1.Name of epilepsy, does it matter?
Kheng Seang Lim ; Shi Chuo Li ; Josephine Casanova-Gutierrez ; Chong Tin Tan
Neurology Asia 2012;17(2):87-91
Names of epilepsy may refl ect misconception and contribute to stigma in epilepsy. Epilepsy in Chinese (dian xian, madness; yang dian feng, goat madness) is associated with insanity and animals. Because of the infl uence of Traditional Chinese Medicine, the names of epilepsy in certain East and Southeast Asian languages also convey the image of insanity and associated with animals. In the case of Malay who are mainly Muslim, it is also religiously unclean (gila babi, mad pig disease), contributing to stigma of the epilepsy patients. Of the East and South East Asian languages, epilepsy in Chinese, Japanese, Korean, Malay, Lao, Thai, Burmese, and Khmer (Cambodia) has the connotation of madness. The names of epilepsy have been replaced by a neutral terminology in Malay in Malaysia, and recently also for Chinese in Hong Kong, and Korean in South Korea.
2.Clinical report: a case of Williams Syndrome and Klinefelter Syndrome.
Le Ye LEE ; Swee Chye QUEK ; Samuel S CHONG ; Arnold S C TAN ; Josephine M S LUM ; Denise Li-Meng GOH
Annals of the Academy of Medicine, Singapore 2006;35(12):901-904
INTRODUCTIONWilliams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. Many patients are identified through the presence of dysmorphic features and associated cardiac abnormalities. Klinefelter syndrome (KS) is associated with gynaecomastia, small testes, azoospermia and elevated gonadotropin levels. They are recognised in the second decade of life by their tall stature and delay in pubertal development. A combination of constitutive WS and KS has yet to be described.
CLINICAL PICTUREWe report a child with these genetic aberrations, highlighting the clinical characteristics of such an individual.
CONCLUSIONThe manifestations and interactions of both conditions are also discussed.
Body Height ; Body Weight ; Child, Preschool ; Comorbidity ; Humans ; In Situ Hybridization, Fluorescence ; Klinefelter Syndrome ; diagnosis ; epidemiology ; Male ; Williams Syndrome ; diagnosis ; epidemiology
3.Ultrasonography-guided ilioinguinal-iliohypogastric nerve block for inguinal herniotomies in ex-premature neonates.
Shuying LEE ; Josephine Swee Kim TAN
Singapore medical journal 2013;54(11):e218-20
The ilioinguinal-iliohypogastric (IG-IH) nerve block provides effective opioid-sparing analgesia for inguinal surgeries. The technique is especially useful in apnoea-prone premature neonates with sacral anomalies and coagulopathy. A recent retrospective review of 82 ex-premature neonates who underwent inguinal herniotomy at KK Women's and Children's Hospital, Singapore, reported a success rate of 89% for landmark-guided IG-IH blocks. All blocks in that study were performed by senior paediatric anaesthetists using the landmark-based technique, which relies on fascial clicks. The IG-IH block is expected to be technically more difficult in neonates. There is also a stronger need to ensure success in these patients in order to avoid the use of opioids and reduce the risk of postoperative apnoea. Ultrasonographic guidance has been reported to improve the success of IG-IH blocks in older children to up to 94%. Herein, we report a series of six ex-premature neonates in whom ultrasonography-guided IG-IH blocks were successfully performed using reduced volumes of local anaesthetics (mean volume 0.17 mL/kg) for inguinal herniotomy.
Cohort Studies
;
Female
;
Follow-Up Studies
;
Hernia, Inguinal
;
congenital
;
diagnostic imaging
;
surgery
;
Herniorrhaphy
;
methods
;
Humans
;
Hypogastric Plexus
;
surgery
;
Infant, Extremely Premature
;
Infant, Newborn
;
Male
;
Nerve Block
;
methods
;
Retrospective Studies
;
Risk Assessment
;
Singapore
;
Treatment Outcome
;
Ultrasonography, Doppler, Color
;
Ultrasonography, Interventional
;
methods
4.Clinical outcomes and hospital length of stay in 2,756 elderly patients with hip fractures: a comparison of surgical and non-surgical management.
Stephen Thong Soon TAN ; Wei Ping Marcus TAN ; Josephine JAIPAUL ; Siew Pang CHAN ; Sathappan S SATHAPPAN
Singapore medical journal 2017;58(5):253-257
INTRODUCTIONThe purpose of this study was to compare the clinical outcomes of elderly hip fracture patients who received surgical treatment with those who received non-surgical treatment.
METHODSThis retrospective study involved 2,756 elderly patients with hip fractures who were admitted over a six-year period. The patients' biodata, complications, ambulatory status at discharge and length of hospital stay were obtained from the institution's hip fracture registry.
RESULTSAmong the 2,756 hip fracture patients, 2,029 (73.6%) underwent surgical intervention, while 727 (26.4%) opted for non-surgical intervention. The complication rate among the patients who underwent surgical intervention was 6.6%, while that among the patients who underwent non-surgical intervention was 12.5% (p < 0.01). The mean length of hospital stay for the surgical and non-surgical hip fracture patients was 15.7 days and 22.4 days, respectively (p < 0.01).
CONCLUSIONSurgical management of hip fractures among the elderly is associated with a lower complication rate, as well as a reduced length of hospital stay.
5.Interim Singapore guidelines for basic and advanced life support for paediatric patients with suspected or confirmed COVID-19.
Gene Yong-Kwang ONG ; Beatrice Hui ZHI NG ; Yee Hui MOK ; Jacqueline Sm ONG ; Nicola NGIAM ; Josephine TAN ; Swee Han LIM ; Kee Chong NG
Singapore medical journal 2022;63(8):419-425
The COVID-19 pandemic has resulted in significant challenges for the resuscitation of paediatric patients, especially for infants and children who are suspected or confirmed to be infected. Thus, the paediatric subcommittee of the Singapore Resuscitation and First Aid Council developed interim modifications to the current Singapore paediatric guidelines using extrapolated data from the available literature, local multidisciplinary expert consensus and institutional best practices. It is hoped that this it will provide a framework during the pandemic for improved outcomes in paediatric cardiac arrest patients in the local context, while taking into consideration the safety of all community first responders, medical frontline providers and healthcare workers.
Infant
;
Child
;
Humans
;
Cardiopulmonary Resuscitation/methods*
;
COVID-19/therapy*
;
Pandemics
;
Singapore
;
Heart Arrest
6.Clinical profile and prescribing patterns of therapy in children with bronchial asthma in a rural site in the Philippines: A retrospective cohort study
Gayle Therese K. Gonzales-Javier ; Leonila F. Dans ; Kristine Tanega-Aliling ; Carol Stephanie C. Tan-Lim ; Cara Lois T. Galingana ; Mia P. Rey ; Maria Rhodora D. Aquino ; Josephine T. Sanchez ; Antonio L. Dans
Acta Medica Philippina 2024;58(Early Access 2024):1-7
Background:
Bronchial asthma is one of the most common chronic childhood diseases encountered in the primary care setting. Adherence to recommendations from clinical practice guidelines on asthma can be utilized as an indicator of quality of care when evaluating the implementation of the universal health care in the Philippines.
Objectives:
To determine the clinical profile of pediatric patients with bronchial asthma; and to evaluate the
prescription patterns for asthma treatment in a primary care setting.
Methods:
This was a retrospective cohort study that involved review of the electronic medical records in a rural site of the Philippine Primary Care Studies (PPCS). All patients less than 19 years old who were diagnosed with asthma from April 2019 to March 2021 were included. Quality indicators for asthma care were based on adherence to recommendations from the 2019 Global Initiative for Asthma (GINA) Guidelines.
Results:
This study included 240 asthmatic children with mean age of 6 years (SD ± 4.9) and a slight male
preponderance (55.4%). Majority (138 children or 57.5%) were less than 6 years old. Out of the 240 children, 224 (93.3%) were prescribed inhaled short-acting beta-agonists (SABA) and 66 (27.5%) were prescribed oral SABA. Only 14 children (5.8%) were prescribed inhaled corticosteroids (ICS), with 13 children (5.4%) given ICS with longacting beta-agonists (LABA) preparations, and one child (0.4%) given ICS alone. Quality indicators used in this study revealed underutilization of ICS treatment across all age groups, and an overuse of SABA-only treatment in children 6 years old and above. Moreover, 71.3% of the total patients were prescribed antibiotics despite the current GINA recommendation of prescribing antibiotics only for patients with strong evidence of lung infection, such as fever or radiographic evidence of pneumonia.
Conclusion
There were 240 children diagnosed with asthma over a 2-year period in a rural community, with a mean age of 6 years old and a slight male predominance. This quality-of-care study noted suboptimal adherence of rural health physicians to the treatment recommendations of the GINA guidelines, with overuse of SABA and underuse of ICS for asthma control.
Asthma
7.Health benefit utilization and out-of-pocket expenses in outpatient care and hospitalizations: Baseline surveys of three primary care sites in the Philippines
Leonila F. Dans ; Jose Rafael A. Marfori ; Regine Ynez H. De Mesa ; Cara Lois T. Galingana ; Noleen Marie C. Fabian ; Mia P. Rey ; Josephine T. Sanchez ; Jesusa T. Catabui ; Nannette B. Sundiang ; Ramon Pedro P. Paterno ; Edna Estifania A. Co ; Carol Stephanie C. Tan-Lim ; Antonio Miguel L. Dans
Acta Medica Philippina 2024;58(Early Access 2024):1-8
Background:
The Philippine Primary Care Studies (PPCS) is a network of pilot studies that developed, implemented, and tested strategies to strengthen primary care in the country. These pilot studies were implemented in an urban, rural, and remote setting. The aim is to use the findings to guide the policies of the national health insurance program (PhilHealth), the main payor for individualized healthcare services in the country.
Objective:
The objective of this report is to compare baseline outpatient benefit utilization, hospitalization, and health spending, including out-of-pocket (OOP) expenses, in three health settings (urban, rural, and remote). These findings were used to contextualize strategies to strengthen primary care in these three settings.
Methods:
Cross-sectional surveys were carried out using an interviewer-assisted questionnaire on a random sample of families in the urban site, and a stratified random sample of households in the rural and remote sites. The questionnaire asked for out-patient and hospitalization utilization and spending, including the OOP expenses.
Results:
A total of 787 families/households were sampled across the three sites. For outpatient benefits, utilization was low in all sites. The remote site had the lowest utilization at only 15%. Unexpectedly, the average annual OOP expenses for outpatient consults in the remote site was PhP 571.92/per capita. This is 40% higher than expenses shouldered by families in the rural area, but similar with the urban site.
For hospital benefits, utilization was lowest in the remote site (55.7%) compared to 75.0% and 78.1% for the urban and rural sites, respectively. OOP expenses per year were highest in the remote site at PhP 2204.44 per capita, probably because of delay in access to healthcare and consequently more severe conditions. Surprisingly, annual expenses per year for families in the rural sites (PhP 672.03 per capita) were less than half of what families in the urban sites spent (PhP 1783.38 per capita).
Conclusions
Compared to families in the urban site and households in the rural sites, households in remote areas have higher disease rates and consequently, increased need for outpatient and inpatient health services. When they do get sick, access to care is more difficult. This leads to lower rates of benefit utilization and higher out-of-pocket expenses. Thus, provision of “equal” benefits can inadvertently lead to “inequitable” healthcare, pushing disadvantaged populations into a greater disadvantage. These results imply that health benefits need to be allocated according to need. Families in poorer and more remote areas may require greater subsidies.
8.Pediatric conditions and platforms of telemedicine used in Philippine primary care: A cross-sectional study
Angelique Celina F. Lahoz ; Leonila F. Dans ; Carol Stephanie C. Tan-Lim ; Angelica Cecilia V. Tomas ; Cara Lois T. Galingana ; Josephine T. Sanchez ; Maria Rhodora N. Aquino ; Arianne Maever L. Amit ; Mia P. Rey ; Janelle Micaela S. Panganiban ; Antonio L. Dans
Acta Medica Philippina 2024;58(15):39-45
BACKGROUND AND OBJECTIVE
Inequity in access to healthcare continues to be a problem in the Philippines. This was further aggravated by the COVID-19 pandemic. Telemedicine is considered a potential strategy to address inequitable access to healthcare; however, it only gained popularity during the pandemic. This study aims to determine the pediatric conditions diagnosed through telemedicine consults and the platforms utilized by patients in the Philippine Primary Care Studies pilot sites during the pandemic.
METHODSThis is a cross-sectional study of pediatric patients below 19 years of age who sought consult using telemedicine. Using the electronic medical records (EMR) system adapted by the Philippine Primary Care Studies in UP Health Service (UPHS) Quezon City, Metro Manila (urban site), Samal, Bataan (rural site), and Bulusan, Sorsogon (remote site), pediatric conditions diagnosed through telemedicine consults and the platforms utilized by patients from September 2021 to August 2022 were extracted and summarized. Data was summarized using descriptive statistics.
RESULTSA total of 5,388 consults involving pediatric patients were recorded from September 2021 to August 2022, of which 1,562 (29.0%) were done through telemedicine. Majority of the telemedicine consults (67.5%, n=1,055) were in the rural site. There were 274 telemedicine consults (17.6%) in the remote site, and 233 (14.9%) in the urban site. The most common diagnosis was acute upper respiratory tract infection (30.8%). Other common conditions diagnosed through telemedicine were lower respiratory tract infections, skin infections, urinary tract infections, obesity, anxiety disorders, allergic rhinitis, conditions related to pregnancy, and myalgia. The most common platforms used by patients are video calls (20.2%, n=315) and voice calls (18.4%, n=287) across all three sites. However, the most common platform differed per area—video calls for the urban site (85.8%), live chat for the rural site (76.1%), and voice calls for the remote site (60.6%).
CONCLUSIONThe most common condition diagnosed among pediatric patients consulting through telemedicine is upper respiratory tract infection. The most common platforms used to seek consult through telemedicine are live chat, video calls, and voice calls, with differences noted per site.
Telemedicine ; Primary Health Care
9.Frequency distribution of pediatric primary care cases in a rural site in the Philippines: A cross-sectional study.
Jonah Mikka B. Dorado ; Leonila F. Dans ; Carol Stephanie C. Tan-Lim ; Cara Lois T. Galingana ; Janelle Micaela S. Panganiban ; Mia P. Rey ; Josephine T. Sanchez ; Herbert S. Zabala ; Maria Rhodora N. Aquino ; Antonio L. Dans
Acta Medica Philippina 2024;58(18):71-78
BACKGROUND
Primary care for pediatric patients focuses on providing comprehensive, accessible, and coordinated healthcare from the neonatal period to adolescence. The implementation and use of electronic medical records (EMR) in pediatric primary care facilities is an efficient strategy to gather necessary information on the epidemiology of common pediatric diseases in the Philippines.
OBJECTIVESThis study aimed to determine the frequency distribution of pediatric diseases in a rural primary healthcare facility in the Philippines.
METHODSThis cross-sectional study reviewed the EMR of all pediatric patients who consulted in a primary care facility in Samal, Bataan from April 2019 to March 2021. Data gathered include sex, age in years, chief complaint, diagnosis, and month of consultation. Data was summarized using descriptive statistics.
RESULTSA total of 14,462 pediatric consults were recorded from April 2019 to March 2021. There were slightly more male patients (52.1%). The mean age of the patients was 6.5 years (standard deviation 5.22). The highest number of consults came from the 1- to 4-year-old age group (41.5%). The most common chief complaints were cough (45.9%), fever (25.5%), and colds (24.9%). The most frequent diagnoses were upper respiratory tract infections (47.4%), followed by lower respiratory tract infections (6.9%), and skin and soft tissue infections (5.3%). Majority of the consults for respiratory tract infections, skin and soft tissue infections, gastroenteritis, asthma, and dermatitis were in the 1- to 4-year-old age group. Urinary tract infections and otitis media or externa were recorded more frequently in the 5- to 9-year-old age group.
CONCLUSIONSRespiratory tract infections, followed by skin and soft tissue infections, were the most frequently identified diseases in children consulting a primary care facility at a rural site in the Philippines. The most common chief complaints, defined as the primary reason for seeking consult, were cough, fever, and colds. Data was gathered through EMR review, which may aid in the planning of programs and policies to improve primary care service delivery.
Electronic Health Records ; Electronic Medical Record
10.Health benefit utilization and out-of-pocket expenses in outpatient care and hospitalizations: Baseline surveys of three primary care sites in the Philippines.
Leonila F. Dans ; Jose Rafael A. Marfori ; Regine Ynez H. De Mesa ; Cara Lois T. Galingana ; Noleen Marie C. Fabian ; Mia P. Rey ; Josephine T. Sanchez ; Jesusa T. Catabui ; Nannette B. Sundiang ; Ramon Pedro P. Paterno ; Edna Estifania A. Co ; Carol Stephanie C. Tan-Lim ; Antonio Miguel L. Dans
Acta Medica Philippina 2024;58(16):133-140
BACKGROUND
The Philippine Primary Care Studies (PPCS) is a network of pilot studies that developed, implemented, and tested strategies to strengthen primary care in the country. These pilot studies were implemented in an urban, rural, and remote setting. The aim is to use the findings to guide the policies of the national health insurance program (PhilHealth), the main payor for individualized healthcare services in the country.
OBJECTIVEThe objective of this report is to compare baseline outpatient benefit utilization, hospitalization, and health spending, including out-of-pocket (OOP) expenses, in three health settings (urban, rural, and remote). These findings were used to contextualize strategies to strengthen primary care in these three settings.
METHODSCross-sectional surveys were carried out using an interviewer-assisted questionnaire on a random sample of families in the urban site, and a stratified random sample of households in the rural and remote sites. The questionnaire asked for out-patient and hospitalization utilization and spending, including the OOP expenses.
RESULTSA total of 787 families/households were sampled across the three sites. For outpatient benefits, utilization was low in all sites. The remote site had the lowest utilization at only 15%. Unexpectedly, the average annual OOP expenses for outpatient consults in the remote site was PhP 571.92/per capita. This is 40% higher than expenses shouldered by families in the rural area, but similar with the urban site. For hospital benefits, utilization was lowest in the remote site (55.7%) compared to 75.0% and 78.1% for the urban and rural sites, respectively. OOP expenses per year were highest in the remote site at PhP 2204.44 per capita, probably because of delay in access to healthcare and consequently more severe conditions. Surprisingly, annual expenses per year for families in the rural sites (PhP 672.03 per capita) were less than half of what families in the urban sites spent (PhP 1783.38 per capita).
CONCLUSIONSCompared to families in the urban site and households in the rural sites, households in remote areas have higher disease rates and consequently, increased need for outpatient and inpatient health services. When they do get sick, access to care is more difficult. This leads to lower rates of benefit utilization and higher out-of-pocket expenses. Thus, provision of “equal” benefits can inadvertently lead to “inequitable” healthcare, pushing disadvantaged populations into a greater disadvantage. These results imply that health benefits need to be allocated according to need. Families in poorer and more remote areas may require greater subsidies.
Primary Health Care ; Insurance, Health