets were photographed. For prolonged admissions, only the first 7 days were reviewed. Each chart was evaluated by two people who then met and agreed on the errors identified.
RESULTS: The overall prevalence of medication errors is 97.8%. Pediatrics had the most (63.3/chart), followed by Medicine, OB-Gynecology, and Surgery (7.3/chart). The most common type of errors identified were prescribing, followed by compliance, then administration errors.
CONCLUSION: Medication errors are present in the four main wards in our hospital. We recommend orientation of all incoming first year residents on proper ordering and prescribing of drugs, as well as a prospective observational study to determine true prevalence of all types of medication errors.

Medication Errors

OBJECTIVES

This quality improvement study aimed to explore the viability of a learning pedagogy for medical students, the interactive journal club (IJC), in stimulating active learning and engagement among learners. The study intends to explore the benefits provided by the IJC when compared to traditional learning methods (e.g., traditional journal clubs). It attempts to highlight the importance of didactics which focus on active learning and interactive engagement between learners.

METHODS

The IJC was implemented as a course requirement in HI 201: Health Informatics, a midyear elective course at the College of Medicine, University of the Philippines Manila. A class of MD-PhD (Molecular Medicine) students was divided into two separate groups: the designated leaders who presented the article and moderated the discussion, and the audience who did not read the article beforehand yet were involved in its critical analysis. The IJC was conducted twice in two different sections of MD-PhD (Molecular Medicine) students, across two different midyear terms, Midyear Term 2021, and Midyear Term 2022. Reflection papers were collected and the responses through this requirement were collated before the primary takeaways were extrapolated. A survey was also sent out to the students of each class to itemize the consolidated feedback of students on the proposed didactic.

RESULTS

The overall process of IJC was deemed both exciting and stimulating. The learning pedagogy provided an alternative platform for active learning, fostering a student-centered approach that placed a heavy emphasis on critical thinking. One major challenge identified in the implementation of the educational design was the heavy reliance on student participation which was identified to, at times, be a difficult factor to overcome. In order to improve its implementation, expectations may be set at the beginning and assessed at the end of the session. In addition, a pre- and post-questionnaire may be given to assess the perceived usefulness of this new method for qualitative comparison.

CONCLUSION

Interactive and student-centered modes of learning are empirical for the improvement of literature appraisal, journal presentation, and evidence-based critical thinking among medical students. IJCs may be utilized as an alternative and effective learning strategy in teaching pertinent skills expected of a proper physician. When compared to traditional pedagogies, IJCs provide a platform for deeper learning and enable the achievement of learning outcomes, with learner engagement as the focal point. Future attempts at executing IJCs may consider the implementation of learning outcomes setting, and the use of pre- and post-IJC surveys to assess the effectiveness of the modality.

Education ; Active Learning ; Critical Thinking