Pub Date : 2022-12-07DOI: 10.35460/2546-1621.2022-sp11
J. Li-Yu, Dominic Dela Cruz, Millicent Tan-Ong, L. Zamora, Richelle Joy Bayson
Objective. Double contour sign (DCS) is considered part of the new gout classification. This study aims to determine the agreement of blinded musculoskeletal sonologists in identifying the double contour sign among asymptomatic hyperuricemic patients. Methods. Participants with asymptomatic hyperuricemia (n=65) underwent a gray-scale ultrasound assessment of both of their 1st metatarsophalangeal joints (MTPJs) done on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 independent blinded sonologists for presence of double contour sign. Results. Among the 130 1st MTPJs, the sonologists were able to positively identify DCS on 48R and 52L, negative in 10R and 10L, with discordant readings in 7R, 3L. The overall kappa agreement was statistically significant at 0.674 (substantial agreement) and 0.842 (almost perfect agreement) on the right and left respectively, (both p<0.001). Conclusion and Recommendation. There is a high proportion of positive double contour sign seen among persistently asymptomatic hyperuricemic patients. It might be prudent to perform musculoskeletal ultrasound early on to detect monosodium urate crystal deposits in similar patients. A close follow up to monitor clinical gouty arthritis may be necessary or consider utility of urate lowering drugs in crystal dissolution in prospective studies.
{"title":"Double Contour Sign In Early Detection Of Gout Among Asymptomatic Hyperuricemic Filipino Patients: A Single Center Tertiary Hospital Observational Study","authors":"J. Li-Yu, Dominic Dela Cruz, Millicent Tan-Ong, L. Zamora, Richelle Joy Bayson","doi":"10.35460/2546-1621.2022-sp11","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-sp11","url":null,"abstract":"Objective. Double contour sign (DCS) is considered part of the new gout classification. This study aims to determine the agreement of blinded musculoskeletal sonologists in identifying the double contour sign among asymptomatic hyperuricemic patients. Methods. Participants with asymptomatic hyperuricemia (n=65) underwent a gray-scale ultrasound assessment of both of their 1st metatarsophalangeal joints (MTPJs) done on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 independent blinded sonologists for presence of double contour sign. Results. Among the 130 1st MTPJs, the sonologists were able to positively identify DCS on 48R and 52L, negative in 10R and 10L, with discordant readings in 7R, 3L. The overall kappa agreement was statistically significant at 0.674 (substantial agreement) and 0.842 (almost perfect agreement) on the right and left respectively, (both p<0.001). Conclusion and Recommendation. There is a high proportion of positive double contour sign seen among persistently asymptomatic hyperuricemic patients. It might be prudent to perform musculoskeletal ultrasound early on to detect monosodium urate crystal deposits in similar patients. A close follow up to monitor clinical gouty arthritis may be necessary or consider utility of urate lowering drugs in crystal dissolution in prospective studies.","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130340695","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}
Pub Date : 2022-12-07DOI: 10.35460/2546-1621.2022-sp18
Sandra V Navarra
In the summer heat of 1966, racial tensions between African Americans and whites in Cleveland erupted into a riot that left four people dead, 30 critically injured, and 240 homes and businesses burned in the Hough community. In October, 1966, the Black Panthers, founded " to serve the needs of the oppressed people in our communities and defend them against their oppressors (www.blackpanther.org), " adopted their party platform and program. " What We Want & What We Believe " demanded housing, education, military exemption for black men, an immediate end to police brutality and murder of black people, jury trials of blacks by their peers, release of all black prisoners, and the establishment of a black colony in the United States under the auspices of the United Nations that would empower black people to determine their own national destiny societal oppression. Subsequently, its focus shifted to the creation of community programs to address poverty and improve health. The late Larry Slaughter was a Black Panther. I met him in the decade that followed the Hough riots in Cleveland at Myron T. Herrick Junior High School. He was a well-established presence in the building; I had recently arrived from an across town senior high school. He taught industrial arts; I taught English, but most importantly, we both taught children. Within weeks of my arrival in the school, Mr. Slaughter confronted me and tried to dissuade me from making home visits in the neighborhood. I was determined to contact the parents of truant/disruptive students; he was equally determined that I would not
{"title":"The things that truly matter…","authors":"Sandra V Navarra","doi":"10.35460/2546-1621.2022-sp18","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-sp18","url":null,"abstract":"In the summer heat of 1966, racial tensions between African Americans and whites in Cleveland erupted into a riot that left four people dead, 30 critically injured, and 240 homes and businesses burned in the Hough community. In October, 1966, the Black Panthers, founded \" to serve the needs of the oppressed people in our communities and defend them against their oppressors (www.blackpanther.org), \" adopted their party platform and program. \" What We Want & What We Believe \" demanded housing, education, military exemption for black men, an immediate end to police brutality and murder of black people, jury trials of blacks by their peers, release of all black prisoners, and the establishment of a black colony in the United States under the auspices of the United Nations that would empower black people to determine their own national destiny societal oppression. Subsequently, its focus shifted to the creation of community programs to address poverty and improve health. The late Larry Slaughter was a Black Panther. I met him in the decade that followed the Hough riots in Cleveland at Myron T. Herrick Junior High School. He was a well-established presence in the building; I had recently arrived from an across town senior high school. He taught industrial arts; I taught English, but most importantly, we both taught children. Within weeks of my arrival in the school, Mr. Slaughter confronted me and tried to dissuade me from making home visits in the neighborhood. I was determined to contact the parents of truant/disruptive students; he was equally determined that I would not","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133786887","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}
Pub Date : 2022-12-07DOI: 10.35460/2546-1621.2022-sp14
M. Marcial
Objectives: To determine if online team-based learning (TBL) is effective in improving knowledge outcomes and confidence about hyponatremia in its clinical recognition, classification, diagnostic work up, and management among fourth year medical students Study design: A quantitative evaluative design. Population and Setting: Fourth year medical students (medical clerks) rotating in the Department of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines from July to December 2020. Methodology: A modified TBL workshop is adopted in teaching fourth year medical clerks about hyponatremia. The TBL session was held with a group of medical clerks weekly from July to December 2020. As a pre-workshop preparation, the medical clerks were assigned to read ahead of time the clinical practice guidelines on the diagnosis and treatment of hyponatremia developed by the European Renal Best Practice. After reading it, they were asked to answer an Individual Readiness Assessment Test (IRAT) composed of 20 case-based multiple-choice questions (MCQ). The group was thereafter divided into 4 subgroups and asked to discuss the same MCQ-based exam and present it as a Team Readiness Assessment Test (TRAT). As each subgroup presented their IRAT, the facilitator discussed the underlying concepts for each question and its application in actual cases of hyponatremia. The facilitator then summarized the learning outcomes at the end of the TBL workshop. For team application (TAPP), the students created a concept map and formulated admitting orders. The medical clerks were then surveyed on their confidence in hyponatremia diagnosis and management during pre-TBL workshop, after IRAT, after TRAT, and after discussion with the facilitator. Statistical Design: Descriptive statistics were used to summarize the study variables and included the mean, standard deviation, frequency, and percentage. Within-group comparisons of different outcomes across the different timeframes were conducted using one-way multivariate analysis of variance (one-way MANOVA). Cognizant that the study has multiple outcomes or dependent variables which were compared at four different timeframes, multivariate analysis was utilized to minimize the inflation of family-wise errors (FWE). Results: Comparative analysis indicated that the mean readiness scores of the respondents after TRAT was significantly higher (t=–91.61, p=0.001) compared to the mean readiness scores after IRAT. Comparative analysis using paired t-test indicated that the mean confidence scores of the respondents in the recognition, diagnosis, and treatment of hyponatremia were significantly higher among the respondents after the IRAT (t=–24.26, p=0.001), TRAT (t=–34.58, p=0.001), and facilitator discussion (t=–42.72, p=0.001) approaches compared to the mean pre-TBL confidence score. The mean knowledge score of the respondents on the creation of a concept map and the formulation of admission orders of patients w
目的:确定在线团队学习(TBL)在四年级医学生低钠血症的临床识别、分类、诊断工作和管理方面是否有效提高知识成果和信心。人口和环境:2020年7月至12月在菲律宾马尼拉圣托马斯大学医学和外科学院医学系轮岗的四年级医学生(医务文员)。方法:采用改进的TBL工作坊对四年级医务人员进行低钠血症教学。从2020年7月至12月，每周与一批医务文员举行TBL会议。作为研讨会前的准备工作，医务人员被要求提前阅读由欧洲肾脏最佳实践制定的关于低钠血症诊断和治疗的临床实践指南。读完之后，他们被要求回答一个由20个基于案例的多项选择题组成的个人准备评估测试(IRAT)。小组随后被分成4个小组，并被要求讨论相同的基于mcq的考试，并将其作为团队准备评估测试(TRAT)呈现。当每个小组介绍他们的IRAT时，主持人讨论了每个问题的基本概念及其在低钠血症实际病例中的应用。主持人随后在TBL研讨会结束时总结了学习成果。在团队申请(TAPP)中，学生们绘制了概念图并制定了录取命令。然后调查医务人员在tbl前研讨会、IRAT后、TRAT后以及与主持人讨论后对低钠血症诊断和管理的信心。统计设计:描述性统计用于总结研究变量，包括平均值、标准差、频率和百分比。采用单因素方差分析(single - multivariate analysis of variance, single - MANOVA)对不同时间段的不同结果进行组内比较。认识到研究有多个结果或因变量，在四个不同的时间框架进行比较，使用多变量分析来最小化家庭错误(FWE)的膨胀。结果:对比分析表明，被调查者在TRAT后的平均准备得分显著高于IRAT后的平均准备得分(t= -91.61, p=0.001)。配对t检验的对比分析显示，采用IRAT (t= -24.26, p=0.001)、TRAT (t= -34.58, p=0.001)和引导者讨论(t= -42.72, p=0.001)方法的被调查者对低钠血症的识别、诊断和治疗的平均置信分数显著高于tbl前的平均置信分数。被调查者对低钠血症患者概念图制作和住院医嘱制定的平均知识得分为25.54±1.98 (95% CI 25.26 ~ 25.82)。结论:本研究的发现不应被解释为证明因果关系。此外，这些结果充其量只是假设。本研究表明，在线TBL有可能成为一种有效的方法，提高四年级医学生对低钠血症的临床识别、分类、诊断检查和管理的知识成果和信心。作为对TBL的初步评价，在作为一种教与学活动被采用之前，可以进行进一步的研究，以确定其作为一种教学方式在医学课程中的有效性，并与传统方法进行比较。关键词:团队学习，在线学习，COVID-19，低钠血症，医学教育
{"title":"Online Team-Based Learning in Teaching Hyponatremia Among Medical Clerks of the University of Santo Tomas Faculty of Medicine and Surgery, Philippines","authors":"M. Marcial","doi":"10.35460/2546-1621.2022-sp14","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-sp14","url":null,"abstract":"Objectives: To determine if online team-based learning (TBL) is effective in improving knowledge outcomes and confidence about hyponatremia in its clinical recognition, classification, diagnostic work up, and management among fourth year medical students Study design: A quantitative evaluative design. Population and Setting: Fourth year medical students (medical clerks) rotating in the Department of Medicine, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines from July to December 2020. Methodology: A modified TBL workshop is adopted in teaching fourth year medical clerks about hyponatremia. The TBL session was held with a group of medical clerks weekly from July to December 2020. As a pre-workshop preparation, the medical clerks were assigned to read ahead of time the clinical practice guidelines on the diagnosis and treatment of hyponatremia developed by the European Renal Best Practice. After reading it, they were asked to answer an Individual Readiness Assessment Test (IRAT) composed of 20 case-based multiple-choice questions (MCQ). The group was thereafter divided into 4 subgroups and asked to discuss the same MCQ-based exam and present it as a Team Readiness Assessment Test (TRAT). As each subgroup presented their IRAT, the facilitator discussed the underlying concepts for each question and its application in actual cases of hyponatremia. The facilitator then summarized the learning outcomes at the end of the TBL workshop. For team application (TAPP), the students created a concept map and formulated admitting orders. The medical clerks were then surveyed on their confidence in hyponatremia diagnosis and management during pre-TBL workshop, after IRAT, after TRAT, and after discussion with the facilitator. Statistical Design: Descriptive statistics were used to summarize the study variables and included the mean, standard deviation, frequency, and percentage. Within-group comparisons of different outcomes across the different timeframes were conducted using one-way multivariate analysis of variance (one-way MANOVA). Cognizant that the study has multiple outcomes or dependent variables which were compared at four different timeframes, multivariate analysis was utilized to minimize the inflation of family-wise errors (FWE). Results: Comparative analysis indicated that the mean readiness scores of the respondents after TRAT was significantly higher (t=–91.61, p=0.001) compared to the mean readiness scores after IRAT. Comparative analysis using paired t-test indicated that the mean confidence scores of the respondents in the recognition, diagnosis, and treatment of hyponatremia were significantly higher among the respondents after the IRAT (t=–24.26, p=0.001), TRAT (t=–34.58, p=0.001), and facilitator discussion (t=–42.72, p=0.001) approaches compared to the mean pre-TBL confidence score. The mean knowledge score of the respondents on the creation of a concept map and the formulation of admission orders of patients w","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123487833","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}
Pub Date : 2022-12-07DOI: 10.35460/2546-1621.2022-sp12
J. Visperas
Background and Objectives of the Study The study aimed to determine the effectiveness of combining flipped classroom on pulmonary ultrasound instruction in first-year medical students with traditional classroom-based instruction and compared it to traditional classroom-based instruction alone. The insights of the teachers and the students on the implementation of both interventions were also evaluated. Research Methodology This is a mixed qualitative (concurrent triangulated) and quantitative research. Baseline procedural knowledge and skills of a total of 282 students on the lung ultrasound scanning using pre-test 20-item summative test, multiple-choice question type of examination, and a pre-test narrative test on lung ultrasound were obtained. A post-intervention summative assessment and narrative test were administered. Statistical analyses were done to compare the scores. A thematic analysis was done to evaluate the responses to the survey. Results 138 students were randomly assigned to the classroom-based instruction group, while 144 students in the combined flipped and classroom-based instruction group. The number of students who passed the summative (MCQ) test and were given flipped classroom and classroom-based instruction increased (6.3% to 79.9%; p<0.001) and the number of students given classroom-based instruction only, significantly increased (4.3% to 79.9%; p<0.001). The number of students who passed the narrative test and were given flipped classroom and classroom-based instructions increased (2.1% to 84.0%; p<0.001) and the number of students given the classroom-based instruction only, also significantly increased (3.6% to 84.2%; p<0.001). The students appreciated the classroom-based instruction because of the knowledgeable facilitators, the very concise approach, that is understandable and done in real-time. In addition, the flipped classroom was likewise helpful and a good introduction before the classroom-based instruction. The facilitators have noticed that the ease in instruction was influenced by the student’s enthusiasm and willingness to learn. Conclusion Flipped classroom in addition to classroom-based instruction, and classroom based instruction were effective in teaching pulmonary ultrasound to First-year medical students Key words: flipped classroom, lung ultrasound, pulmonary ultrasound, medical school, medical students, medical education, blended classroom, classroom-based instruction, ultrasound, ultrasound medical education, video-based instruction
{"title":"Effectiveness of Combined Flipped and Classroom-based Instruction in Teaching Pulmonary Ultrasound to First-year Medical Students","authors":"J. Visperas","doi":"10.35460/2546-1621.2022-sp12","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-sp12","url":null,"abstract":"Background and Objectives of the Study The study aimed to determine the effectiveness of combining flipped classroom on pulmonary ultrasound instruction in first-year medical students with traditional classroom-based instruction and compared it to traditional classroom-based instruction alone. The insights of the teachers and the students on the implementation of both interventions were also evaluated. Research Methodology This is a mixed qualitative (concurrent triangulated) and quantitative research. Baseline procedural knowledge and skills of a total of 282 students on the lung ultrasound scanning using pre-test 20-item summative test, multiple-choice question type of examination, and a pre-test narrative test on lung ultrasound were obtained. A post-intervention summative assessment and narrative test were administered. Statistical analyses were done to compare the scores. A thematic analysis was done to evaluate the responses to the survey. Results 138 students were randomly assigned to the classroom-based instruction group, while 144 students in the combined flipped and classroom-based instruction group. The number of students who passed the summative (MCQ) test and were given flipped classroom and classroom-based instruction increased (6.3% to 79.9%; p<0.001) and the number of students given classroom-based instruction only, significantly increased (4.3% to 79.9%; p<0.001). The number of students who passed the narrative test and were given flipped classroom and classroom-based instructions increased (2.1% to 84.0%; p<0.001) and the number of students given the classroom-based instruction only, also significantly increased (3.6% to 84.2%; p<0.001). The students appreciated the classroom-based instruction because of the knowledgeable facilitators, the very concise approach, that is understandable and done in real-time. In addition, the flipped classroom was likewise helpful and a good introduction before the classroom-based instruction. The facilitators have noticed that the ease in instruction was influenced by the student’s enthusiasm and willingness to learn. Conclusion Flipped classroom in addition to classroom-based instruction, and classroom based instruction were effective in teaching pulmonary ultrasound to First-year medical students Key words: flipped classroom, lung ultrasound, pulmonary ultrasound, medical school, medical students, medical education, blended classroom, classroom-based instruction, ultrasound, ultrasound medical education, video-based instruction","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130468491","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}
Pub Date : 2022-12-07DOI: 10.35460/2546-1621.2022-sp09
Maria Graciela Garayblas-Gonzaga
{"title":"Healthcare: Is it a Business or a Profession?","authors":"Maria Graciela Garayblas-Gonzaga","doi":"10.35460/2546-1621.2022-sp09","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-sp09","url":null,"abstract":"","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134156918","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}
Pub Date : 2022-12-07DOI: 10.35460/2546-1621.2022-sp07
M. Marcial
Background: The impact of online learning during internal medicine rotation among graduating medical students was evaluated during COVID 19 pandemic. Objectives: The study aimed to gauge acceptability of a self-directed learning, recognize frustrations, identify coping mechanisms, assess rate of learning, evaluate study habits and appraise level of readiness in handling actual patients later in practice among graduating medical clerks. Methodology: An ambispective cohort design study involving both retrospective and prospective follow-up of respondents. The retrospective component involved blended learners with clinical experience (Group 1). The prospective component included online learner with clinical experience (Group 2) and online learner without clinical experience. Results: Group 1 showed that they favor pure traditional learning over pure online learning in contrast to the other 2 groups which rated acceptability of online learning high. All groups had high levels of frustration with their inability to experience actual patient exposure, had moderate to high level of coping mechanisms, and rated high the traditional learning and blended learning methodologies. In contrary, all groups rated low to moderate contributions of online learning to their learning. Group 3 had a significantly higher mean overall readiness score compared to the two other groups. Conclusion: The study showed the different levels of impact of online learning to the different population of medical clerks in terms of its acceptability as an alternative way of learning. Actual patient exposure is of main concern while different coping mechanisms maximize knowledge acquisition. Key words: Online learning, self directed, COVID 19 pandemic, Medical clerks
{"title":"The Impact of Online Learning In The Internal Medicine Rotation Among Medical Clerks During The Covid 19 Pandemic and Lockdown","authors":"M. Marcial","doi":"10.35460/2546-1621.2022-sp07","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-sp07","url":null,"abstract":"Background: The impact of online learning during internal medicine rotation among graduating medical students was evaluated during COVID 19 pandemic. Objectives: The study aimed to gauge acceptability of a self-directed learning, recognize frustrations, identify coping mechanisms, assess rate of learning, evaluate study habits and appraise level of readiness in handling actual patients later in practice among graduating medical clerks. Methodology: An ambispective cohort design study involving both retrospective and prospective follow-up of respondents. The retrospective component involved blended learners with clinical experience (Group 1). The prospective component included online learner with clinical experience (Group 2) and online learner without clinical experience. Results: Group 1 showed that they favor pure traditional learning over pure online learning in contrast to the other 2 groups which rated acceptability of online learning high. All groups had high levels of frustration with their inability to experience actual patient exposure, had moderate to high level of coping mechanisms, and rated high the traditional learning and blended learning methodologies. In contrary, all groups rated low to moderate contributions of online learning to their learning. Group 3 had a significantly higher mean overall readiness score compared to the two other groups. Conclusion: The study showed the different levels of impact of online learning to the different population of medical clerks in terms of its acceptability as an alternative way of learning. Actual patient exposure is of main concern while different coping mechanisms maximize knowledge acquisition. Key words: Online learning, self directed, COVID 19 pandemic, Medical clerks","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130329704","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}
Pub Date : 2022-12-07DOI: 10.35460/2546-1621.2022-sp03
J. L. Tarranza, Christine Joy Bongon, Maria Monica Valdez, John Paul Tiopianco, Alexander Reyes, John Patrick Ona, Don Robespierre Reyes, M. Ramirez, Aileen Cynthia De Lara, C. Mendoza, Wilson Tan de Guzman, Manuel B. Zacarias, E. S. Caguioa, Milagros E. Yamamoto
This clinical pathway for the diagnosis and risk stratification of patients presenting with acute chest pain, including acute coronary syndromes, provides recommendations and algorithms for clinicians to diagnose, risk stratify, and manage acute chest pain in adult patients. The writing committee reviewed existing international and local guidelines. Modifications to the algorithm following face-to-face and virtual meetings resulted in expert decisions written as recommendations and presented in a flow diagram format. The USTH Chest Pain Pathway provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities. We recommend its use to ensure quality patient care in the hospital. Key Words: angina pectoris, acute chest pain, acute coronary syndrome, clinical decision pathway, diagnostic pathway, risk stratification, emergency care
{"title":"The University of Santo Tomas Hospital (USTH) 2022 Institutional Chest Pain Pathway: Approach to Diagnosis, Risk Stratification, and Management","authors":"J. L. Tarranza, Christine Joy Bongon, Maria Monica Valdez, John Paul Tiopianco, Alexander Reyes, John Patrick Ona, Don Robespierre Reyes, M. Ramirez, Aileen Cynthia De Lara, C. Mendoza, Wilson Tan de Guzman, Manuel B. Zacarias, E. S. Caguioa, Milagros E. Yamamoto","doi":"10.35460/2546-1621.2022-sp03","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-sp03","url":null,"abstract":"This clinical pathway for the diagnosis and risk stratification of patients presenting with acute chest pain, including acute coronary syndromes, provides recommendations and algorithms for clinicians to diagnose, risk stratify, and manage acute chest pain in adult patients. The writing committee reviewed existing international and local guidelines. Modifications to the algorithm following face-to-face and virtual meetings resulted in expert decisions written as recommendations and presented in a flow diagram format. The USTH Chest Pain Pathway provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities. We recommend its use to ensure quality patient care in the hospital. Key Words: angina pectoris, acute chest pain, acute coronary syndrome, clinical decision pathway, diagnostic pathway, risk stratification, emergency care","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128894482","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}
Pub Date : 2022-12-07DOI: 10.35460/2546-1621.2022-sp15
Maria Faye Anne S Gomez, Leonid D Zamora, Paul John Ablaza, M. Marcial, L. Mercado-Asis
Background and Objective: Teaching clinical skills to undergraduate medical students has brought significant challenges during the COVID-19 pandemic. Patient discussion utilized hypothetical cases from history taking to diagnosis and management. Further, everything was delivered online. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates the basic medical sciences, such as anatomy, physiology, pathology, microbiology, and pharmacology, at the clinical level. TOCSE has been proven to improve the clinical performance of fourth-year medical students. However, clinical confidence remains an issue, especially for medical students on pure online mode of learning during the pandemic. Therefore, this study was undertaken to determine if TOCSE also facilitates the development of confidence in the clinical performance of 4th-year medical students during the first-time patient encounter after online undergraduate classes. Methods: Eight-item Clinical Performance Confidence Scale survey was performed at three (3) time points of fourth-year medical student’s rotation in the Department of Medicine: (1) prior to the deployment to the outpatient department (Pre-OPD), (2) after the first-time patient encounter without TOCSE workshop (Post-OPD no TOCSE), and (3) after the patient encounter with TOCSE workshop (Post-OPD with TOCSE). Mean and standard deviations were used to summarize the confidence level of the 4th-year medical students, based on the 10-point differential scale being 0 as not confident at all and 10 as very confident. Wilcoxon Signed Rank assessed improvements of confidence level from Pre-OPD to Post-OPD. Effect sizes were also calculated to compare the improvement in the items. All statistical tests were performed in SPSS version 26.0. P-values less than 0.05 indicate a significant increase in the confidence level of 4th-year medical students. Results: There is a significant increase in the clinical confidence of 4th-year medical students from Pre-OPD to Post-OPD no TOCSE (mean ± SD: 6.32 ± 1.02 to 7.06 ± 0.95, p<0.001). Comparing the eight items between Pre-OPD and Post-OPD with no TOCSE, performing a complete physical examination has the most remarkable improvement. Further, there is a significant increase in the clinical confidence of 4th-year medical students from Post-OPD no TOCSE to Post-OPD with TOCSE (mean ± SD: 7.06 ± 0.95 to 7.51 ± 0.89, p<0.001). The performance of a complete history-taking has the most considerable improvement (7.29 + 1.03 to 7.89 + 1.01, p<0.001). Correspondingly, the most significant increase in the clinical confidence of 4th-year medical students was seen among the Post-OPD with TOCSE compared to their Pre- OPD confidence scores (mean ± SD: 6.32 ± 1.02 to 7.51 ± 0.89, p<0.001). Among the eight items between Pre-OPD and Post-OPD with TOCSE confidence scores, the item on performing a complete physical examination has the most remarkable improvement (5.67 ± 1.37 to 7.20 ±
背景与目的:新冠肺炎疫情期间，医学生临床技能教学面临重大挑战。患者讨论采用从病史到诊断和治疗的假设病例。此外，一切都是在线交付的。面向目标的临床技能增强(TOCSE)是一种将解剖学、生理学、病理学、微生物学和药理学等基础医学学科整合到临床层面的教学工具。TOCSE已被证明可以提高四年级医学生的临床表现。然而，临床信心仍然是一个问题，特别是对于大流行期间纯在线学习模式的医学生。因此，本研究旨在确定TOCSE是否也有助于四年级医学生在在线本科课程后首次与患者接触时对临床表现的信心的发展。方法:采用八项临床表现置信度量表对四年制医学生在内科轮转的三个时间点进行问卷调查:(1)转到门诊前(Pre-OPD)，(2)首次就诊后没有TOCSE研讨会(Post-OPD no TOCSE)，(3)患者就诊后TOCSE研讨会(Post-OPD with TOCSE)。采用均值和标准差来总结四年级医学生的信心水平，基于10分差异量表，0为完全不自信，10为非常自信。Wilcoxon sign Rank评估了opd前到opd后置信水平的提高。还计算了效应量，以比较项目的改进。所有统计检验均在SPSS 26.0版本中进行。p值小于0.05表示四年级医学生的置信水平显著提高。结果:四年级医学生从opd前到opd后无TOCSE的临床置信度显著增加(平均值±SD: 6.32±1.02至7.06±0.95,p<0.001)。对比术前和术后未做TOCSE的8个项目，进行全面体检的改善最为显著。此外，从没有TOCSE的四年级医学生到有TOCSE的四年级医学生的临床信心显著增加(平均±SD: 7.06±0.95至7.51±0.89,p<0.001)。完成历史记录的性能有最显著的改善(7.29 + 1.03到7.89 + 1.01,p<0.001)。相应地，四年级医学生的临床信心在OPD后与OPD前相比有显著的增加(平均±SD: 6.32±1.02至7.51±0.89,p<0.001)。在opd前、opd后的8个TOCSE信心评分项目中，完成完整体格检查项目的改善最为显著(5.67±1.37至7.20±1.22,p<0.001)，其次是完成病史记录项目(6.53±1.19至7.89±1.01,p<0.001)。与没有TOCSE的opd后与opd前的信心得分相比，在有TOCSE的opd后的所有项目中，临床信心得分的改善最为显著。此外，有TOCSE的医学生中，得分在7.50及以上的人数增加了3倍以上(分别为17.4%和58.7%，p<0.001)。结论:以目标为导向的临床技能增强(TOCSE)有效地建立了四年级医学生在第一次与病人接触时的信心。关键词:针对性临床技能提升、临床信心、临床技能、医四年级学生、医本科生挑战、新冠肺炎在线教学
{"title":"Target-Oriented Clinical Skill Enhancement (TOCSE) Builds Up Confi dence of Fourth-Year Medical Students During First-Time Patient Encounter: An Effective Bridging Tool After Online Didactic Undergraduate Classes During the COVID-19 Pandemic","authors":"Maria Faye Anne S Gomez, Leonid D Zamora, Paul John Ablaza, M. Marcial, L. Mercado-Asis","doi":"10.35460/2546-1621.2022-sp15","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-sp15","url":null,"abstract":"Background and Objective: Teaching clinical skills to undergraduate medical students has brought significant challenges during the COVID-19 pandemic. Patient discussion utilized hypothetical cases from history taking to diagnosis and management. Further, everything was delivered online. Target-Oriented Clinical Skill Enhancement (TOCSE) is a teaching and learning tool that integrates the basic medical sciences, such as anatomy, physiology, pathology, microbiology, and pharmacology, at the clinical level. TOCSE has been proven to improve the clinical performance of fourth-year medical students. However, clinical confidence remains an issue, especially for medical students on pure online mode of learning during the pandemic. Therefore, this study was undertaken to determine if TOCSE also facilitates the development of confidence in the clinical performance of 4th-year medical students during the first-time patient encounter after online undergraduate classes. Methods: Eight-item Clinical Performance Confidence Scale survey was performed at three (3) time points of fourth-year medical student’s rotation in the Department of Medicine: (1) prior to the deployment to the outpatient department (Pre-OPD), (2) after the first-time patient encounter without TOCSE workshop (Post-OPD no TOCSE), and (3) after the patient encounter with TOCSE workshop (Post-OPD with TOCSE). Mean and standard deviations were used to summarize the confidence level of the 4th-year medical students, based on the 10-point differential scale being 0 as not confident at all and 10 as very confident. Wilcoxon Signed Rank assessed improvements of confidence level from Pre-OPD to Post-OPD. Effect sizes were also calculated to compare the improvement in the items. All statistical tests were performed in SPSS version 26.0. P-values less than 0.05 indicate a significant increase in the confidence level of 4th-year medical students. Results: There is a significant increase in the clinical confidence of 4th-year medical students from Pre-OPD to Post-OPD no TOCSE (mean ± SD: 6.32 ± 1.02 to 7.06 ± 0.95, p<0.001). Comparing the eight items between Pre-OPD and Post-OPD with no TOCSE, performing a complete physical examination has the most remarkable improvement. Further, there is a significant increase in the clinical confidence of 4th-year medical students from Post-OPD no TOCSE to Post-OPD with TOCSE (mean ± SD: 7.06 ± 0.95 to 7.51 ± 0.89, p<0.001). The performance of a complete history-taking has the most considerable improvement (7.29 + 1.03 to 7.89 + 1.01, p<0.001). Correspondingly, the most significant increase in the clinical confidence of 4th-year medical students was seen among the Post-OPD with TOCSE compared to their Pre- OPD confidence scores (mean ± SD: 6.32 ± 1.02 to 7.51 ± 0.89, p<0.001). Among the eight items between Pre-OPD and Post-OPD with TOCSE confidence scores, the item on performing a complete physical examination has the most remarkable improvement (5.67 ± 1.37 to 7.20 ± ","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117248960","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}
Pub Date : 2022-12-07DOI: 10.35460/2546-1621.2022-sp04
Isaias A. Lanzona
The history of physical diagnosis started with Hippocrates and his school. History taking, inspection, palpation, and sometimes immediate auscultation and examination of the urine are fundamental diagnostic tools. The Hippocratic Corpus and Galen’s authoritative theoretical writings dominate medical thinking for over 1000 years. Clinical examination advances through Vesalius and Morgagni’s discoveries of human dissection (1543) and pathologic anatomy (1761) respectively. The Vienna school through Auenbrugger introduces percussion in 1760. The Paris school formally establishes physical diagnosis with the invention of the stethoscope by Laennec in 1816.
{"title":"The Development of Physical Diagnosis: Historical Perspectives","authors":"Isaias A. Lanzona","doi":"10.35460/2546-1621.2022-sp04","DOIUrl":"https://doi.org/10.35460/2546-1621.2022-sp04","url":null,"abstract":"The history of physical diagnosis started with Hippocrates and his school. History taking, inspection, palpation, and sometimes immediate auscultation and examination of the urine are fundamental diagnostic tools. The Hippocratic Corpus and Galen’s authoritative theoretical writings dominate medical thinking for over 1000 years. Clinical examination advances through Vesalius and Morgagni’s discoveries of human dissection (1543) and pathologic anatomy (1761) respectively. The Vienna school through Auenbrugger introduces percussion in 1760. The Paris school formally establishes physical diagnosis with the invention of the stethoscope by Laennec in 1816.","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126597325","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}
Pub Date : 2022-10-31DOI: 10.35460/2546-1621.2021-0141
Ruela Joyce L. Sigue, D. Decena
Background: Polycystic ovarian syndrome (PCOS) is a common, reproductive endocrinopathy associated with ovarian dysfunction, cardiovascular disorders, obesity, and infertility. Myo-inositol is a novel treatment for women with PCOS that claimed to have improved fertility rate in this population. This systematic review and meta-analysis examined the effect of myo-inositol on pregnancy rate, menstrual cycle, and adverse effects from randomized controlled trials (RCTs). Methods: RCTs that evaluated the efficacy of myo-inositol in improving pregnancy rate and regulation of menstrual cycle in women with PCOS. Electronic databases were searched and studies published up to October 24, 2021 were included in the systematic review and meta-analysis. Study selection and assessment of quality were conducted independently by two review authors. Results: Seven studies with 729 patients treated with myo-inositol and 677 patients treated with placebo and/or metformin were included in the analysis. The research groups did not diverge significantly in terms of basic characteristics, such as age, adnexal or uterine pathology, body mass index, and duration of infertility. In the myo-inositol group, regulation of the normal menstrual cycle is at 20%, significantly higher than the metformin group at 12%, (p<0.001). However, there is no significant difference in the pregnancy rate between myoinositol and placebo (p=0.42) and/or metformin (p=0.17). Conclusion: This systematic review and meta-analysis showed that myo-inositol can be an alternative treatment for PCOS in terms of regulation of menses and may improve the success of spontaneous pregnancies. However, additional randomized, double-blind controlled trials with larger sample sizes, low heterogeneity, and uniform inclusion criteria are recommended to establish the effects of myo-inositol on PCOS treatment and pregnancy rate.
{"title":"Efficacy of Myo-inositol in Improving Pregnancy Rate and Regulation of Menstrual Cycle for Patients With Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis","authors":"Ruela Joyce L. Sigue, D. Decena","doi":"10.35460/2546-1621.2021-0141","DOIUrl":"https://doi.org/10.35460/2546-1621.2021-0141","url":null,"abstract":"Background: Polycystic ovarian syndrome (PCOS) is a common, reproductive endocrinopathy associated with ovarian dysfunction, cardiovascular disorders, obesity, and infertility. Myo-inositol is a novel treatment for women with PCOS that claimed to have improved fertility rate in this population. This systematic review and meta-analysis examined the effect of myo-inositol on pregnancy rate, menstrual cycle, and adverse effects from randomized controlled trials (RCTs). Methods: RCTs that evaluated the efficacy of myo-inositol in improving pregnancy rate and regulation of menstrual cycle in women with PCOS. Electronic databases were searched and studies published up to October 24, 2021 were included in the systematic review and meta-analysis. Study selection and assessment of quality were conducted independently by two review authors. Results: Seven studies with 729 patients treated with myo-inositol and 677 patients treated with placebo and/or metformin were included in the analysis. The research groups did not diverge significantly in terms of basic characteristics, such as age, adnexal or uterine pathology, body mass index, and duration of infertility. In the myo-inositol group, regulation of the normal menstrual cycle is at 20%, significantly higher than the metformin group at 12%, (p<0.001). However, there is no significant difference in the pregnancy rate between myoinositol and placebo (p=0.42) and/or metformin (p=0.17). Conclusion: This systematic review and meta-analysis showed that myo-inositol can be an alternative treatment for PCOS in terms of regulation of menses and may improve the success of spontaneous pregnancies. However, additional randomized, double-blind controlled trials with larger sample sizes, low heterogeneity, and uniform inclusion criteria are recommended to establish the effects of myo-inositol on PCOS treatment and pregnancy rate.","PeriodicalId":399180,"journal":{"name":"Journal of Medicine, University of Santo Tomas","volume":"123 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134575697","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}
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