BACKGROUND

This first clinical practice guideline (CPG) on osteoporosis prevention and management in the Philippines is the output of a shared undertaking by a multidisciplinary CPG development team spearheaded by the Osteoporosis Society of the Philippines Foundation, Inc. and joined by the Philippine Academy of Family Physicians; the Philippine College of Endocrinology, Diabetes, and Metabolism; the Philippine Orthopedic Association; the Philippine Obstetrics and Gynecological Society and the Philippine Rheumatology Association. This guideline seeks to augment and update the "Consensus statements on osteoporosis diagnosis, prevention and management in the Philippines," initially published in 2011, incorporating evidence-based practices developed in the last decade.

METHODOLOGY

The steering committee formulated and prioritized clinical questions based on meetings and stakeholder consultations. A PICO (population, intervention, comparator, outcome) format was used to develop clinical questions and guide the systematic search for evidence. The development of guidelines followed the ADAPTE process. Once completed, panel discussions were done using the Evidence to Decision Framework. After the panel discussions, the final recommendations were revised.

RESULTS

Thirty-four recommendations were formulated to address 27 clinical questions related to screening, prevention, diagnosis, pharmacologic and nonpharmacologic treatment, surgical management, follow-up, and continuity of care. With these recommendations, the developers aim to establish a standard of care in the prevention, diagnosis and management of osteoporosis and fragility fractures in both in-patient and out-patient cases that are appropriate to the Philippine context. Specifically, the CPG development group aims to use these recommendations to define the standard of care for osteoporosis as part of universal healthcare services once the program is implemented nationally. Relevant stakeholders may also use the recommendations to inform public and private payor policies for patients with fragility fractures, as well as by local government units or private companies looking to establish orthogeriatric centers with fracture liaison services.

CONCLUSION

This guideline is helpful for physicians and other allied health personnel in screening, diagnosis, management and prevention of primary osteoporosis and fragility fractures among postmenopausal women and older men.

Human ; Philippines ; Guideline ; Osteoporosis

BACKGROUND: The Alfredo T. Ramirez (ATR) Burn Center of the University of the Philippines-Philippine General Hospital, being the first burn unit assembled in the Philippines, is currently at the forefront of burn care in the country. It remains the largest tertiary burn center locally with an 11-bed capacity and caters to every Filipino in need of treatment due to burns.

OBJECTIVE: To describe the c1inico-epidemiologic profile of pediatric patients admitted to the UP-PGH ATR Burn Center from January 2004 to December 2008 as to the following: Age, Gender, % total body surface area (%TBSA) involvement, Severity of injury based on % TBSA involvement, Etiology of burn, Place of injury, Incidence of inhalational injury, Length of time prior to consult, Number of operations, Morbidity, Mortality; to determine the factors predictive of mortality among pediatric burn patients.

METHODS: A retrospective study on pediatric patients admitted to the ATR Burn Center UP-PGH treated for burn injuries from January 2004 to December 2008 was conducted. The Integrated Surgical Information System (ISIS), a computerized registry of the patients of the Department of Surgery was searched to identify pediatric burn patients aged 0 to 18 years old.

RESULTS: Of the 361 patients, 234 patients were male (64.82%) while 127 patients were female (35.18%). The odds of mortality in patients with flame burns was 2.24 (OR 95% CI: 1.01 to 4.96) times that of those who were scalded. The odds of mortality in patients with inhalational injury was 11.98 (OR 95% 0: 5.07 to 27.88) times higher than those without. The odds of mortality in patients with late consultation (>8 hours post-injury) was 2.24 (1.05 to 4.77) times that of those who were treated early. There was a significant association between survival outcome and the aforementioned factors.

CONCLUSION: The presence of inhalational injury, flame burns, delayed time of consultation, increased number of operations and the presence of nosocomial pneumonia, burn wound infection, and/or graft loss, were the variables noted to be independent predictors of mortality. Age, gender, burn size, severity, place of injury and length of stay were not found to be statistically associated with mortality.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Burn Units ; Incidence ; Hospitals, General ; Body Surface Area ; Length Of Stay ; Philippines ; Cross Infection ; Burns ; Morbidity ; Registries ; Pneumonia ; Wound Infection