BACKGROUND AND OBJECTIVE

The Philippine Package of Essential Noncommunicable Disease Interventions (PhilPEN) was introduced by the Department of Health through AO 2012-0029. This is anchored to WHO PEN, a prioritized set of cost-effective interventions that can be carried out to provide an acceptable standard of care at the primary health care level, even in low-resource settings. The study aims to evaluate the availability and adequacy of primary health care facilities in providing the PhilPEN package of interventions using the WHO assessment tool.

METHODS

A cross-sectional survey was conducted in 25 randomly selected primary health care facilities in Metro Manila. Data were collected through structured interviews with facility staff and direct observation using a standardized questionnaire aligned with PhilPEN and WHO PEN guidelines. The tool assessed PhilPEN inputs (infrastructure, human resources, basic tools and equipment, essential medicines, record-keeping, financing) and services (risk assessment and screening, early diagnosis and monitoring, treatment and follow-up, counseling, referral of patients).

RESULTS

All facilities met the basic standards for infrastructure, human resources, record keeping, and financing. However, only 40% had all essential medicines, and just 16% had complete tools, including urine ketone/protein test strips. Risk assessment and patient counseling were consistently implemented, but early diagnosis and follow-up services were inconsistent due to training and supply gaps.

CONCLUSION

Primary health care centers in Metro Manila demonstrate partial readiness for PhilPEN implementation. Gaps in tools, medicines, and protocol availability should be addressed to optimize NCD service delivery.

Human ; Primary Health Care ; Noncommunicable Diseases ; Delivery Of Health Care ; Standard Of Care ; Cardiovascular Diseases

Laparoscopic cholecystectomy has become the standard of care in the management of gallstone disease with a slightly increased risk for bile duct injury. It is therefore essential that a standard grading system can be utilized and thus predict whether cholecystectomy can be completed laparoscopically or warrants the need for bailout procedure to prevent biliary injury. This study includes all patients who underwent laparoscopic cholecystectomy in Capitol University Medical Center and Maria Reyna Xavier University Hospital from March 2021 to January 2022. Total of 220 patients underwent laparoscopic cholecystectomy but only 173 patients were included due to incomplete data. Age, BMI, sex and G10 scoring were collected. This scoring system focuses on four components: the gallbladder’s operative appearance, whether distended or contracted, ease of access including limited access due to adhesions from prior surgery, the presence of sepsis in the peritoneal cavity, either biliary peritonitis or purulent fluid, and/or a cholecystoenteric fistula, and the degree of gallbladder adhesions. Descriptive statistics and univariate analysis were used to determine the need for bailout procedure in laparoscopic cholecystectomy. It was found that each year increase in age raises the odds of doing bailout surgery by 8.2% (OR: 1.0823, p = 0.009), while higher G10 scores nearly triple the odds (OR: 2.9227, p < 0.0001). The G10 scoring system is a practical scoring system with easy to remember assessment variables. G10 score of greater than 3 with increasing age shown to have increased chance of employing bailout procedure.

Gallbladder ; Cholecystectomy, Laparoscopic ; Standard Of Care

BACKGROUND: Adolescence was associated with suboptimal diabetes control. Studies supporting the use of mobile technology to improve glycemic control and adherence to treatment had mixed results.

OBJECTIVES: This study aimed to evaluate the effect of SMS reminders on improving glycemic control in adolescents with Type 1 Diabetes Mellitus (T1DM)

METHODOLOGY: A randomized control study among adolescents with poorly controlled type 1 diabetes mellitus was done. Data were processed from 56 out of 64 subjects who were randomized into control (N=29) who received standard of care and SMS group (N=27), who received standard of care and a daily SMS reminder regarding diabetes self-care for 12 weeks. An adherence form was answered by all participants and glycosylated hemoglobin (HbA1c) before and after intervention was compared.

RESULTS: HbA1c did not significantly differ between SMS and control groups after 12 weeks of intervention (SMS 9.98+2.12 vs control 10.54+2.13, p value of 0.305). Post intervention, there was no significant difference between SMS and control group in terms of adherence to insulin injection (no p value), blood glucose (BG) monitoring (p value 0.106), and diabetic diet (p value 0.803). However, adherence on exercise was significantly higher among control group than SMS group (p value 0.003).

CONCLUSION: A 12-week SMS intervention reminder in adolescents with type 1 diabetes mellitus did not significantly improve glycemic control and adherence to standard of care (insulin injection, blood glucose monitoring, diet and exercise).

RECOMMENDATION: Future researches could include a bigger study population and longer duration of intervention. Other forms of mobile technology could also be used as a form of reminder.

Human ; Male ; Female ; Child: 6-12 Yrs Old ; Adolescent: 13-18 Yrs Old ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Text Messaging ; Glycated Hemoglobin ; Therapeutics ; Technology ; Standard Of Care ; Self Care

Background: Management of COVID--19 patients during surges have been a challenge as hospitals have to deal with staff, room, and medication shortages. Among these medications is tocilizumab which is given to patients with severe/critical conditions. In Ospital ng Makati, patients are given baricitinib as alternative immunomodulator to prevent possible cytokine storm during tocilizumab shortages. The current recommendation for baricitinib is to give it in addition to dexamethasone and remdesivir for hospitalized COVID-19 patients requiring low to high-flow oxygen, and non-invasive ventilation. However, there is not enough evidence to recommend it as an alternative to tocilizumab in COVID--19 patients. This study aims to find out the real-world efficacy of baricitinib in addition to standard of care among admitted patients with severe COVID-19 pneumonia admitted in Ospital ng Makati. Methods: This is a retrospective, case control study that reviewed records of adult patients admitted at Ospital ng Makati from December 2020 to May 2021 due to severe COVID-19. Patients who were given standard of care was compared to those who were given baricitinib by measuring the duration of clinical improvement, in-hospital all-cause mortality, number of hospital stay, and progression to acute respiratory distress syndrome (ARDS) and need for mechanical ventilator. Results: The use of baricitinib led to a faster improvement time (10 vs 12 days) however did not reach level of significance (p=0.069). There was also no significant difference in the mortality, number of hospital days, and progression to ARDS between the two groups. Conclusion There is not enough evidence to recommend baricitinib as an alternative to tocilizumab in patients with severe COVID--19 infection.
COVID-19 ; Standard of Care

Humans ; Aminoquinolines/therapeutic use* ; Carcinoma, Non-Small-Cell Lung/genetics* ; Lung Neoplasms/genetics* ; Mutation/genetics* ; Standard of Care

OBJECTIVE: To compare patient survival outcomes between completion hysterectomy and conventional surveillance in locally advanced adenocarcinoma of the cervix after concurrent chemoradiotherapy (CCRT).METHODS: Patients with adenocarcinoma of the cervix after CCRT were identified in a tertiary academic center database from 2004 to 2018. Patients received completion hysterectomy or surveillance after CCRT. We compared the progression-free survival (PFS) and overall survival (OS) between the patients with or without adjuvant hysterectomy. Surgery features, operative complications, and pathologic characteristics were documented. Patient outcomes were also analyzed according to clinicopathologic factors.RESULTS: A total of 78 patients were assigned to completion surgery and 97 to surveillance after CCRT. The PFS was better in the surgery group compared to the CCRT only group, at 3 years the PFS rates were 68.1% and 45.2%, respectively (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.282–0.749; p=0.002). Adjuvant surgery was also associated with a higher rate of OS (HR=0.361; 95% CI=0.189–0.689; p=0.002), at 3 years, 87.9% and 67%, respectively. Tumor stage, size, lymph-vascular space invasion (LVSI), lymphadenopathy were associated with PFS but not with OS. Hysterectomy specimens revealed 64.1% (50/78) of the patients had pathologic residual tumor. Patients age less than 60, tumor size over 4 cm, stage IIB and persistent residual disease after CCRT were most likely to benefit from hysterectomy. Hysterectomy was associated with a lower rate of locoregional recurrence but did not reach statistical significance (5.13% vs. 13.5%, p=0.067).CONCLUSION: Completion hysterectomy after CCRT was associated with better survival outcome compared with the current standard of care.
Adenocarcinoma ; Cervix Uteri ; Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Hysterectomy ; Lymphatic Diseases ; Neoplasm, Residual ; Recurrence ; Standard of Care ; Uterine Cervical Neoplasms

standard of care, they pose considerable risks and require prolonged postoperative rehabilitation. Obtaining proper informed consent and establishing realistic outcome expectations are imperative for successful postoperative outcomes.]]>
Congenital Abnormalities ; Contracture ; Erectile Dysfunction ; Humans ; Informed Consent ; Male ; Penile Induration ; Penile Prosthesis ; Penis ; Rehabilitation ; Sensation ; Standard of Care ; Surgeons ; Transplants

No abstract available.
Breast Neoplasms ; Breast ; Humans ; Neoadjuvant Therapy ; Standard of Care

BACKGROUND: Neoadjuvant chemoradiation therapy (nCRT) has become the standard of care for esophageal cancer patients prior to esophagectomy. However, the optimal timing for surgery after completion of nCRT remains unclear. METHODS: A retrospective review was performed of patients who underwent esophagectomy with cervical anastomosis for esophageal cancer at a single institution between January 2000 and June 2015. Patients were categorized into 3 cohorts: those who did not receive nCRT prior to esophagectomy (no nCRT), those who underwent esophagectomy within 35 days after nCRT (≤35d), and those who underwent esophagectomy more than 35 days after nCRT (>35d). RESULTS: A total of 366 esophagectomies were performed during the study period, and 348 patients met the inclusion criteria. Anastomotic leaks occurred in 11.8% of all patients included in the study (41 of 348). Within each cohort, anastomotic leaks were detected in 14.7% of patients (17 of 116) in the no nCRT cohort, 7.3% (13 of 177) in the ≤35d cohort, and 20.0% (11 of 55) in the >35d cohort (p=0.020). Significant differences in the occurrence of anastomotic leaks were observed between the no nCRT and ≤35d cohorts (p=0.044), and between the ≤35d and >35d cohorts (p=0.007). CONCLUSION: Esophagectomy with cervical anastomosis within 35 days of nCRT resulted in a lower percentage of anastomotic leaks.
Anastomotic Leak ; Chemoradiotherapy ; Cohort Studies ; Esophageal Neoplasms ; Esophagectomy ; Humans ; Incidence ; Neoadjuvant Therapy ; Retrospective Studies ; Standard of Care

PURPOSE: Sperm cryopreservation before cancer treatment is the most effective method to preserve the fertility of male patients. We present our 21 years experience with sperm cryopreservation for cancer patients, including an examination of semen quality, the current status of cryopreserved sperm, and the rate of sperm use for assisted reproductive technology (ART). MATERIALS AND METHODS: A total of 721 cancer patients at Fertility Center of CHA Gangnam Medical Center successfully performed sperm cryopreservation for fertility preservation from January 1996 to December 2016. Medical chart review was used to analyze patient age, marital status, cancer type, semen volume, sperm counts and motility, length of storage, and current banking status. RESULTS: The major cancers of the 721 patients were leukemia (28.4%), lymphoma (18.3%), testis cancer (10.0%). The mean age at cryopreservation was 27.0 years, and 111 patients (15.4%) performed sperm cryopreservation during or after cancer treatment. The mean sperm concentration was 66.7±66.3 ×106/mL and the mean sperm motility was 33.8%±16.3%. During median follow-up duration of 75 months (range, 1–226 months), 44 patients (6.1%) used their banked sperm at our fertility center for ART and 9 patients (1.2%) transferred their banked sperm to another center. The median duration from cryopreservation to use was 51 months (range, 1–158 months). CONCLUSIONS: Sperm cryopreservation before gonadotoxic treatment is the most reliable method to preserve the fertility of male cancer patients. Sperm cryopreservation should be offered as a standard of care for all men planning cancer therapy.
Cryopreservation ; Fertility Preservation ; Fertility ; Follow-Up Studies ; Humans ; Leukemia ; Lymphoma ; Male ; Marital Status ; Methods ; Reproductive Techniques, Assisted ; Semen ; Semen Analysis ; Semen Preservation ; Sperm Count ; Sperm Motility ; Spermatozoa ; Standard of Care ; Testicular Neoplasms