Acta Medica Philippina最新文献

{"title":"Massive Retinal Gliosis - A Rare Benign Condition Masquerading as a Malignant Intraocular Tumor: A Case Report.","authors":"Xavier Daryl L Martinez, Charisse Ann S Tanlapco, Armida L Suller-Pansacola","doi":"10.47895/amp.vi0.11602","DOIUrl":"10.47895/amp.vi0.11602","url":null,"abstract":"<p><p>Massive retinal gliosis (MRG) is a rare, benign intraocular condition resulting from reactive glial cells undergoing exaggerated repair phenomenon. A 52-year-old male presented with 6-year history of enlarging mass in the right eye, associated with progressive vision loss and worsening proptosis. He reported history of trauma to that eye secondary to a vehicular crash one year prior. Magnetic resonance imaging (MRI) of the orbits revealed an intraocular lesion with calcifications raising the possibility of a malignant tumor. Enucleation of the right globe was performed and histopathologic examination revealed the entire vitreous cavity and retina replaced by glial cells arranged in interlacing bundles and whorls with foci of calcifications, highly suspicious of MRG. This was further confirmed by a positive, diffuse, and robust cytoplasmic expression of glial fibrillary protein (GFAP). The disease is known to have favorable outcomes as no complications, such as reemergence of the mass, active bleeding, and secondary infection, were observed from the patient during subsequent visits. Distinction of MRG from other intraocular neoplasms is clinically challenging, hence biopsy is necessary. MRG should be considered as a differential diagnosis when encountering intraocular tumors, especially if there is a history of eye trauma. This is the first reported case of MRG in the Philippines.</p>","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HBV Catch-up Vaccination in Children and Adults with Incomplete or Unknown Vaccination to Reduce Hepatitis B-related Morbidity: A Systematic Review.","authors":"Germana Emerita V Gregorio, Sally Jane G Velasco-Aro","doi":"10.47895/amp.vi0.9874","DOIUrl":"10.47895/amp.vi0.9874","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hepatitis B virus causes life-threatening chronic liver infection and increases the risk of death from cirrhosis and liver cancer. A three-dose series of universal HBV vaccination initiated from birth is effective against the disease. It is unclear if catch-up vaccination is also effective in those with incomplete or no HBV vaccination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To review the evidence on the effect of HBV catch-up vaccination on children and adults to decrease HBV-related morbidity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched MEDLINE, Cochrane CENTRAL, ChinaXiv, MedRXIV, BioRXIV, Google Scholar, and ongoing and completed trials on USA: https://clinicaltrials.gov/; China: http://www.chictr.org.cn/searchprojen.aspx, and WHO: https://www.who.int/clinical-trials-registry-platform. The last search date was 30 June 2023. We considered experimental or observational studies, meta-analysis/systematic reviews, completed trials and preprints that investigated the efficacy of catch-up HBV immunization in decreasing morbidity from hepatitis B infection including acute and chronic hepatitis B infection, liver cirrhosis, and hepatocellular carcinoma. There was no age and language restriction. Two reviewers independently rated the quality of included studies using Newcastle - Ottawa Quality Assessment Scale for cohort and cross-sectional studies. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach was used to determine the certainty of evidence. Data was presented as number (%) for categorical values. Differences between the unvaccinated and vaccinated group was described as relative risk or odds ratio for categorical variables. Data was pooled using Review Manager 5.4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of four observational studies were included, one of which had data in children and adults [two (one with data in adults) studies in children; 3 in adults]. The cross-sectional study was assessed as good quality; and the three cohorts as fair to good. In children, a high certainty evidence study showed that catch up vaccination in 9 to 18 years old decreased risk of HBsAg positivity [RR: 0.09 (0.004, 0.21)], reduced HBV DNA detection [RR: 0.084 (0.026, 0.273)], and increased anti-HBs seroconversion [RR: 2.08 (1.84, 2.33)]. The quality of evidence was deemed high based on a large treatment effect. Another low certainty evidence study in Italy showed that HBV mass immunization in 0-10 years old decreased the prevalence of HBsAg anti-HBc and increased anti-HBs seroconversion after vaccination. In adults, three low certainty evidence studies were included. Two studies showed decreased incidence of acute hepatitis B [OR: 0.08 (0.05, 0.12), I2 = 33%]. Another study demonstrated a decreased prevalence of hepatocellular carcinoma with HBV vaccination with the incidence ratio of vaccinated with chronically infected at 0.04 (0.02, 0.07) showing a large magnitude of benefit for vaccination against","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"68-76"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial Interventions for Mental Health Problems of In-patients in Non-psychiatry Units of Selected Tertiary Hospitals in the Philippines: A Mixed-Methods Approach.","authors":"Ma Cynthia R Leynes, Ma Kristine Joy S Calvario, Victoria Patricia De La Llana, Joffrey Sebastian E Quiring, Norieta C Balderrama, Victor A Amantillo, Anna Josefina Vazquez-Genuino, Bihildis C Mabunga, Joan Mae Perez-Rifareal, Candice F Genuino-Montaño","doi":"10.47895/amp.vi0.10429","DOIUrl":"10.47895/amp.vi0.10429","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study described the demographic and clinical profile, mental health problems, prevalence of psychiatric conditions, psychosocial interventions used, and outcomes of the management of mental health problems among in-patients admitted to non-psychiatry units of tertiary hospitals referred to mental health care providers; and described gender-disaggregated data related to mental health care providers and patients receiving psychosocial interventions in tertiary hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study employed a mixed-method design, using both qualitative and quantitative methodologies following the convergence model of triangulation. The following were the data sources: (1) cross-sectional review of charts of patients referred for psychosocial problems using the ICD-10 classification; (2) a survey of mental health service providers; (3) key informant interviews of mental health service providers; and (4) focus group discussions of mental health providers. All data were collated, compared, and contrasted, then analyzed using the convergence model of triangulation design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 3,502 patients in the chart review, 1,870 (53.40%) were males. The median age was 46.08 years and 92.06% were adults. The most common diagnosis among the patients were mood disorder (744, 21.25%) and organic mental disorder (710, 20.27%). Combination treatment of psychosocial intervention and pharmacology was the most common strategy received by patients. There was a higher proportion of patients admitted to public hospitals (996, 45.27%) who received psychosocial interventions only compared to those admitted to private hospitals (235, 18.05%). There were 3,453 out of 3,502 in-patients referred for psychiatric intervention. Of these 2,420 (70%) received psychoeducation, 2,365 (68.5%), received supportive psychotherapy/counseling, 535 (15.5%) family therapy, and 286 (8.3%) behavior modification. There were more patients given psychosocial interventions 2,541 (72.56%) who were discharged with instruction to follow-up, while around one in 10 (456, 13.02%) was not instructed to do a follow-up consultation. The types of interventions across all data sources were similar.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The most common type of management for psychosocial problems of in-patients in tertiary hospitals was a combination of psychosocial intervention and pharmacotherapy. Psychoeducation, supportive psychotherapy/ counseling, and family therapy were the most often given psychosocial interventions. The patient-related reasons for the choice of interventions were patient's medical status (diagnosis and severity of symptoms) and psychological status (psychological mindedness), while the provider-related factors influencing the choice of intervention were provider's skills and personal preference. Moreover, resources (human and material) and service provision policies (treatment guidelines and aftercare i","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"28-43"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting Patient Referral to Periodontists from General Dental Practitioners in the City of Manila: A Descriptive Cross-sectional Study.","authors":"Khimberly Joyce A Flores, Ma Celina U Garcia, Kristine Rachelle R Pacete-Estrera","doi":"10.47895/amp.vi0.11278","DOIUrl":"10.47895/amp.vi0.11278","url":null,"abstract":"<p><strong>Background and objective: </strong>The primary determinant for patient referral by general dental practitioners (GDPs) to periodontists differs based on the country of practice. Moreover, previous research has revealed that GDP preferences for managing periodontal patients, actual number of referrals, and the overall decision-making process have evolved over time. Understanding the periodontal referral pattern of Filipino GDPs could help identify factors that promote or inhibit referral to periodontists. These factors may in turn be used as basis for the formulation of periodontal referral guidelines for use by GDPs in the Philippines. Therefore, this study aimed to determine the factors that affect the referral patterns of Filipino GDPs to periodontists, with GDPs practicing in the City of Manila as the representative population.</p><p><strong>Methods: </strong>A descriptive cross-sectional study design with the use of a self-administered survey was utilized for this study. Participants were 75 licensed dentists practicing in the City of Manila who were members of the Philippine Dental Association-Manila Dental Chapter. The questionnaire collected information on sociodemographic characteristics of the participants, periodontal referral pattern, and the factors considered by the participants when referring patients to a periodontist. Descriptive statistics (frequency and percentage) were used to report the study's findings.</p><p><strong>Results: </strong>Majority (92%) indicated that they regularly referred patients with periodontal disease to periodontists, with a personal estimate of up to 20 periodontal case referrals monthly by 81.3% of the participants and >20 referrals for 10.7%. The clinical factors considered as most important when referring to a periodontist were the type of periodontal disease (81.3%), periodontitis severity (74.7%), and the presence of a complex medical history (61.3%). Among the non-clinical factors, the most influential were the following: uncooperative patient (32%), perceived personal skill (24%), postgraduate training of the periodontist (21.3%), and the patient's financial capacity (13.3%).</p><p><strong>Conclusion: </strong>Multiple factors affect the decision of general dental practitioners in the City of Manila when referring patients to a periodontist. Majority are influenced by clinical factors such as the type and severity of periodontal disease and the systemic condition of the patient. Although considered to a much lesser degree compared to clinical factors, the top non-clinical factors that Manila GDPs base their referral decisions include the assessment that a patient is uncooperative and the perceived adequacy of personal skills in managing periodontal patients.</p>","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"60-67"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparing for the Futures of Health Professions Education in the Philippines.","authors":"Laurence Lloyd B Parial","doi":"10.47895/amp.v59i12.13709","DOIUrl":"10.47895/amp.v59i12.13709","url":null,"abstract":"","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cecal Perforation in an Adolescent as a Paradoxical Response to Anti-tuberculosis Treatment: A Case Report.","authors":"Pilarica I Caguiat-Jo, Germana Emerita V Gregorio","doi":"10.47895/amp.vi0.9832","DOIUrl":"10.47895/amp.vi0.9832","url":null,"abstract":"<p><p>Paradoxical response to anti-tuberculosis treatment, defined as clinical or radiologic worsening of pre-existing lesions or the development of new lesions while ongoing treatment, poses diagnostic dilemma. Intestinal perforation as a paradoxical response is rare. We report a 10-year-old female who presented with recurrent abdominal pain, anorexia, and bloody diarrhea, and was diagnosed with disseminated tuberculosis. She had marked improvement after one month of anti-tuberculosis treatment but developed a recurrence of initial symptoms on the third month of therapy and was treated for cecal perforation. Histopathology of cecum revealed chronic granulomatous inflammation. The patient improved after the surgery and the resumption of anti-tuberculosis medications. Recognition of paradoxical reactions and differentiating it from drug resistance of other pathology is important as these necessitates different management strategies.</p>","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"92-98"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Nerve Block for PD Catheter Insertion in a Pediatric Patient with Decompensated Heart Failure: A Case Report.","authors":"Jeanne Pauline W Orbe, Lina May C Osit","doi":"10.47895/amp.vi0.11005","DOIUrl":"10.47895/amp.vi0.11005","url":null,"abstract":"<p><p>Peripheral nerve block (PNB) has been successfully used as the sole anesthetic for Peritoneal dialysis (PD) catheter insertion, and has been shown to provide satisfactory anesthesia and analgesia perioperatively, especially among critically-ill patients. This report describes the anesthetic management of an 18 - year old underweight pediatric patient with End-stage renal disease (ESRD) and decompensated heart failure who was scheduled for PD catheter insertion. He was given a left lateral Transversus abdominis plane (TAP) block and a right Rectus sheath (RS) block as the main anesthetic. Fifteen mL of Isobaric Bupivacaine 0.375% with Epinephrine 1:400,000 dilution was injected for the TAP block, and 10mL for the RS block, for a total volume of 25mL (93.7mg). Sedation was given via a Remifentanil infusion at 0.1mcg/kg/min. Intraoperatively, the patient was awake, conversant, and comfortable, no pressors were used, and no conversion to general anesthesia was done. Post-operatively, he had good pain control, with a pain score of 1/10, and successfully underwent dialysis via the PD catheter on the 2nd hospital day. This pediatric patient who is critically-ill is not a good candidate for general or neuraxial anesthesia due to the risk of hemodynamic instability and perioperative decompensation. PNB was done to provide satisfactory anesthesia, and ensure good pain control post-operatively, and left TAP and right RS blocks were done instead of a bilateral TAP to lower the LA volume and decrease the risk of LA toxicity. Unilateral TAP with contralateral RS is a safe anesthetic technique among critically-ill pediatric patients who will undergo PD catheter insertion without the risk of hemodynamic instability with general or neuraxial anesthesia, and to decrease the risk of LA toxicity.</p>","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"83-86"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Splenic Angioembolization for Refractory Chronic Immune Thrombocytopenia: A Case Report.","authors":"Rowel David D Yap, Anne Kristine H Quero-Taggaoa","doi":"10.47895/amp.vi0.11389","DOIUrl":"10.47895/amp.vi0.11389","url":null,"abstract":"<p><p>Despite observed and theoretical effectiveness and safety in immune thrombocytopenia (ITP), partial splenic angioembolization has not yet been included in clinical practice recommendations. At present, this is the first and only recorded case of partial splenic angioembolization done for chronic ITP in our institution. This case report will add to the growing body of evidence of partial splenic angioembolization as a viable and attractive alternative in treating refractory ITP among patients who refuse or are otherwise unfit for surgery. We present a 61-year-old female, known chronic ITP unresponsive to steroids, vincristine, rituximab, mycofenolate mofetil, avatrombopag and azathioprine. She refused splenectomy and was offered partial splenic angioembolization. She achieved a durable response at post-procedure days 67, 82, and 130 with platelet count at 50 x 10⁹/L, 85 x 10⁹/L, and 72 x 10⁹/L, respectively, despite continued slow tapering of prednisone and discontinuation of TPO-RA and other immunosuppressive agents. Immune thrombocytopenia (ITP) results from decreased platelet function and increased platelet destruction. About 10% of ITP becomes refractory to treatment within a year. Even among hematologists, the management of refractory chronic ITP remains to be challenging. Splenic artery angioembolization has traditionally been used as an optimization prior to splenectomy of massively enlarged spleens. Its effectiveness in treating ITP remains uncertain. However, current practice endorses it as a rescue therapy in patients deemed unfit for splenectomy.</p>","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"87-91"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Practice Preparedness among Novice Nurses in Private Hospitals: A Cross-sectional Study.","authors":"Mickhail C Pilay, Trisha Mae G Antonio, Zakhary Cazter Z Castro, Angel Jane V Derla, Sophia Aisha Marie R Fontanilla, Arianne M Garcia, Precious Micah A Jimenez, Gwen Alexa I Macadangdang, Trisha Nicole C Nayao, Mikka Diane T Soriano, Cheryll M Bandaay","doi":"10.47895/amp.vi0.11098","DOIUrl":"10.47895/amp.vi0.11098","url":null,"abstract":"<p><strong>Background: </strong>The crop of novice nurses who are currently employed is a product of flexible learning who had limited contact hours with actual patients, which is contrary to those who graduated from traditional learning modalities. Hence, it is essential to evaluate how the impact of flexible learning modality has affected the practice preparedness levels of novice nurses in the hospital setting.</p><p><strong>Objective: </strong>This study aimed to determine the level of practice preparedness and its associated factors among novice nurses who work in private hospitals.</p><p><strong>Methods: </strong>The study utilized a cross-sectional survey design. Data was gathered from a total enumeration of ninetyfour novice staff nurses who graduated from the flexible learning curriculum and are currently employed in private hospitals in Baguio City and La Trinidad. The tool used was a questionnaire in two parts. Part 1 consisted of questions related to demographic information and factors related to practice preparedness, and part 2 included the Nursing Practice Readiness Scale, with validity and reliability scores of >0.924 and 0.90, respectively. The data was analyzed using the SPSS V27 trial version. The protocol was approved by the Saint Louis University Research Ethics Committee.</p><p><strong>Results: </strong>Findings reveal that more novice nurses in private hospitals perceived themselves as well-prepared across all domains of practice preparedness: \"Collaborative Interpersonal Relationship\" (n = 94, 100%); \"Patient Centeredness\" (n = 92, 97.90%); \"Self-regulation\" (n = 90, 95.70%); \"Clinical Judgment and Nursing Performance\" (n = 78, 83.00%); and \"Professional Attitudes\" (n = 76, 80.90%). There is a significant association between practice preparedness and the following factors: \"Attended more than one Training/Seminars per year\" (<i>p</i> = 0.02), \"Graduated from Private Schools\" (<i>p</i> = 0.03), and \"Assigned in Regular Wards\" (<i>p</i> = 0.05).On the other hand, no significant association was found between practice preparedness and the following factors: \"Sex\" (<i>p</i> = 0.61) and \"Membership in Professional Organizations\" (<i>p</i> = 0.73).</p><p><strong>Conclusion: </strong>In agreement with existing studies, practice preparedness is multifactorial. However, what this study contributes are new factors that are favorable in making novice nurses more confident in performing their roles and responsibilities. These include being a graduate of private schools, being assigned to regular wards, and attending professional training/seminars more than once annually. Advantageously, these factors that promote practice preparedness are modifiable.</p>","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"7-18"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the Process of Initial Antibiotic Therapy for Patients with Sepsis in the Emergency Department of a Tertiary Hospital in the Philippines: A Mixed Methodology.","authors":"James Robert J Go, Marvin M Mangulabnan, Ma Cecile S Añonuevo-Cruz, Evalyn A Roxas","doi":"10.47895/amp.vi0.11164","DOIUrl":"10.47895/amp.vi0.11164","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis is a life-threatening organ dysfunction in response to an infection, and immediate administration of the first antibiotic dose, along with other resuscitative efforts, improves patient outcomes. This paved the way for the development of evidence-based sepsis pathways in different health institutions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aims to assess the process of initial antibiotic therapy, from the time the loading dose of antibiotic was ordered to the time it was administered, for adult patients with sepsis admitted at the Emergency Department (ED) of the University of the Philippines - Philippine General Hospital (UP-PGH).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In phase 1 of the study, a review of medical records was done to identify all adult patients diagnosed with sepsis in the ED from February 1 to August 31, 2022. A variant of time-motion analysis was used wherein three points in the sepsis pathway were identified: the time of diagnosis of sepsis/first chart order of antibiotics (point A), the time the chart order was noted by the nurse-in-charge (point B), and the documented time of first dose administration (point C). The mean and median duration (in hours) were then computed between these points. As an additional aim, we briefly presented the outcome of the population used. In phase 2, individual interviews and focused group discussions were done, involving key medical personnel in the sepsis pathway: physicians, nurses, pharmacists, and utility personnel. The data transcribed from these interviews was analyzed through a thematic examination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 508 adult patients were diagnosed with sepsis on record review, 442 of whom met the inclusion criteria. The median time it took for the nurse-in-charge to acknowledge the antibiotic order (points A to B) is 0.73 hours (IQR 0.27-1.7). Meanwhile, the median time between acknowledgment of the order to administration of antibiotics is 1.94 hours (IQR 0.83-6.63). More importantly, the median time from diagnosis-to-first dose (points A to C) is 3.53 hours (IQR 1.59-7.96), while the corresponding mean duration is 5.72 hours. In all cases, 44.6% and 12.4% of loading doses were given within three hours and within one hour after diagnosis, respectively. The all-cause mortality of all qualified cases was 64.7%. A total of 28 key medical personnel were recruited for phase 2. Issues regarding governance, information systems, finances, service delivery, and human resources were identified. In particular, the electronic chart system, a more stable supply of antibiotics, and the new pharmacy at the ER helped facilitate antibiotic delivery. Lack of personnel, gaps in information, and repetitive paperwork were cited as areas for improvement in the existing system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In more than half of the study population, the target time from diagnosis to loading dose of at least 1 hour was not reached. The sig","PeriodicalId":6994,"journal":{"name":"Acta Medica Philippina","volume":"59 12","pages":"44-51"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}