BACKGROUND AND OBJECTIVE

Morbidity and mortality conferences (M&M) have been an important part of the hospital governance since the early 1900s. It has been shown to improve overall quality of care, minimize adverse occurrences and preventable fatalities, and provide chances for educational learning. However, medical trainees have different perceptions of M&M conferences which may affect its effectiveness in improving patient outcomes. The aim of this study is to determine the perception of surgical trainees towards M&M conferences.

METHODS

The study is a questionnaire-based survey among surgical trainees of the Department of Surgery, Philippine General Hospital (PGH), for the training year of 2023. The survey consisted of 24 questions on their perception regarding the conduct of M&M. A Likert scale was used by the respondents to rate their perceptions (1 – negative, 10 – positive). Descriptive analysis and ANOVA were used to summarize the responses to the survey.

RESULTS

A total of 64 surgical trainees from the Department of Surgery responded to the survey (response rate = 71.9%). Most respondents (68.8%) reported that the ideal frequency of M&M conferences is once a month. 78.1% were not aware of the inclusion criteria of the cases discussed in the departmental M&M conferences. Most reported (64.1%) that M&M conferences did not regularly include data on outpatient events. A mean rating of 5.2 was observed among surgical trainees on how judgmental they feel about the environment of M&M conferences. Surgical trainees were willing to talk openly about their complications (mean rating 7.1). They were fearful of criticism (mean rating 4.4) and the negative repercussions of their presentations (mean rating 4.1) during M&M conferences. The respondents perceive M&M conferences to be conducive for learning and service improvement with both having a mean rating of 7.8. Most felt that M&M conferences focused on the individual performance (mean rating 7.3) while participants were divided regarding the focus on systems and processes (mean rating of 5.6). In terms of dissemination, about half (45.3%) mentioned that they did not know how the discussions/outcomes were disseminated following an M&M conference. The mean rating of willingness to talk openly of complications were significantly higher among senior residents (7.7) compared to junior residents (6.3) (p=0.008).

CONCLUSION

This study observed variability in the perceptions of surgical trainees on M&M conferences. Surgical trainees tend to feel fear of criticism and negative repercussions during M&M conferences. There are opportunities for improving the format of M&M in terms of clarity of inclusion criteria and dissemination, and focusing on systems and processes rather than individual faults.

Human ; Clinical Conference ; Training ; Education ; Survey ; Surveys And Questionnaires

Objective: This study was designed to assess the impact of the COVID-19 pandemic on ophthalmology training from the perspective of ophthalmology residents and fellows in the Philippines. Methods: A 55-item online survey on the COVID-19 pandemic’s impact on ophthalmology training was sent to 168 ophthalmologists-in-training from March 15, 2021 to April 19, 2021. Participants from all ophthalmology training programs in the Philippines were selected via random sampling and proportional allocation. Results: A total of 158 ophthalmologists-in-training (138 residents and 20 fellows) completed the survey. The areas of ophthalmology training that were found to be most disrupted during the COVID-19 pandemic were surgical training (95%), clinical activity (94%), and in-person interaction with consultants in the out-patient department (94%) and operating room (85%). In contrast, trainees found an increase in didactic teaching activities (75%) and research activities (39%). Overall, 78% of the trainees felt that the pandemic had a negative impact on their ophthalmology training. The aspects which were most frequently found to be negatively impacted by the pandemic were mental health (70%), followed by technical skills (69%), and clinical skills (61%). No major differences were found on the impact of COVID-19 on training when compared across year levels and across institutions compared by location (National Capital Region vs. non-National Capital Region) and funding type (government vs. private funding). Ninety-nine percent (99%) of institutions shifted most of their didactic teaching activities to online platforms. Surgical video conferences and simulator training or skills labs were thought to be helpful to surgical training by 89% and 81% of the trainees, respectively. Majority of trainees attended to patients via telemedicine averaging 40% of their clinic consults. However, only 16% reported confidence in handling their patients through telemedicine. Conclusion The COVID-19 pandemic has had an overall negative impact on ophthalmology training in the Philippines. It caused significant disruption in trainees' clinical and surgical activities, and affected their mental health. Despite this, the situation provided an opportunity to boost trainees' theoretical knowledge. Majority are receptive to new technology-based learning tools to preserve the effectiveness of their training. Efforts to re-evaluate current training programs are needed to ensure sustainability and quality of ophthalmology training in the Philippines.
COVID-19 ; ophthalmology ; survey

Background: The low detection rate of tuberculosis (TB) cases in Malaysia remains a challenge in the effort to end TB by 2030. The collaboration between private and public health care facilities is essential in addressing this issue. As of now, no private-public health care collaborative program in pulmonary tuberculosis (PTB) screening exists in Malaysia. Aim: To determine the feasibility of a collaborative program between private general practitioners (GPs) and the public primary health clinics in PTB screening and to assess the yield of smearpositive PTB from this program. Methods: A prospective cohort study using convenient sampling was conducted involving GPs and public health clinics in the North-East District, Penang, from March 2018 to May 2019. In this study, GPs could direct all suspected PTB patients to perform a sputum acid fast bacilli (AFB) direct smear in any of the dedicated public primary health clinics. The satisfaction level of both the GPs and their patients were assessed using a self-administered client satisfaction questionnaire. IBM SPSS Statistical Software was used to analyze the data. Results: Out of a total of 31 patients who underwent the sputum investigation for PTB, one (3.2%) was diagnosed to have smear-positive PTB. Most of the patients (>90%) and GPs (66.7%) agreed to continue with this program in the future. Furthermore, most of the patients (>90%) were satisfied with the program structure. Conclusion: It is potentially feasible to involve GPs in combating TB. However, a more structured program addressing the identified issues is needed to make the collaborative program a success.
Food Insecurity ; Malaysia ; Adult ; Nutrition Survey

Food insecurity affects food intake, and it could prevent an individual from consuming enough nutritious food to support and maintain health. The aim of this paper is to determine the prevalence and factors influencing food insecurity among Malaysian households. In 2014, the Malaysian Adult Nutrition Survey (MANS) was carried out, and one of the components measured was food insecurity. Six out of sixteen questions from the food security core-module questionnaire were adopted and answered by 2962 adults. The results showed that about 25.0% adult experienced food quantity insufficiency, 25.5% had food variety insufficiency, 21.9% practised reduced size of the meal, and 15.2% skipped main meal due to lack of money to spend on. For the parents, 23.7% only rely on cheap food to feed children, and 20.8% could not afford to purchase various foods to feed their children. Location, strata, race, level of education, working status and household income shows significant difference while none of the nutritional status components found to be difference in all six parameters of food insecurity measured. Logistic regression with adjusted odds ratios discovered race, education level and household income were related to risk to all six parameters of food insecurity. In conclusion, food insecurity can be a serious problem in Malaysia. An effective and comprehensive effort by the government in terms of policy solution is required to increase education level and ensure an adequate income for every household. Therefore, future research should focus on some of those promising policy solutions and at the same time, study the other possible underlying factors that may lead to food insecurity.
Food Insecurity ; Malaysia ; Adult ; Nutrition Survey

BACKGROUND

Stroke is the second leading cause of death and the leading cause of disability in the Philippines. Despite the availability of clinical practice guidelines, there exist variation in the management pattern among neurologists.

OBJECTIVE

To determine the current practice patterns of Filipino adult neurologists caring for stroke patients and their conformity with the current clinical guidelines of the Stroke Society of the Philippines (SSP). Results are compared to a previous similar survey done in 2002 to determine changes in practice trends.

METHODOLOGY

Cross-sectional survey using a 3 page, 23-item questionnaire reviewed by the Stroke Council of the Philippine Neurological Asssociation (PNA).

RESULTS

From November 2007 to October 2008, 1 76 of 217 1ocally practicing board-certified adult neurologists of the Philippine Neurological Association (PNA) answered the survey achieving an 81.1% response rate. The following were the important findings: 1) 76.9% underestimated the benefit of warfarin for nonvalvular atrial fibrillation (NVAF); 2) despite the average 22 stroke patients seen in a week, 67% have used oral anticoagulation to no more than 8 patients during the past 6 months; 3) the two most important reasons provided for not giving oral anticoagulation were uncertainty of good follow-up from the patient and fear of bleeding complications; 4) for acute infarcts, although the recommended systolic blood pressure (SBP) threshold is ≥220mmHg, 65.3% would start antihypertensive treatment at 1 80mmHg; 5) ) for acute primary intracerebral hemorrhage (ICH), although SBP threshold is >180 mmHG, 89.6% would start antihypertensive treatment at 1 60mmHg; 6) despite the absence of guidelines recommending neuroprotective drugs for acute stroke, 75.6% and 48.0% prescribed it to >80% of their patients with infarcts and ICH respectively; 7) 54.3% have not experienced giving thrombolytic therapy to any of their patients with acute ischemic stroke; 8) among patients with clinically stable hemorrhagic strokes, 81 .4% of the neurologists would start antithrombotics and 35% of them would start it at 30 days after the onset of stroke; 9) among patients with ischemic stroke and atrial fibrillation who developed hemorrhagic transformation, 25.1% of respondents would start anticoagulation at 30 days post stroke; 1 0) length of neurology practice was significantly associated with the following variables (PCONCLUSIONS

The following practice patterns of Filipino neurologists in relation to the SSP guidelines are noted: underutilization of warfarin among patients with NVAF, preference to start pharmacologic control of BP below the recommended systolic levels especially in ischemic stroke, extensive use of neuroprotective agents and limited experience with thrombolytic use. Compared to the survey done in 2002, the general trends in stroke management remained unchanged though more in conformity to existing stroke guidelines.

Stroke ; Clinical Practice Variations ; Survey ; Atrial Fibrillation ; Neuprotection