BACKGROUND: Dyspepsia is any chronic or recurrent discomfort in the epigastric area described as bloatedness, fullness, gnawing or burning continuously or intermittently for at least 2 weeks. About 40% of the adult population may suffer from dyspeptic symptoms but most of them are un-investigated because only about 2% consult their physician.
OBJECTIVE: The general objective of this clinical pathway is to improve outcomes of patients with dyspepsia in family and community practice
METHOD: The PAFP Clinical Pathways Group reviewed the previous Clinical Practice Guideline for the Treatment of Dyspepsia in Family Practice, a local guideline developed by the Family Medicine Research Group and adopted as policy statement by the Philippine Health Insurance Corporation. The reviewers then developed a time-related representation of recommendations on patient care processes, in terms of history and physical examination, laboratory tests, pharmacologic and non-pharmacologic interventions as well as social and community strategies to treat hypertension and prevent complications.
RECOMMENDATION: All patients with gastrointestinal pain or discomfort should have a detailed history focusing on weight loss, hematemesis, hemetochezia, melena, dysphagia, odynophagia, vomiting, NSAID intake, alcohol intake, smoking, frequent medical complaints, depression, anxiety, personal or family history of gastrointestinal disease using family genogram. Physical examination findings provide minimal information but should be done to rule out an organic pathology and to look for alarm clinical features like anemia, abdominal tenderness or mass, jaundice, melena etc. If the patient is with history of previous dyspepsia treatment, more than 45 years old or long-term use of NSAID, the physician may request for non-invasive H. pylori test. Upper abdominal ultrasound, liver function test, pancreatic amylase may be done if organic problem is considered. Start therapeutic trial of prokinetic treatment for 1-2 weeks or proton-pump inhibitor depending on the symptoms. Fixed drug combination may be used if symptoms are undifferentiated. The patient should be educated about upper gastrointestinal disorders and dyspepsia, risk factors and complications. If medications were prescribed, explain the dose, frequency, intended effect, possible side effects and importance of medication adherence. Lifestyle modifications focusing on low fat meals, weight reduction, avoidance of alcohol intake and smoking cessation, eating way before bedtime, elevated head while sleeping, etc. may also be done. Recommendations were also made on subsequent visits.
IMPLEMENTATION: Quality improvement strategy is recommended for implementation of this pathway. This will involve pre- and post-intervention data collection using records review. Intervention strategies may be feedback, group consensus or incentive mechanisms.

Human ; Dyspepsia ; Smoking ; Smoking Cessation ; Hematemesis ; Melena ; Weight Loss ; Deglutition Disorders ; Medication Adherence ; Gastrointestinal Diseases ; Helicobacter Pylori ; Hypertension

Human ; Male ; Middle Aged ; Abdominal Pain ; diagnosis ; Fibrosis ; Carcinoma, Hepatocellular

BACKGROUND: Millennials are the demographic cohort born from 1982-2004. They exhibit optimism, multi-tasking, techno-savy, but with constant need for structure. Medical trainees are no exception. As local studies on this concern have been trending, available data are lacking.
OBJECTIVE: This cross-sectional study describes the characteristics of millennial physicians as to attitudes towards their profession, approach to authority and rules, learning preferences, and healthcare practice.
METHODOLOGY: Focused group interviews and quantitative survey were conducted among 150 physicians, aged 25-34 years, at the University of Santo Tomas Hospital Manila.
RESULTS: Most respondents perceive medical profession as a noble way of contributing to society. However, they rarely consider it as a full-time vocation. Rather, they intend to pursue part-time entrepreneurial endeavors for economic reasons, or otherwise. Respect for authority based on values over professional accomplishments is a prominent finding. They prefer approachable and friendly mentors. They only comply with rules that they agree on, unless it is morally unacceptable. Furthermore, the millennial participants learn most effectively in a quiet environment, by listening and taking notes than reading and discussing with others. They attend medical lectures most of the time but when they don't, no remorse is associated. They learn most efficiently through repetition and demonstration. Practical skills are favored more than theoretical knowledge. All use medical apps for healthcare practice. Majority chooses digital over printed materials in seeking treatment information. However, in patient education, they do not prefer the use of text messages or social networking sites. They put more value in face-to-face teachings to families than sharing links for online health materials.
CONCLUSION: The qualities and preferences of millennial physicians provide insights and challenges for the medical faculty to better engage the future healthcare providers. Actions to address the emerging generational gaps are recommended to meet the demands of young physicians of today.

Human ; Male ; Female ; Adult ; Demography ; Faculty, Medical ; Learning ; Mentors ; Morals ; Occupations ; Optimism ; Philippines ; Physicians ; Social Networking ; Surveys And Questionnaires

BACKGROUND: In the recent years, there appeared to be a rise of herbal products in the market. Thus, it becomes imperative for health practitioners to become knowledgeable on this aspect of complementary medicine. However, data on familiarity with and actual utilization of the 10 DOH-endorsed herbal medicine plants by the health practitioners is lacking.
OBJECTIVE: This study was done in order to determine the knowledge and utilization of the 10 DOH-endorsed herbal medicinal plants among the resident physician trainees of the University of Santo Tomas Hospital (USTH).
METHODS: A total of 143 randomly selected trainees from different specialties and year levels were included in this study. A one-time interaction with the residents was done, during which, they were asked to answer a 5-page face to face survey questionnaire.
RESULTS: The study revealed that majority of the respondents is aware of the 10-DOH endorsed herbal medicinal plants. However, most of them perceive the use of herbal medicines to be only " a little effective". Prescribers are prompted mainly by its affordability. The residents can fairly identify the herbal medicinal plants and are adept with the indication for use of these plants. In spite of this, majority of the residents are not familiar with the proper preparation methods.
CONCLUSION: Overall, the respondents appear to be more aware with certain herbal medicinal plants such as ampalaya, bawang, lagundi and sambong but obviously lack familiarity with other plants including ulasimang bato, yerba buena and niyog-niyogan.

Human ; Male ; Female ; Herbal Medicine ; Plants, Medicinal ; Icodextrin ; Phytotherapy ; Glucans ; Glucose ; Complementary Therapies ; Surveys And Questionnaires

BACKGROUND: As part of their requirements for Family Medicine rotation, the postgraduate interns (PGIs) are required to construct and present a family case report. Each team of PGIs, led by a family medicine (FM) resident, identifies a family to be enrolled in the Family Health Care Program. Although this has been ongoing for years, no feedback mechanism has yet been established.
OBJECTIVE: The purpose of this study was to determine the learning experiences and insights of PGIs in constructing and presenting a family case report during their rotation in the Family and Community Medicine.
METHODS: A survey questionnaire, consisting of 10 items, was given to the respondents. The respondents took as much time as they needed to complete the survey.
RESULTS: Overall, the results revealed that the construction and presentation of Family Case Reports provided the PGIs an avenue to practice certain competencies required in primary care setting such as patient engagement, health promotion and family oriented care. Critical thinking skills as well as patient-doctor communication were enhanced during this activity. However, a good number of PGIs resounded their sense of inadequacy and uneasiness with the application and interpretation of family assessment tools. They perceived this to be a main hindrance in coming up with the best possible case report.
CONCLUSION: The family case report remains to be a unique and productive learning endeavor for PGIs assigned in the Department of Family Medicine.

Human ; Male ; Female ; Community Medicine ; Family Health ; Patient Participation ; Family Practice ; Physician-patient Relations ; Primary Health Care ; Health Promotion

Background and Objective: Palliative care is a human right. In the local setting, only a few data have been published regarding its practice among healthcare workers. This study aimed to determine the gaps and potential barriers in palliative care services among resident physicians. Methodology: A cross-sectional study design using a 27-item interview-based questionnaire was conducted from July to September 2019 among resident trainees in seven departments of four hospitals in Manila, Philippines. The data gathered were tallied using Microsoft Excel and analyzed using STATA Statistical Software with p-value of 0.05 as statistically significant. Results: A total of 200 physicians participated in the study. Majority of the respondents referred patients to palliative care services, primarily for symptom control and home care upon the diagnosis of a terminal illness. Sixty percent of respondents correctly identified patients eligible for hospice care. The 3 services rated as most important in palliative care were pain control, symptom control and psychological support. Most of the respondents perceived that palliative care is underutilized, and yet they felt that attending doctors know when referral to such is appropriate. The discrepancy is due to their lack of knowledge on the nature of its scope of care and eligibility criteria. The common barriers for referral to palliative care were “no time to refer secondary to rapid demise of the patient”, “difficulty in accurately predicting death”, and “lack of time to discuss issues of dying and hospice care”. These presumed barriers contradicted the respondents’ perceived practices in advance care planning, particularly on confirming the goals of treatment with the patient and family. Conclusion The prevailing illiteracy on palliative care that poorly translates to actualization is alarming as it deprives many patients of their right to a dignified and quality of life given their limited days. The inexcusable lack of awareness must be the impetus to a massive knowledge drive to impact clinical practice.
Hospices ; Physicians

Background: Spiritual struggle is a state of distress a person experiences when relationships with the sacred are fundamentally challenged or broken. Its presence has been associated with increased morbidity and mortality. During the COVID-19 pandemic, attempts to address the whole being of patients, including spiritual well-being, were explored to improve outcomes of care. Objective: The study determined the prevalence of spiritual struggle among COVID-19 related cases and assessed the effectiveness of a formulated spiritual regimen versus the standard pastoral care. Methods: This is a randomized, triple-blind, controlled trial. COVID-19 patients tagged as having religious struggle were randomized into two equal groups (chaplain-led spiritual intervention and self-driven standard pastoral care). The Religious Struggle Screening Scale (RSSS) was measured at baseline and 4 weeks after the intervention in both groups. Results: Prevalence of spiritual struggle among COVID-19 patients was 67%. Baseline patient demographics were similar for both groups. The overall RSSS slightly decreased throughout the 4-week duration for both groups. In addition, the six dimensions of the RSSS, namely: divine, demonic, interpersonal, moral, ultimate meaning and doubt were noted to have slightly improved. However, the differences in the two groups were not significant. Conclusion There is no difference in the effect on religious struggle of a formulated spiritual regimen and standard care given to COVID-19 patients.
COVID-19 ; Religion

BACKGROUND: Depression and anxiety are the most common mental disorders seen and managed in primary care. Both mental disorders have been increasingly prevalent worldwide. Filipinos are known for being family-centered and the family has been consistently a good ally in healthcare. A family- focused intervention is believed to be a good adjunct in the reduction of symptom severity of depression and anxiety.
Objective: This study aims to systematically analyze the effectiveness of family-focused interventions among patients with depression and anxiety.

METHODS: Studies were obtained from electronic search for literature (PubMed, Cochrane, HERDIN). Additional cross-referencing was done from the reference lists of included studies. Two independent reviewers assessed the methodological quality of included trials.

RESULTS: Two studies met the selection criteria and were included for meta-analysis. There was a total of 224 participants who were all clinically diagnosed with depression and anxiety. Compared with the standard care for depression and anxiety, family-focused intervention was found to be more effective (SMD=-1.20, z=6.92, p=0.001, 95% CI=-1.54 to -0.86). There was also no substantial heterogeneity (I2=13.80%) seen among the included studies (Q=1.16, p=0.281; ?2=0.01).

CONCLUSION: Family-focused intervention was shown to be effective in reducing the symptom severity of depression and anxiety.

RECOMMENDATION: The authors recommend future researchers to use more studies, both published and unpublished, on the utilization of family-focused interventions in the management of depression and anxiety. Applicability of the results in the Asian region, especially in the Philippines, should be explored. This review also suggests the option to provide different family-focused intervention techniques as an adjunct in the management of depression and anxiety in primary care.

Human ; Depression ; Anxiety

Introduction: Telemedicine services have steadily been relied upon since the onset of the COVID-19 pandemic. Understanding its usability and contextual performance is of paramount importance if it were to pervade the local health delivery system. Hence, a tool to assess usability is warranted. Objective: The study aims to adapt a reliable and validated instrument in English to Filipino, the Telehealth Usability Questionnaire (TUQ), on evaluating the usability of telemedicine services in the Philippines. Methodology: The research is a translation and validation study. The methodology includes forward translation in collaboration with our UST Sentro sa Salin at Araling Salin and expert panel review with five experts using the telehealth system. It was followed by pretesting (pilot testing and cognitive debriefing) of the pre-final tool to 30 family medicine telehealth patients and field testing of the final instrument to 85 telehealth patients from USTH. Appropriate statistical methods for assessment included internal consistency, content validity and linguistic with conceptual equivalence. Results: All translated items were retained, but through the focus group discussion, several statements were modified to fit the cultural context. Each item and the overall tool showed excellent validity and internal consistency. The mean difference scores for each item and domain were less than ±0.25. Tests of equivalence showed that majority of items and each domain were not statistically different (p>0.05), suggesting that both questionnaires are similar and homogenous. Furthermore, the Bland-Altman plots for each dimension/domain are within the upper and lower boundaries indicating agreement between the two versions. Conclusion TUQ-Filipino is a valid and appropriate instrument to assess telehealth usability in the local setting.
Telemedicine