In summary, the theorized causes of death are as follows: Immediate Cause: Cardiovascular collapse secondary to Hemorrhagic/Cardiogenic Shock. Antecedent Cause: Acute Renal Failure probably Rapidly Progressive Glomerulonephritis with Pulmonary Hemorrhage. Underlying Cause: Goodpasture's Syndrome, r/o Systemic Lupus Erythermatosus.
Human ; Male ; Child ; RENAL INSUFFICIENCY ; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS WITH PULMONARY HEMORRHAGE

Objective: To determine the efficacy Eucalyptus teritocornis ethanoloic leaf extract in the treatment of Staphylococcus aureus infected skin wound in Albino Spraque Dawley rats (Rattus norvegicus). Design: Experimental design: four (4) treatment groups with 5 rats each. Population: Twenty (20) Albino Spraque Dawley rats of the same age, sex and weight (+/-20 grams) were randomly distributed into 4 treatment groups. Intervention: Each group was assigned, to either E. tereticornis ethanol extract, 2 percent Mupirocin cream. Plain normal saline solution and no treatment. Outcome measures: Cure rate, rate of epithelialization, Rate of granulation, Scar formation and Bacterial growth in culture Results: The study revealed a 100 percent cure rate for the E. tereticornis extract treated group 7 days post treatment which is clinically higher than the 40 percent cure rate of the no treatment group, 60 percent cure rate of the Plain NSS group and 80 percent cure rate of the 2 percent. Mupirocin cream treated group. On the histologic findings, the rate of epitheliazation and rate of granulation of tissue was found to be comparable in the E. tereticornis group and 2 percent Mupirocin cream group and was significantly higher than the NSS group and no treatment group. Growth of bacterial culture and scar formation were found not be statistically significant. Conclusion: Based on the data, there is no sufficient evidence to suggest that E. Tereticornis ethanolic leaf extract is efficacious in the treatment of S. aureus infected wound lesions, however, the rate of epithelialization and granulation of tissue was found to be statistically higher in the E. tereticornis group which is comparable to the rate of epitheliazation and granulation of tissue of the 2 percent Mupirocin group.
Child ; STAPHYLOCOCCUS AUREUS ; PLANTS, MEDICINAL ; RATS ; SPRAGUE-DAWLEY

Background: Stroke is a leading cause of morbidity and mortality not only in our country but in other countries as well imposing a substantial economic burden on individuals and society overall. The financial cost of stroke is considerable but few cost effectiveness studies are available to guide clinical practice. It is the aim of this research then to provide comparison of cost-effectiveness or cost-benefit in stroke care to cast new light on which methods are better than others. Objectives: To compare cost-effectiveness of Home care versus Hospital care program in stroke patients age 35-70 years old at General Hospital from January 1998 to January 1999. Perspective: The study was done in a program perspective for the General Hospital. Methods: A decision analysis based on available published information was formulated. The probable outcomes were 1) probability of survival, 2) probability of good quality of life, 3) probability of poor quality of life and 4) probability of mortality after 1 year. Effectiveness measure was evaluated as the product of 1 year survival and good quality of life for both home care and hospital-based care. The cost of each branch was then divided by these 2 outcomes. The cost-effectiveness was compared between the 2 alternative programs. Results: The probability of 1 year survival for home care is 0.84 while in hospital care, probability was higher at 0.87. The probability of dying from stroke in 1 year for home care was .16 while only 0.13 was noted in hospital care. It is apparent that hospital care is more effective than home care alternative. In contrast to the results of the decision analysis, the cost-effectiveness of home care was P56,900.45 per stroke patient with good quality of life in contrast to hospital care which was higher at P65,291.70 per stroke patient with good quality of life. Although hospital-based care was more effective, incremental analysis showed that the cost of the advantage was P669,462. Conclusion: Hospitals are more effective than home care based on probability analysis while cost-effectiveness analysis favors the home care alternative.
Human ; Aged ; Middle Aged ; Adult ; HOME CARE SERVICES ; COST-BENEFIT ANALYSIS ; STROKE

In the earlier issues of the journal, there were articles that dealt with the issue of evidence-based medicine, its basic principles. Different approaches and methodologies to doing research were also discussed. The succeeding is a presentation on the common terms and measurements used in this area.
EVIDENCE-BASED MEDICINE ; RESEARCH

OBJECTIVE: To evaluate the effectiveness of chart reminder flyers in increasing the appropriateness of coronary primary preventive care. DESIGN: Randomized controlled trial. SETTING: A university-based clinic in the period January-June, 2000. PATIENTS: 120 charts randomly selected from 256 patients in the intervention group were considered. Another 120 randomly chosen from 295 patients were selected for the control. These subjects were those who consulted from January-June 2000 at the university clinic. INTERVENTIONS: Each clinic day was randomized to be either "with reminder flyer day" or "without reminder flyer day." On "with reminder flyer days", a one-page flyer that contained a letter of reminder for physicians to perform coronary primary preventive care was placed on the charts of all patients consulting at the clinic. The reminder flyer was detached from the chart right after each consultation. On "without reminder flyers days", no intervention was done. At the end of the trial, 120 charts from each group were randomly selected for auditing for appropriateness of coronary primary preventive care. RESULTS: The proportions of charts that recorded appropriate history taking, physical examination and pharmacological and non-pharmacological interventions were all significantly greater in the intervention group than in the control group (p values 0.001, 0.005 and 0.0001). When coronary primary prevention was taken as a whole, the proportion of charts that reflected appropriate care was significantly greater in the intervention group than in the control group (25 percent vs. 5 percent, p 0.001). Reminder flyers reduced the relative risk of not being given appropriate coronary prevention to 0.79 (p, 0.001). MAIN OUTCOME MEASURES: Proportion of charts that documented appropriate primary coronary preventive care in the intervention and controlled groups were compared using the test for equality of proportions. The changes in appropriateness of the preventive care from baseline for each group was taken and compared. CONCLUSION: The proportion of charts that recorded appropriate coronary primary preventive care was significantly higher in the reminder flyer group.
Human ; DELIVERY OF HEALTH CARE ; PRIMARY PREVENTION ;

DIABETES MELLITUS, TYPE 2 ; PRACTICE GUIDELINE ; DIAGNOSIS ; THERAPY ;

OBJECTIVES: To determine the effectiveness of visual cues/prompts to promote On-the-job physical activities. DESIGN: Cross-over experimental design, using On-the-Job Physical Activity Questionnaire. SETTING: A four-storey building of a government corporation. PATIENTS: Responses of 289 randomly selected government employees who hold office in the fourth floor were deemed evaluable out of 561 (52 percent, response rate). INTERVENTIONS: The control and experimental groups baseline on-the-job physical activity were measured and compared to their post-intervention physical activity. For Phase 1, after a one-week waiting period, a "walk" sign and a "stair" sign visual prompt were placed in the corridors and elevator entrances of the employees in their building for two weeks for the intervention group whereas the control had none. A one-week wash-out period was made. Then, phase 2 commenced with the visual prompts now placed in the building of the previous control group, and the previous experimental group now had no prompts (the cross-over). MAIN OUTCOME MEASURES: Comparison of the baseline physical activity with the post-interventional activity using the Chi-square goodness of Fit Test. RESULTS: The post-intervention group showed improved walking and use of stairs in their time on-the-job spent. CONCLUSION: Visual prompts promote the use of walking and climbing stairs among government workers in their office in a corporate setting.
WALKING, ; WORKPLACE ; EXERCISE

Adrenal Insufficiency is a deceptive disorder that may mimic other diseases and could be lethal once diagnosis is delayed. Management is mainly fluids and steroids. Upon referral to an endocrinologist on his second admission and the fear of another critical condition the patient eventually complied with the medications and improved.
Human ; Male ; Adult ; ADVERSE EFFECTS ; STEROIDS ; DEXAMETHASONE ; CUSHING SYNDROME

At the end of this module you should be able to: 1. Extract a medical history that is useful for preventive health care. 2. Perform additional recommended physical examination procedures. 3. Perform only the recommended screening procedures. 4. Provide the recommended medical counselling. 5. Give the recommended vaccines. 6. Formulate a health maintenance plan for the patient.
FAMILY PRACTICE ; STANDARDS ; PREVENTIVE HEALTH SERVICES ; ADULT ; GUIDELINE

Background: Clinical Practice Guidelines are made to help practitioners in decision making towards improving appropriateness of care. However, successful implementation strategies are still lacking. Patient mediated intervention as away of CPG implementation is being recommended. Methods: This study is a three-phase, randomized controlled trial. Following a 3-month baseline period, a one-hour interactive lecture on guideline recommendations was conducted among family medicine residents. After 3 months, clinic days were randomized to days with and days without public health lecture. A one-hour interactive lecture on the recommendations on sinusitis and rhinitis was conducted on patients at the out-patient waiting area on pre-selected days. Appropriateness of care by chart audit was done at every phase. Results: Baseline appropriateness of care was low at 10.8 percent on history taking and physical examination, 56.8 percent on request for diagnostics, 75.7 percent on antibiotic prescription, 48.6 percent on overall treatment. Referrals at baseline were appropriately high at 94.6 percent. Interactive lecture did not increase appropriateness of care. The addition of public health lecture significantly increased appropriateness in history taking and physical examination to 25.9 percent, and request of diagnostics to 70.6 percent. No change noted on antibiotic prescription at 41.2 percent, overall treatment at 41.2 percent and referrals at 88.2 percent. Conclusions: The addition of public health lecture to interactive lecture was effective in increasing appropriateness of care in history and physical examination and request of diagnostics.
Human ; PATIENT EDUCATION ; PUBLIC HEALTH ; PRACTICE GUIDELINE