BACKGROUND AND OBJECTIVE

Randomized controlled trials (RCTs) are essential for advancing evidence-based healthcare by evaluating the effectiveness and safety of health interventions. Despite the increasing recognition of clinical research, the Philippines has had limited contributions to global RCT output. This bibliometric analysis aims to assess the trends, characteristics, and impact of RCTs conducted in the Philippines and published online.

A systematic search of Medline (PubMed), and EMBASE, along with Acta Medica Philippina, was conducted to identify published RCTs from January 1990 to October 2022. Eligible studies were screened and analyzed based on publication trends, funding sources, study designs, research settings, and institutional contributions. Descriptive statistics were used to summarize key findings.

A total of 391 RCTs were identified, with a notable increase in number of RCTs published over time. Most studies (91.8%) were published in international journals, and funding was primarily sourced from pharmaceutical companies (47.1%). The predominant RCT design was two-arm parallel (64.7%), with hospitals being the most common research setting (54.2%). Research areas were led by infectious diseases, particularly vaccine-preventable illnesses (23.8%). While the University of the Philippines Manila (21.1%) and the Research Institute for Tropical Medicine (13.7%) were the leading institutions in terms of highest number of published RCTs, foreign authors accounted for nearly half (47.3%) of primary authorships. The most cited studies focused on cardiovascular diseases, infectious diseases, and oncology.

The increasing number of published RCTs in the Philippines reflects growth in research capacity and institutional engagement. Strengthening national research dissemination platforms and fostering regional collaborations will be essential in advancing the Philippines’ contribution to global clinical research.

INTRODUCTION

The suspension of face-to-face education across all public and private institutions in the Philippines during the COVID-19 pandemic prompted nationwide adoption of blended learning-a hybrid model combining online and modular instruction with limited in-person components, while blended learning became primary instructional approach during this period, the Dr. Jose Fabella Memorial Hospital School of Midwifery‘s specific implementation lacked formal evaluation. This study aimed to analyze students’ and instructors’ experiences, self-efficacy, and satisfaction with blended learning during the pandemic-era “new normal,” addressing a critical gap in assessing pedagogical effectiveness in specialized vocational training contexts.

This study used mixed method approach to assess of DJFMH midwifery students and instructors’ experiences, self-efficacy, and satisfaction by using quantitative questionnaires and qualitative focus groups to explore deeper insights. This pattern enabled the researchers to evaluate the level of experiences, self-efficacy, and satisfaction but also the strengths and weaknesses of the program.

The findings revealed that the demographic profile predominantly consists of young, single, first-time midwifery students with no prior experience in information and communication technologies (ICT) literacy experience and limited professional background. This group was compared to a more experienced cohort of instructors, with both groups using PLDT as their internet service provider. Both students and instructors reported moderate agreement regarding blended learning experiences. In addition, the results indicated a positive correlation between experience and satisfaction. However, there was only a weak correlation between experience and self-efficacy. Instructors generally reported high self-efficacy, while students expressed mixed feelings about their preparedness and skill acquisition, especially in practical midwifery competencies. Overall, both groups demonstrated moderate levels of satisfaction with the blended learning approach. Instructors largely report higher self-efficacy, while students exhibit mixed feelings about their preparedness and skill acquisition, particularly regarding practical midwifery competencies. Both groups display moderate satisfaction with blended learning, especially appreciating its flexibility in time and location, as well as the fresh perspectives it brings to education. However, they also identify several challenges, including the pressure of expectations, limited adjustment to online platforms, technological issues, gaps in applying midwifery skills, disparities in learning resources, and environmental distractions. Despite recognizing the strengths of blended learning, there remains a strong preference among participants for in-person instruction.

The study highlighted the need for multifaceted approach to midwifery education that addresses the disparities in ICT literacy, preferences for in-person instructions, technological competencies, emotional wellbeing, and practice. Policymakers should focus on practical skill development of students and the professional development of instructors to create a more effective and supportive environment. Future studies should conduct longitudinal research to track the progress of students’ skills and confidence.

INTRODUCTION: Antimicrobial resistance (AMR) poses a critical global health threat, with millions of deaths attributed to it annually. Antibiotic stewardship to combat AMR is the responsibility of all healthcare professionals. Despite evidence suggesting that it is unnecessary, dentists routinely prescribe prophylactic antibiotics following third molar (3M) surgeries. METHOD: This mixed-methods study examined the behavioural barriers influencing antibiotic prescribing practices within the Division of Oral and Maxillofacial Surgery at the National University Centre for Oral Health Singapore. This study used the capability, opportunity and motivation for behavioural change or COM-B framework to implement interventions targeting the behavioural barriers. RESULTS: Pre- and post-intervention data over 6 months showed a significant reduction in antibiotic prescriptions from 84.45% to 20.89%, following the implementation of COM-B strategies (P<0.001). Qualitative feedback from focus group discussions highlighted a positive shift in clinicians' attitudes towards antibiotic reduction, acknowledging the minimal infection risk associated with non-prescribing practices. Notably, complication rates remained stable throughout the study period, indicating no adverse effects from reduced antibiotic usage. CONCLUSION These findings demonstrated that the COM-B model can be successfully applied to modify deeply ingrained prescription habits, and underscored the effectiveness of a structured behavioural change intervention in enhancing compliance with antibiotic stewardship guidelines. The study advocates continuation of initiatives to sustain this positive trend and mitigate AMR in clinical practice.
Humans ; Molar, Third/surgery* ; Anti-Bacterial Agents/therapeutic use* ; Singapore ; Antimicrobial Stewardship/methods* ; Practice Patterns, Dentists'/statistics & numerical data* ; Antibiotic Prophylaxis ; Female ; Attitude of Health Personnel ; Male ; Tooth Extraction ; Adult ; Focus Groups ; Practice Patterns, Physicians'

INTRODUCTION: Paediatric sexual assault (SA) victims should be assessed for post-exposure prophylaxis (PEP) to mitigate the risk of sexually transmitted infections (STIs). We describe the clinical characteristics of children and young persons (CYPs) presenting with SA at KK Women's and Children's Hospital in Singapore, viral PEP (human immunodeficiency virus [HIV] and hepatitis B virus [HBV]) prescribing practices, and STI evaluation at follow-up. METHOD: Medical records of CYPs ≤16 years who presented with SA between January 2022 and August 2023 were reviewed, including assault and assailant characteristics, baseline and follow-up STI screening, PEP prescription, adherence and follow-up attendance. CYPs with SA in the preceding 72 hours by HIV-positive or HIV-status unknown assailants with high-risk characteris-tics were eligible for HIV PEP. RESULTS: We analysed 278 CYPs who made 292 SA visits. There were 40 (13.7%) CYPs eligible for HIV PEP, of whom 29 (82.9%) received it. Among those tested at baseline, 9% and 34.9% of CYPs tested positive for Chlamydia trachomatis and Gardnerella vaginalis, respectively. None tested positive for Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, HBV or hepatitis C. Majority of CYPs tested were HBV non-immune (n=167, 67.6%); only 77 (46.1%) received the vaccine. Out of 27 CYPs eligible for HBV PEP with immunoglobulin, only 21 (77.7%) received immunoglobulin. A total of 37 CYPs received HIV PEP, including 8 who were retrospectively deemed ineligible. Only 10 (27%) completed the course. Overall, 153 (57.7%) CYPs attended follow-up, and none seroconverted for HIV or HBV. CONCLUSION We report suboptimal rates of HBV post-exposure vaccination, and low compliance to HIV PEP and follow-up among paediatric SA victims. Factors contri-buting to poor compliance should be examined to optimise care for this vulnerable population.
Humans ; Post-Exposure Prophylaxis/methods* ; Female ; Child ; Adolescent ; Singapore/epidemiology* ; HIV Infections/prevention & control* ; Male ; Sexually Transmitted Diseases/epidemiology* ; Retrospective Studies ; Hepatitis B/prevention & control* ; Follow-Up Studies ; Child, Preschool ; Sex Offenses/statistics & numerical data* ; Child Abuse, Sexual

Background: Regional anesthetic techniques are becoming increasingly more common for a variety of surgeries. Current literature regarding regional anesthesia for breast surgery also involves sedation or general anesthesia (GA).Case: A 53 year old female underwent wide local excision breast surgery and sentinel node biopsy under combined thoracic paravertebral block and pectoralis nerve I and II block without concurrent sedation or GA. Conclusions This case report demonstrates patient acceptability for completely awake breast surgery with good surgical conditions. This technique could be used for high risk or motivated patients where a GA and its associated complications could be avoided.

Ulcerative colitis (UC) is an inflammatory condition of the intestine, resulting from an increase in oxidative stress and pro-inflammatory mediators. In this study, the extract of endophytic bacterium Rhizobium aegyptiacum was prepared for the first time using liquid chromatography-mass spectrometry (LC-MS). In addition, also for the first time, the protective potential of R. aegyptiacum was revealed using an in vivo rat model of UC. The animals were grouped into four categories: normal control (group I), R. aegyptiacum (group II), acetic acid (AA)‍-induced UC (group III), and R. aegyptiacum-treated AA-induced UC (group IV). In group IV, R. aegyptiacum was administered at 0.2 mg/kg daily for one week before and two weeks after the induction of UC. After sacrificing the rats on the last day of the experiment, colon tissues were collected and subjected to histological, immunohistochemical, and biochemical investigations. There was a remarkable improvement in the histological findings of the colon tissues in group IV, as revealed by hematoxylin and eosin (H&E) staining, Masson's trichrome staining, and periodic acid-Schiff (PAS) staining. Normal mucosal surfaces covered with a straight, intact, and thin brush border were revealed. Goblet cells appeared magenta in color, and there was a significant decrease in the distribution of collagen fibers in the mucosa and submucosal connective tissues. All these findings were comparable to the respective characteristics of the control group. Regarding cyclooxygenase-2 (COX-2) immunostaining, a weak immune reaction was shown in most cells. Moreover, the colon tissues were examined using a scanning electron microscope, which confirmed the results of histological assessment. A regular polygonal unit pattern was seen with crypt orifices of different sizes and numerous goblet cells. Furthermore, the levels of catalase (CAT), myeloperoxidase (MPO), nitric oxide (NO), interleukin-6 (IL-6), and interlukin-1β (IL-1β) were determined in the colonic tissues of the different groups using colorimetric assay and enzyme-linked immunosorbent assay (ELISA). In comparison with group III, group IV exhibited a significant rise (P<0.05) in the CAT level but a substantial decline (P<0.05) in the NO, MPO, and inflammatory cytokine (IL-6 and IL-1β) levels. Based on reverse transcription-quantitative polymerase chain reaction (RT-qPCR), the tumor necrosis factor-‍α (TNF-‍α) gene expression was upregulated in group III, which was significantly downregulated (P<0.05) by treatment with R. aegyptiacum in group IV. On the contrary, the heme oxygenase-1 (HO-1) gene was substantially upregulated in group IV. Our findings imply that the oral consumption of R. aegyptiacum ameliorates AA-induced UC in rats by restoring and reestablishing the mucosal integrity, in addition to its anti-oxidant and anti-inflammatory effects. Accordingly, R. aegyptiacum is potentially effective and beneficial in human UC therapy, which needs to be further investigated in future work.
Animals ; Colitis, Ulcerative/prevention & control* ; Rats ; Male ; Rhizobium ; Disease Models, Animal ; Colon/pathology* ; Rats, Sprague-Dawley ; Oxidative Stress ; Cyclooxygenase 2/metabolism*

Background and Objectives: Understanding worsening heart failure events (WHFEs) and clinical practices in the real world is essential in heart failure (HF) management. The primary objective of this single-center, retrospective, observational study, including a patient survey, was to characterize WHFEs and associated factors during the first year after the incident HF diagnosis in Finnish patients. Secondly, implementation and adherence to guideline-directed medical therapy (GDMT) and mortality during the whole follow-up were assessed. Methods: Incident HF patients (International Classification of Diseases, 10th Revision: I50) with reduced ejection fraction (HFrEF; <40%) were identified between 2013–2019 from the hospital data lake of Southwest Finland. Clinical characteristics, healthcare resource utilization, medication prescriptions and purchases, and deaths were collected from hospital records and national registers between 2011–2021. A survey was linked with register data for a subgroup of patients. Associations between explanatory factors, WHFEs, and mortality were studied using logistic and Cox regression models. Results: Among 570 HFrEF patients, 23% (n=133) experienced a WHFE within the first year after the incident diagnosis. During this 1-year period, 85% used angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 90% beta-blockers, and 44% mineralocorticoid receptor antagonists, and >80% of patients were adherent to these medications. WHFEs were associated with higher risk of mortality (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.31–2.53; p<0.001), whereas adherence was associated with a lower risk of WHFEs (odds ratio, 0.31; 95% CI, 0.20–0.48; p<0.001) and mortality (HR, 0.66; 95% CI, 0.47–0.94; p=0.021) in multivariate models. Quality of life was lower in patients with (n=47) than without WHFEs (n=100). Conclusions Improving adherence is crucial for mitigating adverse outcomes in HF.

Background: The optimal screening interval for diabetic retinopathy (DR) remains controversial. This study aimed to develop a risk algorithm to predict the individual risk of referable sight-threatening diabetic retinopathy (STDR) in a mainly Chinese population and to provide evidence for risk-based screening intervals. Methods: The retrospective cohort data from 117,418 subjects who received systematic DR screening in Hong Kong between 2010 and 2016 were included to develop and validate the risk algorithm using a parametric survival model. The risk algorithm can be used to predict the individual risk of STDR within a specific time interval, or the time to reach a specific risk margin and thus to allocate a screening interval. The calibration performance was assessed by comparing the cumulative STDR events versus predicted risk over 2 years, and discrimination by using receiver operative characteristics (ROC) curve. Results: Duration of diabetes, glycosylated hemoglobin, systolic blood pressure, presence of chronic kidney disease, diabetes medication, and age were included in the risk algorithm. The validation of prediction performance showed that there was no significant difference between predicted and observed STDR risks in males (5.6% vs. 5.1%, P=0.724) or females (4.8% vs. 4.6%, P=0.099). The area under the receiver operating characteristic curve was 0.80 (95% confidence interval [CI], 0.78 to 0.81) for males and 0.81 (95% CI, 0.79 to 0.83) for females. Conclusion The risk algorithm has good prediction performance for referable STDR. Using a risk-based screening interval allows us to allocate screening visits disproportionally more to those at higher risk, while reducing the frequency of screening of lower risk people.