BACKGROUND AND OBJECTIVES

The comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary evaluation and management process to identify and address the needs of an older person (OP). However, there are several challenges faced in its implementation which limit its full potential and utility to promote healthy aging. This paper aimed to describe the issues and challenges of those involved in the conduct of the traditional paper-based CGA, specifically older persons and the research and health facility-based assessors.

This is a descriptive convergent parallel mixed-methods study utilizing both quantitative and qualitative data from the UP Manila Wellness Initiative for Seniors and Elders research program. Mixed methods of data collection were conducted online, namely survey and focus group discussions (FGD). Purposively recruited OPs aged 60 years and above who previously underwent CGA served as online survey respondents. Similarly, purposively recruited healthcare professionals (HCP) who conduct research-based and facility-based CGA participated in the FGDs. STATA and NVivo PRO Plus were used to analyze the quantitative and qualitative data, respectively. Descriptive statistics were used namely frequencies, percentages, mean, standard deviation, and median. Guided by the interpretivist paradigm, thematic analysis was conducted. Triangulation of results was done by the multidisciplinary team.

A total of 30 OPs with mean age of 67.1 years (SD±5.7) responded to the online survey. A total of 10 healthcare professionals, mostly geriatricians, participated in two separate FGDs.

Most (83%) liked the comprehesiveness of the CGA. However, OPs had difficulties with the following: follow-ups (43%), sensitive questions (40%), and recall (23%). Thirty percent (30%) rated the CGA as long to too long. HCP assessors’ challenges were related to the participants/patients, assessors, and operational factors. Participant/ patient-related factors include health conditions, follow-up issues, language, sensory impairment, and familiarity with the tools. Assessors-related factors include competency, missing information, illegible handwriting, and asking sensitive questions. Operations-related factors include the length of the questionnaire and process, physical set up, fragmented system, data storage and protection, and inadequate human resource.

The common issues and challenges identified by the older persons and healthcare professional assessors in the conduct of paper-based CGA include the length of the CGA, sensitive questions, and follow-up issues. Addressing these issues and challenges is necessary to maximize the utility of the comprehensive geriatric assessment in promoting healthy aging. With the advent of technology, digitizing the paper-based CGA is a promising approach to address these challenges.

INTRODUCTION

This retrospective cohort study investigated the quality of care provided to patients with acute myocardial infarction (AMI) at a non-PCI capable tertiary hospital. We employed validated quality indicators (QIs) endorsed by the European Society of Cardiology (ESC) to assess adherence to evidence-based guidelines for AMI care.

This retrospective cohort study aims to comprehensively evaluate the quality of acute myocardial infarction (AMI) care provided at a non-PCI capable tertiary hospital by utilizing validated quality indicators (QIs). The study assesses adherence to evidence-based guidelines, identifies areas of improvement, and explores the association between care processes and patient outcomes.

This retrospective cohort study analyzed patients admitted with acute myocardial infarction (AMI) to a non-percutaneous coronary intervention (PCI) capable tertiary hospital between January 2021 and December 2022. Data on quality indicators were systematically extracted from medical records to assess adherence to clinical guidelines and patient outcomes. Logistic regression was used to identify predictors of mortality, while controlling for potential confounders such as demographic and clinical characteristics. Ethical approval was granted, and patient data was anonymized in compliance with national regulations.

The study identified a patient population consistent with established cardiovascular risk factors. Adherence rates to QIs varied across different domains. Notably, the risk-adjusted 30-day mortality rate was 29.09%, highlighting the need for further investigation into factors influencing patient outcomes.

Our study highlights both strengths and gaps in adherence to AMI quality indicators at a non-PCI hospital. While key treatments such as P2Y12 inhibitor use and anticoagulation were well implemented, areas like reperfusion protocols, LVEF measurement, and data collection require improvement. These findings reinforce the importance of evidence-based practices and the need for targeted quality improvement initiatives to address disparities in care. Future efforts should focus on enhancing data collection and exploring the reasons behind regional variations to optimize outcomes for AMI patients in resource-limited settings.

Background: In 2008, the Department of Health (DOH) issued Administrative Order 2008-0023 that called for an “effective and efficient monitoring system that will link all patient safety initiatives”. However, there are still no explicit and harmonized targets to measure effectiveness and to provide benchmarks that assess whether previous efforts were helpful. Objective: The study aimed to describe the status of patient safety performance measures and indicators on the international patient safety goals (IPSGs) in select hospitals in the Philippines. Methods: Descriptive, cross-sectional design was used to investigate currently used performance measures and indicators. Data collection included administration of a Hospital Patient Safety Indicators Questionnaire (HPSIQ) that summarized the currently used patient safety measures and indicators in the sampled Level 2 and level 3 hospitals and triangulation by review of documents such as hospital databases, protocols on reporting, and manuals for information gathering regarding patient safety. Performance measures were categorized using the Donabedian framework. Core indicators were identified through review of standards that cut across the six IPSGs and evaluation of overarching processes and concepts in patient safety. Results: Forty-one level 2 and 3 hospitals participated in the study. Most performance indicators were process measures (52%), while structure (31%) and outcome measures (17%) accounted for the rest. There is an obvious lack of structural requirements for patient safety in the hospitals included in this study. Less than half the hospitals surveyed implement risk assessment and management consistently. Reporting of events, near- misses, and patient safety data are widely varied among hospitals. Data utilization for quality improvement is not fully established in many of the hospitals. Patient engagement is not integrated in service delivery and performance measurement but is crucial in promoting patient safety. Conclusion Mechanisms to improve hospitals’ capacity to monitor, anticipate, and reduce risk of patient harm during the provision of healthcare should be provided. Having a unified set of definitions and protocols for measurement will facilitate reliable monitoring and improvement. Leadership and governance, both internal (e.g., hospital administrators) and external (e.g., DOH) that recognize a data-driven approach to policymaking and improvement of service delivery are crucial in promoting patient safety
Patient Safety ; Outcome and Process Assessment, Health Care

Background and Objectives: The comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary evaluation and management process to identify and address the needs of an older person (OP). However, there are several challenges faced in its implementation which limit its full potential and utility to promote healthy aging. This paper aimed to describe the issues and challenges of those involved in the conduct of the traditional paper-based CGA, specifically older persons and the research and health facility-based assessors. Methods: This is a descriptive convergent parallel mixed-methods study utilizing both quantitative and qualitative data from the UP Manila Wellness Initiative for Seniors and Elders research program. Mixed methods of data collection were conducted online, namely survey and focus group discussions (FGD). Purposively recruited OPs aged 60 years and above who previously underwent CGA served as online survey respondents. Similarly, purposively recruited healthcare professionals (HCP) who conduct research-based and facility-based CGA participated in the FGDs. STATA and NVivo PRO Plus were used to analyze the quantitative and qualitative data, respectively. Descriptive statistics were used namely frequencies, percentages, mean, standard deviation, and median. Guided by the interpretivist paradigm, thematic analysis was conducted. Triangulation of results was done by the multidisciplinary team. Results: A total of 30 OPs with mean age of 67.1 years (SD±5.7) responded to the online survey. A total of 10 healthcare professionals, mostly geriatricians, participated in two separate FGDs. : Most (83%) liked the comprehesiveness of the CGA. However, OPs had difficulties with the following: follow-ups (43%), sensitive questions (40%), and recall (23%). Thirty percent (30%) rated the CGA as long to too long. HCP assessors’ challenges were related to the participants/patients, assessors, and operational factors. Participant/ patient-related factors include health conditions, follow-up issues, language, sensory impairment, and familiarity with the tools. Assessors-related factors include competency, missing information, illegible handwriting, and asking sensitive questions. Operations-related factors include the length of the questionnaire and process, physical set up, fragmented system, data storage and protection, and inadequate human resource. Conclusion The common issues and challenges identified by the older persons and healthcare professional assessors in the conduct of paper-based CGA include the length of the CGA, sensitive questions, and follow-up issues. Addressing these issues and challenges is necessary to maximize the utility of the comprehensive geriatric assessment in promoting healthy aging. With the advent of technology, digitizing the paper-based CGA is a promising approach to address these challenges.
geriatric assessment ; Philippines

Humans ; Nutrition Assessment ; Prognosis ; Silicosis/prevention & control* ; Occupational Diseases ; China/epidemiology* ; Occupational Exposure ; Silicon Dioxide

Environmental Exposure/adverse effects* ; Risk Assessment ; Epidemiologic Studies

BACKGROUND

Several studies have shown the serious implications of malnutrition, yet it is still underestimated, understudied and an undertreated problem in hospitalized patients. It remains a challenge for hospitals in the Philippines. Pre operative malnutrition is a risk factor of perioperative morbidity and mortality. Thus, assessing the pre operative nutritional status is necessary in planning early nutritional interventions and may predict risk of developing postoperative complications.

A prospective cohort study was conducted among adult patients ages 18 to 70 years old admitted for abdominopelvic surgery at St. Paul’s Hospital Iloilo from January 2021 to January 2022. Within 24-48 hours of admission, patients’ demographic and clinical profiles were identified and the presence of nutritional risk was evaluated using the Malnutrition Universal Screening Tool (MUST). Further statistical analysis was done using cross tabulation, and Pearson’s chi-square and logistic regression.

The study demonstrated that nutritional risk, age, presence of malignancy, smoking and alcoholic beverage drinking were significantly correlated with post-operative complications.

Nutritional risk screening using MUST pre-operatively can help predict the outcomes of post-operative patients undergoing abdominopelvic operation.

Background: The COVID-19 pandemic has affected the well-being of children with Autism Spectrum Disorder (ASD) and their families. The core deficits of the condition and increased parental stress during this time made them more vulnerable. Objectives: This study aims to explore how the pandemic has affected these families by identifying their needs and capabilities in order to provide support. Methods: A total of 227 parents of children with ASD completed an online survey consisting of items on sociodemographic, family needs, and coping strategies. Descriptive statistics were used and t-test and ANOVA/Kruskal Wallis were used to determine the relationship between parent and child factors with needs and coping. Results: Needs for Information, Community Services, and Finances are the top categories while the greatest identified need during this pandemic was for financial assistance. Religiosity, Problem-Solving, and Cognitive Reappraisal were the widely used coping strategies by the parents. Fathers, younger children, daughters with ASD, and having more than one child with ASD showed significant association with needs. Parents with primary and tertiary education were associated with use of the cognitive reappraisal strategy and those with jobs were associated with substance use. Conclusion Families of children with ASD have multiple needs during this pandemic, from autism-specific information and services, to more generic concerns such as financial assistance. Despite these challenges, these families have positive strategies in place to facilitate coping mechanisms.
Autistic Disorder ; COVID-19 ; Needs Assessment ; Coping Skills

Several studies have shown the serious implications of malnutrition, yet it is still underestimated, understudied and an undertreated problem in hospitalized patients. It remains a challenge for hospitals in the Philippines. Pre-operative malnutrition is a risk factor of perioperative morbidity and mortality. Malnourished patients have longer hospital stay and have higher risk of complications. Thus assessing the pre-operative nutritional status is necessary in planning early nutritional interventions and may predict risk of developing postoperative complications.

A prospective cohort study was conducted among adult patients ages 18 to 70 years old admitted for abdominopelvic surgery at St. Paul's Hospital lloilo from January 2021 to January 2022. Within 24-48 hours of admission, patient demographic and clinical profiles were identified and the presence of nutritional risk was evaluated using the Malnutrition Universal Screening tool (MUST). SPSS version 20 was used to analyze the data. Further statistical analysis was done using Cross Tabulation, Pearson Chi-Square and Logistic Regression.

The study demonstrates that nutritional risk, age, presence of malignancy, smoking and alcoholic beverage drinking are significantly correlated with post-operative complications.

Thus, nutritional risk screening using MUST pre-operatively can predict the outcomes of postoperative patients undergoing abdominopelvic operation.

Objective: The purpose of this study was to describe the perceptions and satisfaction of the graduates and trainees of the fellowship programs of the Philippine General Hospital - Department of Ophthalmology and Visual Sciences (PGH DOVS). Methods: A uniform survey was conducted among all graduates and ongoing trainees of the External Disease and Cornea, Medical and Surgical Vitreo-Retina, Glaucoma, Orbit and Oculoplastics, and Pediatric Ophthalmology and Strabismus fellowship programs. The survey link was emailed to all the participants. Results: Response rate was 74%. Majority of graduates were clustered in the National Capital Region (NCR) (56.4%), and Luzon excluding NCR (46.4%). Majority of the graduates perceived that the objectives of their fellowship program were met (60%). Overall, 65.4% of the fellows assessed their training as completely adequate. Strengths identified were volume of patients, level of independence, and consultant supervision. Weaknesses identified were the lack of specialized instruments, lack of inter-department exposures, and difficulties in the conduct of research. Conclusion Majority were satisfied with their training and would recommend their training program to others despite the difficulties and deficiencies identified. Some of the perceived weaknesses observed by the graduates have been addressed since their graduation from their program. This is the first attempt to assess post-residency fellowship programs in ophthalmology in the Philippines.
fellowship ; training ; ophthalmology ; evaluation ; assessment