BACKGROUND

This first clinical practice guideline (CPG) on osteoporosis prevention and management in the Philippines is the output of a shared undertaking by a multidisciplinary CPG development team spearheaded by the Osteoporosis Society of the Philippines Foundation, Inc. and joined by the Philippine Academy of Family Physicians; the Philippine College of Endocrinology, Diabetes, and Metabolism; the Philippine Orthopedic Association; the Philippine Obstetrics and Gynecological Society and the Philippine Rheumatology Association. This guideline seeks to augment and update the "Consensus statements on osteoporosis diagnosis, prevention and management in the Philippines," initially published in 2011, incorporating evidence-based practices developed in the last decade.

METHODOLOGY

The steering committee formulated and prioritized clinical questions based on meetings and stakeholder consultations. A PICO (population, intervention, comparator, outcome) format was used to develop clinical questions and guide the systematic search for evidence. The development of guidelines followed the ADAPTE process. Once completed, panel discussions were done using the Evidence to Decision Framework. After the panel discussions, the final recommendations were revised.

RESULTS

Thirty-four recommendations were formulated to address 27 clinical questions related to screening, prevention, diagnosis, pharmacologic and nonpharmacologic treatment, surgical management, follow-up, and continuity of care. With these recommendations, the developers aim to establish a standard of care in the prevention, diagnosis and management of osteoporosis and fragility fractures in both in-patient and out-patient cases that are appropriate to the Philippine context. Specifically, the CPG development group aims to use these recommendations to define the standard of care for osteoporosis as part of universal healthcare services once the program is implemented nationally. Relevant stakeholders may also use the recommendations to inform public and private payor policies for patients with fragility fractures, as well as by local government units or private companies looking to establish orthogeriatric centers with fracture liaison services.

CONCLUSION

This guideline is helpful for physicians and other allied health personnel in screening, diagnosis, management and prevention of primary osteoporosis and fragility fractures among postmenopausal women and older men.

Human ; Philippines ; Guideline ; Osteoporosis

Objective: To measure the levels of environmental noise in the medical intensive care unit, surgical intensive care unit, and adult ward of the Makati Medical Center for the morning, afternoon, and evening shifts, on weekdays and weekends, and to compare noise levels across shifts, and between weekdays and weekends. Methods: Design: Environmental Noise Survey. Setting: Tertiary Private Training Hospital. Participants: None. Results: The overall mean environment noise levels in all the areas surveyed (medical intensive care unit, surgical intensive care unit and adult ward) exceeded World Health Organization recommendations by more than 20 dB across different working shifts on both weekdays and weekends. There was no significant difference in noise levels between weekdays and weekends across shifts in all areas, except for the afternoon shift in the Medical ICU. Using Repeated Measures ANOVA, results showed that there is no sufficient evidence to conclude that at least one shift has significantly different mean noise level in any of the 3 areas (MICU: F(2)=4.73, p-value=.1124; SICU: F(2)=7.91, p-value=.0540; WARD: F(2)=2.73, p-value=.1948) Conclusion The overall environmental noise levels in the different areas of MICU, SICU and Adult ward exceeded the WHO recommendation. It is recommended that a change in strategy is needed for prevention of environmental noise, setting guidelines and policies to assure quality health care and noise control. Further investigations to ascertain exact sources may give rise to feasible solutions.
Noise ; Hospitals ; Sound ; Intensive Care Units