Introduction: Fast-setting high viscosity cement was introduced in the last decade, offering arthroplasty surgeons the benefit of shortened setting time. This could reduce the operating time, which may reduce the risk of infection and improve theatre efficiency. PALACOS® Fast R+G high viscosity cement has an average setting time of less than 6 minutes (30% faster than regular PALACOS® R+G) due to the lack of a waiting phase. The aim of this study was to investigate the safety of total knee arthroplasty performed using this fast-setting, high viscosity cement and short-term radiological outcomes. Materials and methods: This single surgeon case series looked at 344 primary TKAs performed using PALACOS® fast R+G cement from January 2016 to March 2020. Data were collected on patient demographics, perioperative events, and complications. Radiographs taken immediately post-operatively and at the one-year follow-up were analysed using the Knee Society Roentgenographic Evaluation and Scoring System (KSRESS). Results: This case series included 313 consecutive patients (31 bilateral) with a mean age of 70 years (range 44-93). A total of 237 patients (76%, 262 TKA patients) had a minimum one-year follow-up. No adverse events were noted perioperatively; ten patients had superficial wound issues and were managed successfully with wound care and/or oral antibiotics. Six (1.7%) patients underwent re-operation in the study period. These included one DAIR, one staged revision for deep infection, two revisions for instability, one manipulation under anaesthetic for stiffness, and one patella internal fixation for fracture. The mean combined valgus angle for the prosthesis was 183.1° (range 177.7° to 187.8°), indicating adequate alignment. At one-year follow-up, no radiographs demonstrated any new loosening or worsening of any previously noted radiolucent lines. Conclusion: This study reports the largest case series that looks at the use of fast-setting bone cement in primary TKA. It demonstrates good safety, as evidenced by a low reoperation rate, deep infection rate, and no adverse events during implantation. Fast-setting cement offers the promise of improving theatre efficiency and decreasing total running costs. Further studies are needed to provide data on improved theatre efficiency, cost savings and the longevity of implanted knees utilising this cement.

Mental health has profound effects on an individual’s quality of life, and it can also affect the families and the communities of persons with mental illness. In early 2020, the World Health Organization (WHO) Special Initiative for Mental Health in the Philippines recorded at least 3.6 million Filipinos suffering from a mental, neurological, or substance abuse disorder.1 In 2015, schizophrenia was the top mental disorder in the Philippines,2 and it is estimated that 1 million Filipinos (1% of the population) suffer from schizophrenia.3 Schizophrenia, a debilitating mental health condition, is characterized by both positive (e.g., hallucinations, delusions, confused thoughts, etc.) and negative (e.g., lack of pleasure, flattening, withdrawal, etc.) symptoms.4 5 6 The condition can affect the individual’s personal and social aspects of daily life, such as self-care, interpersonal relationships, education, and employment.7 8 9 10 Hospitalization is generally indicated for patients who are actively experiencing delusions/hallucinations, those who pose a serious threat of harm to themselves or others, or those who are unable to care for themselves and need constant supervision and support. Other possible indications for hospitalization include the presence of general medical or psychiatric problems that may render outpatient treatment unsafe or ineffective.11 12 Recent therapeutic advances, especially the introduction of atypical antipsychotic medications that have demonstrated better efficacy rates compared to older generation oral antipsychotic drugs, have allowed the reintegration of persons with mental health disorders (e.g., schizophrenia, other psychotic disorders, major depression, mood disorder, or bipolar disorder) into the society.13 14 15 Yet, despite the availability of such medications, there still exists substantial gaps in the delivery of mental health services. In the Philippines, mental health has remained poorly-resourced, with only 3-5% of the total health budget spent on mental health care.16 Mental health specialists have been in shortage, and a large proportion of these specialists work in urban for-profit services or private practices. 16 Mental health care services are delivered largely in hospital and private clinic settings,16 18 while community-based services remain underdeveloped.17 19 Prohibitive economic conditions and stigma on mental illness20 21 are some of the factors that contribute to low diagnosis and treatment rates. These factors, as well as funding issues that limit patient access, especially to newer innovative drugs, have rendered mental health care relatively inaccessible, leaving many patients undiagnosed and untreated or undertreated.17 In 2015, the Davao Center for Development (DCHD) Mental Health Program facilitated the establishment of Community-Based Mental Health Programs (CBMHPs) and the implementation of the WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in several municipalities in the region. Since their launching, CBMHPs in Davao Region documented annual increases ranging from 10 to 13% in the number of patients availing mental health services in primary and tertiary care facilities from 2016 to 2019. 22 During the program implementation review conducted by the National Mental Health Program in 2019, two Centers for Health Development (CHD)—those in Davao and in CaLaBaRZon—planned to implement a common project for patients with schizophrenia in some areas with CBMHPs in their respective regions.22 This is in accordance with the Republic Act 11036, also known as the Philippine Mental Health Act, which mandates that basic mental health services be provided in community settings.23 The Schizophrenia Project was designed to make mental health services accessible and antipsychotic medications readily available in municipalities with the highest burden of schizophrenia, the most common mental health condition in the region. The project involves community-level assessment, management, and follow up of patients with schizophrenia through the process described in the mhGAP-IG. In Davao, the ongoing Schizophrenia Project implementation has been made possible by the collaboration of primary care providers in rural health units (RHU) with psychiatrist consultants. Johnson & Johnson Philippines, the marketing authorization holder of paliperidone palmitate in the country, conducts training of health care workers involved in the project. DCHD finances the project and provides technical assistance to the RHUs. A pilot phase of the project was planned to run for one year in four implementation sites—Boston in Davao Oriental, Santo Tomas in Davao del Norte, Sta. Cruz in Davao del Sur, and Jose Abad Santos in Davao Occidental—which have been identified by DOH DCHD as having the highest numbers of patients diagnosed with schizophrenia in Davao Region. DCHD purchased paliperidone palmitate needed for project implementation in December 2019. In March 2020, Johnson & Johnson conducted the first training for health workers. Patient enrollment into the pilot phase started in July 2020 and was completed in October 2020. RHUs in the four implementation sites identified patients with probable schizophrenia through a community-based case-finding and referral strategy patterned after the mhGAP-IG. Among the four municipalities, a total of 49 patients—9 from Boston, 10 from Santo Tomas, 11 from Sta. Cruz, and 19 from Jose Abad Santos—were enrolled into the program. The enrolled patients were diagnosed, treated, and monitored at least every six months by the collaborating psychiatrists and RHU physicians. The RHUs were also tasked with setting-up communication lines for emergency consultations with the collaborating psychiatrists during crisis, providing counseling to the patients’ families, and conducting health promotion events to raise awareness on schizophrenia. After the one-year implementation of the pilot phase, health care providers were highly satisfied with the project. After initiation of treatment, most of the patients demonstrated improved symptoms, and some of them were able to perform household chores or return to work within a few months. None of the patients experienced hospitalization or relapse during the pilot phase. Health workers involved in drug dispensing and patient monitoring observed that the intravenous preparation of paliperidone palmitate used in this project facilitates easier supply inventory and patient tracking. DCHD also noted cost savings in expenditure on antipsychotic drugs when paliperidone palmitate was used in this project instead of the oral and conventional depot antipsychotic drugs used in the past. Health workers involved in the project also encountered some challenges during implementation. Many caregivers and families of patients in the project were not very cooperative in complying with the demands of the treatment sessions and social reintegration. After initiation of antipsychotic treatment, many patients could not comply with the regular follow up sessions, mostly because they live very far from the RHUs and could not afford the transportation costs of the visits. The Schizophrenia Project did not have a structured reintegration program, so many patients who were already in remission after a few months of treatment could not be properly reintegrated into their respective families and communities. During the project review after the pilot phase, stakeholders pointed out several good practices of individual municipalities that can possibly be scaled up or replicated by other CBMHPs implementing similar projects in the future. In Boston, the municipal health officer conducted a series of lectures on the social dimensions of mental health disorders to the caregivers and families of patients in the project. Those who attended the lectures have expressed an increased understanding of the nature of their patients’ condition. In Sta. Cruz, the RHU provided food (rice and snacks) and fare reimbursements to the families of patients who came during follow up checkups. The RHUs of Santo Tomas and Sta. Cruz involved the social welfare service units of their respective municipalities in the process of family and community reintegration of patients on remission. The pilot phase implementation of the Schizophrenia Project in the four municipalities in Davao has demonstrated that it is highly possible to integrate mental health services at the primary care and community settings, and achieve positive outcomes for patients, caregivers, health care providers, and the health system.
Quality of Life ; Schizophrenia

Background: An insight on the association of psychosocial factors with postmastectomy pain syndrome (PMPS) can help in the holistic management of patients with PMPS. Objective: To determine the proportion of patients with PMPS among those who underwent mastectomy for breast cancer and identify factors associated with the syndrome. Design: Cross-sectional study. Setting: Outpatient Unit in Southern Philippines Medical Center. Participants: 45 women who had mastectomy for breast cancer. Main outcome measures: Proportion of patients with PMPS; prevalence odds ratios (POR) of having PMPS for selected factors. Main results: The patients had a mean age of 53.18 ± 8.09 years, mean BMI of 23.57 ± 2.65, and--on average--were 27.09 ± 35.76 months postmastectomy upon entry into the study. Of the 45 patients, 22 (48.89%) had PMPS. Univariate POR of having PMPS were significantly high for patients who: had distant metastasis (POR=5.56; 95% CI 1.27 to 24.29; p=0.0227), experienced premastectomy breast pain (POR=35.70; 95% CI 6.14 to 207.52; p<0.0001), were in late-stage family life cycle (POR=9.18; 95% CI 1.02 to 82.22; p=0.0476), and were in late-stage family illness trajectory (POR=4.96; 95% CI 1.39 to 17.70; p=0.0137). Conclusion In this study, 48.89% of patients had PMPS. Factors associated with PMPS include: having distant metastases, having premastectomy breast pain, being in late-stage family life cycle, and being in late-stage family illness trajectory.
Family