BACKGROUND AND OBJECTIVE

Identifying the factors and reasons behind medical students’ choice of medical specialty will provide an understanding to the health sectors and may serve as data for interventions necessary to address issues such as manpower allocation. This study aimed determine the factors that affect career interest in emergency medicine among postgraduate interns (PGI) of the University of the Philippines-Philippine General Hospital (UP-PGH).

A cross-sectional study was conducted among UP-PGH PGI from August 2022 to June 2023. A website link for the validated questionnaire utilized previously by a similar study among medical students in Saudi Arabia was sent to the respondents which instructed them to choose the top 3 medical specialties that they were interested to pursue. Their top choices were evaluated through a 5-point Likert scale that ranged from 1-no influence to 5-major influence which included factors such as medical lifestyle, social orientation, prestige, hospital orientation, role model and varied wide scope of practice that were further divided into 30 variables. Data analysis was done using one-way ANOVA to compare the factors among specialty groups.

A total enumeration was conducted, involving 161 respondents. Respondents chose the following in order of preference as top choice: primary care (PC) (54.7%), controllable lifestyle (CL) (27.3%), surgical specialties (SS) (16.8%), and emergency medicine (EM) (5.6%). In the EM group, medical lifestyle was ranked the highest influential categorized factor and prestige as the least. The most important individualized factors that influence career interest in EM are acceptable hours of practice, able to spend appropriate time with family and focus on urgent care.

EM specialty was the least chosen top specialty among PGI. Medical lifestyle was considered to be the most influential factor among the EM group and prestige as the least. The low number of respondents who expressed interest in EM necessitates active promotion of the specialty to prevent the shortage of emergency physicians in the future.

BACKGROUND

Graduating student nurses are crucial to healthcare delivery, yet concerns about their clinical performance persist. They often face challenges translating theoretical knowledge into practice, leading to a theory-practice gap. Clinical competence is essential for ensuring safe and effective nursing care.

This study assessed the clinical competence of graduating student nurses in HEIs within Baguio City. It specifically evaluated their proficiency in professional behavior, general performance, core nursing competency, and advanced nursing skills. Additionally, it examined whether significant differences in clinical competence existed based on sex, area of duty, and accreditation status.

A descriptive-quantitative non-experimental research design was employed. The study surveyed 285 graduating student nurses from six HEIs in Baguio City, selected through fishbowl sampling. Data was collected using the Clinical Competence Questionnaire (CCQ), a 47-item questionnaire with an I-CVI rating of 1.0 and a Cronbach’s Alpha of 0.94. Data analysis included descriptive statistics, Welch's T-test, One-way ANOVA, and Welch's ANOVA.

Students demonstrated high competence with the following means: 4.42 in nursing professional behaviors, 4.32 in general performance, 4.35 in core nursing skills, and 3.92 in advanced nursing skills. While the results were interpreted as high competence, specific advanced nursing skills require further enhancement. No significant differences (p-value < 0.05) in clinical competence were found concerning sex (0.38), duty area (0.92), or accreditation status (0.07).

Graduating student nurses show high competency upon entering level IV, emphasizing ongoing skill development for quality patient care. Both genders exhibit proficiency, indicating fair training and effective education regardless of duty area exposure and accreditation status.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique used to treat major depressive disorder (MDD), particularly in patients with treatment resistant depression. More recently, accelerated transcranial magnetic stimulation (aTMS) has shown comparable efficacy while offering a faster treatment option. This review assesses whether aTMS is non-inferior to rTMS. This systematic review compared aTMS and rTMS protocols for MDD treatment. Studies were identified through PubMed, Cochrane Library, and Web of Science (September 2024).Non-MDD populations and non-aTMS techniques were excluded, such as studies that did not qualify as clinical trials, cohort or randomized controlled trial. Inclusion criteria required direct protocol comparisons and a minimum sample of 10 participants. Bias assessment followed the Cochrane Collaboration’s robvis tool. Four studies were included, encompassing a total sample of 219 patients. Results showed symptom improvement across all groups, with accelerated protocols demonstrating faster response in some cases. However, long-term efficacy varied, and no study provided conclusive superiority of one protocol over the other. This study reveals the variability in aTMS protocols and the inconsistency in the depression rating scales selected across studies, noting that the lack of standardised assessment methods limits meta-analytical potential. Short follow-up durations contrast with antidepressant studies, restricting long-term efficacy evaluation. Additionally, improvements in sham methodologies have increased placebo responses, further influencing treatment outcome interpretation. This systematic review highlights the efficacy, tolerability, and cost-effectiveness of aTMS, suggesting its non-inferiority to rTMS and underscoring the need for further research to define the optimal accelerated protocol.

Objectives: Majority of the existing patient safety culture tools are designed for healthcare workers. Despite the claims that this patient safety tools are patient-centered, limited attention was given to the patients’ perspectives and cultural considerations in the development. Local studies are not available in extant literature that capture patient perspectives on being safe during hospitalization. The goal of the study was to develop and provide preliminary psychometric analysis on a tool that measures patients’ perception of safety culture in a hospital setting. Methods: The study was a quantitative methodological study. The instrument was developed in three phases, conceptualization and item generation through literature review, clinical observation, and focus group discussion, two rounds of expert panel review, and pilot testing. The tool was tested on 122 eligible patients admitted in a tertiary hospital. Factor analysis of the items was done to determine the underlying factor under each item. Cronbach’s alpha was used to test the degree of internal consistency of the scale. Results: The Patient Perceptions on Safety Culture in Hospital Setting Scale consists of 25 items. The analysis yielded four factors explaining a total of 69.23% of the variance in the data. Items were grouped in four dimensions: Hospital workforce (4 items), Hospital Environment (5 items), Heath Management and Care Delivery (7 items), and Information Exchange (9 items). Each factor registered a Cronbach’s alpha of 0.81, 0.78, 0.91, 0.94, respectively. The overall Cronbach’s alpha of the scale is 0.95. Conclusion The study offers preliminary evidence on the psychometric properties of a newly developed tool that measures patient perceptions on hospital safety culture. Subsequent studies on larger samples need to be conducted to determine the reliability and validity of the tool when applied to different population and contexts as well as determining valid cut-off points in scoring and interpretation.
Patient Safety ; Patient Participation

Objectives: Nurse empowerment is essential to ensure delivery of the best quality patient care and attaining positive nurse outcomes. Studies describe its relationship to retention, patient safety, commitment, productivity, job satisfaction, and positive outcomes. The study aimed to determine the level of empowerment of nurses in a tertiary university hospital during the pandemic crisis. Methods: The study was an exploratory descriptive cross-sectional design. Participants (N = 176, Nurses) were randomly selected through a sampling frame. The validated self-administered questionnaire, the Conditions of Work Effectiveness Questionnaire II, was used for data collection. One-way analysis of variance (ANOVA) was used to determine whether there were statistically significant differences between the means of the participants’ empowerment scores when grouped according to their demographic profile. Results: The study found that the nurses in the tertiary university hospital have an overall moderate level of empowerment (TSE x̄ = 22.69, SD = 3.53; GE x̄ = 3.72, SD = 1.01). It was also found that there were statistically significant differences between the means of their total structural and global empowerment scores when grouped according to their age group, civil status, length of service, level of position, and area designation; while no statistically significant difference existed when grouped by their sex and level of education. Conclusion Since nurse empowerment leads to positive nurse and patient outcomes, improving levels of empowerment is thus essential. The results of this study will help administrators identify groups of nurses with relatively lower levels of empowerment and in turn develop programs that will help improve their levels of empowerment.
pandemic

INTRODUCTION: The Philippines tops globally for time spent on social media. This study aimed to explore the association between social media addiction, body image, and social comparison among young adult Filipino women aged 18-25 years old in Metro Manila. METHODS: The Social Media Addiction Scale (SMAS), Body Image Questionnaire (BIQ), and Iowa-Netherlands Comparison Orientation Measure (INCOM) were used to assess social media addiction, body image, and social comparison, respectively. PRR (CI 95%) assessed the association between SMA and BI, and SMA and SC. RESULTS: Majority of participants had social media addiction (91.11%), while most reported a neutral body image (87.64%). Additionally, more than half of the participants exhibited a high tendency towards social comparison (53.15%). The study found a positive association between social media addiction and negative body image, as well as a significant positive association between social media addiction and social comparison. Obesity showed a significant positive association with negative body image perception, while being overweight was significantly associated with a lower likelihood of having a positive body image. Spending at least 4 hours per day on social media was significantly associated with a higher tendency towards social comparison. CONCLUSION These findings suggest the presence of social media addiction among young adult Filipino women and its association with body image and social comparison. Awareness of these associations can contribute to the development of targeted interventions and educational programs to promote healthier social media use and positive body image among young adults.
Social media addiction ; body image ; social comparison

Background/Aims: Endoscopic resection has become the preferred treatment approach for select early esophageal adenocarcinoma (EAC); however, the epidemiology of early stage disease has not been well defined. Methods: Surveillance Epidemiology and End Results (SEER) data were analyzed to determine age-adjusted incidence rates among major epithelial carcinomas, including EAC, from 1973 to 2017. The percent change in incidence over time was compared according to tumor subtype. Early T-stage, node-negative EAC without metastasis was examined from 2004 to 2017 when precise T-stage data were available. Results: The percent change in annual incidence from 1973 to 2017 was 767% for EAC. Joinpoint analysis showed that the average annual percent change in EAC from 1973 to 2017 was 5.11% (95% confidence interval, 4.66%–5.56%). The annual percent change appeared to plateau between 2004 and 2017; however, early EAC decreased from 2010 to 2017, with an annual percent change of -5.78%. Conclusions There has been a 7-fold increase in the incidence of EAC, which was significantly greater than that of the other major epithelial malignancies examined. More recently, the incidence of early EAC has been decreasing. Approximately one in five patients has node negative, potentially resectable early stage disease.

Atypical parathyroid adenoma (APA) is a rare cause of primary hyperparathyroidism (PHPT) and represents a diagnostic challenge since it is an intermediate form of parathyroid neoplasm of uncertain malignant potential with atypical histological features that require differential diagnosis of parathyroid carcinoma (PC). We present 2 cases of parathyroid crisis as a presentation of APA. The first case was that of a 56-year-old man with parathyroid crisis, constitutional syndrome, and anemia, with evidence of APA after en bloc resection, evolving with hungry bone syndrome after surgery and curation criteria at 6 months after parathyroidectomy (PTX). The second case was a 64-year-old woman with acute chronic kidney disease and parathyroid crisis, with evidence of APA after selective PTX and >50% reduction in parathyroid hormone levels after surgery; however, persistent PHPT at 6 months post-surgery was observed. These cases represented a diagnostic challenge due to their rare clinical presentation (parathyroid crisis), with a heterogeneous spectrum of target organ damage and infrequent symptoms (constitutional syndrome and acute chronic renal disease), in turn caused by a rare pathology (APA). The presentation of these patients may be indicative of PC; however, histopathological diagnosis is a key to the diagnosis of APA. The differential diagnosis of APA vs. PC in clinical practice is indispensable.

Sarcopenia, defined as decrease in muscle function and mass, is common in patients with moderate to advanced chronic kidney disease (CKD) and is associated with poor clinical outcomes. Muscle mitochondrial dysfunction is proposed as one of the mechanisms underlying sarcopenia. Patients with moderate to advanced CKD have decreased muscle mitochondrial content and oxidative capacity along with suppressed activity of various mitochondrial enzymes such as mitochondrial electron transport chain complexes and pyruvate dehydrogenase, leading to impaired energy production. Other mitochondrial abnormalities found in this population include defective beta-oxidation of fatty acids and mitochondrial DNA mutations. These changes are noticeable from the early stages of CKD and correlate with severity of the disease. Damage induced by uremic toxins, oxidative stress, and systemic inflammation has been implicated in the development of mitochondrial dysfunction in CKD patients. Given that mitochondrial function is an important determinant of physical activity and performance, its modulation is a potential therapeutic target for sarcopenia in patients with kidney disease. Coenzyme Q, nicotinamide, and cardiolipin-targeted peptides have been tested as therapeutic interventions in early studies. Aerobic exercise, a well-established strategy to improve muscle function and mass in healthy adults, is not as effective in patients with advanced kidney disease. This might be due to reduced expression or impaired activation of peroxisome proliferator-activated receptor-gamma coactivator 1α, the master regulator of mitochondrial biogenesis. Further studies are needed to broaden our understanding of the pathogenesis of mitochondrial dysfunction and to develop mitochondrial-targeted therapies for prevention and treatment of sarcopenia in patients with CKD.

Background: A considerably large portion of the cases of cancer, particularly squamous cell carcinoma (SCC) involving the head and the neck may be due to consumption of tobacco and alcohol. However, its increase in occurrence at specific sites of the head and neck may indicate the possibility of other etiological factors. One of which is infection by certain high-risk human papillomavirus (HPV). P16 immunochemistry serves as a very good surrogate marker of active HPV in these tumors. The detection of HPV-related head and neck cancers have relevance in clinical practice because of its prognostic implications. Objectives: The general objective of this study is to determine the prevalence of p16-positive squamous cell carcinoma in the oral cavity, oropharynx, and larynx in Rizal Medical Center from January 2019 to December 2019. The specific objective is to compare the Hematoxylin and Eosin (H&E) stain histomorphology (keratinization and mitotic activity) of p16-positive versus p16-negative specimens. Methodology: This is a cross-sectional study which included all routine histopathology specimens coming from the oral cavity, oropharynx and larynx in Rizal Medical Center for the year 2019 with a diagnosis of squamous cell carcinoma. The tissue specimens considered were those that measured at least 1 cm in diameter, or aggregate diameter if tissue is fragmented. The slides of all eligible cases were reviewed and immunohistochemically stained for p16. The p16 IHC slides were read as either positive or negative, while the mitotic activity and keratinization were observed in the H&E-stained slides. The interpretation of the diplomate pathologists for each of the slides were documented and corresponding statistical analyses were performed. Results: P16 IHC showed twenty-one (88%) p16 negative cases and three (12%) p16 positive cases. In terms of mitosis, ten cases have mitosis falling within the 1-10 per high power field (HPF) range (42%), six within 11-20 per HPF (25%), and 8 cases have ≥21 mitosis per HPF (33%). In terms of keratinization, three cases are non-keratinizing (12%) and twenty-one cases are keratinizing (88%). There is significant difference in the keratinization histology (p<0.05) of the p16-positive versus the P16-negative cases. On the other hand, no significant difference in the mitotic activity (p>0.05) was noted. Conclusion There is a low prevalence of HPV-related SCC of the oral cavity, oropharynx, and larynx in Rizal Medical Center. The histomorphologic findings confirm that keratinization, significantly predicts HPV status in oropharyngeal SCC. Mitotic activity may not be reliable in predicting the HPV status or p16 IHC reactivity of a case. Keratinization in oropharyngeal SCCs may provide valuable information in certain instances, particularly when HPV testing is not immediately available, although the combined tumor morphology and p16 IHC is more ideal.
Papillomavirus Infections ; Squamous Cell Carcinoma of Head and Neck ; Mouth ; Larynx