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

OBJECTIVE: This study aims to determine the relationship between the different factors associated with the severity of Fibroscan with CAP findings among patients with Type 2 diabetes and fatty liver.

METHODOLOGY: This is a cross-sectional study. Seven hundred four Fibroscan with Controlled Attenuation Parameter (CAP) results were electronically retrieved from a diagnostic center. Two hundred eighty-five charts of diabetic patients with fatty liver on ultrasound were reviewed. One hundred sixty-four patients with fatty liver on ultrasound and Fibroscan with CAP were included in the study. Several factors were analysed in relation to the severity of Fibroscan with CAP findings in the study group.

RESULTS: Fifty five point five percent (55.5%) (91/164) had significant fibrosis and cirrhosis. Hepatic steatosis prevalence was 96% (158/164). Diabetes >5 years (OR 1.75), HbA1c >7% (OR 2.25) and high SGPT levels (OR 2.39) were associated with liver fibrosis and cirrhosis. BMI >25 kg/m2 (OR 1.45), triglyceride levels >150 mg/dl (OR 1.31) and HbA1c >7% (OR 1.74) were associated with hepatic steatosis.

CONCLUSION: Factors associated with the severity of hepatic fibrosis, cirrhosis and steatosis included above normal BMI, disease duration of >5 years, poor glycemic control and elevated levels of ALT, and serum triglycerides.

Human ; Diabetes Mellitus, Type 2

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 establish a normal range of values for thyroid volume among adult Filipinos and to correlate thyroid dimensions with age, sex, weight, height, and urinary iodine.
METHODS: This is a cross-sectional study conducted at the University of the Philippines-Philippine General Hospital. Out of 212 health personnel screened, 169 were included based on the following exclusion criteria: goiter stage Ib to III as defined by WHO, hyperthyroid or hypothyroid, hospitalization within the past month, chronic renal disease, chronic alcohol intake, more than 4 pack years of smoking, and abnormal laboratory profile. Laboratory parameters included FT3, FT4, TSH, creatinine, anti-thyroglobulin, anti-thyroid peroxidase, 24-hr urinary iodine , and thyroid ultrasonography. There were 55 males and 114 females with a mean age of 38.98 +/- 11.21 years old, mean weight of 59.84 +/- 11.91 kg.
RESULTS: The size of the right lobe ranged from 3.58-5.09 x 1.15-1.89 x 1.01-1.90 cm (LxWxD) while the left lobe ranged from 3.62-5.01 x 1.15-1.93 x 1.03-1.84, comparable with established values in literature. Using Hotelling's T-squared, male sex was associated with a larger thyroid dimension, (p-value <0.01) There was no statistically significant relationship between thyroid dimension and urinary iodide level. (Pillai's Trace p=0.88, Wilk's Lambda p=0.88, Hotteling's Trace p=0.88, Roy's Largest Root p=0.57). In general, thyroid dimensions were significantly correlated with the demographic variables using canonical correlation (0.5431, p=0.0232).
CONCLUSIONS: The normative thyroid dimensions established among Filipino adults were comparable with the accepted reference values. Thyroid dimensions were significantly correlated with weight, height, and sex but not with urinary iodide levels.

Thyroid Gland ; Body Weight ; Body Height ; Gender Identity ; Reference Values ; Cross-sectional Studies ; Iodine ; Urine ; Creatinine ; Ultrasonography

This article discusses some methods by which the facilitator can evaluate effectiveness of small groups in promoting learning. The paper focuses on evaluation of the small group process using the sociogram and Bales' checklist. Additionally, it presents checklists for evaluating facilitation skills. Combination of the tools presented in this article and revision of the content of the checklists to make it more context-specific and attuned to the realities of your small group settings is suggested to maximize the evaluative potential of these tools.

Human ; Male ; Female ; Checklist ; Group Processes ; Learning ; Evaluation Studies As Topic

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

Purpose: Radiotherapy is essential for the treatment of breast cancer (BC). However, adverse effects may occur in healthy tissue, during treatment and even after several months. Although it is known that this clinical radiosensitivity is multifactorial, the factors involved are unknown yet. In this study, we evaluated the effect of these factors on the development of radiodermatitis in patients undergoing radiotherapy. Materials and Methods: Demographic and lifestyle data collected during face-to-face interviews of 122 BC patients and data from clinical records were investigated. Most patients underwent conventional three-dimensional radiotherapy treatment. A total dose of 50 Gy was administered (2 Gy/day), followed by a boost in a tumor bed with a total dose of 18 Gy (2 Gy/day). Radiotoxicity was evaluated weekly using the Radiation Therapy Oncology Group classification system (range, 0 to 4, according to the severity). Results: In the present study, 75.4% of patients presented acute skin toxic effects with different degrees of severity. In 25% of cases, these effects manifested at the end of the fourth week at a cumulative dose of 40 Gy. The association of grade ≥2 acute skin reactions with body mass index (BMI) and breast size and between grade 3–4 and age was positive compared with controls. However, the role of the other factors could not be confirmed. Conclusion Analysis of the factors related to individual radiosensitivity suggests that age, BMI and breast size play an important role in the development of acute skin toxicity during treatment. Particular attention to patients who present these characteristics would help to control treatment effectiveness and therefore optimize their quality of life.

PURPOSE: Reactive oxygen species (ROS) are generated as an indirect product of radiation therapy (RT). Genetic variation in genes related to ROS metabolism may influence the level of RT-induced adverse effects. We evaluated the potential association of single nucleotide polymorphism (SNP)-related response to radiotherapy injury in breast cancer patients undergoing RT. MATERIALS AND METHODS: Eighty patients receiving conventional RT were included. Acute effects were evaluated according to the Radiation Therapy Oncology Group (RTOG) scores. DNA was extracted from blood and buccal swab samples. SNPs were genotyped for GSTP1, GSTA1, SOD2, and NOS3 genes by polymerase chain reaction-based restriction fragment length polymorphism. Univariate analysis (odds ratios [ORs] and 95% confidence interval [CI]) and principal component analysis were used for correlation of SNPs and factors related to risk of developing ≥ grade 2 acute effects. RESULTS: Sixty-five patients (81.2%) showed side effects, 32 (40%) presented moderate to severe acute skin toxicity, and 33 (41.2%) manifested minimal acute skin reactions by the end of treatment. In both univariate and multivariate analyses, nominally significant associations were found among body mass index (OR, 3.14; 95% CI, 8.5338 to 1.1274; p=0.022), breast size (OR, 5.11; 95% CI, 17.04 to 1.54; p=0.004), and grade ≥ 2 acute radiation skin toxicity. A significant association was also observed between NOS3 G894T polymorphism (OR, 9.8; 95% CI, 211.6 to 0.45; p=0.041) and grade ≥ 2 acute radiation skin toxicity in patients with neo-adjuvant chemotherapy treatment. CONCLUSION: The analysis of the factors involved in individual radiosensitivity contributed to the understanding of the mechanisms underlying this trait.
Body Mass Index ; Breast Neoplasms* ; Breast* ; DNA ; Drug Therapy ; Genetic Variation ; Humans ; Metabolism ; Multivariate Analysis ; Oxidative Stress* ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single Nucleotide ; Principal Component Analysis ; Radiation Tolerance ; Radiotherapy* ; Reactive Oxygen Species ; Skin