Psychosometric properties of the Filipino version of the international consultation on incontinence questionnaire-male lower urinary tract symptoms and female lower urinary tract symptoms

OBJECTIVE: The purpose of this study was to translate the International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) into Filipino and determine its psychosometric properties mainly feasibility, internal consistency (reliability), and stability (test-retest reliability).METHODS: This was an observational, non-interventionist study, which recruited 100 male and 100 female patients seeking consult at the Philippine General Hospital for lower urinary symptoms. The questionnaires were completed in a single visit with the exception of 20 patients who were asked to answer the questionnaire again after 2 weeks to evaluate test-retest reliability. The ICIQ-MLUTS Filipino questionnaire is a 14-item self-administered questionnaire while the ICIQ-FLUTS Filipino questionnaire is a 13-item self-administered questionnaire.RESULTS: There was an 81% completion rate for the ICIQ-MLUTS questionnaire and 100% completion rate for the ICIQ-FLUTS questionnaire. Reliability testing revealed Cronbach's alpha coefficient of 0.949 for the ICIQ-MLUTS and 0.956 for the ICIQ-FLUTS questionnaire while test-retest reliability showed intraclass coefficient values above 0.9 for individual items of both questionnaires.CONCLUSION: The Filipino versions of the ICIQ-MLUTS and ICIQ-FLUTS questionnaires show adequate feasibility, reliability and validity.

Bechmarking anesthesia-controlled times at a tertiary general hospital in the Philippines

The need to measure and improve quality in the health care management setting necessitates the development of performance standards. The drive for operating room (OR) efficiency has led administrators to investigate the anesthesia-controlled times (ACTs), which are the specific periods of anesthesia task completion including preparation for anesthetic induction, anesthetic induction itself and the wake up time or time to emergence from anesthesia.OBJECTIVES: This study aims to conduct an internal benchmarking of ACTs using a secondary analysis of the data collected in a cross sectional survey of randomly selected elective surgical cases from October 2011 to January 2012, looking into the efficiency status of the operating room under the Department of Surgery of the Philippine General Hospital (PGH).METHODS: Mean observed times for each of the milestone comprising the ACT were calculated taking in consideration the various anesthetic techniques, type of surgical procedures, duration of the operation and the anesthesiologist's experience. Analysis of variance and Fisher's exact test were used to determine the association of these factors with length of the ACT. For those where an association was noted, a multivariate analysis was done to determine its impact on the actual ACT.RESULTS: Based on data from 539 cases, a set of benchmarks for ACT that better reflects the local setting, is proposed for the different surgical procedures and anesthetic techniques. This includes times for anesthesia preparation of 5 mins, anesthesia induction of 10 minutes and emergence times of 10 mins for total intravenous anesthesia; 20,15 and 15 mins for inhalational anesthesia; 15,10, 10mins for spinal anesthesia; 20, 25, 10 mins for epidural anesthesia and 10, 25, and 15 minutes for combined general-regional anesthesia.CONCLUSION: It is imperative to standardize ATCs in order to reduce variability and improve efficiency. The first step in achieving this goal is to describe the standards in a particular institution, which in turn may be used as a benchmark by other institutions in a similar setting.

Efficiency status of the elective non-cardiac surgery operating rooms of the Department of Surgery of the Philippine General Hospital

INTRODUCTION: The operating room (OR) is one of the most cost-intensive units of any health care facility. Hence, OR effeciency has become a priority of many institutions. Delays in the OR lead to poor cost effectiveness and cause frustration both to patients and to OR staff.OBJECTIVES: This study aims to describe the efficiency of the Philippine General Hospital Department of Surgery elective non-cardiac surgery operating room services using established parameters and identify causes of delays.METHODS: A cross-sectional survey was conducted of randomly selected elective cases from October 2011 to January 2012. A framework of elements in the OR process and timing milestones were defined. These times were recorded during the OR process. Mean and median observed times for these elements were calculated and compared with target times based on previous research. Causes of delay were recorded.RESULTS: Once anesthesia was started, target times for most parameters were met in the majority of cases. Delays were most notable between patient entry to the OR complex and start of anesthesia, particularly for first cases. Only 3.9% of cases started at or before the scheduled time; 49.7% of cases started more than one hour late. 54.3% of late starts were caused by surgeons not being in the OR complex on time. Errors in estimating case duration were commonplace: more than one third of cases took more than an hour longer or shorter than estimated. While the mean delay in start for first cases was nearly one hour, the mean delay for second and third cases was nearly two hours.CONCLUSION: The majority of cases start late. The most common cause of delay is the surgeon's tardiness. Considerable discrepancy between the predicted and actual case duration was also observed.

Nutritional assessment of adult cancer patients admitted at the Philippine General Hospital using the scored patient generated subjective global assessment tool (PG-SGA)

OBJECTIVES: Malnutrition is common among cancer patients. The aim of this study was to determine the nutritional status of preoperative cancer patients upon admission at a tertiary hospital in the Philippines. It also aimed to identify common symptoms with adverse impact on nutrition and to correlate the nutritional status to the length of hospital stay and development of post-operative complications. METHODS: A hospital-based prospective cohort study design was conducted among pre-operative adult cancer patients admitted from September to December 2010. Nutritional status assessment was done using the Scored Patient-Generated Subjective Global Assessment (PG-SGA) tool and correlation to their symptoms, length of hospital stay, and post-operative complications were determined using analysis of variance (ANOVA) and Chi-Square tests. RESULT: A total of 103 patients were included for the study amongst whom prevalence of malnutrition was 83%. Symptoms that were significantly associated with severity of malnutrition were early satiety, lack of appetite and alteration in taste perception. Poor nutritional status was associated with increased mean length of hospital stay: 7.5, 14.1 and 15.1 days for well-nourished, moderately malnourished and severely malnourished, respectively (p=0.048). CONCLUSION: Using the Scored PG-SGA tool, this study observed a correlation between severity of nutritional status and increased length of hospital stay among cancer patients. Presence of nutritional impact symptoms such as lack of appetite, early satiety, and alteration of taste perception correlated with the degree of malnutrition on admission. RECOMMENDATIONS: Formal objective assessment of the nutritional status of cancer patients should be done. Addressing the symptoms of lack of appetite, early satiety, and alteration of taste perception should be prioritized to prevent deterioration in nutrition.

The bacteriology of urine in urologic patients with prolonged indwelling urinary catheters in the Philippine General Hospital

OBJECTIVE: The objective of this study was to determine the bacteriologic pattern (strain and sensitivity) of the urine of urologic patients with prolonged indwelling urinary catheters. The study also aimed to determine the presence and nature of any relationship between age, presence of significant pyuria/ hematuria, catheter type, elevated creatinine level, duration of catheterization and a positive urine culture.MATERIALS AND METHODS: This is a prospective surveillance study of urine cultures of urologic patients with prolonged indwelling urinary catheters. A urine specimen was aseptically collected for urinalysis and urine culture. Blood was also extracted for serum creatinine determination. The susceptibility and resistance pattern of isolated bacteria against the most commonly used antibiotics in the Philippine General Hospital were evaluated. Various patient factors were statistically analyzed using Fisher's exact test and unpaired T-test to determine their association with a positive urine culture.RESULTS: A total of 116 patients were included in this study. The most commonly isolated microorganism was Escherichia coli. Of the 44 samples with E. coli, 97.73% showed sensitivity against meropenem. This was followed by nitrofurantoin (75.00%) and ceftazidime (59%). Other gram-negative organisms isolated were Enterobacter aerogenes (12.41 %), Pseudomonas aeruginosa (9.66%), Enterobacter agglomerans (9.66%) and Proteus mirabilis (6.21 %). Most of the bacteria isolated were resistant to ampicillin, with a resistance rate of 92.14%., ciprofloxacin (80.71 %), and cotrimoxazole (80.0%). Not enough evidence was found to associate any clinical factor with a positive urine culture.CONCLUSION: Escherichia coli was found to be the most common bacteria in the urine of urologic patients with long-term indwelling catheters. Meropenem, nitrofurantoin and ceftazidime were found to be the most effective antibiotics against E. coli. High resistance rates were demonstrated with ampicillin, ciprofloxacin and cotrimoxazole. A larger study is recommended to establish the association of patient factors to the occurrence of bacteriuria in catheterized patients.

Predictors of postoperative complications of transurethral resection of the prostate in a resource-poor setting

INTRODUCTION: Transurethral resection of the prostate (TURP) is the gold standard in the surgical management of bladder outlet obstruction caused by an enlarged prostate. Morbidity rate is reported at 1-3%. In developed countries, this rate has decreased during the last three decades because of the technological improvements. This study aimed to determine the incidence of postoperative complications of TURP in a setting where not all technological advancements are available. It also identified the risk factors associated with the occurrence of complications. METHODS: This is a prospective cohort study of 408 patients who underwent TURP at the Philippine General Hospital from 2010-2012. Age, presence of medical conditions, pre-operative intake of alpha adrenergic blockers and alpha reductase inhibitors, duration of pre-operative urinary retention, gland size, resection time, volume of resected prostatic tissue, preoperative presence of catheter related infection and presence of capsular perforation were evaluated in terms of their association with the occurrence of complication using univariate analysis and multivariate logistic regression.RESULTS: The overall complication rate was 27.7% (113/408). TURP syndrome was the most common complication, noted in 9.6% (39/408) of patients. Factors significantly associated with the development of complications were the presence of urinary tract infection preoperatively, presence of hypertension, resection time of more than 60 minutes and capsular perforation. TURP syndrome was found to be significantly associated with the preoperative intake of ARI, capsular perforation, prostate tissue of more than 50 grams and resection time of more than 60 minutes.CONCLUSIONS: The complication rate of TURP is higher in this study compared to published literature. Risk factors associated with complications were similar to those in previous reports, including presence of urinary tract infection preoperatively, presence of hypertension, and resection time of more than 60 minutes and capsular perforation and prostate tissue of more than 50 grams.

A questionnaire survey on the knowledge, attitudes and beliefs regarding vasectomy of male patients consulting in the Philippine General Hospital

OBJECTIVE: This study aimed to determine the knowledge, attitudes and beliefs of adult Filipino males consulting in the Philippine General Hospital on vasectomy, and the affect of marital status, length of marriage, number of children, level of education, economic status, religion and type of mass -media exposure on these attitude and beliefs. MATERIALS AND METHODS: This is a descriptive cross-sectional study. A total of 1120 adult male patients were included in the study. Data were collected using a standardized, self-administered questionnaire. Percentages and means were calculated for all variables. Analysis was done using multiple regression models. RESULTS: The mean age of the participants was 50.7 years (SD 16.5) and the mean number of children was 2.5 (SD 2.2). Of the whole sample, 363 (32.4%) have used or are currently using one from of contraception. Among the 518 (46.2%) of men who knew about vasectomy as a form of contraception, 451(87.1%) knew that vasectomy involves ligation of the vas deferens. Higher educational status, previous or current use of contraceptive and not being a Roman Catholic were shown to be statistically significantly associated with knowing about vasectomy as a form of contraception. Only knowledge about the safety of vasectomy was shown to influence men's willingness to undergo the procedure. CONCLUSION: Improved awareness of the safety and reversibility of vasectomy may lead to increased acceptance of the procedure amongst Filipino men. Physicians play an important role in the dissemination of information about contraception, alongside the mass media, and should make efforts to ensure that adequate and accurate information is made available.

A survey of common biofilm microorganisms in indwelling urinary catheters and their antibiotic sensitivity pattern

OBJECTIVES: The study aimed to determine the biofilm microorganisms colonizing the indwelling urinary catheters, the antibiotic sensitivity pattern of the biofilm microorganisms isolated and the presence, if any, and the nature of the relationship of some clinical factors to the biofilm microorganism isolated and/or the antibiotic sensitivity pattern. MATERIALS AND METHOD: Indwelling catheter tips of urology patients were collected and processed. Biofilm microorganisms were extracted from the catheters and subjected to culture studies. Analysis of its antibiotic resistance and sensitivity pattern was performed. RESULTS: E. coli was the most common microorganism isolated in the biofilms of indwelling catheter. Imipenem and nitrofurantoin showed high sensitivity in all isolated biofilm microorganisms. The presence of co morbidity and the previous use of antibiotics were two factors found to be significantly associated with antibiotic sensitivity/resistance patterns. CONCLUSION: In dealing with catheter related infections, one should consider local antibiotic sensitivity pattern of E. coli. Based on this study, nitrofurantoin or imipenem can be expected to be effective empiric treatment for catheter related urinary track infections.

Tuberculosis orchitis in patients who have undergone radical orchiectomy for testicular mass

OBJECTIVE: This study aimed to determine clinical characteristics that are associated with tuberculosis orchitis in patients who present with a testicular mass. MATERIALS AND METHODS: This is an analytic retrospective cohort study of patients who underwent radical orchiectomy for a possible testicular malignancy based on a testicular mass from 2005 to 2009. The following data were derived from a review of the patient's charts: patient age, laterality of the disease, duration of symptoms, concomitant extra-testicular tuberculosis (TB), pre-operative anti-TB treatment received, pertinent pre-operative physical findings, pertinent diagnostics done pre-operatively, and intra-operative findings. RESULTS: The prevalence of testicular tuberculosis in persons who underwent radical orchiectomy for a scrotal mass is 31.8%. TB orchitis occurs more often in younger patients, those who have had tuberculosis in the past, or have received treatment, those with larger testicular masses, those with scrotal skin sinus and tenderness or swelling, tunica, vaginalis invasion, scrotal skin invasion, and epididymal enlargement, and those with cheesy substance noted in intraoperative findings. There were no significant differences between testicular tuberculosis and testicular tumor in terms of ultrasound findings. CONCLUSION: Testicular tuberculosis is prevalent among patients who underwent radical orchiectomy due to a scrotal mass. Several clinical characteristics preoperatively and intraoperatively may predict TB orchitis in these patients.