OBJECTIVES

Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.

METHODS

This was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.

RESULTS

Two hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid - stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.

CONCLUSION

Overall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult ; Albumins ; Blood ; Blood Urea Nitrogen ; Calcium ; Cardiology ; Chart ; Charts ; Cohort Studies ; Critical Care ; Critical Pathways ; Diagnostic Equipment ; Disease ; Diuretics ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Equipment And Supplies ; Evaluation Studies As Topic ; Feedback ; Heart ; Heart Diseases ; Heart Failure ; Hormones ; Hospitals ; Hospitals, General ; Humans ; Hypertension ; Indicators And Reagents ; Infection ; Infections ; Inpatients ; Intensive Care Units ; Internal Medicine ; Lead ; Magnesium ; Male ; Medicine ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Nitrogen ; Overall ; Oxygen ; Partial Thromboplastin Time ; Patients ; Peptides ; Philippines ; Physicians ; Potassium ; Prothrombin ; Prothrombin Time ; Quality Of Health Care ; Referral And Consultation ; Sodium ; Statistics ; Tertiary Care Centers ; Thorax ; Thromboembolism ; Thromboplastin ; Thyroid Gland ; Time ; Troponin ; Troponin I ; Universities ; Urea ; Urinalysis ; Urine ; Venous Thromboembolism ; Vital Signs ; Work ; Workforce

BACKGROUND AND OBJECTIVE.

Severe Acute Respiratory Syndrome - Coronavirus-2 (SARS-CoV-2) was initially known to affect the respiratory system and has been reported to also involve the cardiovascular system leading to myocardial damage. Remdesivir is one of the approved treatments for COVID-19, wherein viral replication is inhibited by terminating the RNA transcription prematurely. According to studies, the primary electrocardiographic effect of remdesivir in COVID-19 patients are sinus bradycardia and QT prolongation. The use of electrocardiogram (ECG) is an essential diagnostic tool in assessing the electrical conditions of the heart. The objective of this study is to describe the electrocardiographic profile of adult patients with COVID-19 who were given remdesivir and admitted in the University of the Philippines-Philippine General Hospital (UP-PGH). To this date, this is the only study done locally identifying the electrocardiographic profiles of adult patients with COVID-19 who were given remdesivir.

METHODS

This was a retrospective descriptive study involving adult patients with COVID-19 who were given remdesivir and admitted in UP-PGH from June 2021 to June 2022. Demographic profiles and 12-lead ECG done during the hospital admission were gathered. Descriptive statistics was used to summarize the clinical characteristics and the electrocardiographic findings of the patients.

RESULTS

There were 412 confirmed COVID-19 patients who were given remdesivir (mean age 56 years old; female 52%) included in this study. The most common comorbidities were hypertension, diabetes mellitus, and stroke. Majority of the patients had severe (58%) to critical (22%) COVID-19 infection. Most of the patients had sinus rhythm (94%), normal rate (72%), and normal axis (93%). The most common baseline ECG findings were non-specific ST-T wave changes (42%). Some patients had atrioventricular blocks (3.4%), bundle branch blocks (3.6%), prolonged QT interval (1.9%). Among those with repeat 12-L ECG (136 patients) during admission, ECG changes observed were sinus bradycardia (6%), prolonged QT interval (4%), and both (1.5%).

CONCLUSION

Based on this retrospective review, which to our knowledge is the only study done locally investigating the effects of remdesivir on ECG of adult Filipino patients with COVID-19 infection, majority of the patients had sinus rhythm, normal rate, and axis. The most common ECG finding was non-specific ST-T wave changes. This study demonstrated a low incidence of adverse ECG changes that would preclude the administration of remdesivir when indicated. These include sinus bradycardia and QT interval prolongation which did not require further interventions. ECG remains to be useful, low-cost noninvasive tool that can help monitor electrophysiologic adverse events of remdesivir.

Electrocardiography ; COVID-19 ;

OBJECTIVES

This study aimed to identify problems and highlight opportunities for pharmaceutical sciences research in the Philippine pharmaceutical industry's regulatory and clinical research sectors that might have been previously overlooked or underrepresented. It identified current issues that can be addressed by research covering four areas of pharmaceutical sciences: drug design and discovery, pharmacokinetic/pharmacodynamic studies, formulation design and pharmaceutical technology, and regulatory science.

METHODS

A descriptive qualitative approach was used in this study. Data collection was facilitated by key informant interviews (KII) using a standardized interview guide with open-ended questions to identify the pharmaceutical science research needs of the specific sectors. A purposive sampling method was employed, with five key informants (KIs), including the company vice president, director, and top-level managers from different local and multinational pharmaceutical companies. ATLAS.ti software was utilized to facilitate thematic synthesis for qualitative data analysis.

RESULTS

Thirteen common themes were identified from the KIs, such as (1) incomplete development of therapeutic compounds, (2) sustainability of raw materials supply, (3) regulation of herbal medicines versus food supplements, (4) mapping disease priorities through the Philippine pharmaceutical roadmap, (5) government incentives and policies to support research, (6) technical personnel, (7) suboptimal regulatory process, approvals, and implementation, (8) gap in utilization of acquired knowledge on regulations, (9) regulatory governance, (10) passive regulatory action on counterfeit drugs, (11) PIC/S GMP version 14 adaption, (12) formulation optimization, and (13) active pharmaceutical ingredient (API) sourcing and regulation. Based on insights from the International Pharmaceutical Federation regarding anticipated hurdles in pharmaceutical sciences over the next 5-10 years, priority research needs were identified through KIs' input. Relevant action plans were developed, including the creation of research proposals to isolate, purify, and determine chemical structures of natural products, as well as analyzing recent Philippine Health Statistics to help assess the appropriateness of new drug releases for patient needs. Other action plans include forecasting future disease burdens in the country, performing toxicology studies (Health-Based Evaluation Levels/No Observed Adverse Effect Level or HBEL/NOAEL) for common generic drugs, and ensuring that research efforts are directed toward addressing the Philippine pharmaceutical regulatory and clinical research sector's most pressing needs practically and feasibly.

CONCLUSION

This study offers valuable insights into pharmaceutical sciences research and development initiatives within the regulatory and clinical research sectors in the Philippine pharmaceutical industry. These findings have the potential to catalyze transformative advancements in healthcare delivery and outcomes, positioning the Philippines for global excellence and competitiveness.

Occupational Groups ; No-observed-adverse-effect Level ; Social Control, Formal ; Patients ; Pharmaceutical Preparations

BACKGROUND

Self-management is crucial for individuals with chronic illnesses. While mobile applications (mAPPs) have emerged to support diverse health needs, evidence regarding their efficacy for self-management among chronically ill Filipino patients is inconsistent and limited, particularly in provincial settings.

OBJECTIVE

To investigate the effectiveness of the Health Storylines mAPP compared to a traditional pamphlet for enhancing self-management among individuals with chronic illnesses in Baguio City, Philippines.

METHODS

We conducted a two-arm quasi-experimental study with 33 participants diagnosed with cancer, type 2 diabetes, or heart disease/hypertension. Participants were recruited via convenience sampling and allocated to an intervention group (n=17), which used the Health Storylines mAPP for four weeks, or a comparison group (n=16), which received a traditional pamphlet. Selfmanagement was assessed pre- and post-intervention using the Self-Management Assessment Scale (SMASc).

RESULTS

Participants demonstrated a high level of selfmanagement at baseline (μ=5.20, SD=0.70). After four weeks, the intervention group showed a non-significant decrease in self-management scores (from μ=5.25 to 5.00, p=0.27), while the comparison group exhibited a non-significant increase (from μ=5.19 to 5.37, p=0.61). There was no statistically significant difference in posttest self-management scores between the two groups (U=83.50, p=0.23).

CONCLUSION

In a population of chronically ill patients already proficient in managing their condition, the Health Storylines mAPP had a marginal impact on selfmanagement, while the use of a traditional pamphlet showed a slight positive effect. The findings suggest that for this population, familiar, low-barrier resources remain valuable, and mHealth interventions must account for baseline self-management capabilities and digital literacy. Chronic Illness; Health Storylines mAPP; Self-management; mHealth; Philippines.

Chronic Disease ; Chronic Illness ; Self Care ; Self-management ; Telemedicine

Introduction: This study aimed to develop an innovative bilayer tablet formulation of dapagliflozin and vildagliptin to increase therapeutic outcomes and patient compliance in diabetes management. Methods: By employing wet granulation, immediate-release, and sustained-release layers were formulated using various super-disintegrating and release-retarding agents, respectively. Several pre-compression parameters were utilized, such as Carr’s index, Hausner ratio, physical attributes (weight variations, friability, hardness), and disintegration time. Drug-excipient interactions were determined through employing FTIR, SEM, DSC, and TGA. In-vitro dissolution studies were performed to assess the release kinetics of these formulations. Results: For immediate-release dapagliflozin, our earlier study demonstrated that the formulations showed Carr’s index (23.5-33.3), physical attributes (weight (145–155 mg), thickness (4.42 ± 0.04 -4.46 ± 0.05 mm), hardness (3.7-5.6 kg/cm2), friability (<1%), and optimized rapid dissolution (F1: 80.50% ± 5.2 in 30 minutes). For sustained-release vildagliptin, the formulations showed Carr’s index (10.48-20), physical attributes (weight (194-203 mg), thickness (3.32 ± 0.06-3.33±0.04 mm), hardness (4.8 ± 0.1-7.6 ± 0.2 kg/cm2), friability (<1%)), and optimized controlled release (A5: 81.76% ± 2.4 in 360 minutes). The results found that F1 and A5 were the optimum formulation for the immediate release of dapagliflozin, and the sustained release of vildagliptin, respectively, and BT-1 was the optimum bilayer tablet because of its rapid onset of action for dapagliflozin (84.23% within 60 minutes) and sustained release for vildagliptin (80.026% within 360 minutes). Conclusion: Based on these data, the optimized bilayer tablet holds the potential to be a convenient and effective treatment option. Further, in-vivo assays are necessary to confirm its efficacy and safety.

Objective: Mobility limitations and falls are common in people with Parkinson’s disease (PwP). Compared with exercise alone, a tailored, multidomain intervention has the potential to be more effective in improving mobility safety and preventing falls. This study aimed to explore the feasibility and potential effectiveness of a multidomain fall prevention intervention (Integrate) designed for PwP who experience frequent falls. Methods: The home-based intervention was delivered over a span of 6 months by occupational therapists and physiotherapists. The personalized intervention included home fall hazard reduction, exercise, and safer mobility behavior training. The participants received 8 to 12 home visits and were supported by care-partners (when necessary) to participate in the intervention. Results: Twenty-nine people (recruitment rate: 49%; drop-out rate: 10%) with moderate to advanced Parkinson’s disease, a history of recurrent falls, and mild to moderate cognitive impairment participated in the study, with 26 people completing the study. A moderate-to-high adherence to the intervention was observed, and there were no adverse events related to the intervention. Twenty-one (81%) participants met or exceeded their safer mobility goal based on the Goal Attainment Scale. The participants exhibited a median 1.0-point clinically meaningful improvement according to the Short Physical Performance Battery. An exploratory analysis revealed that fall rates were reduced by almost 50% in the 6-month follow-up period (incidence rate ratio: 0.51; 95% confidence interval 0.28–0.92). Conclusion A multidomain occupational therapy and physiotherapy intervention for PwP experiencing recurrent falls was feasible and appeared to improve mobility safety. A randomized trial powered to detect the effects of the intervention on falls and mobility is warranted.

Objective: Using semiquantitative risk scoring, this study estimated the probability of ASF transmission in 23 selected provinces. Methods: The factors influencing ASF spread were identified; 10 through a literature review and the positivity for ASF virus (ASFv) of meat samples from an ongoing surveillance study.Secondary data from each sampled province were collected, and the provinces were scored across these factors and classified into one of three risk categories. Results: Six out of 23 provinces were categorized as high-risk due to the high number of ASFv-positive meat samples, backyard pigs, and ASF occurrences. Conversely, four provinces were classified as low-risk due to consistently low scores across all indicators. The difference in the meat contamination level between low- and high-risk provinces emphasizes the importance of including this factor in the ASF spread assessment. Conclusions and Relevance: Risk estimation of ASF transmission must consider meat sample contamination. Active surveillance at local borders can monitor contamination and prevent ASFv sources from entering areas. This approach allows the government to allocate resources and prioritize higher-risk areas.

BACKGROUND AND OBJECTIVE

COVID-19 has been associated with cardiac injury, often detectable through electrocardiographic (ECG) changes. This study seeks to characterize the cardiovascular and electrocardiographic profiles of adult patients diagnosed with COVID-19.

METHODS

This study included adult patients with confirmed COVID-19 from June 2021 to June 2022. Clinical profiles and 12-lead ECG tracings were obtained from electronic medical records and reviewed independently by three cardiologists. Descriptive analysis was performed to summarize the cardiovascular and electrocardiographic findings in this population.

RESULTS

The study included 998 COVID-19 patients (mean age: 50 years; 53.7% male). The most common comorbidities were hypertension, diabetes, and dyslipidemia. A majority (31.36%) presented with severe COVID-19 infection. The most frequent significant ECG abnormalities observed at admission were sinus tachycardia (22.8%), and atrial fibrillation (11.02%). Additional ischemic findings included ST segment depression (2.91%), T-wave inversion (1.70%), and ST segment elevation (2.71%).

CONCLUSION

The baseline ECG findings among COVID-19 patients were predominantly normal; however, significant abnormalities were also identified. The most frequent abnormalities included sinus tachycardia, atrial fibrillation, and ischemic changes, all of which may have clinical implications.

Human ; Coronavirus Disease 19 ; Covid-19 ; Electrocardiography ; Atrial Fibrillation

Objective: Mobility limitations and falls are common in people with Parkinson’s disease (PwP). Compared with exercise alone, a tailored, multidomain intervention has the potential to be more effective in improving mobility safety and preventing falls. This study aimed to explore the feasibility and potential effectiveness of a multidomain fall prevention intervention (Integrate) designed for PwP who experience frequent falls. Methods: The home-based intervention was delivered over a span of 6 months by occupational therapists and physiotherapists. The personalized intervention included home fall hazard reduction, exercise, and safer mobility behavior training. The participants received 8 to 12 home visits and were supported by care-partners (when necessary) to participate in the intervention. Results: Twenty-nine people (recruitment rate: 49%; drop-out rate: 10%) with moderate to advanced Parkinson’s disease, a history of recurrent falls, and mild to moderate cognitive impairment participated in the study, with 26 people completing the study. A moderate-to-high adherence to the intervention was observed, and there were no adverse events related to the intervention. Twenty-one (81%) participants met or exceeded their safer mobility goal based on the Goal Attainment Scale. The participants exhibited a median 1.0-point clinically meaningful improvement according to the Short Physical Performance Battery. An exploratory analysis revealed that fall rates were reduced by almost 50% in the 6-month follow-up period (incidence rate ratio: 0.51; 95% confidence interval 0.28–0.92). Conclusion A multidomain occupational therapy and physiotherapy intervention for PwP experiencing recurrent falls was feasible and appeared to improve mobility safety. A randomized trial powered to detect the effects of the intervention on falls and mobility is warranted.