METHODOLOGY<p style="text-align: justify;" data-mce-style="text-align: justify;">A descriptive, cross-sectional design was utilized, involving the translation of the SS-QOL from English to Filipino through Collaborative Translation Protocols, which centered on group consensus. Three Filipino language experts rigorously evaluated the initial translation for linguistic and cultural appropriateness. To assess content and face validity, an expert committee of three neurology consultants provided ratings, which were analyzed using the item-level content validity index (i-CVI). Subsequently, a pilot testing phase was conducted with 10 stroke survivors recruited via purposeful sampling in Metro Manila to evaluate the SS-QOL-Filipino’s clarity, layout, understandability and answerability, while also measuring the intraclass correlation coefficient (ICC) to assess consistency and agreement among itemsp>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">This study successfully developed a stroke-specific HRQOL tool for the Philippines, addressing a critical need for objective measures in patient-centered care. The use of Collaborative Translation Protocols ensured the questionnaire’s conceptual, linguistic and cultural equivalence, incorporating nuances specific to the Filipino context in areas like eating habits, emotional expressions and technological terms. The high face and content validity, coupled with strong consistency and high understandability observed during pilot testing underscore the SS-QOL-Filipino’s suitability for the target population, positioning it as a valuable instrument for both clinical practice and research.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">The SS-QOL scale was successfully translated into Filipino using Collaborative Translation Protocols and rigorously validated. The SS-QOL-Filipino version demonstrates high content and face validity, strong consistency and excellent understandability and answerability, affirming its status as a reliable and appropriate outcome measure for assessing the QOL among stroke patients in Metro Manila.p>
Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Adult: 25-44 Yrs Old ; Life ; Quality Of Life ; Stroke ; Survivors

BACKGROUND AND OBJECTIVES<p style="text-align: justify;" data-mce-style="text-align: justify;">Neuraxial anesthesia, which includes techniques such as spinal anesthesia, traditional epidural, combined spinal-epidural (CSE), and dural puncture epidural (DPE), is considered the most effective, safe, and reliable method for providing pain relief during labor and delivery. The choice between DPE, CSE, and EPL depends on various factors, including the parturient’s labor, pain intensity, and preferences. This network meta-analysis (NMA) aimed to determine which analgesic technique among DPE, CSE, and pure epidural (EPL) techniques would be more effective in providing adequate analgesia and producing fewer adverse effects and/or complications for parturients undergoing labor.p>METHODOLOGY<p style="text-align: justify;" data-mce-style="text-align: justify;">In this study, the different analgesia techniques were assigned. DPE is assigned as group A, CSE as group B, and EPL as group C. This NMA combines direct and indirect evidence obtained from randomized controlled trials (RCTs). An electronic systematic search was done using electronic databases and online published RCTs. Critical appraisal of studies, collection, and extraction of data was facilitated by the primary investigator and a peer. A total of 31 journal articles were initially identified for screening and a total of 5 studies – 1 from database searches and 4 from citation chaining – were included in this meta-analysis after Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Outcome measures were pooled and analyzed using Review Manager Web version 5.4.1.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">Among parturients, the likelihood of experiencing a rapid onset of analgesia was significantly greater among those on CSE, whereas the onset of DPE approximates that of EPL. Subsequent sensitivity analysis improved the onset of DPE over EPL, thus overall CSE > DPE > EPL. The odds of developing maternal hypotension were CSE > DPE. Overall, the comparative odds are as follows: CSE > EPL = DPE. The incidence of fetal bradycardia is almost equal for both interventions in studies comparing DPE versus CSE analgesia and DPE versus EPL although there is a greater likelihood of developing fetal bradycardia when parturients are on CSE > EPL, hence the comparative odds of developing fetal bradycardia are as follows: CSE > EPL = DPE.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">Overall, these findings suggest that CSE may offer advantages for labor analgesia among parturients in labor, in terms of faster onset of analgesia, although potentially causing higher risk of maternal hypotension and fetal bradycardia when compared to DPE and EPL. Based on the results of the current NMA article, further studies are required to compare DPE, CSE, and EPL for labor analgesia, to fully evaluate the risks and benefits of each intervention, particularly in relation to maternal and fetal outcomes.p>
Human ; Analgesia

BACKGROUND AND OBJECTIVES<p style="text-align: justify;" data-mce-style="text-align: justify;">Neuraxial anesthesia, which includes techniques such as spinal anesthesia, traditional epidural, combined spinal-epidural (CSE), and dural puncture epidural (DPE), is considered the most effective, safe, and reliable method for providing pain relief during labor and delivery. The choice between DPE, CSE, and EPL depends on various factors, including the parturient’s labor, pain intensity, and preferences. This network meta-analysis (NMA) aimed to determine which analgesic technique among DPE, CSE, and pure epidural (EPL) techniques would be more effective in providing adequate analgesia and producing fewer adverse effects and/or complications for parturients undergoing labor.p>METHODOLOGY<p style="text-align: justify;" data-mce-style="text-align: justify;">In this study, the different analgesia techniques were assigned. DPE is assigned as group A, CSE as group B, and EPL as group C. This NMA combines direct and indirect evidence obtained from randomized controlled trials (RCTs). An electronic systematic search was done using electronic databases and online published RCTs. Critical appraisal of studies, collection, and extraction of data was facilitated by the primary investigator and a peer. A total of 31 journal articles were initially identified for screening and a total of 5 studies – 1 from database searches and 4 from citation chaining – were included in this meta-analysis after Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Outcome measures were pooled and analyzed using Review Manager Web version 5.4.1.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">Among parturients, the likelihood of experiencing a rapid onset of analgesia was significantly greater among those on CSE, whereas the onset of DPE approximates that of EPL. Subsequent sensitivity analysis improved the onset of DPE over EPL, thus overall CSE > DPE > EPL. The odds of developing maternal hypotension were CSE > DPE. Overall, the comparative odds are as follows: CSE > EPL = DPE. The incidence of fetal bradycardia is almost equal for both interventions in studies comparing DPE versus CSE analgesia and DPE versus EPL although there is a greater likelihood of developing fetal bradycardia when parturients are on CSE > EPL, hence the comparative odds of developing fetal bradycardia are as follows: CSE > EPL = DPE.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">Overall, these findings suggest that CSE may offer advantages for labor analgesia among parturients in labor, in terms of faster onset of analgesia, although potentially causing higher risk of maternal hypotension and fetal bradycardia when compared to DPE and EPL. Based on the results of the current NMA article, further studies are required to compare DPE, CSE, and EPL for labor analgesia, to fully evaluate the risks and benefits of each intervention, particularly in relation to maternal and fetal outcomes.p>
Human ; Analgesia

BACKGROUND AND OBJECTIVES<p style="text-align: justify;" data-mce-style="text-align: justify;">Neuraxial anesthesia, which includes techniques such as spinal anesthesia, traditional epidural, combined spinal-epidural (CSE), and dural puncture epidural (DPE), is considered the most effective, safe, and reliable method for providing pain relief during labor and delivery. The choice between DPE, CSE, and EPL depends on various factors, including the parturient’s labor, pain intensity, and preferences. This network meta-analysis (NMA) aimed to determine which analgesic technique among DPE, CSE, and pure epidural (EPL) techniques would be more effective in providing adequate analgesia and producing fewer adverse effects and/or complications for parturients undergoing labor.p>METHODOLOGY<p style="text-align: justify;" data-mce-style="text-align: justify;">In this study, the different analgesia techniques were assigned. DPE is assigned as group A, CSE as group B, and EPL as group C. This NMA combines direct and indirect evidence obtained from randomized controlled trials (RCTs). An electronic systematic search was done using electronic databases and online published RCTs. Critical appraisal of studies, collection, and extraction of data was facilitated by the primary investigator and a peer. A total of 31 journal articles were initially identified for screening and a total of 5 studies – 1 from database searches and 4 from citation chaining – were included in this meta-analysis after Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Outcome measures were pooled and analyzed using Review Manager Web version 5.4.1.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">Among parturients, the likelihood of experiencing a rapid onset of analgesia was significantly greater among those on CSE, whereas the onset of DPE approximates that of EPL. Subsequent sensitivity analysis improved the onset of DPE over EPL, thus overall CSE > DPE > EPL. The odds of developing maternal hypotension were CSE > DPE. Overall, the comparative odds are as follows: CSE > EPL = DPE. The incidence of fetal bradycardia is almost equal for both interventions in studies comparing DPE versus CSE analgesia and DPE versus EPL although there is a greater likelihood of developing fetal bradycardia when parturients are on CSE > EPL, hence the comparative odds of developing fetal bradycardia are as follows: CSE > EPL = DPE.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">Overall, these findings suggest that CSE may offer advantages for labor analgesia among parturients in labor, in terms of faster onset of analgesia, although potentially causing higher risk of maternal hypotension and fetal bradycardia when compared to DPE and EPL. Based on the results of the current NMA article, further studies are required to compare DPE, CSE, and EPL for labor analgesia, to fully evaluate the risks and benefits of each intervention, particularly in relation to maternal and fetal outcomes.p>
Human ; Analgesia

Introduction: The coronavirus (CoVid-19) pandemic brought about a massive impact to the healthcare system, including disruption of patient follow-ups and consultations. Subsequently, an increase in physicians’ use of telemedicine was seen. While this technology has been documented to improve delivery of care, it has encountered varied acceptance among physicians. Gaps in specific national legislation, lack of established rules and accreditation standards, and ethical/legal implications add to the concerns. Anchored on the Unified Theory of Acceptance and Use of Technology model, this study aimed to segment physicians according to their perspectives regarding telemedicine during the pandemic. Methods A mixed methods sequential explanatory design using Q-methodology was applied to identify distinct patterns and perceptions of physicians on the use of telemedicine during the pandemic. A Q-sample of 25 statements on perceptions of telemedicine was developed through literature review, and 24 physicians were purposively selected. Participants were instructed to sort statements into a distribution grid according to their degree of agreement/disagreement. Post-sorting interview was conducted to expound on their response. Data were analyzed using by-person factor analysis through the PQMethod software version 2.35.
Telemedicine ; Physicians ; Pandemic ; COVID-19

<p style="text-align: justify;">Background: Exercising discretion is vital when making decisions. While decision-making implies having to choose between predefined alternatives, discretion requires sifting through several solutions and critically choosing the desired one that implies a choice between many alternatives without rigid guidelines pointing to one direction or the other. While previous studies have constantly investigated the nature and dynamics of creative insubordination or discretionary insubordination in primary and secondary education little is known as to how such a construct operates in higher education.p><p style="text-align: justify;">Purpose: This study was undertaken to address the central question: "What attributes define creative insubordination as a decision-making strategy among Philippine medical school deans?"p><p style="text-align: justify;">Design: Anchored on descriptive phenomenology, 21 medical deans who have been in the position for at least 4.5 years (range 4.5-26 years) were purposively selected for in-depth semi-structured interviews. Guided by the rules of cool and warm analyses, transcribed texts were phenomenologically reduced and interpreted, and validated via member checking procedure.p><p style="text-align: justify;">Findings: Five interesting elements that typify the modes of behavior in the practice of creative insubordination surfaced, namely: cognitional elasticity, emotional sensitivity, conational sincerity, relational mobility and axiological reflectivity.p><p style="text-align: justify;">Conclusion: This study provides eidetic images of the multidimensional facets of individual attributes necessary for the praxis of discretionary decision-making by a select group of Philippine medical deans in varied instances.p>

<p style="text-align: justify;">Introduction: The 'first generation' physician gathers a lot of strength to venture into a world unknown to him. Unlike a physician born to a family of physicians who has a family to guide him, the 'first generation' physician only has himself to survive this endeavor. Through the life worlds of a select group of 'first generation' physician-in-training, this study seeks to answer the following central question: How do 'first generation' Filipino physicians collectively characterize their liminal spaces in transition from medical school to clinical practice?p><p style="text-align: justify;">Methodology: Anchored on the Theory of the Rites of Passage, this phenomenological inquiry, intends to surface the lebenswelt or essence of the experience of being the only physician in the family. Respondents comprised a purposive sample of physicians-in-training (residents and fellows), who are the only physicians in the family. Data were gathered using semi-structured interviews. Triangulation and member checking procedures were done to ensure the data reliability. Data were then subjected to cool (categorization) and warm analysis (thematization) using the Colaizzi's method.p><p style="text-align: justify;">Findings and Discussion: With all the transcribed experiences summarized and those with the same meaning analyzed, the following categories and themes were generated: The Intending Facet / Purpose: From Uncertainty towards Redefinition; The Thinking Facet / Process: From Perplexity towards Self-efficacy; The Relating Facet / People: From Isolation towards Integration; and The Transforming Facet / Power: From Vulnerability towards Empowerment. It was shown that a 'first generation' physician in this liminal space undergoes challenges and struggles during his training in medicine. This served as his Rite of Passage to transition him to someone dreaming only to become a physician, to become redefined with conviction, supported and integrated into the health system, empowered and transformed to the physician he is meant to be.p><p style="text-align: justify;">Recommendations: Physicians undergo a lot of challenges and mental stress and it means a lot for trainers to enter into the trainees' life-world, especially that of a 'first generation' physician, so that they can build socio-emotional learning and mentoring programs and counselling services that address different facets of liminal space that the trainees go through.p>
Physicians

<p style="text-align: justify;">Research writing evokes feelings of anger and anxiety even among graduate students. Feelings are an inseparable part of the human lived experience and are important to learning and decision making. Research anxiety is powerful but not impossible to overcome. Various affective, cognitive, linguistic, and pedagogical mitigating strategies can be employed. By simply acknowledging its existence, we lead our students in the direction of doing just that... towards a transformational mindset to overcome research anxiety. Written qualitatively in the hermeneutic strand, this paper explores the lived experience and collective portrayals of the phenomenon of graduate research writing anxiety using prose poetry. The main forms of poetry qualitative researchers create vary from data poems or transcription poems, research poems, and autoethnographic poetry. Autoethnographic poetry is created by the author through self-reflection and writing to explore anecdotal and personal experiences and connect this autobiographical story to wider cultural, political, and social meanings and understandings. In this paper, the author writes from an emic perspective utilizing intertextual chaining to create an autoethnographic research prose poetry. The paper describes in rich detail, the dominant feelings about research writing anxiety and anger that surfaced from participants' narratives of their shared experience of research writing anxiety. Prose poetry is written in paragraphs rather than verse but contains the elements of poetry, such as poetic meter, language play, and a focus on images rather than narrative, plot, and character.p>
Hermeneutics

<p style="text-align: justify;">Background: The seafarers' poor mental health has been associated with significant morbidity, inefficiency, and accidents on board. Mental and physical health is largely dependent on the way seafarers handle stressors.
Anchored on the Transactional Model of Stress and Coping, this study aimed to identify the typology of Filipino merchant marine ratings according to their coping strategies to stressors on board vessels.p><p style="text-align: justify;">Methods: Thirty-seven (37) Filipino merchant marine ratings participated in this study. They were chosen by purposive sampling. They rank-ordered 25 opinion statements on various stressors and coping mechanisms. The rank-ordered sorts were subjected to by-person factor analysis with Varimax rotation using the PQ Method version 2.32. The resulting factors were interpreted using the inductive approach, aided by the interview done after Q sorting.p><p style="text-align: justify;">Results: Four factors were generated: solution-focused seafarers, stressor-focused seafarers, self-management- focused seafarers, and the social milieu-focused seafarers. There is a consensus on the supplication-focused seafarers who ask for God's help in times of stress.p><p style="text-align: justify;">Conclusion: The generated typology provides a better understanding of seafarers' outlook on stress and coping and may help the stakeholders craft individualized strategies to help improve their coping mechanisms and overall mental health. Occupational health research must continue to focus on understanding the role of culture and adaptation on stress and coping behaviors to retain quality seafarers and promote a healthier workplace.p>
Mental Health

Background and objective : Neurodevelopmental disabilities in adolescents have signifi cant effects on medical and social function. One of these challenges is their transition into adult care. Parental involvement is critical because these young adults may have more diffi culties in making informed decisions independently. Thus, the transition process involves not only the direct health care needs of the young adult, but the needs and concerns of the parents or carers who are instrumental in guiding that process. This study aims to explore the expectations and experiences of family carers of youths with chronic neurodevelopmental disorders who have undergone or are about to undergo transition into adult healthcare in a Filipino-based health care system. Methods: A descriptive phenomenology was used to gain an in-depth understanding of parents’ perceptions and experiences of their youths’ transition process from a pediatric to an adult health care setting. The results were analyzed manually using Colaizzi’s method, which involves integrating both the destructured and restructured analysis principles of phenomenology. Purposive sampling was used to interview 13 family carers of 13 youths with various neurodevelopmental disorders using a semi-structured interview questionnaire. Results : Despite the lack of information on the transition process, our study found that carers did not have a strong inclination to resist the transition event. Most of the carers treat the health care provider as a major decision maker in determining the timing and manner of transition, adopting a “doctor knows best” attitude. Several other hindrances and facilitators to successful transition were also identifi ed and are similar to the current literature. Conclusion This study provides a greater understanding of carers’ perceptions and experiences of transition care for youths with neurodevelopmental disorders in the local setting. They exhibited trust and confi dence in the medical profession as a whole, and had a “doctor knows best” attitude that may enable successful transitioning.
Transitional Care ; Neurology ; Neurodevelopmental Disorders ; Caregivers