Background: Diabetes is a life-long chronic illness. Management is geared towards controlling the blood sugar levels in order to avoid acute and chronic complications. However, adherence to medical and non-pharmacologic interventions is one of the many pressing problems of patients with Diabetes Mellitus Type 2. Objectives: The study seeks to determine the effectiveness of designated treatment partners selected according to a doctor and a patient's preference in controlling the hemoglobin A lc levels (HbA lc) at values lesser than or equal to 6.5% among non-insulin treated diabetes patients. Design, Setting and Patients: The study is an open-labeled randomized controlled trial conducted from January to June 2009 at the Family Medicine Clinic of the Philippine General Hospital. A total of 60 target subjects with uncontrolled Hemoglobin A 1 c (HbA 1 c) were recruited and enrolled in this investigation. Intervention: The study subjects were randomized to two groups namely, treatment partners according to doctor's and patient's preference. These subjects were followed-up on the third and sixth month. Main Outcome Measure: The primary outcome measure was targeted towards controlling the HbAlc levels to values equal to or less than 6.5% with a 0.6% difference between treatment arms. Results and Discussion: The baseline sociodemographic and clinical characteristics were similar at the start of the study except for the duration of diabetes (P=0.04) and baseline systolic blood pressure (P=0.04). The mean scores for burden of illness, health perception, and perceived adherence factors were similar for both arms. The mean HbA lc scores for both groups were similar at baseline (8.41 v 7.89, P = 0.43). Results showed that the HbA lc levels of both groups were lower than the cut-off value of 6.5% after a six-month study period however, these differences were not statistically significant (p = 0.28) in between treatment groups. But using the general linear model to assess significance across the follow-up period, results of the study showed that the difference of HbA lc levels obtained after a six month follow-up compared to the baseline was statistically significant (P = 0.003). Majority of the chosen partners in both treatment arms are their spouses. It is postulated that marital adjustment and high levels of perceived intimacy could have facilitated a healthy adaptation to diabetes hence, achieving the target HbAlc levels across arms. Conclusion: Selection of designated treatment partners according to a doctor's preference is unlikely to be effective over treatment partners selected according to a patient's preference.
DIABETES MELLITUS ; TREATMENT

The Bereavement Support Program, as an annual event, sought to assist the individuals and families of the deceased patient in this difficult transition process.
DEATH

OBJECTIVE: As with every institution lay a cigarette smoker, in fact, most of them already desired of quitting the habit. Hence, identifying the factors associated with successful smoking cessation is of utmost importance and needed to be addressed. This study aimed to determine the prevalence of cigarette smokers among employees of BIHMI in Davao City, assess their willingness to quit, and identify the factors which could affect successful smoking cessation.
METHODS: This study was a descriptive cross-sectional study carried out among the employees of Brokenshire Integrated Health Ministries, Inc. in Davao City. Th authors compared 39 successful quitters wit 70 current smokers by conducting a research assisted question and answer using a semi-structured questionnaire. They examined the relationship of sociodemographic, behavioral characteristics, presence of comorbid medical conditions, and environmental factors to successful smoking cessation.
RESULTS: Religious belief, higher level of educational attainment. higher socioeconomic status (higher income), fewer number of cigarette sticks smoked per day, presence of comorbid medical condition, no concomitant alcohol use, and having a nonsmoking spouse or cohabitant have been identified as factors of successful smoking cessation.
CONCLUSION: This study suggests that the identified factors that affect successful smoking cessation among the employees be looked into, and appropriate strategies be carried out. Putting up a smoking cessation clinic can help not only the smoking population of the institution who desired of quitting the habit to attain long-lasting abstinence but ideally extending beyond the walls of the institution. As wellness advocates, it is our calling to address these factors.

Human ; Male ; Female ; Smoking ; Alcohol Drinking ; Alcohols ; Cross-sectional Studies ; Habits ; Motivation ; Philippines ; Prevalence ; Smoke ; Smoking Cessation ; Surveys And Questionnaires ; Tobacco Products

OBJECTIVE: Advanced cancer pain is associated with pain in two-thirds of patients impairing quality of life. Poor control is often attributed to poor assessment and classification. This study aimed to determine current pain assessment and management for solid tumors in a private tertiary hospital in Davao City.
METHODS: The study utilized a retrospective descriptive cross-sectional study wherein 298 charts with diagnoses of solid tumor were included.
RESULTS: Clinical outcomes of this study include that 28% and 32% died and did not improve due to these solid tumors. This data therefore reflect that 60% of these patients, when combined, may have have advanced diseases. Of these, 19% experienced moderate to severe pain either as a chief complaint or as part of the medical history and review of systems, while 78% have no record or evidence of pain assessment. Only nine percent received opioid therapy while 13%  were given non-opioids. Approximately six percent of these patients' pain responses were monitored or followed-up by medical service versus none of the nursery service after initiation of pharmacotherapy.
CONCLUSION: The present study showed a very big gap as far as pain assessment and management are concerned. These deficiencies may be attributed to non-adherence to the WHO guidelines for pain which includes inadequate pain assessment, recording, management and monitoring. Information dissemination regarding pain assessment and management is of paramount importance as to giving optimal pain management in cancer patients experiencing pain. 

Human ; Male ; Female ; Analgesia ; Quality Of Life ; Analgesics, Opioid ; Cancer Pain ; Cross-sectional Studies ; Death ; Neoplasms ; Pain ; Pain Management ; Pain Measurement ; Philippines ; Retrospective Studies

Safety culture is term used to determine the commitment, style and proficiency of an organization's health safety management. Medical errors increase morbidity, causes significant complications, increase hospital costs and prolongs hospital stays for the patient.
OBJECTIVE: The aim of this study was to determine the perceived incidence rate and the patient safety attitudes of health care professionals at the Davao Medical School Foundation Hospital (DMSFH)
METHODOLOGY: The study involved the health care professionals of DMSFH. The safety Attitudes Questionnaire (SAQ)was used and measured on a 5-point Likert scale for the following domains, Teamwork, Safety Climate, Job Satisfaction, Stress Recognition, Perceptions of Management, Working Conditions, Collaboration and Communication. The last part of the survey questionnaire determines the perceived incidence rate. It is composed of three items: accidents, near-misses and errors and were rated on a 6-point Likert scale.
RESULTS: Among the 145 respondents, 88.96% were nurses, 1.38% doctors and 9.66% pharmacists. The overall patient safety climate at the DMSFH was good with a mean rate of 3.5 ± 0.42. Perception of management has the lowest perceived rates with a mean of only 3.06 ±  0.21. In terms of mean perceived incident rates, errors had the highest mean rates of 3.27 ± 1.09. Overall, perceived incidence rates are negatively, albeit weakly, correlated with the DMSFH safety climate.
CONCLUSION: The perceived incidence rates are significantly affected by the patient safety measures that are practiced by the health care professionals.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Patients ; Attitude ; Hospital Costs ; Incidence ; Length Of Stay ; Medical Errors ; Nurses ; Organizational Culture ; Patient Safety ; Pharmacists ; Philippines ; Safety Management ; Schools, Medical ; Surveys And Questionnaires

Background: Colorectal cancer is highly preventable through early screening, but disparities in screening create a negative impact on the lives of those at risk. One approach to address this is patient navigation. This systematic review and meta-analysis therefore aimed to provide evidence of the effectiveness of patient navigation in increasing colorectal cancer screening uptake. Objectives: This study aimed to determine the effectiveness of patient navigation on colorectal cancer screening uptake. Specifically, it aimed to study the effects of different methods of navigation on the uptake of initial screening tests among persons with average risk. Methods: The studies included were randomized clinical trials conducted within 2011-2021 and involving only humans as participants. Data were analyzed by calculating the risk ratio and 95% confidence intervals of each successful outcome, and the investigators independently appraised each study’s risk of bias. Subgroup analysis was conducted to assess consistency of study effects. Certainty of evidence was assessed using the GRADE standard. Results: Eleven (11) studies were included in this systematic review and meta-analysis. All studies encompassed health systems of different countries, and they utilized different means of navigation to achieve outcome measure of colorectal cancer screening uptake. Results show a statistically significant increase in screening uptake with patient navigation in a forest plot. However, there is a high level of heterogeneity among the studies, hence a subgroup analysis was conducted among these studies according to navigation method. Conclusion This systematic review and meta-analysis show an increase in screening rates in those who were navigated. Results in favor of patient navigation was consistent when all studies were analyzed together and when they were analyzed according to navigation method. Increase in screening uptake is more statistically significant among patients navigated via face-to-face and via phone call, but data is more consistent for patient navigation via phone call alone.
Colorectal Neoplasms ; Patient Navigation

Background: Organ donation (OD) is the major component for transplant programs. The need for the transplants is high and the gap between organs available for transplantation and the number of patients waiting for a transplant is widening globally. Nurses can play a vital role in promoting organ donation process that may influence the decision-making of donors and their families Objective: This study sought to determine the knowledge and attitudes of nurses in Southern Philippines Medical Center on organ donation. Methodology: A descriptive survey design was used in this study. Sample size computation was done in Epi Info version 7.1.4.0. A modified Organ Donor Attitude Questionnaire based on the previous study by Bishop was utilized. Results: The mean score for question pertaining to knowledge of the 268 participants was 6.34 ± 1.99 out of total of 10 points. A total of 138/268 (51.49%) participants have scores above the average score accumulated by the participants of the study. The overall mean attitude of respondents towards organ donation was 3.25 which is interpreted as undecided. Conclusion Nurses do not have adequate knowledge and attitude towards their role in OD process. There is a need to increase the nurses’ level of knowledge by exposing them to nursing courses to improve knowledge and attitudes.
Knowledge ; Attitude ; Tissue and Organ Procurement ; Nurses

Background: The early stage of cancer can be asymptomatic. Thus, different strategies were utilized to increase breast screening attendance which resulted in better treatment outcomes. Therefore, this review aimed to provide evidence on the effectiveness of the different approaches of breast screening uptake in improving screening attendance. Objectives: The primary objective of this systematic review was to determine the effectiveness of the different approaches to breast screening uptake in improving screening attendance. The secondary objective was to identify the socio-geographic profile that affects the screening uptake. Methods: Online databases, such as PubMed and Cochrane Central Register of Controlled Trials, were searched for studies published between January 2010 to December 2020. This review only included comparative randomized clinical trials involving humans as the research participants. In addition, reference lists of included studies were reviewed to identify additional relevant papers. Results: The study included the review of 12 randomized controlled trials. Seven studies were conducted in a European setting, two in the United States of America, another two studies in Asia, and one study conducted in Canada. The intervention strategy to increase screening uptake were diverse in different studies. Ten of these studies used multiple strategies, while the remaining two studies utilized individualized strategies. Most of the studies were individual-based interventions. One study was a group-based intervention. The results showed that these interventions increase the uptake of breast cancer screening than no intervention at all. Conclusions The review confirmed that any interventions to increase breast screening uptake showed favorable outcomes in increasing breast screening attendance. However, the effectiveness of any one specific intervention cannot be made as these interventional studies greatly varied in terms of their intervention, study population, and geographical area.
Systematic Review

Background: Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China in December 2019. This has rapidly spread worldwide, causing a pandemic. The Philippines ranks 3rd in Southeast Asia with more than 15,000 confirmed cases, and a case fatality rate of 6.01%, close to the global average of 6.33%. Objective and Methods: This review aims to provide Family and Community Physicians the latest updates on epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment options, and prognosis of COVID-19. Online literature search was done with WHO and DOH websites prioritized for epidemiologic data, and MEDLINE for the most recent and relevant journal articles. Pathogenesis: SARS-CoV-2, the etiologic agent of COVID-19, is an enveloped, positive sense single-stranded RNA virus which triggers immune-mediated responses responsible for most of the clinical manifestations of the disease. Angiotensin Converting Enzyme 2 appears to play a critical role in viral entry and disease severity. Clinical Manifestations: There have been reports of asymptomatic cases. Majority have mild illness, with common symptoms of fever, cough, headache and fatigue. Those who progress to the critical stage of the disease present with Severe Acute Respiratory Syndrome, sepsis or Multiple Organ Dysfunction. Diagnostic Evaluation: The definitive diagnosis of SARS-CoV-2 requires an analysis of respiratory specimens collected through oropharyngeal and nasopharyngeal swabs. The reverse transcriptase-polymerase chain reaction (RT-PCR) is considered the confirmatory test. Serological rapid detection test (RDT) for SARS-CoV-2 IgM and IgG may be done, but as an adjunct only because antibodies appear later in the course of disease. Imaging studies and other tests are used to monitor the severity of the condition, but not for diagnosis. Treatment and Prognosis: Supportive therapy is the cornerstone of management. Currently, there is no FDA-approved drug or agent specifically for the treatment of COVID-19. Drugs being investigated for treatment are those that are currently used for other viral infections or indicated for other conditions. A vaccine is yet to be developed. Old age, the presence of comorbidities such as hypertension, diabetes, cardiovascular and lung diseases, and smoking history are risk factors that lead to severe complications and death. Conclusion COVID-19 has caused a global public health crisis. In the Philippines, cases are still on the rise. Majority of cases are mild. More severe and fatal disease is associated with old age and the presence of comorbidities. Definitive diagnosis is through RT-PCR. Supportive therapy is the cornerstone of management. The search continues for a proven, effective drug for treatment and vaccine for prevention of COVID-19.

BACKGROUND: Evidence-based medicine is the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients. Several studies have emphasized its value and how its practice can translate into tangible patient outcomes. However, despite its undeniable role in improving patient outcomes, various multinational studies have also shown that very few medical practitioners are aware of or practice evidence-based medicine.

OBJECTIVE: This study aimed to determine the level of perceived knowledge, attitude and practice of evidence-based medicine among resident physicians in various private  training institutions in Davao City.

METHODS: This study used a descriptive cross-sectional research approach. Resident physicians from various private training hospitals in Davao City were surveyed.

RESULTS: A total of 174 respondents were recruited, of which 124 agreed to participate and be included in the study. The over-all mean for the level of knowledge and skills was 4.70 (+/-0.32), for the attitude and practice of EBM were 5.28 (+/-0.59) and 4.98 (+/-0.27) respectively.

CONCLUSION: The results of this study demonstrated that the level of knowledge and skills on EBM among resident physicians in various training institutions in Davao City is higher as compared to those cited in the literature, although it is lower than the acceptable level set by the proponents based on best assumption. The level of attitude towards EBM is also lower and only the practice of EBM is above the set acceptable level.

Human ; Evidence-based Medicine ; Physicians ; Surveys And Questionnaires ; Perception