Before and after the Sin Tax Law: Perceived changes in tertiary government hospitals by inpatients and healthcare workers

@#<p><strong>Background:</strong> The implementation of the "Sin Tax Law" (RA 10351) in 2013 has increased revenues for healthcare in the Philippines. What changes have taken place in government hospitals since the passage of the law? This qualitative study sought to answer this question by presenting perspectives from patients, doctors, and nurses.</p><p><strong>Methods:</strong> Four focus group discussions (FGDs) and eight semi-structured interviews (SSIs) were conducted among patients, doctors, and nurses in two tertiary government hospitals in Metro Manila, Philippines.</p><p><strong>Results:</strong> Significant changes noted by study participants over the past several years included increased financial assistance for patients as well as improvements in health services and continuity of care. However, their narratives underscored shortcomings in human resources and facilities, raising questions of 'absorptive capacity'.</p><p><strong>Conclusion:</strong> Given that the Sin Tax Law was the main policy intervention to which the changes reported by study participants can be attributed, the study provides a strong case for a continuation - if not expansion - of the Law, with the recommendation that increased health revenue should also translate to greater support for healthcare workers and enhanced health facilities. As these insights may be overlooked by traditional metrics, the study also recommends that policymakers consider qualitative studies in evaluating the efficacy of health care reforms.</p>

Weathering an adenosine insensitive right ventricular outflow tract ventricular tachycardia (Ado-insensitive RVOT VT) storm in an adolescent female: A case report

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Ventricular tachycardias (VT) are commonly associated with structural heart disease. However, 10% of VTs have no identifiable cause. Right ventricular outflow tract ventricular tachycardia (RVOT VT), a small subgroup of idiopathic VTs localized in the right ventricular outflow tract is highly sensitive to adenosine (ADO). Only 11% of RVOT VT is ADO-insensitive, posing a diagnostic challenge. We present a peculiar case of an ADO-insensitive RVOT-VT storm and the challenges of recognizing and managing it in a resource-limited setting.</p><p style="text-align: justify;"><strong>CASE SUMMARY:</strong> A 15-year-old female, asthmatic, complained of palpitations, lightheadedness, chest pain and dyspnea a few hours prior to admission. She had a similar episode a month ago, which necessitated ER admission, electrical cardioversion and amiodarone.</p><p style="text-align: justify;">On admission, she was tachycardic but normotensive. She had diffuse wheezes. Cardiac exam was normal. ECG revealed a wide complex tachycardia (WCT). Work-up revealed a normal chest x-ray, thyroid function tests and electrolytes. Echocardiogram showed a structurally normal heart. She was managed as a case of viral myocarditis and SVT with aberrancy. Vagal maneuvers and adenosine was given which slowed down the tachycardia. She was then started on IV anti-arrhythmics however, sustained symptomatic VT recurred on the same day. ECG analysis showed a WCT, LBBB, AV dissociation with positive QRS complexes in inferior leads suggestive of VT originating from the RVOT. RVOT VT storm was considered and adenosine (maximum dose) was given. The patient did not revert to sinus, hence, ADO-insensitive RVOT VT was considered. Cardioversion terminated the VT storm.</p><p style="text-align: justify;">On electrophysiology study, the VT was induced/ localized at the RVOT via 3D mapping. Ablation of the RVOT focus was performed, immediately terminating the VT. Post ablation, the patient was asymptomatic and was discharged improved with excellent prognosis.</p><p style="text-align: justify;"><strong>DISCUSSION:</strong> This case report highlights two things. The ECG remains a reliable tool in recognizing and localizing VTs clinically. Secondly, it highlights the importance of prompt recognition of ADO-insensitive RVOT VT because its management and prognosis is very different from the common causes of VT.</p>

Non-invasive ventilation versus conventional oxygen therapy in immunocompromised patients: A meta-analysis

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Respiratory failure is common in immunocompromised patients. Intubation and mechanical ventilation (MV) is the mainstay of treatment but is associated with increased risk of pneumonia and other complications. Non-invasive ventilation (NIV) is an alternative to MV in a select group of patients and aims to avoid the complications of MV. In these patients, we performed a meta-analysis on the effect of NIV versus conventional oxygen therapy in reducing intubation rates and other important clinical outcomes.</p><p style="text-align: justify;"><strong>METHODS:</strong> We performed an extensive online and unpublished data search for relevant studies that met the inclusion criteria. Randomized controlled trials that used NIV versus conventional oxygen therapy in immunocompromised patients with respiratory failure were included in the metaanalysis. Eligbility and risk of bias assessments were performed independently by three authors. The primary outcome of interest was intubation and mechanical ventilation rate. The secondary outcomes were intensive care unit (ICU) and all-cause mortality, ICU length of stay and duration of mechanical ventilation.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Out of the twenty initially screened studies, four studies with a total of 553 patients met the criteria for inclusion and were included in the analysis. Patients given NIV were 38% less likely to be intubated vs. those given oxygen, RR 0.62 (95%CI 0.42,0.93); however, this analysis result is significantly heterogenous. After sensitivity analysis, results showed 48% less likelihood of intubation and mechanical ventilation in the group treated with NIV, RR 0.52 [95% confidence interval (CI) 0.35,0.77]. Patients on NIV had 1.18 days less stay in the ICU vs. oxygen group (95%CI -1.84,-0.52 days ).</p><p style="text-align: justify;">Three studies included ICU mortality in their outcomes and showed a 54% decrease in ICU mortality among patients given NIV, RR 0.46 (95% CI 0.17, 1.29), however this result is non-significant and heterogenous I2=58%. There was no statistically significant decrease in all-cause mortality between the two groups, RR 0.77 (95% CI 0.53,1.11). After a sensitivity analysis performed specifically for this outcome, results showed a 32% reduction in all cause mortality in patients given NIV vs. oxygen therapy, however was not statistically significant RR 0.68 (95% CI 0.53-1.11) and was heterogenous I2=50%. There is no difference in the duration of mechanical ventilation between groups.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> In immunocompromised patients with respiratory failure, NIV reduced intubation rates, and length of ICU stay, compared to standard oxygen therapy. This intervention also showed trend toward ICU and all-cause mortality reduction.</p>