ABSTRACT
Introduction@#The Hearing for Life (HeLe) is a novel newborn hearing screening device initially designed according to specifications of clinicians of the Philippine National Ear Institute (PNEI). Unfortunately, targeted end-users, rural health workers, had difficulty using it. This research applied the user-centered design (UCD) methodology involving rural health workers in recommending design, content, and function requirements for HeLe. @*Objectives@#This study aims to 1) describe how UCD was applied in a time-limited and resource-constrained environment, 2) assess the usability of the design prototypes, and 3) recommend design, content, and function requirements for HeLe. @*Methods@#This research is a descriptive study using mixed methods. Six rural health units (RHU) involved in the HeLe research program were purposively selected for the study. There were 30 participants included, five health care workers per RHU. Applying the UCD method, the study had three phases: 1) user profiling (where participants accomplished a survey questionnaire, 2) inspiration phase (focus group discussions, workflow analysis, and interviews with a technical expert were conducted), and 3) ideation phase (designing and assessment of prototypes were done). @*Results@#Participatory methods and structured procedures (i.e., card sorting, MoSCoW matrix prototyping, etc.) were applied to help determine and prioritize user requirements and elicit user feedback. These methods were chosen considering the time and resource constraints in the RHU. The prototype's System Usability Scale (SUS) score (81.94) was higher than the SUS score previously obtained (68) from the older version of the interface. Accuracy, durability, in-app instructions, feedback, and an easily understood interface were the most requested requirements for the telemedicine device. The need for the technology to be aligned with the RHU's workflow and available resources was highlighted in the focus group discussions. @*Conclusions@#The study documents practices and lessons learned in applying UCD methodology in design and development that have been demonstrated to improve usability of the device. The involvement of the users surfaced in the design, content, and functional requirements which can guide future iterations of HeLe and contribute to better understanding of ways to develop user-friendly telemedicine devices in the Philippines. This paper emphasizes that users should be involved in the entire process and not just recipients of the technology.
Subject(s)
User-Centered Design , Digital Technology , TelemedicineABSTRACT
@#Thyroid storm and thionamide-induced agranulocytosis are both rare and serious medical emergencies. We report a case of a patient in which these two rare events simultaneously occurred. A 33-year-old male, maintained on Methimazole for Graves’ Disease, presented with fever, throat pain, and uncontrolled thyrotoxic symptoms. Methimazole was promptly discontinued. Thyroid storm was alternatively treated with lithium, hydrocortisone, and propranolol. Agranulocytosis was managed supportively with GCSF and empiric antibiotics. Lithium was maintained until after radioablation. When thionamides are contraindicated, lithium is a viable option for the acute management of thyroid storm and a bridge to definitive therapy.
Subject(s)
Methimazole , LithiumABSTRACT
Objectives@#The use of Facebook (FB) to share and gather information on diabetes is commonplace but no data is available on its use among Filipinos during the COVID-19 pandemic. We sought to determine the engagement from instructional slide decks on diabetes and its management shown on two Philippine-based FB pages under the Enhanced Community Quarantine (ECQ).@*Methodology@#We used Insights data from the slide decks and slide shows shown on the Philippine Society of Endocrinology, Diabetes and Metabolism’s (PSEDM) public FB page and the Endocrine Witch’s FB page. The slide set contained a mix of mostly images and text on COVID-19 and Diabetes, dietary advice, medications and self-care in the setting of the ECQ where access to insulin, ambulatory clinics and healthy food is limited. Data was summarized in terms of post clicks, reactions, shares and comments. Total engagement rate was computed.@*Results@#We noted a high engagement rate (4-15%) in both public FB pages with higher engagement rates in slides shown in the Filipino language for most topics. The slides that gathered more shares and reactions were primarily those containing general information on COVID-19 and diabetes, nutrition including the safety of canned goods, as well as sick day rules.@*Conclusion@#In the setting of the ECQ, the use of image and text-based slide-decks on the PSEDM and Endocrine Witch FB pages to communicate health information yielded high engagement.
Subject(s)
Social Media , Diabetes Mellitus , COVID-19ABSTRACT
@#<p><strong>OBJECTIVE:</strong> This study assessed whether short message service (SMS) reminders would improve follow-up rate among gestational diabetes mellitus (GDM) patients by 12 weeks postpartum.</p><p> METHODOLOGY:</b> In this single-center, single-blind randomized controlled trial, we assigned 308 patients with GDM to either of 2 arms, usual care alone versus usual care with SMS reminders. In the usual care group, 154 patients received a 10-minute short lecture on GDM and a 75 g oral glucose tolerance test (OGTT) request prior to discharge. In the SMS group, 154 patients received twice a week SMS reminders at 4 weeks, 8 weeks, and 10 weeks after delivery in addition to usual care. The primary outcome was clinic visit within 6 to 12 weeks postpartum with a 75 g OGTT result.</p><p><strong>RESULTS:</strong> In our population, the overall follow-up rate was 19.8% (61/308). Follow up rates were 20.1% (31/154) for the usual care group and 19.5% (30/154) for the SMS. The addition of SMS reminders was not associated with an increase in follow-up rate at 12 weeks postpartum (adjusted RR 0.98, 95% CI 0.63-1.52; p=0.932). The use of insulin or metformin for GDM control was associated with increased follow-up (adjusted RR 1.92, 95% CI 1.20-3.07; p=0.006).</p><p> CONCLUSION:</b> SMS reminders did not improve postpartum follow-up rate among GDM patients at 12 weeks postpartum.</p>
Subject(s)
Humans , Diabetes, Gestational , Text MessagingABSTRACT
Objectives@# The increasing use of the Internet as a source of health information makes the accuracy of such information crucial. An example is the use of the widely advertised bitter melon (Momordica charantia) in treating diabetes despite its unproven efficacy. This study aims to assess the accuracy of websites containing information on bitter melon’s role in diabetes, to search for the presence of the proposed quality indicators, and to determine their correlation with accuracy. @*Methodology@#An Internet search was used to generate a list of websites. The accuracy of each website was determined by comparing its content with that of a tool that was developed from authoritative sources. The presence of the proposed quality indicators, taken from published guidelines, was then correlated with accuracy. @*Results@#Of the 158 websites identified, 10 (6.33%) were characterized as “most accurate” and 21 (13.3%) as “somewhat accurate.” The identified indicators of accuracy were the HONcode logo (OR 12.1, p=0.011); the author, identified as a healthcare professional (OR = 6.11, p = 0.008); and a citation from a peer-reviewed medical literature (OR 2.92, p = 0.029). @*Conclusion@#These findings suggest that most of the Internet-based information on bitter melon’s role in diabetes is inaccurate. The public can use several indicators of accurate information on the use of bitter melon in diabetes to improve health care.
Subject(s)
Internet , Diabetes Mellitus , Momordica charantiaABSTRACT
@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To assess the validity of the Filipino-translated version of the Michigan Neuropathy Screening Instrument(MNSI) in screening for diabetic neuropathy among Filipino patients with diabetes mellitus using nerve conduction velocity(NCV) as gold standard and to determine the most accurate cut-off score for the diagnosis of neuropathy using MNSI.<br /><strong>METHODOLOGY:</strong> A cross-sectional analytic study was done among adult diabetic patients. The original MNSI Questionnaire was translated and back-translated to the Filipino language. Each patient answered the Filipino version of MNSI Questionnaire followed by a lower extremity examination done by the investigator. All patients underwent NCV as reference standard. Sensitivity and specificity of MNSI were determined.<br /><strong>RESULTS:</strong> We studied a total of 150 subjects. Eighty-seven (58%) were diagnosed to have diabetic neuropathy based on NCV. The sensitivity and specificity of the MNSI Questionnaire improved to 73.6% and 52.4% respectively when the cut off was reduced to ?4, whereas for the MNSI Examination, the sensitivity and specificity improved to 86.2% and 55.6% respectively when the cut off was reduced to ?1. Combining both MNSI Questionnaire and MNSI Examination further improves the sensitivity to 95.4% whereas specificity is at 39.7%.<br /><strong>CONCLUSION:</strong> The analyses in 150 subjects confirm that the Filipino-version of MNSI is a valid screening tool for diabetic neuropathy when compared with NCV as gold standard.</p>
Subject(s)
Humans , Male , Female , Adult , Surveys and Questionnaires , Diabetes Mellitus , Philippines , PatientsABSTRACT
Objectives@#The increasing use of the Internet as a source of health information makes the accuracy of such information crucial. An example is the use of the widely advertised bitter melon (Momordica charantia) in treating diabetes despite its unproven efficacy. This study aims to assess the accuracy of websites containing information on bitter melon’s role in diabetes, to search for the presence of the proposed quality indicators, and to determine their correlation with accuracy. @*Methodology@#An Internet search was used to generate a list of websites. The accuracy of each website was determined by comparing its content with that of a tool that was developed from authoritative sources. The presence of the proposed quality indicators, taken from published guidelines, was then correlated with accuracy. @*Results@#Of the 158 websites identified, 10 (6.33%) were characterized as “most accurate” and 21 (13.3%) as “somewhat accurate.” The identified indicators of accuracy were the HONcode logo (OR 12.1, p=0.011); the author, identified as a healthcare professional (OR = 6.11, p = 0.008); and a citation from a peer-reviewed medical literature (OR 2.92, p = 0.029). @*Conclusion@#These findings suggest that most of the Internet-based information on bitter melon’s role in diabetes is inaccurate. The public can use several indicators of accurate information on the use of bitter melon in diabetes to improve health care.
Subject(s)
Internet , Momordica charantiaABSTRACT
Objective@#To determine the association of adverse perinatal outcomes among women with gestational diabetes mellitus (GDM) according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the Philippine Obstetrical and Gynecological Society (POGS) diagnostic cut-offs for 75 g oral glucose tolerance test (OGTT). @*Methodology@#A review of deliveries from September to December 2013 at the charity services of the Philippine General Hospital (PGH) looking at 75 g OGTT results and perinatal outcomes was done. The association between GDM and perinatal outcomes were estimated and tested using logistic regression analysis. The diagnostic accuracy between the POGS and the IADPSG criteria was tested by comparing their areas under the curve (AUC). @*Results@#A total of 236 deliveries were included. The GDM group had a significantly increased risk for primary Caesarean section (CS) (OR=1.79, 95% CI: 1.02-3.16, p=0.041) and infant admission to the Neonatal Intensive Care Unit (NICU) (OR=2.66, 95% CI: 1.3-5.44, p=0.007). Per category of glycemia, a 1-hour OGTT value >180 mg/dL was associated with an increased risk for primary CS (OR=1.968, 95% CI: 1.08-3.55); a fasting blood sugar (FBS) >92 mg/dL with increased risk for large for gestational age (LGA) infants (OR=20.97, 95% CI 2.27-192.97); and elevated FBS, 1-hour and 2-hour OGTT blood glucose values with increased risk for infant admission to the NICU (OR=2.18, OR=2.39, OR=2.34, respectively). There was no significant difference in outcomes between women diagnosed using the IADPSG and POGS criteria (n=104) and those diagnosed with the IADPSG criteria only (n=90). @*Conclusion@#The currently used cut-off values in diagnosing GDM was associated with increased risk for primary CS and infant admission to NICU. No significant difference in outcomes was found between the group of women that included those diagnosed with the more stringent POGS criteria from the group that excluded them, implying adequacy of the IADPSG thresholds for local use.
Subject(s)
Diabetes, Gestational , Pregnancy Outcome , Glucose Tolerance TestABSTRACT
Objective@#To evaluate the efficacy, safety, and clinical outcomes of, and protocol deviations with the use of the Modified Yale Insulin Infusion Protocol (IIP) compared to usual/standard care in the local setting. @*Methods@#Chart review of patients admitted in two ICUs over a 2-year period was done. Patients eligible for intensive glycemic control were identified. Efficacy, safety and clinical outcomes were compared between the Modified Yale IIP and usual/standard care. Charts managed with the IIP were appraised for protocol deviations.@*Results@#Eighty-one patients met the inclusion criteria and 34.6% used the IIP. The IIP group achieved a lower mean blood glucose (185.1 vs 212.1 mg/dl, p<0.05). They reached normoglycemia (5 vs 12 hours, p<0.05) and target range of 140-180 mg/dl (8.3 vs 18.3 hours, p<0.05) earlier. Hypoglycemia was rare (median 0%) in both groups. No difference in mortality or morbidity was seen. Hospital (13.9 vs 8.1 days, p<0.05) and ICU stay (5.5 vs 3.0 days, p<0.05) were longer in the IIP group. A mean of 11 deviations per patient occurred, the majority of which were errors on insulin dose administered (66.6%). @*Conclusion@#The Modified Yale IIP is efficaceous, safe and yielded better glycemic profiles than usual care. Majority of protocol deviations were on the insulin dose administered
Subject(s)
Hyperglycemia , Intensive Care UnitsABSTRACT
Objectives@#The primary objective is to determine if 3 times a week SMS will improve adherence to diet and exercise. The secondary objective is to determine the mean change in body weight, body mass index and glycosylated hemoglobin A1c (HbA1c). @*Methodology@#This is an open-randomized controlled trial conducted for 6 months which included 104 subjects. Z test of two proportions was used to determine difference in dietary and exercise adherence. Mean change in body weight, BMI and HbA1c were also determined.@*Results@#After 3 months, significant difference is observed in mean HbA1c (SMS= 7.13 + 0.99, control= 7.53 + 0.91, p=0.034). At 6 months, significant difference is seen in mean number of meals/day (SMS=2.61 + 0.63, control= 2.29 + 0.72, p= 0.018), mean number of minutes/exercise (SMS= 37.40 + 14.87, control=31.44 + 10.82,p= 0.021) and mean HbA1c (SMS=6.99 + 0.86, control= 7.34 + 0.90, p= 0.0452).@*Conclusion@#The use of SMS as an adjunct to the standard of DM care improved adherence to diet after 6 months in terms of mean number of meals, improved adherence to exercise after 6 months in terms of mean number of minutes/exercise and significant reduction in HbA1c levels after 3 and 6 months.