BACKGROUND/IMPORTANCE OF THE STUDY

At present, there is not much data on the prevalence of cancer in the young adult population in the local setting, in addition to prevalence and determinants of distress in this population. The findings of this study may help to understand the current situation of this young population, and it may also provide a reference for further improving outcomes among these patients who have a distinct set of needs compared to the older counterparts, in addition to a long life expectancy ahead of them.

This study employed an observational cross-sectional design that included young adult cancer patients, aged 19 to 39 years old, seen at the hospital outpatient clinics and Cancer Center from October 2023 to December 2023. Demographic and clinical data were collected. The participants were also asked to fill out the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) Screening Tool and Problem List after signing the written informed consent. Data were collated and analyzed per clinical variable.

The mean age of the participants was 34.55 years (SD=3.97), with most of them being 36 to 39 years old (51.67%). Comparative analyses of different demographic and clinical characteristics indicated that none of the characteristics were significantly different between those without and with significant distress levels (p >0.05). The mean distress score was 4.11 (SD=2.60) and categorizing these scores using the established cut-off score showed that 58.33% (95% CI = 44.88% to 70.93%) had distress. Time from cancer diagnosis significantly predicted distress development, specifically between 6 and 12 months from cancer diagnosis (aOR = 0.03, p = 0.042). Factors significantly contributing to distress are concerns on changes in eating, loss or change of physical abilities, worry or anxiety, sadness or depression, loss of interest or enjoyment, loneliness, changes in appearance, feelings of worthlessness or being a burden, relationship with friends, ability to have children, taking care of oneself, finances, access to medicine, issues on sense of meaning or purpose, and on death, dying and afterlife (pCONCLUSION

Significant distress is present in more than 50% of young adult cancer patients seen in a private tertiary institution in the Philippines. The time from cancer diagnosis significantly predicted distress development. Emotional and practical concerns significantly contributed to distress in this population.

OBJECTIVE

This study aimed to determine if selenium supplementation for a period of six months can decrease signs and prevent worsening of mild Graves’ ophthalmopathy among Filipino patients.

We conducted an open-label, assessor-masked, randomized controlled trial involving adult patients diagnosed with mild Graves’ ophthalmopathy. Participants were divided into two groups: one group received standard care (eye drops) alone (control group), while the other group received an additional 200 mcg/day oral selenium supplementation alongside standard care. Inclusion criteria encompassed adult patients with Graves’ hyperthyroidism presenting at least one sign of mild ophthalmopathy and a disease duration of less than 18 months. Statistical analyses were performed using independent sample t-test, Mann-Whitney U test and Fisher’s Exact/Chi-square test to compare means, ranks and frequencies between the two intervention groups. Paired sample t-test, Wilcoxon signed rank test and McNemar test were employed to assess changes from baseline to the third and sixth month observations.

A significant difference in clinical activity score (CAS) was observed between the selenium supplementation group and the control group. Initially, 14 eyes (33.33%) in the selenium group exhibited a CAS score of 0, which increased to 27 eyes (64.29%) at the third month of treatment and slightly decreased to 26 eyes (61.9%) at the sixth month. Conversely, the control group had 11 eyes with a CAS score of 0 at baseline, which increased to 16 eyes (38.1%) at three months and decreased to 14 eyes (33.33%) at the sixth month. The improvement in CAS was significantly associated with reductions in caruncle and plica swelling (p = 0.040). Further analysis revealed a statistically significant difference in CAS between the treatment and control groups (p = 0.017) at the sixth month mark.

Selenium supplementation provided significant benefit in reducing the signs and preventing deterioration of mild Graves’ ophthalmopathy, as indicated by improved CAS scores. Future research exploring baseline and end of treatment selenium concentrations in the Philippines is recommended to further substantiate these findings.

Background: Antiplatelet resistance is one factor that contributes to stroke recurrence among patients with noncardioembolic ischemic strokes. Objectives: This paper aims to describe the prevalence of aspirin and clopidogrel resistance, along with frequency of statin, NSAID and proton pump inhibitor use among our cohort of stroke patients. Method. This is a single-center cross-sectional review that included all adult patients with recurrent noncardioembolic ischemic stroke admitted in a tertiary hospital between January 2019 and June 2023. Results: A total of 1,374 patients were admitted for ischemic stroke from January 2019 to June 2023. Among these, 155 (11.28%) were recurrent noncardioembolic ischemic strokes. Prevalence of aspirin and clopidogrel resistance were 25% and 32.7%, respectively. Clinical profiles of those in the resistant group were comparable with those in the nonresistant group. None of the patients taking aspirin had concomitant use of nonsteroidal antiinflammatory drugs. Only 2 of the patients who were resistant to clopidogrel were on proton pump inhibitors. More than half of the patients both in the resistant and the nonresistant groups were on statin. The study had a small sample size and hence it was not enough to establish causal relationship between factors and antiplatelet resistance. Conclusion More patients were resistant to clopidogrel than to aspirin. Further studies with a bigger sample size are recommended to explore factors that contribute to antiplatelet resistance in Filipino patients.
Aspirin ; Clopidogrel ; Ischemic Stroke ; Tertiary Care Centers

Introduction: Acute Ischemic Stroke (AIS) is a medical emergency that affects people globally. In the Philippines, it remains as the third leading cause of mortality. This study aims to determine the use of platelet-lymphocyte ratio (PLR) - a simple, economical, and safe tool - as a predictor of in-hospital outcomes in patients with acute ischemic stroke. Methods: A retrospective cross-sectional study was conducted among AIS patients at the Remedios Trinidad Romualdez Hospital (RTRH) Tacloban City, Leyte, Philippines from January 2020 to December 2022. Clinical demographics, laboratory profile, and hospital outcomes were described. Descriptive statistics, Mann-Whitney test, and T-test were utilized to determine the association between PLR and in-hospital outcomes. Results and Conclusions There were 76 patients enrolled in the study, majority were females (57.9%), and hypertensive (84.2%). Risk factors that are pivotal to the development of AIS were also identified. To note, half of the population presented with unilateral body weakness. Moreover, only 7.9% died due to the disease. Higher PLR levels resulted from an increased platelet count and a decreased lymphocyte count. However, no significant association between PLR levels and AIS outcomes was noted, hence the need for further investigation of these parameters.
Ischemic Stroke ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES

Inpatient physical therapy (PT) care entails careful provision of service for individuals across a spectrum of disorders needing evidence-based physical rehabilitation during their hospital admission. The main difficulty is identifying adequate time allocation for safe patient service within an eight-hour working time frame. At a selected tertiary teaching government-run hospital, an arbitrary personnel-population ratio method is used for human resource allocation which may lead to issues in service delivery and healthcare workforce wellness. Apart from patient care, physical therapists also assume non-clinical roles revolving on administration, clinical education, and research. This highlights the importance of identifying the duration of tasks to assess work efficiency and manage time constraints posed by the limitations of the work shift. Practice guidelines may help improve staff workload scheduling, however, there is a lack of available guidelines regarding physical therapy practice in the hospital or acute care setting for developing countries. The purpose of this study was to determine the duration of care for inpatients with musculoskeletal and neurological conditions and administrative tasks, and to determine the relationship of duration of care with months of experience.

A continuous observation time motion study of a typical workday of all physical therapists in an in-patient setting of a tertiary teaching hospital was conducted. An external observer will time the tasks done by the PT. The external observer kept distance from the direct patient encounter to minimize interference that may affect timing. Patients with conditions of different etiologies and functional levels were included.

Nineteen physical therapists with a mean experience of 54.63 months were observed. There were no adverse events during the implementation of this study. The total mean time in minutes of management of neurological patients is 37:32, and musculoskeletal patients is 28:30. Time for administrative tasks took an average of 20:33 minutes. There was also a low positive correlation on months of experience and treatment duration for patients with neurologic conditions (p=0.0471). Results showed that the allocated treatment duration is determined to be sufficient for performing PT activities. The optimal number of patients to be decked can also be appropriately determined to optimize resource allocation.

Our pilot study attempted to quantify the duration of PT care in an inpatient setting that caters to patients with different diagnosis and varying needs for PT management. Although descriptive statistics and a weak to insignificant correlation was seen in most of the variables, there may be some benefit in gathering more duration data across different acute care settings within the country. Our pilot time and motion study can contribute to the limited evidence of duration of inpatient care that may inform human resource allocation, deliverables prioritization, and employee wellness and development. Figures have been presented which could be the basis for future policy research for management science and resource allocation studies.

Humans ; Bacteremia ; Cross Infection ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Sepsis ; Staphylococcal Infections/epidemiology* ; Staphylococcus aureus ; Tertiary Care Centers ; China

OBJECTIVE: To investigate the development present situation of the department of critical care medicine in Inner Mongolia Autonomous Region (hereinafter referred to as Inner Mongolia), in order to promote the standardized and homogeneous development of critical care medicine in Inner Mongolia, and also provide a reference for discipline construction and resource allocation. METHODS: A survey study was conducted in comprehensive intensive care unit (ICU) of tertiary and secondary hospitals in Inner Mongolia by online questionnaire survey and telephone data verification. The questionnaire was based on the Guidelines for the Construction and Management of Intensive Care Units (Trial) (hereinafter referred to as the Guidelines) issued by the National Health Commission in 2009 and the development trend of the discipline. The questionnaire covered six aspects, including hospital basic information, ICU basic information, personnel allocation, medical quality management, technical skill and equipment configuration. The questionnaire was distributed in September 2022, and it was filled out by the discipline leaders or department heads of each hospital. RESULTS: As of October 24, 2022, a total of 101 questionnaires had been distributed, 85 questionnaires had been recovered, and the questionnaire recovery rate had reached 84.16%, of which 71 valid questionnaires had been collected in a total of 71 comprehensive ICU. (1) There were noticeable regional differences in the distribution of comprehensive ICU in Inner Mongolia, with a relatively weak distribution in the east and west, and the overall distribution was uneven. The development of critical care medicine in Inner Mongolia was still lacking. (2) Basic information of hospitals: the population and economy restricted the development of ICU. The average number of comprehensive ICU beds in the western region was only half of that in the central region (beds: 39.0 vs. 86.0), and the average number of ICU beds in the eastern region was in the middle (83.6 beds), which was relatively uneven. (3) Basic information of ICU: among the 71 comprehensive ICU surveyed, there were 44 tertiary hospitals and 27 secondary hospitals. The ratio of ICU beds to total beds in tertiary hospitals was significantly lower than that in secondary hospitals [(1.59±0.81)% vs. (2.11±1.07)%, P < 0.05], which were significantly lower than the requirements of the Guidelines of 2%-8%. The utilization rate of ICU in tertiary and secondary hospitals [(63.63±22.40)% and (44.65±20.66)%, P < 0.01] were both lower than the bed utilization rate required by the Guidelines (75% should be appropriate). (4) Staffing of ICU: there were 376 doctors and 1 117 nurses in tertiary hospitals, while secondary hospitals had 122 doctors and 331 nurses. There were significant differences in the composition ratio of the titles of doctors, the degree of doctors, and the titles of nurses between tertiary and secondary hospitals (all P < 0.05). Most of the doctors in tertiary hospitals had intermediate titles (attending physicians accounted for 41.49%), while most of the doctors in secondary hospitals had junior titles (resident physicians accounted for 43.44%). The education level of doctors in tertiary hospitals was generally higher than that in secondary hospitals (doctors: 2.13% vs. 0, masters: 37.24% vs. 8.20%). The proportion of nurses in tertiary hospitals was significantly lower than that in secondary hospitals (17.01% vs. 24.47%). The ratio of ICU doctors/ICU beds [(0.64±0.27)%, (0.59±0.34)%] and ICU nurses/ICU beds [(1.76±0.56)%, (1.51±0.48)%] in tertiary and secondary hospitals all failed to meet the requirements above 0.8 : 1 and 3 : 1 of the Guidelines. (5) Medical quality management of ICU: compared with secondary hospitals, the proportion of one-to-one drug-resistant bacteria care in tertiary hospitals (65.91% vs. 40.74%), multimodal analgesia and sedation (90.91% vs. 66.67%), and personal digital assistant (PDA) barcode scanning (43.18% vs. 14.81%) were significantly higher (all P < 0.05). (6) Technical skills of ICU: in terms of technical skills, the proportion of bronchoscopy, blood purification, jejunal nutrition tube placement and bedside ultrasound projects carried out in tertiary hospitals were higher than those in secondary hospitals (84.09% vs. 48.15%, 88.64% vs. 48.15%, 61.36% vs. 55.56%, 88.64% vs. 70.37%, all P < 0.05). Among them, the placement of jejunal nutrition tube, bedside ultrasound and extracorporeal membrane oxygenation were mainly completed independently in tertiary hospitals, while those in secondary hospitals tended to be completed in cooperation. (7) Equipment configuration of ICU: in terms of basic equipment, the ratio of the total number of ventilators/ICU beds in tertiary and secondary hospitals [0.77% (0.53%, 1.07%), 0.88% (0.63%, 1.38%)], and the ratio of injection pump/ICU beds [1.70% (1.00%, 2.56%), 1.25% (0.75%, 1.88%)] didn't meet the requirements of the Guidelines. The equipment ratio was insuffcient, which means that the basic needs of development had not been met yet. CONCLUSIONS The development of comprehensive ICU in Inner Mongolia has tended to mature, but there is still a certain gap in the development scale, personnel ratio and instruments and equipment compared with the Guidelines. Moreover, the comprehensive ICU appears the characteristics of relatively weak eastern and western regions, and the overall distribution is uneven. Therefore, it is necessary to increase efforts to invest in the construction of the department of critical care medicine.
Humans ; Intensive Care Units ; Critical Care ; Surveys and Questionnaires ; Tertiary Care Centers ; China

INTRODUCTION: Acute malignant large bowel obstruction (MBO) occurs in 8%-15% of colorectal cancer patients. Self-expandable metal stents (SEMS) have progressed from a palliative modality to use as bridge to surgery (BTS). We aimed to assess the safety and efficacy of SEMS for MBO in our institution. METHODS: The data of patients undergoing SEMS insertion for MBO were reviewed. Technical success was defined as successful SEMS deployment across tumour without complications. Clinical success was defined as colonic decompression without requiring further surgical intervention. Rates of complications, median time to surgery, types of surgery and rates of recurrence were studied. RESULTS: Seventy-nine patients underwent emergent SEMS placement from September 2013 to February 2020. Their mean age was 68.8 ± 13.8 years and 43 (54%) patients were male. Mean tumour length was 4.2 cm ± 2.2 cm; 89.9% of malignant strictures were located distal to the splenic flexure. Technical and clinical success was 94.9% and 98.7%, respectively. Perforation occurred in 5.1% of patients, with none having stent migration or bleeding. Fifty (63.3%) patients underwent SEMS insertion as BTS. Median time to surgery was 20 (range 6-57) days. Most (82%) patients underwent minimally invasive surgery. Primary anastomosis rate was 98%. Thirty-nine patients had follow-up beyond 1-year posttreatment (median 34 months). Local recurrence and distant metastasis were observed in 4 (10.3%) and 5 (12.8%) patients, respectively. CONCLUSION Insertion of SEMS for acute MBO has high success rates and a good safety profile. Most patients in this audit underwent minimally invasive surgery and primary anastomosis after successful BTS.
Humans ; Male ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Colorectal Neoplasms/pathology* ; Singapore ; Tertiary Care Centers ; Stents/adverse effects* ; Intestinal Obstruction/etiology* ; Treatment Outcome ; Retrospective Studies ; Palliative Care

INTRODUCTION: Postoperative day 1 (POD 1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD 1 mobilisation at our institution and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination. METHODS: In this preliminary observational study, data pertaining to demographics, premorbid function, health status, injury and surgical factors, POD 1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD 1 ambulation formed the early ambulation (EA) group, while the remaining patients formed the delayed ambulation (DA) group. Data were analysed for any significant difference between the groups. RESULTS: One hundred and fifteen patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD 1 was 80.0% (n=92), which was comparable to the data available from international hip fracture audit databases. There were 55 (47.8%) patients in the EA group and 60 (52.5%) patients in the DA group. The EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20, 95% confidence interval 1.50-56.45; P = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to the DA group (P > 0.05). CONCLUSION This is the first local study to offer benchmark of the POD 1 mobilisation status for this population. Patients who attained POD 1 ambulation had better early functional recovery.
Humans ; Early Ambulation ; Patient Discharge ; Tertiary Care Centers ; Hip Fractures/surgery* ; Physical Therapy Modalities ; Length of Stay

Humans ; Tertiary Care Centers ; Singapore ; Endoscopy, Gastrointestinal ; Intestinal Diseases/diagnostic imaging*