BACKGROUND

Simulation immerses learners in guided replications of real-life experiences. Simulation-based learning in the health profession allows trainees and professionals to practice skills in a controlled environment using various modalities, enhancing patient safety and minimizing clinical errors.

To describe the profile of Philippine studies on clinical simulation in healthcare professional education and assess the methodological quality of these studies.

We conducted a scoping review of studies on clinical simulation studies in healthcare education in the Philippines. We followed the methods for scoping review and reported using the PRISMA Scoping review checklist. We searched for relevant studies from electronic databases (PubMed, Scopus, CENTRAL, Herdin, and Cochrane) as of May 17, 2024, and summarized descriptive data on the characteristics of the study, population, clinical simulation technique, and outcomes, using graphical summaries and tables. We assessed the methodological quality of included studies using the Modified Medical Education Research Study Quality Instrument (MMERSQI).

We included 13 studies mostly published in the 2020s (7), by faculty as main author (9), with hospital affiliation (10), single-center (11), setting in NCR (11), analytic (10), medical field (10), educational purpose (7), using task trainers (5), low- to medium-fidelity (11), with technical competencies (mostly skills) as desired outcome (9), median sample size of 40, and including mostly postgraduate level participants (7). There was moderate methodological quality (median MMERSQI score, 51 [range, 40, 77] with the ‘type of data’ item being highly reported and ‘validity of instrument tool’ item poorly reported.

The observed gaps in methodological rigor, study design, and fidelity of simulation techniques in healthcare education in the Philippines highlight opportunities for advancing the field. Future research should aim to address these gaps, particularly by increasing the use of RCTs, enhancing the validity of measurement tools, and incorporating comprehensive simulation components.

BACKGROUND AND OBJECTIVE

Anatomical education utilizes mainly cadaver dissection, but it also depends on innovations such as novel preservation techniques, simulation models, and virtual dissection apps. There is no review on anatomical patents. This study aimed to review the worldwide landscape of existing patents on anatomical education to identify gaps and opportunities for utilization and further innovations.

We conducted a scoping review for inventions, utility models, and industrial design applications on anatomical education. We searched the following databases as of December 31, 2022 (WIPO Patentscope, Espacenet, and Derwent). We deduplicated the records, screened them for eligibility, and extracted information on characteristics of the patent application and applicant. We computed frequency and percentage according to country, type of applicant, number of inventors, type of patent, scope of patent, purpose of patent, organ system, status of patent, and time to patent granting.

Out of 667 merged records from the initial search, we removed 312 duplicates, excluded 97 records, and included 258 reports in the review. The median number of patent applications per year was 58 (range, 32, 61). Majority of the applications were from China and USA (36.0 and 34.9%, respectively), national in scope (62.8%), industry as applicant (49.6%), inventions (77.5%), usable beyond anatomy (70.9%), physical models (53.1%) and with pending status (63.6%). The median time to granting for 65 patents was 316 days (range, 40 to 1568).

For the period 2018-2022, there were 258 patent applications related to anatomical education, both as a basic science and in clinical applications, were mostly inventions, applied for by industry, contributed by US and China, only national in scope, physical 3D models (mostly musculoskeletal, head/neck and sensory organs, and whole body), and usable beyond basic anatomy. The majority of patent applications are still pending with only 65 granted patents. Plastinated specimens, and the urinary, reproductive, and pulmonary organ system models were least represented.

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.

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.

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).

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.

RATIONALE AND OBJECTIVES

The COVID- 19 pandemic and the subsequent designation of the Philippine General Hospital lead to necessary adjustments in internal medicine residency training. This study investigated the impact of the COVID-19 pandemic on internal medicine (IM) residents in the Philippine General Hospital.

A questionnaire was developed and distributed among internal medicine residents employed in the years 2020 and 2021. Qualitative data was then gathered through on line and face-to-face interviews.

A total of 43 Internal Medicine residents responded. This study found that the pandemic significantly affected internal medicine residents and their overall training. The participants reported changes in the number and profile of patients seen, the limited outpatient clinical exposure, the difficulties of telemedicine, and the reduced interactions with consultants and subspecialty fellows. Infection control protocols and workforce limitations also affected the number of procedures done by the residents. Resident participants reported that they were able to allot more time to studying from the textbook because of the skeletal schedules and decreased number of patients. Other learning avenues were shifted to online conferences and lectures.

The COVID-19 pandemic a lso brought about changes in residents' day-to-day routines, schedules, and rotations. Communicating with patients and relatives was also reported to be more difficult. Lifestyle changes varied among resident s. Socialization also shifted to online avenues and social messaging platforms. Having colleagues who test positive tor COVID and subsequently requiring quarantine lead to constant changes in workforce dynamics. This lead to feelings of anxiety and isolation among its trainees.

However, a number of participants still believed that the pandemic allowed them to become better physicians. This was brought about by a sense of service and pride, camaraderie among colleagues, commitment to finishing the program, financial stability, and administrative support. Still, the participants stated areas for improvement, including more consistent protocol measures, additional financial compensation, added workforce, and more transparent administrative support. All in all, participants felt that they were still able to meet the learning outcomes and minimum competencies. Majority of the participants believed the experiences brought about by the pandemic helped them become a better internist.

Ultimately, the new challenges from the pandemic strengthened the sense of service, resilience and clinical acumen of the residents.

OBJECTIVES

This study aimed to develop and to pilot-test a tailored introductory Evidence-Based Practice (EBP) training program for registered nurses. Despite the recognized importance of EBP in nursing, many practicing nurses lacked formal training and confidence in its application. This study addressed the gap in accessible and entry-level EBP education designed specifically for EBP competency among nurses.

A quasi-experimental one-group pretest-post test design was employed in this study. A convenient sample of 23 registered nurses from a tertiary educational institution in Angeles City, Pampanga, Philippines had participated in the pilot testing. The introductory EBP Training Program was developed based on core EBP competencies and structured into a modular format. The program was delivered in a computer laboratory setting and conducted for eight to ten hours. The training included lectures, guided case-based discussions, and hands-on exercises covering each step of the EBP process.

Data were collected using the Academic Center for Evidence-Based Practice Readiness Inventory (ACE-ERI) before and after the intervention. Statistical analysis was performed using paired sample t-tests to assess differences in pre- and post-intervention scores. All analyses were conducted using SPSS version 26. Ethical approval was obtained from the Holy Angel University Institutional Review Board (HAU-IRB).

The EBP training program resulted in a statistically significant improvement in both knowledge and confidence in using evidence-based practice. Participants' knowledge scores increased from a pre-test mean of 7.04 (SD = 1.72) to a post-test mean of 8.30 (SD = 1.87), while confidence scores rose from 64.61 (SD = 17.32) to 88.43 (SD = 16.80). Wilcoxon signed-rank tests confirmed the significance of these improvements in both EBP knowledge (Z = -4.16, p < .001) and confidence (Z = -3.56, p < .001).

The study demonstrated that the evidence-based practice (EBP) training program led to a significant improvement in nurses' knowledge and skills, as evidenced by the marked difference in pre- and post-test scores. EBP training programs can effectively enhance healthcare professionals' capacity to integrate evidence into clinical practice. Based on these findings, healthcare organizations should consider incorporating EBP training into regular professional development programs for nurses. EBP training programs should focus on fostering practical application skills and include more case-based learning to further reinforce the integration of EBP in clinical decision-making. Lastly, future researches may explore focusing on long-term outcomes of EBP training, including its impact on patient care and organizational practices, to assess the sustainability of the knowledge gained through such interventions. Overall, by enhancing EBP training and supporting its widespread adoption, healthcare systems can further improve the quality of patient care and promote a culture of continuous learning and evidence-based decision-making.

Resistance training promotes protein synthesis and hypertrophy, enhancing strength of skeletal muscle through the activation of the mammalian target of rapamycin (mTOR) and the subsequent increases of ribosome biogenesis and translation capacity. Recent studies indicate that resistance training has positive effects on physical fitness and illness treatment, yet the mechanisms underlying hypertrophic adaptation remain insufficiently understood. Human studies focused on the correlation between mTOR signals and hypertrophy-related protein production, while animal research demonstrated that mTOR complex 1 (mTORC1) is the main regulator of resistance training induced-hypertrophy. A number of upstream factors of mTORC1 have been identified, while the downstream mechanisms involved in the resistance training induced-hypertrophy are rarely studied. mTORC1 regulates the activation of satellite cells, which fuse with pre-existing fibers and contribute to hypertrophic response to resistance training. This article reviews the research progress on the mechanism of skeletal muscle hypertrophy caused by resistance training, analyzes the role of mTOR-related signals in the adaptation of skeletal muscle hypertrophy, and aims to provide a basis for basic research on muscle improvements through resistance training.
TOR Serine-Threonine Kinases/physiology* ; Resistance Training ; Humans ; Signal Transduction/physiology* ; Muscle, Skeletal/physiology* ; Hypertrophy ; Animals ; Mechanistic Target of Rapamycin Complex 1

The purpose of the present study was to investigate the effects of resistance combined with aerobic chrono-exercise on the common carotid artery elasticity and hemodynamics. 24 healthy young men (21.96±0.43 years old) underwent a single acute resistance combined with aerobic exercise intervention at eight time periods (6, 8, 10, 12, 14, 16, 18, and 20 o'clock). The axial flow velocity and diameter waveforms of the common carotid artery were measured, and the hemodynamics were calculated using the classical hemodynamic theory before exercise, immediately after exercise, 10 min and 20 min after exercise. The results showed that during exercise recovery, systolic and mean pressures decreased more markedly after exercise at 8 o'clock (P < 0.05); At 20 min post-exercise, arterial stiffness index and pressure-strain elastic modulus after exercise at 6 o'clock were reduced compared with the resting state, but were significantly elevated after exercise at 20 o'clock (P < 0.05). Immediately after exercise, the pressure rise was higher after exercise at 6 o'clock and the mean wall shear stress was higher after exercise at 20 o'clock (P < 0.05). These results suggest that resistance combined with aerobic chrono-exercise produces different effects on common carotid artery hemodynamics in young men. A single acute session of resistance combined with aerobic exercise at 8 o'clock is more effective in lowering blood pressure. Exercise at 6 o'clock is beneficial to improve arterial elasticity but is not recommended for young male individuals with cardiovascular disease risks because of the excessive increase in blood pressure immediately after exercise. Exercise at 20 o'clock is more effective in improving wall shear stress but is accompanied by elevated arterial stiffness indices and pressure-strain elastic modulus. These results provide a scientific basis for healthy young men in choosing the time of exercise by exploring the common carotid artery elasticity and hemodynamic-related indices.
Humans ; Male ; Young Adult ; Exercise/physiology* ; Carotid Artery, Common/physiology* ; Hemodynamics/physiology* ; Vascular Stiffness/physiology* ; Elasticity ; Resistance Training ; Adult

Multimorbidity of chronic diseases is one of the most common health issues among older adults, and the resulting demand for long-term medical care and management imposes a considerable burden on healthcare systems. Muscle strength, a core indicator of overall health status, is closely associated with the risk of developing multimorbidity of chronic diseases in older adults. Decline in muscle strength not only increases the risk of multimorbidity of chronic diseases but also interacts with it to exacerbate disease burden. In older adults with existing multimorbidity of chronic diseases, muscle strength decline can impair physical function and quality of life, leading to a vicious cycle of disease progression and physical disability. Strength training can help prevent multimorbidity, with potential mechanisms including the promotion of anti-inflammatory effects and enhancement of mitochondrial energy metabolism. This review summarizes the impact of muscle strength decline on multimorbidity of chronic diseases in older adults and the effectiveness and potential mechanisms of exercise interventions, providing evidence to delay muscle strength decline, prevent the occurrence and progression of multimorbidity of chronic diseases, and improve quality of life in older adults.
Humans ; Aged ; Chronic Disease/prevention & control* ; Muscle Strength/physiology* ; Multimorbidity ; Quality of Life ; Resistance Training ; Exercise Therapy ; Exercise ; Sarcopenia

Objective:To explore the influence of voice training combined with active breathing and circulation techniques on voice recovery following vocal cord polyp surgery. Methods:A total of 110 patients who underwent vocal cord polyp surgery at our hospital from May 2022 to November 2023 were selected and randomly divided into a control group （n=55） and a combination group （n=55） using a random number table method. During the recovery period, both groups received dietary control and aerosol treatment. The control group participated in voice training, while the combination group received active breathing and circulation techniques in addition to voice training for 2 months. Morphological changes, voice acoustic indicators （Shimmer, Jitter, Maximum Phonation Time[MPT]）, and the Voice Handicap Index （VHI） were compared between the two groups, and clinical efficacy was evaluated. Results:The combination group demonstrated higher clinical efficacy after training compared to the control group, with a statistically significant difference （P<0.05）. The proportion of incomplete closure, abnormal mucosal wave, and supraglottic compensation decreased in both groups after training （P<0.05）. However, there was no significant difference in the proportions of incomplete closure and abnormal mucosal wave between the two groups （P>0.05）. Notably, the proportion of patients with supraglottic compensation in the combination group was lower than in the control group （P<0.05）. After training, the Shimmer and Jitter values decreased in both groups, with the combination group exhibiting lower values （P<0.05）. Conversely, the MPT values increased in both groups, again with higher values in the combination group （P<0.05）. Additionally, after training, the functional, physiological, and emotional scores of the VHI decreased in both groups, with the scores in the combination group lower than those in the control group, demonstrating statistical significance （P<0.05）. Conclusion:Voice training combined with active breathing and circulation techniques has a beneficial effect on recovery following vocal cord polyp surgery. This combined approach significantly improves vocal cord morphology and acoustic indices, alleviates voice disorders, and enhances overall voice recovery.
Humans ; Vocal Cords/surgery* ; Polyps/surgery* ; Voice Training ; Male ; Female ; Voice Quality ; Laryngeal Diseases/surgery* ; Voice ; Middle Aged ; Adult ; Respiration

Objective:To explore the factors influencing adherence to voice therapy among patients with voice disorders in China. Methods:Patients with voice disorders who visited the Voice Therapy Center at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from February to May 2022 were enrolled in the study. Adherence was assessed using the URICA-Voice scale, while influencing factors were assessed through the Voice Handicap Index（VHI） scale and a general information questionnaire. Correlation analysis was conducted using univariate and multivariate logistic regression analysis. Results:A total of 247 patients were included in the study, comprising 57 males（23.08%） and 190 females（76.92%）. The results revealed that: ①Female patients demonstrated higher likelihood of being in the contemplation stage（OR=0.22） compared to males. ②Patients with a monthly family income per capita>6 000 yuan were more likely to be in the contemplation stage than those with<3 000 yuan with an OR = 13.94. ③High vocal-demand occupations increased contemplation stage probability（OR=7.70） compared to moderate-demand occupations. ④Residence within 30-minute commute predicted action/maintenance stages（OR=7.14） versus≥60-minute commute. ⑤Patients whose occupations had high voice demands were more likely to be in the action and maintenance stages than those with average voice demands, with an OR of 16.20. Conclusion:Gender, monthly family income per capita, occupational voice demands, and distance to the hospital significantly impact the URICA-Voice compliance stages of patients. Patients who are female, have higher family income, have occupations with high voice demands, and live closer to the hospital exhibit higher compliance with voice training.
Humans ; Male ; Female ; Voice Disorders/therapy* ; Patient Compliance ; Voice Training ; Surveys and Questionnaires ; China ; Middle Aged ; Adult ; Voice Quality ; Logistic Models ; Aged