OBJECTIVES

This study aimed to describe the demographic profile, intervention sessions, goal attainment scaling (GAS), and health-related quality of life (HRQOL) of autistic children receiving speech and language therapy (SLT) in a higher educational institution in the Philippines.

Deidentified data from 18 autistic children aged 4–16 years (mean=8.2; SD=2.9) who received SLT for two months were analyzed. Their demographic profile, intervention sessions, GAS scores, and generic HRQOL scores were documented.

Most participants were school-age children (n=12; 66%) and were boys (n=14; 78%). After two months, the GAS scores of 11 participants (61%) increased by 1–2 points, whereas the scores of the remaining participants decreased (n=6; 33%) or did not change (n=1; 6%). Their mean generic HRQOL scores before and after SLT were 65.6 (SD=15.2) and 61.2 (SD=17.4), respectively.

While the GAS scores increased for most participants, their generic HRQOL scores did not show clinically significant changes after two months of SLT. This can be attributed to the few therapy sessions and short follow-up period. The findings highlight the need to provide long-term support to SLT services of autistic children in the Philippines to document more desirable quality of life outcomes.

BACKGROUND AND OBJECTIVE

Morbidity and mortality conferences (M&M) have been an important part of the hospital governance since the early 1900s. It has been shown to improve overall quality of care, minimize adverse occurrences and preventable fatalities, and provide chances for educational learning. However, medical trainees have different perceptions of M&M conferences which may affect its effectiveness in improving patient outcomes. The aim of this study is to determine the perception of surgical trainees towards M&M conferences.

The study is a questionnaire-based survey among surgical trainees of the Department of Surgery, Philippine General Hospital (PGH), for the training year of 2023. The survey consisted of 24 questions on their perception regarding the conduct of M&M. A Likert scale was used by the respondents to rate their perceptions (1 – negative, 10 – positive). Descriptive analysis and ANOVA were used to summarize the responses to the survey.

A total of 64 surgical trainees from the Department of Surgery responded to the survey (response rate = 71.9%). Most respondents (68.8%) reported that the ideal frequency of M&M conferences is once a month. 78.1% were not aware of the inclusion criteria of the cases discussed in the departmental M&M conferences. Most reported (64.1%) that M&M conferences did not regularly include data on outpatient events. A mean rating of 5.2 was observed among surgical trainees on how judgmental they feel about the environment of M&M conferences. Surgical trainees were willing to talk openly about their complications (mean rating 7.1). They were fearful of criticism (mean rating 4.4) and the negative repercussions of their presentations (mean rating 4.1) during M&M conferences. The respondents perceive M&M conferences to be conducive for learning and service improvement with both having a mean rating of 7.8. Most felt that M&M conferences focused on the individual performance (mean rating 7.3) while participants were divided regarding the focus on systems and processes (mean rating of 5.6). In terms of dissemination, about half (45.3%) mentioned that they did not know how the discussions/outcomes were disseminated following an M&M conference. The mean rating of willingness to talk openly of complications were significantly higher among senior residents (7.7) compared to junior residents (6.3) (p=0.008).

This study observed variability in the perceptions of surgical trainees on M&M conferences. Surgical trainees tend to feel fear of criticism and negative repercussions during M&M conferences. There are opportunities for improving the format of M&M in terms of clarity of inclusion criteria and dissemination, and focusing on systems and processes rather than individual faults.

Human ; Diagnostic Tests, Routine ; Urolithiasis ; Urologists

Objectives: This study aimed to describe the demographic profile, intervention sessions, goal attainment scaling (GAS), and health-related quality of life (HRQOL) of autistic children receiving speech and language therapy (SLT) in a higher educational institution in the Philippines. Methods: Deidentified data from 18 autistic children aged 4–16 years (mean=8.2; SD=2.9) who received SLT for two months were analyzed. Their demographic profile, intervention sessions, GAS scores, and generic HRQOL scores were documented. Results: Most participants were school-age children (n=12; 66%) and were boys (n=14; 78%). After two months, the GAS scores of 11 participants (61%) increased by 1–2 points, whereas the scores of the remaining participants decreased (n=6; 33%) or did not change (n=1; 6%). Their mean generic HRQOL scores before and after SLT were 65.6 (SD=15.2) and 61.2 (SD=17.4), respectively. Conclusions While the GAS scores increased for most participants, their generic HRQOL scores did not show clinically significant changes after two months of SLT. This can be attributed to the few therapy sessions and short follow-up period. The findings highlight the need to provide long-term support to SLT services of autistic children in the Philippines to document more desirable quality of life outcomes.
Quality of Life ; Autistic Disorder ; Child

Objective: This paper aims to provide a better understanding of the different engagement, cost, and resource considerations in developing and implementing mHealth solutions in the Philippines during the COVID-19 pandemic. Methods: First, six participants completed a form to document the estimated costs of developing a pseudo mobile application with features to mitigate the pandemic. Second, ten key informant interviews determined the facilitators, barriers, and resource requirements in developing mHealth tools. Results: The average cost estimate to develop and roll out a mobile application with public health and epidemiology features is Php 4,018,907 (US $78,650). The analysis of the interviews resulted in 12 themes organized in three domains: 1) facilitators and barriers in developing and sustaining mHealth solutions; 2) costs of sustaining mHealth technologies; and 3) factors affecting the costs of development and maintenance of mHealth technologies. Conclusion While differences in the cost estimates are evident, it provides a ballpark figure and the different factors that implementers need to sustain and maintain an mHealth solution. This paper hopes to inform policies and practices in engaging technology solution partners and in scaling up mHealth technologies.
Telemedicine ; COVID-19 ; Costs and Cost Analysis

Neoplasms of the urachus are uncommon, consisting of only 0.17% of all bladder malignancy. Mucinous cystic tumor of low malignant potential (MCLTMP) is a rare subtype with only 26 cases reported in the literature as of 2023. These tumors may present in a variety of ways such as hematuria, mucusuria, lower abdominal pain and irritative lower urinary tract symptoms. This is a case of 43-year-old female presenting at the emergency room for abdominal pain initially managed as a case of ovarian new growth in complication who underwent exploratory laparotomy, adhesiolysis, bilateral salpingectomy, partial cystectomy enbloc removal of urachal with anterior peritonectomy and excision of umbilicus. Histopathologic examination revealed mucinous cystic tumor of low malignant potential (MCLTMP) of the urachus. It is important to consider the possibility of a ruptured urachal cyst in a female patient who presents with hypogastric abdominal pain. A transabdominal and transvaginal ultrasound may lead to an incorrect diagnosis. In such cases where the patient presented with an acute abdomen, knowledge that a ruptured urachal cyst maybe a differential for such masses would lead to a strategic laparotomy incision aimed at a possible en-bloc removal of the umbilicus while maintaining the connections of the possible urachal mass to the urinary bladder.

Objectives: This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability. Methods: This was a cross sectional mixed methods study comprised of two parts. The first part consisted of Filipino translation of the UW-QOL version 4 questionnaire. The second part validated the internal consistency and testretest reliability through statistical analysis. Results: The Cronbach’s coefficient was high (0.88) which denotes good internal consistency. Pearson’s correlation coefficient was obtained to determine the test-retest reliability of the translated questionnaire. A p value of <0.05 indicates that the questionnaire has good test-retest reliability. The p value was high in most of the items of the questionnaire. Conclusion The internal consistency of the translated questionnaire is high and comparable to other translations of the same questionnaire. The test-retest reliability is low owing to the interventions done between the test and retest.
Quality of Life ; Surveys and Questionnaires

Objective. The study aimed to describe the patient demographic characteristics, clinical factors, surgical interventions, and quality of care parameters in non-survivors and survivors of Fournier's gangrene (FG).

Methods. A total of 131 cases of Fournier's gangrene (FG) were included in a retrospective chart review in the Philippine General Hospital over 10 years using the Department of Surgery research database. We collected data for various direct and derived variables from the identified population. The primary outcome was mortality rate, while other factors studied were genital and colorectal manipulation, bowel diversion, laboratory parameters (white blood cell count, creatinine, hemoglobin).

Results. The mortality rate was 15%. Diabetes mellitus was common comorbidity among patients with Fournier's disease. The following were statistically more common in the non-survivor group: female sex, concomitant bowel diversion surgery. Admission data in the non-survivor group showed a lower serum hemoglobin, a higher serum creatinine, and an increased percentage of patients with an abnormal white blood cell count; these did not statistically differ between cohorts, however. The median time to first antibiotic infusion was six hours. The median time to surgery was 13 hours.

Conclusions. Among patients with Fournier's gangrene, the proportion of women and those undergoing bowel diversion was higher in those who did not survive. The time of infusion of antibiotics or time to surgery did not differ significantly between survivors and non-survivors.

Background. Despite being a clean-contaminated procedure, performed only in patients with sterile urine preoperatively, percutaneous nephrolithotripsy (PCNL) is associated with significant infectious perioperative complications. A local antibiogram is of paramount importance in optimizing antibiotic prophylaxis in PCNL because of the substantial variation in bacterial distribution and antibiotic sensitivity worldwide.

Objectives. The incidence of post-PCNL infectious complications, microorganism distribution, and antibiotic sensitivities from patients admitted for PCNL was determined. The risk factors associated with positive cultures and the development of fever and bacteremia were also analyzed.

Methods. A retrospective study of 102 patients who underwent PCNL under a surveillance protocol was done. The susceptibility of isolates from different specimens was evaluated against the most common antibiotics in the hospital. Chi-square and Student's t-test were used to determine differences in the frequencies and means for other risk factors for those who developed fever and urosepsis and those who did not.

Results. The incidence of fever and urosepsis was 25% and 4%, respectively. The most common organism on urine specimens was Escherichia coli which showed high sensitivity to aminoglycosides. The most common isolate on stones was Pseudomonas aeruginosa, which showed higher sensitivities to the fluoroquinolones. The isolates showed nearly consistent resistance to ceftriaxone. No significant association was found between the clinical variables studied and the occurrence of infectious complications.

Conclusion. There are comparable rates of infectious complications to published literature. A change in antibiotic prophylaxis was warranted, given the high resistance to ceftriaxone and the predominance of Pseudomonas aeruginosa on stone isolates. Further surveillance is required to identify significant risk factors for the development of post-PCNL infectious complications.

Background: Mastectomy is a common surgical procedure done worldwide. Surgical site infection (SSI) is a common healthcare-associated infection. Mastectomy SSIs are frequently under-reported.

Objectives: The study aimed to determine the incidence of SSI among mastectomy cases of the Department of Surgery, University of the Philippines - Philippine General Hospital (UP-PGH) during one year of full implementation of the Surgical Site Infection Surveillance Program and evaluate the program's surveillance follow-up rate.

Methods: This study was an observational practice audit research that included all adult patients who underwent a mastectomy in UP-PGH from January 1, 2018, to January 31, 2019, when the SSI Surveillance Program was fully implemented. SSI was monitored and assessed during the patient's hospital stay, on the day of hospital discharge, and at 30 days (± 2 days) after surgery, either during an outpatient visit or via phone call by a nurse navigator. SSI frequency for mastectomy was computed both during the in-hospital stay and at 30 days after surgery. Surveillance follow-up rate, defined as the proportion of patients who could follow-up up to 30 days after surgery, was determined.

Results: The 30-day SSI rate for mastectomy was 6.8% (19/279). All 279 patients were followed up to 30 days after surgery. Of the 279 patients, 277 (99.3%) were through clinic visits, one was through phone calls, and one was still admitted to the hospital.

Conclusion: Full implementation of the SSI Surveillance Program for mastectomy in UP-PGH for one year showed a higher SSI rate than in published international literature. The program had a complete 30-day patient follow-up, contributing to more accurate SSI reporting. Implementing an SSI surveillance program with standardized protocols, dedicated personnel, patient education component, and the analysis of the information derived from such programs can improve an institution's quality of surgical care.