BACKGROUND

Growing old is a remarkable journey filled with diverse experiences and wisdom. It’s a time when individuals often reflect on their lives, cherish memories, and share invaluable lessons with younger generations. Understanding aging is crucial as it encompasses more than just physiological and psychological processes, to comprehend the subjective sensations of the phenomenon of “being an elderly person”.

The purpose of this study was to describe the daily lives of frail older adults living alone in Quezon City.

The study utilized a qualitative research design. The approach employed was a descriptive phenomenological study describing the fundamental nature of being an elderly. The population consisted of frail older adult people (>60 years old) assessed using the Clinical Frailty Scale and living alone in Quezon city using a purposive sampling of those who were present in their homes during the designated interview period. The study was conducted in a private, safe and secured place both agreed by the participants and the researcher through face to face interview.

Being an frail older adult in this study essentially involves balancing one’s life in a flow of motion. The older adult is balancing a number of life-altering events and a shift in their circumstances influenced by recollections from various stages of life. In the life of an older adult, all ages are harmonious and wisely expressed and developed from pleasant and lovely or less pleasant and beautiful or more stressful early life experiences that went throughout adolescence and young adulthood, middle age, and later years. Their family, children and grandchildren were their source of strength and inspiration.

This study gave light on the realities faced daily by a frail older adult. Insights gained from this study serve as an opportunity to develop or innovate appropriate support. This information is crucial for clinicians, community-based aged care providers, legislators, elderly associations, and other concerned citizens. On a local level, the government unit’s key officials or proponents for the welfare of older adults are encouraged to delve deeper and focus on the unique needs and life experiences of the elderly population.

BACKGROUND

Rolling out palliative pain management had been challenging in the wards due to the hesitancy of nurses in carrying out opioid administration. Studies and daily practices in the hospital show that lack of knowledge, fear of handling opioids and low confidence are some of the barriers in managing palliative care patients efficiently. Through coaching and appropriate training, nursing knowledge, and confidence level in patient care are bolstered.

This study determined the effect of physician’s coaching in addressing hesitancy in opioid administration among QMMC nurses involved in palliative care.

This action research study utilized convergent parallel, mixed methods design with 28 ward nurses handling palliative care referrals. Participants were randomly assigned in the control (lecture only) and intervention (lecture with coaching) groups. Both groups answered a self-administered questionnaire and underwent interviews pre- and post-interventions. The intervention group had additional coaching prior to post-test and final interview.

Baseline characteristics were similar. The control (lecture only) and intervention (lecture with coaching) groups showed a significant difference in improved practices (p < 0.01) and increase in knowledge (p < 0.00) post-interventions. Qualitative analysis of post-intervention responses indicated increased confidence, reduced doubts, and a better understanding of opioid administration.

It is critical to remove the barriers to opioid administration in order to expand patients’ access to effective drugs. Increased knowledge and understanding resulted in a confident and informed attitude towards opioid administration. Continuing education with coaching can effectively minimize nurses’ hesitation to administer opioids.

BACKGROUND

Leadership and leadership development are increasingly recognized as essential aspects of the medical profession today; however, these are not expressly taught and reinforced in current medical education, with many students having to learn on their own time or while already on the job.

This study aimed to determine the perceptions of graduates of the UST Faculty of Medicine and Surgery (Class of 2023) on leadership in the medical profession and leadership development within the basic medical curriculum.

A cross-sectional study using descriptive analysis was done using responses to a web-based questionnaire regarding participants’ perceptions of medical leadership, its incorporation into the basic medical curriculum, and self-assessment of specific leadership competencies.

Two hundred three (203) individuals participated in the study, 83% of whom reported having prior leadership experience. 75% of participants strongly agreed that leadership is relevant in the medical profession, and only 27% strongly agreed that leadership development is adequately incorporated into the medical curriculum. Participants rated themselves highest in emotional self-awareness and adaptability for the intrapersonal domain, and in empathy, organizational awareness, and teamwork for the interpersonal domain. There was a statistically significant positive correlation between perceptions regarding adequacy of incorporation of leadership development into medical education and participants’ mean scores in interpersonal leadership competencies. The top three gaps in leadership development identified by participants were lack of interest from the medical student, lack of time to incorporate leadership development in the medical curriculum, and lack of adequate exposure to leadership development in regular learning activities.

The study was able to determine the perceptions of recent medical graduates regarding leadership in the context of medicine and leadership development in the current basic medical curriculum. It has also ascertained how they viewed themselves regarding specific leadership competencies, particularly communication and interpersonal relations. The contexts provided by the students gave a more nuanced view of what leadership is like for them, both in the classroom and hospital setting.

BACKGROUND

Integrative Medicine is an emerging approach that selectively incorporates elements of complementary and alternative medicine to promote health and well-being. Yet, there is no consensus on the required duration of treatment.

The effects of 15 versus 30 minutes of Integrative Medicine (IM) regimen on well-being and pain were evaluated.

The study used a single-blind, randomized, controlled design. 54 healthcare workers were randomly allocated to one of two intervention groups: a 15 minute IM regimen (3-minute meditation through guided imagery and myofascial release therapy of shoulder, back, arms with hands, and head) or the usual 30-minute IM regimen (6 minutes of each component). Well-being and muscle pain were dependent variables.

Time-bound regimens had no effect on positive mood, but both regimens increased the vitality and general interest of participants. However, the effects of both intervention arms on overall well-being were comparable. Improvement in pain was noted in the 30 minute regimen group.

The general benefits of both interventions were almost similar. Hence, the duration of the intervention did not matter much unless specific treatment outcomes were expected. A 30-minute regimen is recommended if relief from muscle pain is desired. On the other hand, if improvement in well-being is desired, a 15-minute regimen is more practical.

Background: Spiritual struggle is a state of distress a person experiences when relationships with the sacred are fundamentally challenged or broken. Its presence has been associated with increased morbidity and mortality. During the COVID-19 pandemic, attempts to address the whole being of patients, including spiritual well-being, were explored to improve outcomes of care. Objective: The study determined the prevalence of spiritual struggle among COVID-19 related cases and assessed the effectiveness of a formulated spiritual regimen versus the standard pastoral care. Methods: This is a randomized, triple-blind, controlled trial. COVID-19 patients tagged as having religious struggle were randomized into two equal groups (chaplain-led spiritual intervention and self-driven standard pastoral care). The Religious Struggle Screening Scale (RSSS) was measured at baseline and 4 weeks after the intervention in both groups. Results: Prevalence of spiritual struggle among COVID-19 patients was 67%. Baseline patient demographics were similar for both groups. The overall RSSS slightly decreased throughout the 4-week duration for both groups. In addition, the six dimensions of the RSSS, namely: divine, demonic, interpersonal, moral, ultimate meaning and doubt were noted to have slightly improved. However, the differences in the two groups were not significant. Conclusion There is no difference in the effect on religious struggle of a formulated spiritual regimen and standard care given to COVID-19 patients.
COVID-19 ; Religion

Introduction: Prognosis is an issue which most doctors and patients find difficult to discuss. Both patients and physicians find this process distressing as they can be unprepared to receive and give life-altering news. Although clinicians report that they are discussing prognosis, patients and caregivers frequently do not corroborate these reports, creating communication gaps especially in end-of-life situations. Objective: This study determined how attending physicians documented the communication of prognosis on the patients’ records in terms of content, timing, and frequency during the course of hospitalization. Methods: This is a retrospective chart review of 234 terminally-ill patients admitted from January 2020 to March 2020 in five (5) clinical departments of a public tertiary hospital. Discharge summaries and physicians’ daily chart notes were reviewed to identify the major events of each case. Results: Two-thirds of the patients’ records had no documentation of any discussion with patient/family/significant others relating to patients’ worsening condition. The quantitative and qualitative forms of contextual information regarding patient prognosis were infrequently recorded. Notes on conversations of survival rate, probability of treatment response and failure were likewise lacking. However, for the occasional documentation observed, the timing of the communications was appropriate across the disease trajectory and was significantly correlated with all major points of illness deterioration (p<.001). Physician and patient characteristics had no association with the practice of documenting communication prognosis Conclusion Communication prognosis is not a common practice for most physicians. Prognosis was poorly documented on the patients’ charts, which could suggest that either such a communication process did not take place at all or physician education on documentation should be reinforced by an institutional protocol, especially in the care of terminally ill patients.
Terminal illness ; prognosis

Introduction: Telemedicine services have steadily been relied upon since the onset of the COVID-19 pandemic. Understanding its usability and contextual performance is of paramount importance if it were to pervade the local health delivery system. Hence, a tool to assess usability is warranted. Objective: The study aims to adapt a reliable and validated instrument in English to Filipino, the Telehealth Usability Questionnaire (TUQ), on evaluating the usability of telemedicine services in the Philippines. Methodology: The research is a translation and validation study. The methodology includes forward translation in collaboration with our UST Sentro sa Salin at Araling Salin and expert panel review with five experts using the telehealth system. It was followed by pretesting (pilot testing and cognitive debriefing) of the pre-final tool to 30 family medicine telehealth patients and field testing of the final instrument to 85 telehealth patients from USTH. Appropriate statistical methods for assessment included internal consistency, content validity and linguistic with conceptual equivalence. Results: All translated items were retained, but through the focus group discussion, several statements were modified to fit the cultural context. Each item and the overall tool showed excellent validity and internal consistency. The mean difference scores for each item and domain were less than ±0.25. Tests of equivalence showed that majority of items and each domain were not statistically different (p>0.05), suggesting that both questionnaires are similar and homogenous. Furthermore, the Bland-Altman plots for each dimension/domain are within the upper and lower boundaries indicating agreement between the two versions. Conclusion TUQ-Filipino is a valid and appropriate instrument to assess telehealth usability in the local setting.
Telemedicine

Background: Uninvestigated dyspepsia is a common complaint in family practice in the Philippines. Patients usually seek consult due to severity of symptoms which affect their quality of life. The goals of management are short- and long-term symptom control, with reversal of possible underlying mechanisms, achievable through a combination of pharmacologic and non-pharmacologic interventions. Objective: The main objective of this pathway is to guide family physicians and primary care physicians in the assessment, diagnosis and management of adult patients with uninvestigated dyspepsia through a shared decision-making process. Method: This clinical pathway is an update of the PAFP’s Clinical Pathways for the Management of Dyspepsia in Adults (2016). The current panel utilized the ADAPTE method and prioritized reviewing relevant clinical practice guidelines from 2017 to present. Grading of recommendation was achieved through a mixture of strength of available evidence and a consensus from a panel of experts. Summary of Recommendations: The main changes in the recommendations in this update are as follows: symptom-based classification of dyspepsia, screening for anxiety and depression, family and SCREEM assessment; initiation of therapeutic trial for most patients to whom H. pylori testing is not available; extension of initial PPI treatment to 4-8 weeks, consideration of antacids/alginates for immediate symptom relief, consideration of tricyclic antidepressants for non-responders to initial treatment; symptom-based non-pharmacologic advice, consideration of counseling and other psychosocial interventions; empowerment for self-treatment and as-needed therapy for those who have completed the initial treatment regimen Dissemination and Implementation This guideline shall be disseminated and implemented at the clinic and organizational level. It will be published in the “The Filipino Family Physician” journal, social media platforms and will be disseminated through PAFP local chapters, training institutions and during the national convention. Non-FCM primary care physicians will also be reached through relevant agencies. It shall be included in the references required during training activities and national exams of accredited training institutions, in coordination with the PAFP committee on Residency Training. It shall be incorporated in checklists for compliance in audits and QA cycles, with support from the PAFP committee on Quality Assurance and that on Standards for Family Practice. Feedback on utility and applicability will be actively sought from the intended users and other stakeholders.
Dyspepsia ; Community Health Services ; Critical Pathways

Background: Acute tonsillopharyngitis is a common reason for consult in the primary care setting. Although most cases are viral in etiology, more than half of patients with acute tonsillopharyngitis still receive antibiotic therapy for group A beta-hemolytic streptococcal infection. Streptococcal throat infection may lead uncommonly to suppurative complications like peritonsillar abscess and non-suppurative complications like acute rheumatic fever. It is with this consideration that streptococcal throat infection must be distinguished from viral infections. Clinical practice guidelines have focused their efforts on how it can be accurately diagnosed to prevent complications while reducing unnecessary antibiotic prescribing. Objective: This clinical pathway was developed to serve as guidance for family and community medicine practitioners in making clinical decisions regarding the diagnosis and management of acute tonsillophrayngitis. Methods: After defining the scope of the pathway, the PAFP Clinical Pathways Group first identified the key issues in managing patient with acute tonsillopharyngitis. These key issues were then translated to review question. The group then reviewed the published medical literature to identify, summarize, and operationalize the evidence in clinical publication. Databases were first searched for existing clinical practice guidelines from reputable medical organizations. Further search for evidence was also conducted using the terms “tonsillopharyngitis” or “tonsillitis”, “diagnosis” and “treatment”. Evidence was then summarized and its quality assessed using the modified GRADE approach. From the evidence-based summaries, the CPDG then developed general guideline and pathway recommendations which are stated as time-bound tasks of patient-care processes in the management of acute tonsillopharyngitis in family and community practice. The recommendations were then presented to a panel of family and community practitioners in both urban and rural settings, for a consensus agreement on the applicability of the recommendations to family and community practice. Lastly, the final clinical pathway was written and developed to include the recommendations, the clinical pathway tables, and an algorithm. The clinical pathway can be used as a checklist or standards of care. The algorithm can be used to explain the process of care to the patient. Recommendations: This clinical pathway contains updates on recommendations in the 2010 clinical practice guidelines on acute tonsillopharyngitis. Recommendations on the utilization of clinical scoring and rapid antigen tests as basis for deciding on need for antibiotic therapy comprise the major changes from the previously published guidelines. Penicillin remains as the first-line antibiotic therapy for streptococcal throat infection. Implementation Implementation of the clinical pathway will be at the practice and the organizational levels. The pathway may be used as a checklist to guide family medicine specialists or general practitioners in individual clinic and community medicine practice. It may also be used as reference for exams by the training programs and the specialty board. In the commitment to achieve the goal of improving the effectiveness, efficiency and quality of patient care in family and community practice, the clinical pathway may also be implemented through quality improvement activities in the form of patient record reviews, audit and feedback. Audit standards will be the assessment and intervention recommendations in the clinical pathway. Organizational outcomes can be activities of the PAFP devoted to the promotion, development, dissemination and implementation of clinical pathways.
Pharyngitis ; Family Practice

Aims: This meta-analysis aims to synthesize available evidence from published studies on the effectiveness of parental non-pharmacologic smoking cessation programs which aim to reduce children's exposure to secondhand smoke.

Methodology: A database search using The Cochrane Library, PubMed®, Medline, Embase, and Google Scholar, was done by the investigators. This study included 20 randomized controlled trials published up to 2020. Pooled estimates of risk ratio (RR) for quit rates were computed using the random effects model.

Results: Overall, the quit rate among those who underwent parental smoking cessation was 13.4% while the quit rate for controls was 11.9%. The pooled RR demonstrated that the parental smoking cessation program was significantly associated with higher quit rates (RR = 1.22, 95%CI = 1.01 to 1.46, p-value = 0.04). The studies demonstrated moderate heterogeneity only (I2 = 54%). Among studies published prior to year 2000, no significant difference was observed between parental smoking cessation program and control (RR = 1.02, 95% CI = 0.62 to 1.70, p-value = 0.93). On the other hand, the pooled RR demonstrated that among studies published after 2020, parental smoking cessation program was significantly associated with higher quit rates (RR = 1.27, 95%CI = 1.03 to 1.56, p-value <0.0001). Among studies with self-help interventions, parental smoking cessation program has no additional benefit on quit rates (RR = 1.20, 95%CI = 0.94 to 1.58, p-value = 0.14). Among studies with biofeedback intervention also, no significant difference was observed (RR = 1.27, 95% CI = 0.86 to 1.89, p-value = 0.23).

Conclusions: This meta-analysis demonstrated sufficient evidence that non-pharmacologic interventions for parental smoking cessation are effective.