OBJECTIVES

This quality improvement study aimed to explore the viability of a learning pedagogy for medical students, the interactive journal club (IJC), in stimulating active learning and engagement among learners. The study intends to explore the benefits provided by the IJC when compared to traditional learning methods (e.g., traditional journal clubs). It attempts to highlight the importance of didactics which focus on active learning and interactive engagement between learners.

METHODS

The IJC was implemented as a course requirement in HI 201: Health Informatics, a midyear elective course at the College of Medicine, University of the Philippines Manila. A class of MD-PhD (Molecular Medicine) students was divided into two separate groups: the designated leaders who presented the article and moderated the discussion, and the audience who did not read the article beforehand yet were involved in its critical analysis. The IJC was conducted twice in two different sections of MD-PhD (Molecular Medicine) students, across two different midyear terms, Midyear Term 2021, and Midyear Term 2022. Reflection papers were collected and the responses through this requirement were collated before the primary takeaways were extrapolated. A survey was also sent out to the students of each class to itemize the consolidated feedback of students on the proposed didactic.

RESULTS

The overall process of IJC was deemed both exciting and stimulating. The learning pedagogy provided an alternative platform for active learning, fostering a student-centered approach that placed a heavy emphasis on critical thinking. One major challenge identified in the implementation of the educational design was the heavy reliance on student participation which was identified to, at times, be a difficult factor to overcome. In order to improve its implementation, expectations may be set at the beginning and assessed at the end of the session. In addition, a pre- and post-questionnaire may be given to assess the perceived usefulness of this new method for qualitative comparison.

CONCLUSION

Interactive and student-centered modes of learning are empirical for the improvement of literature appraisal, journal presentation, and evidence-based critical thinking among medical students. IJCs may be utilized as an alternative and effective learning strategy in teaching pertinent skills expected of a proper physician. When compared to traditional pedagogies, IJCs provide a platform for deeper learning and enable the achievement of learning outcomes, with learner engagement as the focal point. Future attempts at executing IJCs may consider the implementation of learning outcomes setting, and the use of pre- and post-IJC surveys to assess the effectiveness of the modality.

Education ; Active Learning ; Critical Thinking

Introduction: The Hearing for Life (HeLe) is a novel newborn hearing screening device initially designed according to specifications of clinicians of the Philippine National Ear Institute (PNEI). Unfortunately, targeted end-users, rural health workers, had difficulty using it. This research applied the user-centered design (UCD) methodology involving rural health workers in recommending design, content, and function requirements for HeLe. Objectives: This study aims to 1) describe how UCD was applied in a time-limited and resource-constrained environment, 2) assess the usability of the design prototypes, and 3) recommend design, content, and function requirements for HeLe. Methods: This research is a descriptive study using mixed methods. Six rural health units (RHU) involved in the HeLe research program were purposively selected for the study. There were 30 participants included, five health care workers per RHU. Applying the UCD method, the study had three phases: 1) user profiling (where participants accomplished a survey questionnaire, 2) inspiration phase (focus group discussions, workflow analysis, and interviews with a technical expert were conducted), and 3) ideation phase (designing and assessment of prototypes were done). Results: Participatory methods and structured procedures (i.e., card sorting, MoSCoW matrix prototyping, etc.) were applied to help determine and prioritize user requirements and elicit user feedback. These methods were chosen considering the time and resource constraints in the RHU. The prototype's System Usability Scale (SUS) score (81.94) was higher than the SUS score previously obtained (68) from the older version of the interface. Accuracy, durability, in-app instructions, feedback, and an easily understood interface were the most requested requirements for the telemedicine device. The need for the technology to be aligned with the RHU's workflow and available resources was highlighted in the focus group discussions. Conclusions The study documents practices and lessons learned in applying UCD methodology in design and development that have been demonstrated to improve usability of the device. The involvement of the users surfaced in the design, content, and functional requirements which can guide future iterations of HeLe and contribute to better understanding of ways to develop user-friendly telemedicine devices in the Philippines. This paper emphasizes that users should be involved in the entire process and not just recipients of the technology.
User-Centered Design ; Digital Technology ; Telemedicine

Thyroid storm and thionamide-induced agranulocytosis are both rare and serious medical emergencies. We report a case of a patient in which these two rare events simultaneously occurred. A 33-year-old male, maintained on Methimazole for Graves’ Disease, presented with fever, throat pain, and uncontrolled thyrotoxic symptoms. Methimazole was promptly discontinued. Thyroid storm was alternatively treated with lithium, hydrocortisone, and propranolol. Agranulocytosis was managed supportively with GCSF and empiric antibiotics. Lithium was maintained until after radioablation. When thionamides are contraindicated, lithium is a viable option for the acute management of thyroid storm and a bridge to definitive therapy.
Methimazole ; Lithium

Objectives: The use of Facebook (FB) to share and gather information on diabetes is commonplace but no data is available on its use among Filipinos during the COVID-19 pandemic. We sought to determine the engagement from instructional slide decks on diabetes and its management shown on two Philippine-based FB pages under the Enhanced Community Quarantine (ECQ). Methodology: We used Insights data from the slide decks and slide shows shown on the Philippine Society of Endocrinology, Diabetes and Metabolism’s (PSEDM) public FB page and the Endocrine Witch’s FB page. The slide set contained a mix of mostly images and text on COVID-19 and Diabetes, dietary advice, medications and self-care in the setting of the ECQ where access to insulin, ambulatory clinics and healthy food is limited. Data was summarized in terms of post clicks, reactions, shares and comments. Total engagement rate was computed. Results: We noted a high engagement rate (4-15%) in both public FB pages with higher engagement rates in slides shown in the Filipino language for most topics. The slides that gathered more shares and reactions were primarily those containing general information on COVID-19 and diabetes, nutrition including the safety of canned goods, as well as sick day rules. Conclusion In the setting of the ECQ, the use of image and text-based slide-decks on the PSEDM and Endocrine Witch FB pages to communicate health information yielded high engagement.
Social Media ; Diabetes Mellitus ; COVID-19

OBJECTIVE: This study assessed whether short message service (SMS) reminders would improve follow-up rate among gestational diabetes mellitus (GDM) patients by 12 weeks postpartum.

METHODOLOGY: In this single-center, single-blind randomized controlled trial, we assigned 308 patients with GDM to either of 2 arms, usual care alone versus usual care with SMS reminders. In the usual care group, 154 patients received a 10-minute short lecture on GDM and a 75 g oral glucose tolerance test (OGTT) request prior to discharge. In the SMS group, 154 patients received twice a week SMS reminders at 4 weeks, 8 weeks, and 10 weeks after delivery in addition to usual care. The primary outcome was clinic visit within 6 to 12 weeks postpartum with a 75 g OGTT result.

RESULTS: In our population, the overall follow-up rate was 19.8% (61/308). Follow up rates were 20.1% (31/154) for the usual care group and 19.5% (30/154) for the SMS. The addition of SMS reminders was not associated with an increase in follow-up rate at 12 weeks postpartum (adjusted RR 0.98, 95% CI 0.63-1.52; p=0.932). The use of insulin or metformin for GDM control was associated with increased follow-up (adjusted RR 1.92, 95% CI 1.20-3.07; p=0.006).

CONCLUSION: SMS reminders did not improve postpartum follow-up rate among GDM patients at 12 weeks postpartum.

Human ; Diabetes, Gestational ; Text Messaging

BACKGROUND: Medication errors are preventable events that can cause or lead to inappropriate drug use. Knowing the prevalence and types of errors can help us institute corrective measures and avoid adverse drug events.
OBJECTIVE: This study determined the prevalence of medication errors and its specific types in the four main service wards of a tertiary government training medical center.
METHODS: This is a retrospective, descriptive chart review study. From the master list of admissions, systematic sampling was done to retrieve the required number of charts. Relevant pages such as order sheets, nurses' notes, therapeutic sheets were photographed. For prolonged admissions, only the first 7 days were reviewed. Each chart was evaluated by two people who then met and agreed on the errors identified.
RESULTS: The overall prevalence of medication errors is 97.8%. Pediatrics had the most (63.3/chart), followed by Medicine, OB-Gynecology, and Surgery (7.3/chart). The most common type of errors identified were prescribing, followed by compliance, then administration errors.
CONCLUSION: Medication errors are present in the four main wards in our hospital. We recommend orientation of all incoming first year residents on proper ordering and prescribing of drugs, as well as a prospective observational study to determine true prevalence of all types of medication errors.

Medication Errors

Objectives: The increasing use of the Internet as a source of health information makes the accuracy of such information crucial. An example is the use of the widely advertised bitter melon (Momordica charantia) in treating diabetes despite its unproven efficacy. This study aims to assess the accuracy of websites containing information on bitter melon’s role in diabetes, to search for the presence of the proposed quality indicators, and to determine their correlation with accuracy. Methodology: An Internet search was used to generate a list of websites. The accuracy of each website was determined by comparing its content with that of a tool that was developed from authoritative sources. The presence of the proposed quality indicators, taken from published guidelines, was then correlated with accuracy. Results: Of the 158 websites identified, 10 (6.33%) were characterized as “most accurate” and 21 (13.3%) as “somewhat accurate.” The identified indicators of accuracy were the HONcode logo (OR 12.1, p=0.011); the author, identified as a healthcare professional (OR = 6.11, p = 0.008); and a citation from a peer-reviewed medical literature (OR 2.92, p = 0.029). Conclusion These findings suggest that most of the Internet-based information on bitter melon’s role in diabetes is inaccurate. The public can use several indicators of accurate information on the use of bitter melon in diabetes to improve health care.
Internet ; Diabetes Mellitus ; Momordica Charantia

OBJECTIVES: To assess the validity of the Filipino-translated version of the Michigan Neuropathy Screening Instrument(MNSI) in screening for diabetic neuropathy among Filipino patients with diabetes mellitus using nerve conduction velocity(NCV) as gold standard and to determine the most accurate cut-off score for the diagnosis of neuropathy using MNSI.
METHODOLOGY: A cross-sectional analytic study was done among adult diabetic patients. The original MNSI Questionnaire was translated and back-translated to the Filipino language. Each patient answered the Filipino version of MNSI Questionnaire followed by a lower extremity examination done by the investigator. All patients underwent NCV as reference standard. Sensitivity and specificity of MNSI were determined.
RESULTS: We studied a total of 150 subjects. Eighty-seven (58%) were diagnosed to have diabetic neuropathy based on NCV. The sensitivity and specificity of the MNSI Questionnaire improved to 73.6% and 52.4% respectively when the cut off was reduced to ?4, whereas for the MNSI Examination, the sensitivity and specificity improved to 86.2% and 55.6% respectively when the cut off was reduced to ?1. Combining both MNSI Questionnaire and MNSI Examination further improves the sensitivity to 95.4% whereas specificity is at 39.7%.
CONCLUSION: The analyses in 150 subjects confirm that the Filipino-version of MNSI is a valid screening tool for diabetic neuropathy when compared with NCV as gold standard.

Human ; Male ; Female ; Adult ; Questionnaires ; Diabetes Mellitus ; Philippines ; Patients

OBJECTIVES: Describe health beliefs of pregnant women with diabetes using tweets. Describe how information on diabetes in pregnancy is shared on Twitter.

METHODS: Tweets by women with diabetes were identified from Symplur Signals. "Status" tweets were mapped to the Health Belief Model. Tweets by women with preexisting diabetes and gestational diabetes (GD) were analyzed separately. Links within tweets were surveyed for the Health on the Net (HON) Foundation seal.

RESULTS: Women with GD tweeted about cravings and the connection of high carbohydrate meals with big babies. Perceived barriers included food restriction, hunger, lab tests, clinic consults and blood glucose monitoring. Perceived benefits of blood glucose testing and a healthy diet were linked to healthy babies. Blood glucose monitoring, weight gain, and age of gestation were cues to action. Perceived barriers of women with preexisting diabetes were feelings of helplessness, loss of control, and anger. Nine domains (9.7%) had the HON Code seal. Women with preexisting diabetes shared blog posts. Women with GD shared links from organizations.

CONCLUSION: Women with GD and preexisting diabetes had differing perceptions of susceptibility, severity, barriers, benefits, cues to action, and self-efficacy; and shared links to information differently on Twitter.

Human ; Female ; Pregnancy ; Diabetes, Gestational ; Weight Gain ; Craving ; Blood Glucose ; Self Efficacy ; Hunger ; Cues ; Healthy Diet ; Emotions ; Anger ; Perception

Objectives: The increasing use of the Internet as a source of health information makes the accuracy of such information crucial. An example is the use of the widely advertised bitter melon (Momordica charantia) in treating diabetes despite its unproven efficacy. This study aims to assess the accuracy of websites containing information on bitter melon’s role in diabetes, to search for the presence of the proposed quality indicators, and to determine their correlation with accuracy. Methodology: An Internet search was used to generate a list of websites. The accuracy of each website was determined by comparing its content with that of a tool that was developed from authoritative sources. The presence of the proposed quality indicators, taken from published guidelines, was then correlated with accuracy. Results: Of the 158 websites identified, 10 (6.33%) were characterized as “most accurate” and 21 (13.3%) as “somewhat accurate.” The identified indicators of accuracy were the HONcode logo (OR 12.1, p=0.011); the author, identified as a healthcare professional (OR = 6.11, p = 0.008); and a citation from a peer-reviewed medical literature (OR 2.92, p = 0.029). Conclusion These findings suggest that most of the Internet-based information on bitter melon’s role in diabetes is inaccurate. The public can use several indicators of accurate information on the use of bitter melon in diabetes to improve health care.
Internet ; Momordica charantia