Objectives: A cross-sectional study was conducted to describe the relationship of the resident physicians' knowledge, attitudes and practices on end-of-life and demographic features, medical specialty, formal training on care of the dying, personal and clinical experience on care of the dying patients. Methods: A total of 67 resident trainees participated in the study. They were asked to answer the K-A-P questionnaire on end-of-life care. The data gathered were tallied using Microsoft Excel and analyzed using SPSS 10.0 statistical software. Results: More than half of the respondents have adequate knowledge (52.2 percent), positive attitude (53.7 percent), and have appropriate practices (53.7 percent). Nearly half (49.3 percent and 44.8 percent) of the resident physicians regarded themselves as satisfactory in knowledge and attitudes, nearly half (44.8 percent) and a third (38.8 percent) of the residents respectively assessed themselves as fair and satisfactory in end-of-life care practices. Using chi-square test, the relationship between the different physicians' characteristics and their knowledge, attitudes and practices was assessed. Males had adequate knowledge (68.2 percent) than females (44.4 percent) (p=0.068). More married individuals (77.7 percent) had positive attitude and appropriate practices than single individuals (50.0 percent) (p=0.167). Nearly two-thirds (63.3 percent) of third year and higher residents had positive attitude and appropriate practices than first and second year residents (45.9 percent) (p=0.156). More than two-thirds (66.7%) of those with formal training had more appropriate practices than those without formal training (46.5 percent) (p=0.113). No significant association between end-of-life care knowledge-attitudes-practices and these aforementioned physicians' characteristics was observed. In all other characteristics, relationship was far from being statistically significant. For knowledge, ENT-HNS, Family Medicine and Surgery residents had the most residents with adequate knowledge. The difference in the proportion of residents' knowledge across medical specialties was statistically significant (p=0.055). For attitude, Family Medicine, Obstetrics and Gynecology and Surgery had the most residents with positive attitude. The difference though was not statistically significant (p=0.156). For practices, Family Medicine, Child Health and Surgery had the most residents with appropriate practices. Here, the difference was statistically significant (p=0.010). Because of inadequate sample size however, chi-square test for these associations may not be valid. Those with personal experience with death of a loved one or a close friend (61.2 percent) had appropriate practice in end-of-life care than those without (33.3 percent). The difference was statistically significant (p=0.042). More of those with clinical experience on care of dying patients had appropriate practices (59.3 percent) than those without (30.8 percent). The difference was almost statistically significant (p=0.064). Among those residents with more than three years of clinical practice, 81.8 percent had positive attitude compared to only 45.5 percent both for less than two and 2-3 years of clinical practice. The difference likewise was of borderline significance (p=0.097). Lastly, relationship between the physician's own assessment of their knowledge, attitudes and practices and their actual knowledge, attitudes and practices Was also assessed using the same statistical test. Actual and personal assessment of end-of-life care, residents who rated themselves as either having a very satisfactory and satisfactory knowledge, attitudes and practices in end-of-life care had higher proportion of actual adequate knowledge, positive attitude and appropriate practices.
ATTITUDE ; PATIENT CARE ; TERMINAL CARE

Background & Objective: Currentlythere is limitedintervention for acute ischemic stroke. Recombinant tissue plasminogen activator (rTPA) has been approved for immediate recanalization after a steno-occlusive lesion of cerebral vessels. rTPA has shown its efficacy and safety from several clinical trials. The present study reports our experience with intravenous rTPA from several centers in the Philippines.Method:This is a retrospective cohort study consisting of 157 patients who qualified to receive rTPA following the NINDS trial inclusion and exclusion criteria. The primary outcome is in-hospital and 3-months mortality. Other outcome measures were determined: intracranial hemorrhage secondary to hemorrhagic conversion and functional outcome as measured by modified Rankin Scale. Additionally, standard dose (0.9mg/kg) was compared to low dose (0.6mg/kg) of rTPA in terms of mortality, intracranial bleeding and functional outcome.Results:The in-hospital mortality was seen in 23 (14.6%) and total death within 3 months was 18.3%. Independent patient (mRS 0-2) was seen in 69 (51.1%) at discharge and 95 (73.1%) at 3 months. Intracranial bleeding due to asymptomatic hemorrhagic transformation occurred in 39 (24.8%) and symptomatic hemorrhagic transformation was seen in 19 (12.1%).Conclusion: Comparing our results with SITS-MOST and Cochrane collaborations, our data showed that we have more independent patients however death and intracranial bleeding was noted to be high in our cohort of patients. Additionally, the study showed more independent patients in the low dose group.

Objective: (1) To determine the inter and intra-observer reliability in diagnosing ROP in terms of the stage, zone, and presence of plus disease among local ROP screeners involved in the ROP Working Group; and (2) to determine the inter-observer reliability between 2 groups of subspecialties – retina specialists and pediatric ophthalmologists. Methods: This is a prospective observational study that analyzed the inter- and intra-observer reliability in describing ROP in 3 key observations: stage, zone, and presence of plus disease. This study utilized a test with 32 sets of fundus images from 27 cases, five of which were repeated. Images from previously photographed infants with and without ROP were collated into a downloadable powerpoint test and tested against retina specialists and pediatric ophthalmologists of the ROP Working Group. Outcome measures included presence of variability in ROP diagnosis in terms of the stage, zone, and presence of plus disease among screeners, and reliability coefficient (intra-class coefficient or ICC) in 2 levels: (1) individual and 2-group inter-observer reliability, and (2) intra-observer reliability. Results: There were 11 respondents: 5 retina specialists and 6 pediatric ophthalmologists. Seven (46%) reported prior experience with RetCam image review. There was high inter-observer reliability (ICC 1.0) in the staging of ROP, but poor reliability in the identification of zone (ICC 0.3) and plus disease (ICC 0.5). The group of retina specialists and pediatric ophthalmologists scored high reliability for diagnosis of stage (ICC 1.0 vs 0.9) and plus disease (ICC 0.9 vs 0.9), while both showed poor reliability in the identification of zone (ICC 0.5 vs 0.4). Majority had high intra-observer reliability with regard to the stage (55%) and zone (73%) of ROP and most (73%) had acceptable intra-observer reliability in identifying plus disease. None of the respondents had poor intra-observer reliability. Conclusion The diagnosis of the stage of ROP was consistently reliable for both inter- and intra-observer parameters. However, identification of zone of ROP and plus disease were sources of significant discrepancies.
Retinopathy of Prematurity ; Mass Screening

Objective: (1) To determine if preterm babies with ROP are missed with the existing Philippine Pediatric SocietyPhilippine Academy of Ophthalmology 2005 screening criteria of ≤32 weeks gestational age (GA) and ≤1,500 grams birth weight (BW), (2) to determine the incidence (missed-out rate) of these babies with ROP (>32 weeks GA, >1,500 grams BW), (3) to describe their profile, and (4) to determine the appropriate upper limit for GA and BW that can provide safe and efficient screening for severe ROP. Methods: This is a multicenter, retrospective cohort, observational study using data on ROP screening from the medical records of preterm babies from 4 institutions. All babies born ≤36 weeks GA, regardless of BW, who previously underwent ROP screening in 2011-2013, were included. Outcome measures were: (1) missed-out rate, (2) profile of missed babies with ROP (GA, BW, and risk factors), and (3) the proposed new criteria. Results Of the 762 babies screened, 105 (13.8%) had ROP. Of these, 13 (12%) had severe ROP, 28 (27%) was born at 33-36 weeks GA, and 32 (30%) with >1,500 grams BW. The oldest and heaviest of these missed babies with type 1 ROP was almost consistently reported at <35 weeks GA and <2,000 grams BW. Associated significant risk factors seen among missed babies were sepsis, respiratory distress syndrome (RDS), oxygen supplementation, and blood transfusion. There were 45 babies (43%) with ROP but with no risk factors. Among these were babies with GA >32 weeks and BW >1500 grams with ROP. The incidences of ROP, with and without risk factors, in the 4 institutions were not statistically significant. Seventeen (16.2%) preterm babies were missed with the existing criteria. Two of these had no risk factors but had type 1 and type 2 ROP. When <35 weeks GA and <2,000 grams BW as the new criteria were applied, the missed-out rate was reduced to 2% and was further reduced to zero with the inclusion of risk factors.
Retinopathy of Prematurity ; Mass Screening