Acta Medica Philippina最新文献

{"title":"Validation of Medicinal Plant Use Needs More Support","authors":"Cecilia C. Maramba-Lazarte, MD, MScID, MScCT","doi":"10.47895/amp.v58i8.10339","DOIUrl":"https://doi.org/10.47895/amp.v58i8.10339","url":null,"abstract":"The COVID-19 pandemic was both a curse and a gift. As a curse, it brought immense suffering and death. All aspects of our daily lives were affected, including healthcare, the economy, and social interactions.1 It was a gift because of the enormity of the problem, the same pandemic has fueled national and international initiatives to produce anti-COVID vaccines and therapies in record time.2 In the Philippines, the Department of Science and Technology was at the forefront of providing technical and financial support for local research on COVID-19, specifically for three plant-based therapies or supplements.3 \u0000Our paper was one of the research studies that the DOST supported. It was a two-stage multicenter parallel, randomized clinical trial using the NIRPROMP-IHM formulation of Lagundi (Vitex negundo) for patients with mild COVID-19.4 Stage 1 compared high and regular Lagundi doses. Stage 2 was an efficacy trial comparing the best dose found in Stage 1 to placebo. Compared to the placebo, the Lagundi group had statistically significantly lower total symptom and anosmia scores, indicating beneficial effects. There was a trend for lower symptom scores (cough, colds, fever, fatigue, body malaise, ageusia) in the Lagundi group but not statistically significant. Physician and patient-rated global evaluation ratings were higher for Lagundi than placebo, suggesting better alleviation, but were not statistically significant. Recovery times were similar for both groups, with few adverse events overall. \u0000The second study, published in this issue, is on using virgin coconut oil (VCO) as an adjunctive treatment for hospitalized patients with COVID-19 (pages 31 to 41). Further reading of the paper also showed similar recovery times and duration of hospital stay for both VCO and placebo groups. A positive outcome was that the inflammatory marker CRP was seen to normalize in more patients in the VCO group compared to the placebo. Other positive outcomes for the VCO group included a trend for lower mortality rate and lower ICU admission. The third study involving Tawa tawa (Euphorbia hirta) for COVID-19 patients has yet to be published. \u0000Positive effects were seen for both Lagundi and VCO, as stated above. In a review article by Dayrit, he recommended studies on several Philippine medicinal plants with immunomodulatory activity, including VCO and lagundi.5 More extensive trials may further elucidate their full potential. I would also suggest exploring their use in long COVID. \u0000It is only appropriate to endorse using Philippine medicinal plants for therapeutic purposes after conducting adequate human studies to establish their efficacy and safety profile. Randomized clinical trials are the gold standard; the study should have internal and external validity. More funding should be invested in such studies so that we can fully and correctly utilize our bountiful natural resources. Herbal medicines can potentially address issues in our healthcare system, such as the ","PeriodicalId":502328,"journal":{"name":"Acta Medica Philippina","volume":"11 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140976221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing Cancer Patients for HIV: Just Do It","authors":"Edsel Maurice T. Salvaña, MD, DTM&H","doi":"10.47895/amp.v58i5.10024","DOIUrl":"https://doi.org/10.47895/amp.v58i5.10024","url":null,"abstract":"Who do we test for HIV? In a perfect world, the answer to this question is, “Everyone.” The United States Centers for Disease Control and Prevention (CDC) recommends that anyone between the age of 13 to 64 years old should have at least one HIV test as part of routine healthcare. 1 In addition, they recommend that anyone who comes into contact with the healthcare system be tested, along with all pregnant women. The main justification for these recommendations is that 40% of new HIV infections in the United States are transmitted by people who do not know their HIV status, which is about 10% of their people living with HIV (PLHIV). 2 \u0000In the Philippines, the testing gap is even wider. Out of an estimated 160,000 PLHIV in 2022, only 102,931 PLHIV were tested and diagnosed. This translates to nearly 40% of all Filipino PLHIV remaining undiagnosed and potentially infecting others. 3 The testing coverage for the most-at-risk populations in the Philippines remains dismal at 67% for female sex workers (FSW), 28% for men who have sex with men (MSM), and 27% for persons who inject drugs (PWID). Successfully addressing the HIV epidemic begins at diagnosis, and so improving testing is of paramount importance. \u0000There are two major compelling public health reasons to test people for HIV. First is to start life-saving antiretroviral therapy (ART) as soon as possible. The sooner a PLHIV starts ART and stays on it, the more life years are recovered up to nearly restoring life expectancy. 4 The second reason is to eliminate the risk of transmission to other people. Starting ART and achieving a suppressed viral load renders a PLHIV virtually unable to transmit. 5 \u0000In this issue of the journal, Poblete and his colleagues6 try to make the case for universal HIV screening of Filipino cancer patients. While they did not find any HIV cases among the 124 patients they screened, they did note that risk factors among the study population were low. They still encouraged physicians to offer HIV screening to all cancer patients given the overwhelming benefits of treatment. \u0000Targeted versus universal HIV screening has been a long ongoing academic debate and there are pros and cons supporting each approach. 7 A low overall prevalence like in the Philippines will be associated with higher costs per case detected with universal screening, but this could potentially be offset by the cost of missed cases in targeted screening. The CDC in past guidance has asserted that universal HIV screening in a specific risk population with an HIV prevalence of at least 0.1% is cost-effective. However, it eventually updated this guidance, urging universal screening regardless of risk factors or prevalence due to the clear benefits of early antiretroviral therapy both from an improved survival and decreased transmission standpoint. 1 In 2010, we did a study doing universal screening on cervical cancer patients and found no cases of HIV among 394 subjects at the Philippine General Hospital (PGH).","PeriodicalId":502328,"journal":{"name":"Acta Medica Philippina","volume":" 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140221381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Now Normal","authors":"Joven Jeremius Q. Tanchuco, MD, MHA","doi":"10.47895/amp.v58i4.9943","DOIUrl":"https://doi.org/10.47895/amp.v58i4.9943","url":null,"abstract":"The World Health Organization (WHO) declared COVID-19 as a public health emergency of international concern (PHEIC) on January 30, 2020 and soon thereafter with 118,000 cases in 114 countries and 4,291 deaths, declared it as a pandemic on March 11, 2020. 1,2 In the Philippines, lockdown was declared by then President Rodrigo Duterte on March 15, 2020. 3 It was for an initial one-month period but extended for progressively longer durations afterwards. Adding to the confusion were the various levels of lockdown soon promulgated, subject to the number of COVID-19 cases in the neighborhood. As to be expected, this kept fluctuating over time and disrupted the way people were able to go to work and do their day-to-day activities outside of their homes. More stress was added because of the lack of meaningful information onCOVID-19, sowing anxiety and fear among the populace. 4-6 \u0000One of the more visible effects of the pandemic lockdown was the change in allowed modes of public transportation. 7 This was most difficult for people in the Philippines who got sick of COVID-19 themselves and health workers who had to continue taking care of the rapidly rising COVID-19 cases. 8,9 For those who could choose to continue working from home, they had to quickly familiarize themselves with the digital platforms, skills needed to work with gadgets and devices, as well as the need for internet services. Although initially thought to offer more work flexibility, time saved from taking public transportation and traffic congestion, and being in a more convenient working environment, working from home was soon seen to cause its own mental health issues. 10-13 With this information, it has increasingly become necessary to constantly evaluate working from home arrangements and configure it more specifically to the needs of the worker and/or the job role. 14-17 \u0000In this context, we bring attention to an article from Indonesia published in this issue of the journal by Wibowo and colleagues. 18 Although there have been numerous articles published on the effects of the COVID-19 pandemic on students and health workers, including in this Journal, it would be useful to also look at other sectors who may have been affected as well. 19-24 On top of the concerns on personal safety and challenges with public transportation shared by most students and health workers, non-health workers are also concerned about their job and food security. 25,26 \u0000The paper by Wibobo et al., first published as an Early Access article in the Journal a year ago, involved technical and field workers (construction, manufacturing, mining, oil, and gas industries) who did not have the same option to work from home. 18 These workers were already being exposed to significant workplace hazards even prior to the pandemic. 27-30 For its part, the study looked into psychological (feeling of safety and work pressure) and organizational (management commitment) factors as determinants of job satisfaction. Questionnair","PeriodicalId":502328,"journal":{"name":"Acta Medica Philippina","volume":"175 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140245832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards Relevant and Viable Telehealth Technologies","authors":"Lourdes Marie S. Tejero, PhD, RN, MTM, CGNC","doi":"10.47895/amp.v58i1.9580","DOIUrl":"https://doi.org/10.47895/amp.v58i1.9580","url":null,"abstract":"Disruption of the healthcare system was more pronounced in low- to middle-income countries than in developed countries during the period of the COVID-19 pandemic.1 A reduction of about a third of the patient cases was observed, especially  for the mild to moderate conditions.2 Considering that non-severe cases are most amenable to remote management throughtelehealth, the latter was a popular alternative to going to a health facility. Among its benefits include connecting patients with health providers at their convenient time and place, avoiding exposure to infection, saving time, responding early to medical emergencies, providing e-prescriptions, accessing even remote areas, among others.3 \u0000In this issue of the journal, the article by Gonzales et al., on developing and implementing mobile health technologies presents the Philippine scenario in the development of mobile health (mHealth) technologies. It is noted that the average cost to develop and roll out mHealth is around PhP 4,018,907 (US $78,650). This figure may not be too onerous for those with the means but is challenging for most developers. Thus, the government plays an indispensable role in supporting these ventures for health especially during the pandemic. With taxpayers’ money going to these technologies, it is advantageous to weigh the benefits over the investment. Cost-benefit analyses are important to undertake before plunging into specific projects. \u0000During the pandemic, some of these telehealth services were funded by the government and the developers faced challenges inherent in public funding.4 When the government ceases to fund these projects, entrepreneurs have to rely on their own resources. Financial viability is linked to market success. \u0000To make any product or service successful in the market, it should be designed from the outset, based on the needs of its intended customers. The design thinking principles are important to consider in the design process of mobile health technologies.5 At the core of these principles is that the product is co-designed with the consumers. From the very start of the project, the ‘needs’ of the consumers and not just their expressed ‘wants’, should be well delineated. This can be teased out from qualitative interviews with consumers about their experiences so that the problematic areas can be explored more deeply to bring out the real needs that even the consumers themselves may not realize. In so doing, the developer can design the technology addressing those needs, thus making the product more relevant and acceptable in the market. \u0000For innovations emanating from the university, it is beneficial that academe-industry collaboration be established from the start. There are a number of mechanisms where this can be achieved. In the so-called “reverse-pitching”, companies present their needs to the professors and researchers for them to initiate studies to address those needs. Usually, innovators are the ones pitching their technologies to co","PeriodicalId":502328,"journal":{"name":"Acta Medica Philippina","volume":"32 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139595446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metrics Matter","authors":"Jenniffer T. Paguio, PhD, MA, RN","doi":"10.47895/amp.v58i1.9583","DOIUrl":"https://doi.org/10.47895/amp.v58i1.9583","url":null,"abstract":"There is limited evidence to substantially describe the state of Patient Safety (PS) in the Philippines.1,2 With most publications reflecting respondent-based assessments of institutional patient safety culture, patient-sensitive and records-based indicators are scarce. 3 Despite the Institute of Medicine’s4 call to action to address preventable errors and the publication of patient safety indicators5 , there has been slow progress in patient safety in the country. \u0000The Department of Health’s release of the National Policy on Patient Safety (Administrative Order 2008-0023) 6 and the creation of the National Patient Safety Committee (NPSC) were pivotal in elevating patient safety as priority in Philippine healthcare facilities. The creation of PS committees across hospitals and the mainstreaming of patient safety through campaigns and conferences helped push institution-level research and design programs to reduce events.7,8 The National Policy on Patient Safety in Health Facilities (Administrative Order 2020-0007) 9 presented specific guidelines and strategies for the full implementation of PS programs, including directives on the roles and responsibilities of patient safety officers, strategies to address patient safety issues, and indicators for monitoring. The above national and institutional efforts to promote patient safety strategies are gaining momentum, but without metrics, it is impossible to determine if these initiatives result in real-world changes. \u0000Accurate, reliable, and timely patient safety-sensitive indicators feed learning systems. 10,11 Metrics for patient safety allow for accurate analysis that translate to responsive actions to mitigate risks, ensure continuous improvement, monitor progress, and impact patient-, organization-, and health worker-related outcomes. However, the findings of incapacitated patientsafety committees, missing risk management and patient-centered initiatives, and inconsistent reporting systems are highly concerning. \u0000While hospitals have complied with the activities stipulated in the national policies, the superficial compliance reflects the lack of investment in patient safety architecture. The committee chairs and members are burdened with competing priorities, leaving them with little time to fulfil their roles in policy development, data analysis, and system improvements. These responsibilities are mere add-ons to their already brimming schedules, and the meager budget, if any, further hinders program implementation and their engagement in essential training. \u0000Inadequate time dedicated to engaging in patient safety-focused activities of frontline healthcare personnel 12 could also explain why some patient and direct care indicators receive lower reporting than others like falls, medication errors, adverse drug events, and missed care. Reporting and contributing to learning systems can become a burden for nurses and physicians with inhumane workloads, 13-15 further exacerbating the issue. \u0000Inconsis","PeriodicalId":502328,"journal":{"name":"Acta Medica Philippina","volume":"41 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139595048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Rapid Evidence Generation and Synthesis in the Researcher’s Methods Toolkit","authors":"Carl Abelardo T. Antonio, MD, MPH","doi":"10.47895/amp.v57i11.9097","DOIUrl":"https://doi.org/10.47895/amp.v57i11.9097","url":null,"abstract":"There is currently a predominance of an instrumental view of science, which has produced a social contract between science and society.1 From this perspective, science contributes to the improvement of the human condition through the production of knowledge that can be used as the basis for improving policies, programs, and practices in various spheres of life. This view has permeated different aspects of the scientific enterprise including science governance (e.g., transition of measurement of scientific impact from economic to social/societal) 2, research ethics (i.e., integration of social/public benefit in the ethical criteria for assessing research involving human participants) 3, and the thrust for both evidence-informed decision-making (i.e., the integration of evidence from research and other sources in the process of decision-making for various purposes)4 and knowledge translation in health (i.e., the generation, synthesis, and application of knowledge to improve health, as well as health services and the health system)5. One of the barriers to this ideal, however, is the lag time between the demand for knowledge/evidence from end-users such as policymakers, decision-makers and clinicians, and the production and synthesis of such knowledge/evidence from scientists and researchers.6 This is attributed to, among others, the administrative and quality assurance procedures that a research idea has to go through before it is implemented as a study (e.g., search for funding, technical and ethics review, contract and award set-up, etc.), the actual implementation of the research itself (e.g., search for, and recruitment of, research participants, collection, and analysis of data, etc.), dissemination efforts (e.g., peer review and publication), and the post-dissemination activities (e.g., indexing, integration in evidence synthesis reports, etc.). This lag time is usually cited as being 17 years for clinical research but is actually highly variable as it depends on the research area, not to mention the identified start- and endpoints of measurement of the lag time.6,7 The chasm between evidence generation and evidence use has taken on greater significance in light of the global experience with the COVID-19 pandemic. The rapidly evolving situation of this public health emergency put to light the need for faster turnaround times in evidence production, synthesis, and dissemination so that evidence will be available in a timely manner for its intended end-users. As one observer noted, the pandemic has forced the scientific community to find ways to “speed up science”.8 A way by which the lag time can be reduced is through the use of rapid evidence generation and evidence synthesis approaches, such as the one utilized by Elepaño et al.9 in this issue of Acta Medica Philippina. In their report, the authors undertook a quality improvement initiative, by way of a chart review, to inform a specific set of stakeholders regarding application and use o","PeriodicalId":502328,"journal":{"name":"Acta Medica Philippina","volume":"2014 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139239401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}