Medical education: Effectiveness of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks)

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).<br /><strong>METHODS:</strong> Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.<br /><strong>RESULTS AND DISCUSSION:</strong> The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.<br /><strong>CONCLUSION:</strong> Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.</p>

The rectal cancer program at the UP-PGH: Institutionalizing the multidisciplinary team paradigm

OBJECTIVE: The paper aimed to described and document the multidisciplinary process being ascribed to in the care of the colorectal cancer patient at the UP-PGH as conducted by the UP-PGH Colorectal Cancer and Polyp Study Group.METHODS: A description of the multidisciplinary team (MDT) process is presented. Data supplementing the documentation of the MDT process were, likewise, presented.RESULTS: In 2008, 214 rectal cancer patients were admitted and managed by the Division of Colorectal Surgery. Of these, 52 patients with mid- to low-rectal tumors eventually underwent resection of the primary lesion. Forty-one (79%) underwent a sphincter-saving operation. Only 11 APRs were performed. Our APR rate was, thus, at 21 percent. Among the 52 patients, 18 underwent neoadjuvant treatment with 10 subjected to chemoradiotherapy prior to surgery, a pathologic complete response was observed in 4 patients.CONCLUSION: With the increasing incidence of colorectal malignancies and the continuing collection of evidence supporting multimodality approach, the role of multidisciplinary team in the management of these cancers has come to the fore. UP-PGH Colorectal Cancer and Polyp Study Group has shown that the multidisciplinary team approach may be implemented amidst institutional and financial limitations without compromising the delivery of quality and efficacious cancer management.

Use of locally innovated radiopaque markers (MAKKO pills) for colonic transit study

Locally made radiopaque markers for colonic transit study are presented, specifically on how they were made, and how they compared radiographically with markers available abroad. These markers were produced using locally available materials like barium powder, a feeding tube, cyanoacrylate, and emptied drug capsules. They were then ingested and monitored by X-ray. They were found to be radiographically comparable with imported ones. No adverse events were noted when used in 5 patients: 2 patients with constipation secondary to chronic laxative abuse, 2 patients with reducible complete rectal prolapse, and 1 patient with constipation secondary to short segment Hirschsprungs' Disease. (Author)

Evidence-based clinical practice guidelines on some important aspects of the care of critically ill surgical patients Part II: Surgical intensive care units, implementation of guidelines

The first part of the critical care guidelines of the Philippine College of Surgeons (PCS) and supported by Glaxo Wellcome Philippines, Inc. dealt with resuscitation fluids, blood transfusion, assessment of volume resuscitation, nutritional support and cardiovascular support. The second part deals with the last 2 aspects identified by the Technical Working Group (TWG) namely: surgical intensive care units and implementation of guidelines. The literature search, limited to english publications. Used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane Library, Issue 4, 2000; 2) National Library of Medicine - Medline (PubMed, no time limit): and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD. Manual searching of the reference lists of review articles and some important meta-analyses and randomized controlled trials (RCTs) was also done. The search terms used were: 1) Cochrane library: surgical intensive care, guidelines implementation, 2) Medline: surgical intensive care, 3) HERDIN: intensive care. Titles of all articles were printed and all members of the TWG went over the list and checked the titles of articles whose abstracts they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. (Author)

The utility of Goodsall's rule among Filipino patients with anal fistula

This prospective cross-sectional study was conducted to determine the accuracy of Goodsall's rule in predicting the location of the internal opening of an anal fistula based on the location of the external opening among Filipino patients and the clinical factors that significantly influenced the accuracy of Goodsall's rule. From January 15, 1997 to April 15, 1998, 102 adult patients were analyzed by age, gender, fistula type, previous fistula surgery, symptom duration, location of the external opening, type of fistulous tract and distance of external opening from the anal verge. Overall, in 79 patients (77.5%), the locations of the internal opening were accurately localized according to Goodsall's rule. Univariate analysis showed that only the location of the external opening (posterior vs. anterior) and the distance of the external opening from the anal verge ((3 cm vs.> 3 cm) demonstrated a significant correlation with Goodsall's rule. Multivariate logistic regression analysis further demonstrated that anteriorly located external openings and distance of the opening greater than 3 cm from the anal verge were unlikely to comply with Goodsall's rule (odds ratio=0.008). Only 2 of 14 patients (14.3%) with anterior external openings greater than 3 cm from the anal verge had fistulous tracts which followed this rule. Thus, surgeons are advised to exercise caution during the surgical evaluation and treatment of anal fistula with these characteristics.

Injuries to the rectum and anus following radiation therapy in patients with cervical cancer: 5-year experience at the Philippine General Hospital

A five-year review of anorectal complications seen following radiotherapy for cervical carcinoma was done with the following objectives: 1) to present the profile of patients presenting with anorectal complications following radiation treatment for cervical cancer; 2) to describe the manifestations of these complications and findings on proctosigmoidoscopy with biopsy; and 3) to present the approaches in their management. A total of 116 patients, all with confirmed diagnosis of cervical cancer, were seen over this period. Mean age was 49.5 years. All received external beam cobalt and intracavitary radium. Complications were observed from 10 days to 20 months after treatment. Anal bleeding was the most common complaint (62%), followed by rectovaginal fistula (14%). Residual/recurrent malignancy was noted in seven patients (6%). Treatment modalities varied considerably, ranging from conservative and symptomatic treatment for bleeding, pain, constipation, and diarrhea, to major abdominal procedures for rectovaginal fistula