OBJECTIVE: To explore the efficacy of a Thalassemia risk assessment software for the screening of thalassemia mutation carriers and distribution of thalassemia genotypes detected by screening. METHODS: A total of 6 040 individuals were evaluated at Leshan Maternal and Child Health Care Hospital between 2022 and 2024 using the commonly used clinical thalassemia risk assessment method and the thalassemia screening software, respectively, and the performance indicators of the two methods were compared and analyzed against the result of thalassemia gene testing. This study was approved by the Ethics Committee of our hospital (Ethics No.: LfyLL[2022]005). RESULTS: The high-risk rate by the thalassemia screening software was 11.19%, with a sensitivity of 95.12%, specificity of 93.28%, positive predictive value of 43.20%, negative predictive value of 99.72%, and the area under the ROC curve (AUC) was 0.942. The thalassemia gene detection rate of the high-risk samples screened was 4.83%. The high-risk screening rate of the conventional method was 2.50%, with a sensitivity of 51.22%, specificity of 93.28%, positive predictive value of 80.79%, negative predictive value of 97.40%, and the AUC was 0.754. The thalassemia gene detection rate of the high-risk samples was 2.02%. CONCLUSION The software can effectively detect thalassemia carriers and significantly reduce the missed detection compared with conventional method, thereby significantly improve the efficacy of screening.
Humans ; Thalassemia/diagnosis* ; Software ; Female ; Genetic Testing/methods* ; Male ; Mutation ; Adult ; Genotype ; ROC Curve ; Risk Assessment

BACKGROUND AND OBJECTIVE

The Philippines has significant potential as a clinical trial hub but faces a shortage of skilled clinical research professionals (CRPs). In 2022, a cross-sectional study assessed the self-assessed competencies of CRPs in four countries (Thailand, Vietnam, Congo, Philippines) using the Joint Task Force for Clinical Trial Competency (JTF) framework. This paper presents findings on the self-assessed competency and training needs of Filipino CRPs.

METHODS

We conducted a cross-sectional online survey among Filipino clinical research professionals from March to April 2022. We asked for their self-assessed competency, relevance to their roles, and training needs in the competency domains according to the JTF framework. We also asked for the skills in community engagement and research grant application of the investigators. Results were summarized and analyzed according to their primary roles.

RESULTS

One hundred seventy-five (175) Filipino CRPs participated in the survey. They described themselves as “skilled” across all competency domains in conducting clinical research but did not rate themselves at an advanced level. They reported the lowest confidence in their skills related to study management, investigational product development and regulation, and data management. They exhibited greater confidence in competencies such as ethical considerations, professionalism, and communication. Notably, surveyed investigators had the lowest ratings in research design.

CONCLUSION

This study provides a comprehensive assessment of the self-perceived competencies of a sample of Filipino CRPs using the JTF Clinical Research Competency Framework. It highlights key areas for capacity building, particularly in operational and regulatory competencies. However, due to the non-probability sampling and reliance on self-assessment, findings should be interpreted with caution.

Human ; Research Personnel ; Professional Competence ; Self-assessment ; Needs Assessment ; Philippines

BACKGROUND

Early-stage endometrial cancer often presents with favorable survival rates, but high-risk factors, including TP53 mutations and high-grade serous pathology, can lead to recurrence and poor prognosis. The standard primary treatment for endometrial cancer is surgical staging, and lymph node metastases significantly impact adjuvant therapy decisions. The subgroup of p53-abnormal (p53abn) indicates the worst prognosis and potential benefits from adjuvant chemotherapy. Molecular classification, while recommended, faces practical challenges due to resource constraints.

OBJECTIVES

The study aimed to assess the incidence of p53 abnormal expression in clinical stage 1 endometrial cancer cases that underwent surgery at a government tertiary hospital, and assess its relationship with clinicopathologic factors and pelvic and paraaortic lymph node metastasis (LNM).

METHODS

A cross-sectional retrospective analysis was conducted on clinical early-stage endometrial cancer cases that underwent surgical primary treatment between January 2018 and December 2022. Patient records were reviewed to gather demographics, surgical information, and pathological evaluations. Preoperative clinical staging was determined through imaging, and surgical staging involved comprehensive lymphadenectomy. Immunohistochemistry studies for p53 were carried out on formalin-fixed paraffin-embedded tissue samples.

RESULTS

A total of 233 endometrial cancer cases were included. The mean age at diagnosis was 53.7 years. Common comorbidities included hypertension (47.2%) and dyslipidemia (20.6%). Most cases were endometrioid histology (82.8%) and low-grade tumors (85.8%). Tumor grade (p=0.010), myometrial invasion (p<0.001) and lymphovascular space invasion (p<0.001) significantly correlated with lymph node metastasis. However, tumor size and p53abn were not significantly associated with lymph node metastasis. p53abn overexpression was significantly associated with non-endometrioid histology at 33% and Grade 3 tumors at 23%. Preoperative grading demonstrated moderate reliability (0.51) with postoperative grading, with an agreement of 65.4%.

CONCLUSION

Tumor grade, myometrial invasion, and LVSI were all significantly associated with lymph node involvement. While p53 immunohistochemical stains show promise in predicting metastasis and has been associated with tumor aggressiveness, this should still be correlated with clinicopathological parameters to carry out a more accurate risk stratification of early-stage patients.

Therapeutics ; Survival Rate ; Risk Factors ; Recurrence ; Prognosis ; Pathology ; Endometrial Neoplasms ; Immunohistochemistry ; Tumor Suppressor Protein P53 ; Lymph Node Excision ; Risk Assessment

Abstract Background: Important determinants of dialysis adequacy are blood flow rate (BFR) and dialysis time. This study aimed to evaluate the impact of BFR and duration of dialysis session on nutritional status and quality of life (QoL) in hemodialysis (HD) patients. Methods: Real-world evidence studies (RWE) of 3 HD units that differ in BFR and/or dialysis time. Group I, HD 5 hours and BFR 200-250 mL/minute; group II, HD 4 hours and BFR 270-320 mL/minute, and group III, HD 4 hours and BFR 200-250 mL/minute. All HD units use the same dialysate flow and dialysis frequency. The 3-point Subjective Global Assessment (SGA) scale is used to assess nutritional status, while QOL is assessed using the SF-36. Results: There were 291 chronic HD patients with an average age of 51 (12.3) years, 50.5% were male. The proportion of SGA classes between groups did not differ significantly. Group I was associated with significantly higher PF and RP domain scores of PC and VT domain scores of MC compared to Group III. On the other hand, Group II was associated with significantly lower VT and MH domain scores of MC compared to Group I, while the other domains were not significantly different. In general, Group III had the lowest SF-36 scores compared to the other 2 groups. Conclusion: Duration of HD was not associated with nutritional status. Compared with 4-hour HD but with a faster BFR, 5-hour HD was associated with higher Mental Component QOL scores, but not Physical Component scores.
subjective global assessment ; SF-36 questionnaire ; blood flow rate ; dialysis time

Introduction: Metabolic dysfunction–associated steatotic liver disease (MASLD) is common among patients with type 2 diabetes (T2D) and increases the risk of cirrhosis, yet fibrosis often remains clinically silent until hepatic decompensation occurs. Current diabetes guidelines recommend noninvasive fibrosis risk stratification, such as the fibrosis-4 index (FIB-4), during routine diabetes care, but real-world adoption remains unclear. This study aimed to evaluate the implementation of FIB-4 as a risk stratification tool in patients with T2D. Methodology: This was a retrospective study of consecutive patients with T2D who were seen in the Diabetes Clinic of University of Malaya Medical Centre in 2023. Patients were identified as having a higher risk of future cirrhosis based on elevated FIB-4 ≥1.3. Results: The data for 1,009 patients were analyzed, median age 62 (52–71) years, 40.7% male. Elevated FIB-4 was seen in 28.8% (291/1,009). Only 12.0% (35/291) with elevated FIB-4 were referred for further hepatology evaluation, whereas 3.3% (24/718) with low FIB-4 were referred. Among the patients with elevated FIB-4, those referred were more likely known to have hepatic steatosis, had higher alanine aminotransferase, aspartate aminotransferase, gammaglutamyl transferase, and lower low-density lipoprotein cholesterol and platelet count. Over a median follow-up of 1.71 (0.99–1.95) years, totaling 1,440 person-years, two liverrelated events (0.2%) occurred (one each in the elevated and low FIB-4 group, respectively). Sixteen patients (4.0%) experienced cardiovascular events, including one patient (0.6%) in the elevated FIB-4 group and 15 (2.9%) in the low FIB-4 group. Conclusion Despite automated FIB-4 reporting, this risk stratification tool was underutilized in T2D, resulting in missed opportunities for early identification and management of more severe liver disease. Integration of FIB-4 into diabetes care workflows, alongside structured referral pathways and clinician education, may improve early detection and reduce long-term hepatic complications in T2D.
Diabetes Mellitus, Type 2 ; Risk Assessment ; Liver Diseases ; Referral and Consultation

Introduction: The 2021 IDF-DAR risk calculator had been previously evaluated in multiple studies and subsequently widely accepted and applied in clinical practice as a practical standardized tool for patient risk stratification. Recently updated, the 2026 IDF-DAR Risk calculator enables a more individualized, evidence-related evaluation of patientrelated and disease-related risk factors, incorporating modern diabetes technologies, including continuous glucose monitoring (CGM), automated insulin delivery (AID) systems, and advanced insulin formulations to enhance risk stratification. This tool allows medical professionals to tailor Ramadan practices based on overall factors toward promoting safe fasting. Methodology: This prospective multicentre observational study recruited adults with Type 1 and Type 2 diabetes attending public hospitals nationwide. People with diabetes (PwD) intending to perform Ramadan fasting were invited to participate and assessed using the 2026 IDF-DAR Risk Calculator in the 6-week pre-Ramadan period between 30th January and 19th March 2026. Results: A total of 458 PwD were evaluated and stratified into low (15.7%), moderate (41%), and high risk (43.3%) categories. Most participants had Type 2 diabetes (83.6%), with 60.3% having a disease duration exceeding 10 years and 43% exhibiting poor glycemic control (hemoglobin A1c >9%). Insulin therapy was used by 76.4% of participants, including two individuals with Type 1 diabetes using AID systems. Most participants reported no recent hypoglycemia (76.4%), 81.0% performed glucose monitoring, and 3.3% used CGM. Severe comorbidities were uncommon, with 1.1% having unstable macrovascular disease and 4.4% advanced chronic kidney disease (estimated glomerular filtration rate <30). Notably, 72.2% received structured Ramadan education. Conclusion Majority of PwD attending tertiary diabetes clinics were in the moderate- to high-risk category and intended to fast despite medical advice against fasting in some cases. Although most participants were on insulin therapy, hypoglycemia was low in the pre-Ramadan period. Integration of modern technologies, advanced insulin therapies, and structured education may support safer fasting practices.
Risk Assessment ; Diabetes Mellitus ; Hospitals ; Fasting

Introduction: Obesity is a heterogeneous metabolic disease in which individuals with similar body weight may exhibit markedly different physiological risk profiles. Conventional monitoring using weight alone may fail to capture underlying metabolic and cellular changes during lifestyle intervention. Integrating body composition and biochemical markers may improve risk stratification in clinical practice. Methodology: A prospective observational analysis was conducted among participants enrolled in a structured lifestyle programme. Baseline and follow-up assessments included biochemical markers (fasting glucose, renal function, lipid profile, and liver enzymes) alongside body composition parameters derived from bioelectrical impedance analysis, including percent body fat, visceral fat area, skeletal muscle index (SMI), and phase angle (PhA). Changes over time and associations between metabolic and body composition variables were analyzed. Results: Metabolic responses varied substantially despite similar anthropometric profiles. Renal function improved significantly, with increased estimated glomerular filtration rate (eGFR) observed over time (p = 0.01), and was inversely associated with fasting glucose (r = −0.41, p <0.01). Lipid abnormalities persisted, although reductions in lowdensity lipoprotein cholesterol were noted (p = 0.04). Total cholesterol remained elevated and correlated positively with fasting glucose (r = 0.36, p = 0.02). Improvements in aspartate aminotransferase were observed (p = 0.03), while other liver markers remained stable. Notably, body composition parameters, including PhA and SMI, demonstrated variability independent of weight change, reflecting heterogeneous physiological adaptation. Conclusion Metabolic and physiological responses to lifestyle intervention are heterogeneous and not fully captured by changes in body weight alone. The integration of bioimpedance-derived parameters with biochemical markers provides a more comprehensive approach to metabolic risk stratification and may support more personalized clinical management in obesity care.
Biomarkers ; Risk Assessment ; Body Composition

OBJECTIVES: Injuries are the leading cause of death among children and adolescents. Although numerous risk assessment tools for unintentional injuries in children have been developed and published both domestically and internationally, there is currently no global consensus on standardized use. This study aims to systematically characterize existing unintentional injury risk assessment tools for children aged 0-6 years, with the goal of informing scientific tool selection and optimization. METHODS: Relevant literature published up to January 2025 was retrieved from CNKI, Wanfang, PubMed, and Web of Science. An information extraction form was developed to gather data on the basic features of each assessment tool, assessment format, scoring methods and criteria, dimensions assessed, reliability and validity, and types of unintentional injuries covered. RESULTS: A total of 50 risk assessment tools for unintentional injuries among children aged 0-6 years were included. Among them, 35 tools assessed two or more types of unintentional injuries. Regarding assessment format, 38 tools relied on caregiver self-report, 2 on investigator interviews, 3 on direct observation by investigators, and 7 used multiple methods. The tools covered four major dimensions: knowledge, attitude, behavior, and environment. Eleven tools covered 3 dimensions, while only one tool addressed all 4. Nineteen tools provided clear scoring methods, 14 included criteria for risk determination, and only 11 had both scoring methods and risk criteria. Twenty-eight tools lacked both. Twenty-two tools had been evaluated for reliability and/or validity. Among the 25 English-language tools, only 3 had been translated into Chinese. CONCLUSIONS Currently, no existing tool comprehensively assesses all major types of unintentional injuries for children under six years of age. It is recommended that practitioners select appropriate tools based on specific needs. In addition, improvements should be pursued, such as translating and validating English-language tools, developing quantitative scoring methods and criteria for tools tailored to Chinese children for important but underrepresented injury types (e.g., road traffic injuries, drowning).
Humans ; Infant ; Child, Preschool ; Child ; Risk Assessment/methods* ; Accidental Injuries/prevention & control* ; Infant, Newborn ; Wounds and Injuries/epidemiology* ; Reproducibility of Results

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

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Risk Assessment