ABSTRACT
Background@#Guidelines for osteoporosis have provided recommendations on when to offer pharmacologic management for postmenopausal women, but do not specify which “best” medication to start. The choice of therapy depends on the efficacy, safety/tolerability of the drug and the patient’s profile and preferences. Patient decision aids (PtDA) are tools designed to facilitate shared decision-making (SDM) between the patient and health care provider for conditions where there are several available options, and the “best” choice is unclear. We aimed to develop a culturally acceptable patient decision aid on the treatment of osteoporosis among Filipino postmenopausal women at risk of osteoporotic fractures.@*Methodology@#A qualitative approach and an iterative process was employed in this study following the guidance of the International Patient Decision Aid Standards (IPDAS). Phase 1 (Needs Assessment) involved interviews with 8 physicians who are involved in the care of women with osteoporosis and focus group discussions with 19 postmenopausal women with osteoporosis who have received treatment. Phase 2 (PtDA Development) involved a systematic review of evidence and development of an initial prototype through several iterations with an expert panel. The final prototype was pilot tested in actual clinical encounters (Phase 3).@*Results@#The final PtDA consists of 6 laminated flashcards, which illustrate the different considerations that are important to patients when selecting an anti-osteoporosis treatment (efficacy, method, frequency of administration, side effects and cost), and a fracture worksheet to illustrate individualized effects of the treatments on the patient's fracture risk. These are accompanied by a clinician guide on how to use the PtDA during consultations, which includes information on non-pharmacologic management of osteoporosis. The PtDA was acceptable to physicians and patients.@*Conclusion@#With the integration of decisional needs assessment, clinical expertise, user preference and iterative revision testing, we were able to develop a culturally adapted PtDA on the treatment of osteoporosis among Filipino postmenopausal woman at risk of osteoporotic fractures for use during clinical encounters.
Subject(s)
Osteoporosis , TherapeuticsABSTRACT
@#<p> OBJECTIVE:</b> To develop a locally adapted patient decision aid (PtDA) on treatment intensification among Filipino patients with Type 2 Diabetes Mellitus and to test the feasibility of using PtDAs in a low middle-income country.</p><p><strong>METHODOLOGY:</strong> A qualitative approach and an iterative process of development of a PtDA were employed for this study. We describe the process of developing a Filipino version of the Diabetes Medication Decision Aid. This PtDA was designed to help the patient choose the appropriate treatment intensification based on his own values and preferences, in consultation with his physician. The process involved decisional needs assessment through focus group discussions and key informant interviews, systematic literature review, iterative process of the development of a PtDA with clinical encounters (pilot testing), and preliminary field testing.</p><p><strong>RESULTS:</strong> Decisional needs assessment revealed that Filipino patients are open to participate in shared decision-making if given the opportunity, including those with low socioeconomic status who likely have low health literacy. Physicians prefer to have visual aid tools to help them support their patient's decision-making. A PtDA prototype of a set of flash cards in Filipino was created and revised in an iterative method. We developed a more visually appealing tool after inputs from the expert panel and patient advisory group. Its use during clinical encounters provided additional insights from patients and clinicians on how to improve the PtDA. Preliminary field testing showed that its use is feasible in the target patient population.</p><p><strong>CONCLUSION:</strong> Filipino patients, clinicians, and diabetes nurse educators have contributed to the creation of the first Filipino PtDA for diabetes treatment intensification.</p>
Subject(s)
Humans , Decision MakingABSTRACT
@#Pituitary abscess is a rare condition. It can present with hormonal deficiencies and may affect reproductive health. We present a case of a 43-year-old female presenting with bitemporal hemianopsia and amenorrhea. Imaging of the pituitary showed a sellar-suprasellar mass 2.6 x 2.4 x 1.8 cm with an enhancing nodular component. Pre-operative diagnosis was pituitary adenoma with panhypopituitarism and compression of the optic chiasm. The patient underwent transsphenoidal excision of the tumor. Intraoperative findings revealed purulent fluid consistent with pituitary abscess. There was immediate improvement of vision post operatively. She did not develop diabetes insipidus. Gram stain showed polymorphonuclear (PMN) cells 0-1 per oil immersion field (OIF) and Gram-positive cocci 0-1 per OFI, however there was no growth on culture. The abscess was also negative for acid-fast bacilli and was negative on polymerase chain reaction. Histopathologic evaluation showed benign cyst contents. The patient was treated with ceftriaxone 2 grams every 12 hours for 14 days and was eventually discharged with prednisone and levothyroxine. Pituitary abscess is an important differential diagnosis for sellar and suprasellar masses. There are no specific clinical and radiologic features that will enable a preoperative diagnosis of pituitary abscess.
Subject(s)
AmenorrheaABSTRACT
@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Physical activity is an important factor in reducing morbidity from type 2 diabetes mellitus and maintaining quality of life. There is no available data on physical activity among Filipino patients with type 2 diabetes mellitus.<br /><strong>OBJECTIVES:</strong> The objectives are to assess the physical activity level of patients with type 2 diabetes mellitus at the UP-PGH Diabetes Clinic using Global Physical Activity Questionnaire and to determine the relationship between physical activity, health profiles and socio-demographic characteristics.<br /><strong>METHODOLOGY:</strong> A cross-sectional study was conducted to assess the physical activity levels of 151 patients with type 2 diabetes mellitus (46 men and 105 women) using GPAQ. Anthropometric measurements, socio-demographic profiles and HbA1c were also taken.<br /><strong>RESULTS:</strong> Majority of subjects had moderate to high physical activity (68.9%) and most of the patients had poor glycemic control based on HbA1c of ?7% (68.2%). Subjects aged 60 years and above (68.1%; p=0.022) and with poor glycemic control (89.4%; p=<0.001) had low physical activity level. There is no significant statistical correlation between physical activity, anthropometric profile and other socio-demographic characteristics.<br /><strong>CONCLUSION:</strong> Majority of the patients with type 2 diabetes mellitus at the UP-PGH Diabetes Clinic had moderate to high physical activity level. Subjects with poor glycemic control and older age group were associated with low physical activity.<strong><br /></strong></p>
Subject(s)
Humans , Male , Female , Aged , Middle Aged , Adult , Anthropometry , Cross-Sectional Studies , Diabetes Mellitus, Type 2 , Diabetes Mellitus , Exercise , Hyperglycemia , Quality of Life , Surveys and QuestionnairesABSTRACT
@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To determine cut-off levels of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) for overweight/obesity associated with cardiometabolic diseases (CMDs) among adult Filipinos in a rural community.<br /><strong>METHODOLOGY:</strong> This community-based cross-sectional observational study utilized data from our Phase II of Diabetes Self-Management Education Program in San Juan, Batangas, Philippines. It included 332 Filipino adults with no known illnesses and residing for at least 6 months in the rural communities. Optimal cut-offs were determined by the intersection of sensitivity and specificity curves of having at least 1 or 2 CMDs.<br /><strong>RESULTS:</strong> The study population included 332 participants (72.3% females). Mean BMI, WC and WHR were 23.5 kg/m2, 79.5 cm and 0.87 respectively. Twenty eight percent, 11.1%, 78.3% and 85.8% of the participants have hypertension, diabetes, dyslipidemia, and at least 1 CMD respectively. The optimal cut-off for overweight/obesity and central obesity in males and females are BMI of 24 and 23 kg/m2, WC of 84 and 77 cm, and WHR 0.91 and 0.85 respectively.<br /><strong>CONCLUSION:</strong> Similar to other Asian countries, cut-off levels for overweight, obesity, and central obesity associated with CMDs are lower than the currently recommended cut-offs among Filipino adults in rural communities, particularly for WC in both sexes.</p>
Subject(s)
Humans , Male , Female , Aged , Middle Aged , Adult , Young Adult , Adolescent , Adult , Body Mass Index , Obesity , Overweight , Waist Circumference , Hypertension , Diabetes Mellitus , DyslipidemiasABSTRACT
@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> The study aims to develop and validate a health-related quality of life (HRQoL) questionnaire for adult Filipinos with differentiated thyroid cancer (DTC) that can be used in combination with the European Organization for Research and Treatment of Cancer QLQ-C30 Questionnaire.<br /><strong>METHODOLOGY:</strong> The study had 4 phases. Phase I involved generation of HRQoL issues from literature review, focus group discussions with 6 DTC patients and 5 health care professionals (HCP). Subsequent assessment for relevance and importance of the HRQoL issues by 20 patients and HCP panel was done. Phase II was formulation of the HRQoL issues into questionnaire and subsequent translation into Filipino. Phase III was pilot testing of the questionnaire in 15 patients. Phase IV was validation of the pre-final questionnaire in 231 patients.<br /><strong>RESULTS:</strong> In Phase I, 28 HRQoL issues were generated. In Phase II, a 28-item Filipino questionnaire was created. In Phase III, 22 items that were not upsetting or confusing to patients and with good range of responses were retained. After Phase IV, a 22-item questionnaire with 5 conceptual scales (perceived fears, psychological distress/anxiety, functionality, voice complaints, neck complaints) was created.<br /><strong>CONCLUSIONS:</strong> The developed and validated 22-item questionnaire can be used to assess HRQoL issues in adult Filipinos with DTC.</p>
Subject(s)
Humans , Male , Thyroid Gland , Neoplasms , Quality of Life , Philippines , Validation Study , Patients , AnxietyABSTRACT
Background@#Management of type 2 diabetes mellitus requires the maintenance of self-care behaviors, which include proper nutrition. However, diabetic patients often find that following a healthy diet is the most difficult component of self-care. It is important to assess the eating behaviors of diabetic individuals in order to customize a dietary plan but locally clinicians are hampered by the lack of a culturally adapted or validated tool. @*Objective@#The goal of this study is to develop and validate a Filipino eating behavior questionnaire for adults with type 2 diabetes mellitus. @*Methodology@#Literature review, expert interviews and focus group discussions among type 2 diabetic patients were done. All inputs, including pooled items from existing eating behavior questionnaires, were reviewed and categorized into corresponding eating behavior domains as determined by expert panel consensus. After translation into Filipino and pre-testing, the questionnaire was administered twice to 197 adults with type 2 diabetes. Questionnaire reliability was determined using Cronbach’s α and Spearman’s rank correlation coefficient. @*Results@#A 29-item, self-administered, Filipino eating behavior questionnaire answerable by a 4-point Likert scale was initially developed. This questionnaire featured three known eating behaviors namely: uncontrolled, restrained, and emotional eating; and included two newly identified eating behaviors: social and pro-active eating. In both first and second tests, only the items in the uncontrolled (Cronbach’s α 0.739 & 0.816), social (Cronbach’s α 0.641 & 0.707), and pro-active (Cronbach’s α 0.622 & 0.665), eating domains were found to be internally consistent. One item under the restrained eating domain was deleted to improve the consistency of the items. For the test-retest reliability, moderate to high positive correlation (coefficients ranging from 0.530 to 0.744) between scale scores in the two test runs was achieved. This indicated stable responses to the items. @*Conclusion@#An eating behavior questionnaire for type 2 diabetic individuals that was developed to be culturally appropriate is a generally reliable, reproducible and valid instrument to assess eating behaviors. This study identified social and pro-active eating as behaviors among Filipinos with type 2 diabetes mellitus that were not previously described in foreign literature. The instrument may provide benefit in evaluating eating behaviors and formulating more individualized nutrition management plans.