OBJECTIVE: To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).
METHODS: Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.
RESULTS AND DISCUSSION: The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.
CONCLUSION: Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.

Intubation ; Problem-Based Learning

BACKGROUND: The PCS, through a memorandum of understanding with the WHO, DOH and the PHIC, was tasked as the lead professional organization for the implementation of the patient safety in surgery program of the WHO World Alliance for Patient Safety in Surgery in the Philippines in September 12, 2008. A prospective study was conducted to present the results of the initial implementation of the WHO Safe Surgery Checklist in selected hospitals throughout the Philippines.

METHODS: Training Workshops for personnel of participating hospitals were conducted during the 2009 PCS Annual Clinical Congress and the 2009 PCS Midyear Convention and standard data collection forms and guidelines were disseminated thru the 11 PCS chapters to gather data.

RESULTS: Forty hospitals participated with a total of 44,539 major operations performed between January 1, 2009 and December 31, 2009. Check utilization rates ranged from 0.15%-3.6% and death rates ranged from 0.38%-2.3%. Highest complication and death rates were noted in hospitals with lower checklist utilization rates. Despite repeated training of personnel, variable rates of checklist utilization were observed. Lack of awareness and orientation were cited as common reasons for non-utilization of the checklist while hospitals with high utilization rates cited involvement and commitment of higher administration and the presence of a training environment as crucial to implementation of the checklist.

Human ; Checklist ; Patient Safety ; World Health Organization ; Philippines ; Hospitals ; Orientation, Spatial ; Awareness

OBJECTIVES: The study aimed to describe the use of an improvised vacuum-assisted closure (VAC) system in the management of enterocutaneous fistulas in patients admitted at the Philippine General Hospital (PGH) from January to December 2009. Demographic data as well as outcomes of patients were described.

METHODS: The study is a case series involving patients with enterocutaneous fistulas admitted at the PGH from January to December 2009 on whom an improvised VAC system was employed. Pertinent data were gathered, and frequencies and percentages were also computed.

RESULTS: The modified VAC system was employed in 19 patients. The most common etiology reported was iatrogenic (74%). Nine patients (47%) had spontaneous resolution during admission. The mean time to spontaneous closure with VAC usage was 17 days (range: 5 to 56). Three patients were discharged after a mean of 21 days (range: 8 to 44) on VAC, with efficient effluent collection using a stoma appliance. Of the three, 2 to patients had spontaneous fistula closure on follow up. Five patients declined further treatment. There was one mortality reported.

CONCLUSION: The use of an improvised VAC system may contribute to and hasten successful non-surgical treatment of patients with enterocutaneous fistulas.

Human ; Negative-pressure Wound Therapy ; Hospitals, General ; Iatrogenic Disease ; Philippines ; Intestinal Fistula ; Patient Discharge

For so many years, abdominoperineal excision has been the mainstay of surgical treatment for rectal cancer 7 cm and below the anal verge. With continued research and introduction of new technology, the management of rectal malignancies has involved making it possible to save the sphincter complex mechanism despite the distance from the verge. Concurrent with these developments is the introduction of a multidisciplinary team approach which the UP-Philippine General Hospital Colorectal Division has adopted in managing colorectal cancer cases. With the adoption of these advancements in the management of patients with rectal cancer, it is surmised that the institution's APR rates have decreased.

OBJECTIVES: The study aimed to document and compare the abdominoperineal resection (APR) rates at the Philippine General Hospital (PGH), before and after the introduction of a multidisciplinary team for colorectal cancer, over the course of 5 years (2005-2009).

METHODS: The study included all adult patients undergoing resection for low to mid rectal cancer, described as a tumor with distal extent of 11 cm or below from the anal verge (FAV), from January 1, 2005 to December 31, 2009. Data pertinent to the management were gathered. Frequencies and rates before and after the introduction of a multidisciplinary team approach were computed and compared.

RESULTS: There were a total of 230 rectal resection for cancer over a five-year period. The patients' mean age was 53 years (range: 26 to 83). There were 122 males and 108 females. Almost half of the patients (48.7%) presented with a clinical stage of Stage IIIB. Forty-three percent of patients underwent either pre-operative radiotherapy or combined chemoradiotherapy. Cumulatively, the APR rate was 30.90 percent (sphincter-saving rate 69.10%) The APR rate for 2009 was 12.82 percent (sphincter-saving rate 87.18) corresponding to a 39.18 percent decrease in APR rate from the highest APR rate recorded in 2006 (52%).

CONCLUSION: A multidisciplinary team (MDT) approach resulted in lower APR rates among patients with rectal cancer at the UP-PGH.

Human ; Aged 80 And Over ; Aged ; Middle Aged ; Colorectal Neoplasms ; Hospitals, General ; Philippines ; Rectal Neoplasms ; Rectum ; Chemoradiotherapy ; Digestive System Surgical Procedures ; Patient Care Team

OBJECTIVE: This retrospective, cross-sectional study was conducted to determine the factors associated with a successful outcome in the Philippine Board of Surgery (PBS) certifying examinations (written and oral).
METHODS: The examination records of candidate examinees who applied to take the PBS certifying examinations from 2006-2009 were reviewed. Successful outcome was defined as passing the written and oral examinations on a first attempt. Various factors (both continuous and non-continuous) were analyzed regarding their association with a successful outcome.
RESULTS: There were 370 candidate examinees with 137 (37.0%) successful outcomes. The following factors were found to be significantly associated with a successful outcome: younger age, previous performance in the RITE examinations, taking the examination within a year of completion of residency, training in a university-based program and undertaking subspecialty fellowship during the examination year.
CONCLUSION: These results may provide useful information for the PBS and other stakeholders in general surgery training.

Human ; Male ; Female ; Internship And Residency ; Fellowships And Scholarships ; Universities ; Philippines ; Certification ; Diagnosis, Oral ; Medicine

OBJECTIVE: The paper aimed to described and document the multidisciplinary process being ascribed to in the care of the colorectal cancer patient at the UP-PGH as conducted by the UP-PGH Colorectal Cancer and Polyp Study Group.

METHODS: A description of the multidisciplinary team (MDT) process is presented. Data supplementing the documentation of the MDT process were, likewise, presented.

RESULTS: In 2008, 214 rectal cancer patients were admitted and managed by the Division of Colorectal Surgery. Of these, 52 patients with mid- to low-rectal tumors eventually underwent resection of the primary lesion. Forty-one (79%) underwent a sphincter-saving operation. Only 11 APRs were performed. Our APR rate was, thus, at 21 percent. Among the 52 patients, 18 underwent neoadjuvant treatment with 10 subjected to chemoradiotherapy prior to surgery, a pathologic complete response was observed in 4 patients.

CONCLUSION: With the increasing incidence of colorectal malignancies and the continuing collection of evidence supporting multimodality approach, the role of multidisciplinary team in the management of these cancers has come to the fore. UP-PGH Colorectal Cancer and Polyp Study Group has shown that the multidisciplinary team approach may be implemented amidst institutional and financial limitations without compromising the delivery of quality and efficacious cancer management.

Human ; Colorectal Neoplasms ; Neoadjuvant Therapy ; Colorectal Surgery ; Rectal Neoplasms ; Chemoradiotherapy ; Colonic Neoplasms ; Polyps ; Patient Care Team

Objectives:We described the technique of utilizing the marginal vascular arcade (MVA) of the right colon as blood supply to the ileal pouch in restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA) after high ligation of the superior mesenteric artery (SMA). The results of having performed this surgical procedure on patients with familial adenomatous polyposis (FAP) and (UC) are presented.Methods:The method of RPC with IPAA using the above-mentioned mesentric lengthening technique is described.Results:There were 5 patients, all were male with a mean age of 37 years. Four (80%) had FAP, one (20%) had UC. Two (40%) of the patients had a family history of polyposis or colon cancer. Three (60%) had stapled anastomosis; the remaining (40%) were hand-sewn. All patients had a protecting stoma. The mean total hospital length of stay (LOS) was 21 days with a mean postoperative LOS of 8 days. Two morbidities were reported in a single patient an anastomotic leak and an ileoanal anstomotic structure. There were no mortalities. There were no intra-operative abandonments of the anal restoration.Conclusion:The technique of utilizing the MVA of the right colon provides a safe, reliable and durable alternate blood supply to the ileal pouch in patients undergoing RPC with IPAA.Key words: restorative proctocolectomy, familial adenomatous polyposis, ulcerative colitis
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A rare case of a young pregnant patient on her 32nd week of pregnancy, diagnosed with colorectal cancer, presenting with rectal bleeding, is reported. The various issues concerning the management of this malignancy in a pregnant patient is described and the value of a multidisciplinary approach to achieve favorable results for both the mother and child is emphasized. Key words: colorectal cancer, complications in pregnancy, rectal bleeding

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A rare case of right sided diaphragmatic hernia, in a 49 year-old male with a history of penetrating right chest trauma thirty years prior to consultation, is reported. The salient features of the successful management of this patient, presenting with signs and symptoms of complete intestinal obstruction, is described. The natural history of diaphragmatic hernias is reviewed.

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The first part of the critical care guidelines of the Philippine College of Surgeons (PCS) and supported by Glaxo Wellcome Philippines, Inc. dealt with resuscitation fluids, blood transfusion, assessment of volume resuscitation, nutritional support and cardiovascular support. The second part deals with the last 2 aspects identified by the Technical Working Group (TWG) namely: surgical intensive care units and implementation of guidelines. The literature search, limited to english publications. Used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane Library, Issue 4, 2000; 2) National Library of Medicine - Medline (PubMed, no time limit): and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD. Manual searching of the reference lists of review articles and some important meta-analyses and randomized controlled trials (RCTs) was also done. The search terms used were: 1) Cochrane library: surgical intensive care, guidelines implementation, 2) Medline: surgical intensive care, 3) HERDIN: intensive care. Titles of all articles were printed and all members of the TWG went over the list and checked the titles of articles whose abstracts they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. (Author)

National Library Of Medicine (u.s.) ; Philippines ; Medline ; Pubmed ; Libraries ; Critical Care ; Nutritional Support ; Information Services ; Blood Transfusion ; Surgeons