Validation of the Filipino translation of the impact of vision impairment for children (IVI_C) questionnaire among school children

Background@#Quality of life questionnaires provide valuable information in assessing the effects of health interventions and public health campaigns. In the Philippines, we only have a few validated questionnaires targeted specifically for children.@*Objective@#To translate to Filipino and validate the translated Impact of Vision Impairment for Children Questionnaire (IVI_C).@*Methods@#This is a translation and validation study of the IVI_C. The IVI_C was translated following international guidelines of forward–translation and back-translation methods. After completion of the Filipino IVI_C version, pretesting was performed on school-aged children 8 to 18 years old through convenience sampling in the outpatient department and Pediatric Ophthalmology and Motility Clinic at Sentro Oftalmologico Jose Rizal, Philippine General Hospital from January 1 to August 31, 2018.@*Results@#We included 130 participants in the study. The calculated Cronbach’s alpha coefficient of 0.88 for the translated Filipino version of the IVI_C suggested high reliability and internal consistency. Rasch analysis showed comparability of the Filipino translation to the original English version of the questionnaire.@*Conclusion@#Our study showed that the Filipino version of IVI_C questionnaire was of high reliability and validity.

External beam radiotherapy for bilateral leukemic infiltrative optic neuropathy in a pediatric patient

Objective@#To describe a rare case of acute lymphocytic leukemia (ALL) with optic nerve head tumor cell infiltration treated with external beam irradiation.

Refractive changes after intraocular lens implantation in post-cataract extraction children in a Philippine Tertiary Hospital

Objective@#To determine refractive changes in children post-cataract extraction and intraocular lens (IOL) implantation at a Philippine tertiary hospital. @*Methods@#This is a retrospective cohort study involving patients aged 1 to 10 years in the Department of Ophthalmology of a Philippine tertiary hospital who underwent cataract extraction and IOL implantation between 2004 to 2013. @*Results@#We included 55 eyes of 34 patients in the analysis. Thirty-eight eyes (69%) eyes underwent primary IOL implantation. The mean duration of follow-up was 3.5 ± 2.1 years. The median refractive changes were -2.00 (-2.50, -0.50) diopters (D) for the 1- to 3-year-old group, -1.25 (-1.50, -0.25) D for the 4- to 7-year-old group, and -1.00 (-1.63, -0.25) D for the 8- to 10-year-old group. Only the 1- to 3-year-old group had significant difference between the initial post-operative refraction and the latest follow-up refraction (p<0.001). For the primary implantation group, patients in the 1- to 3-year-old group had the highest median refractive change at -2.00 (-3.125, -1.00) D while patients in the 8- to 10-year-old group had the highest median refractive change at -2.12 (-2.56, -1.69) D in the secondary implantation group. Refractions of eyes with IOL-implanted and normal eyes showed a median difference of -1.00 (-0.25, -3.5) D. @*Conclusion@#The determination of the power of IOL implants in pediatric patients who underwent cataract extraction remains challenging despite availability of recommendations.

Comparison of C-reactive protein serum levels among in-pat ients with acute exacerbation of Schizophrenia at the Veterans Memorial Medical Center (VMMC) Department of Psychiatry from August 2013 – July 2015

BACKGROUND@#Several immunological abnormalities, such as decreased T-cell interleukin-2 production and abnormal cellular and humoral reactivity to neurons, had been associated with patients who have schizophrenia. Several researches have been conducted to study the correlation of elevated inflammatory markers with the symptomatology of schizophrenia.@*OBJECTIVES@#The aim of this study is to determine the levels of C-reactive protein, which is a general marker for infection and inflammation, in patients with Schizophrenia in acute exacerbation and compare these to the levels of C-reactive protein in patients with Schizophrenia in remission.@*METHODS@#A cross-sectional study was carried out on in-patients at the Veterans Memorial Medical Center Department of Psychiatry. Serum levels of C-reactive protein in adult patients were determined during an acute exacerbation of Schizophrenia. These were compared to Creactive protein levels of patients with Schizophrenia in remission. PASW Statistics 18 (SPSS) was used for data management, tabulation and analysis.@*RESULTS@#Cases of eighty-six (86) patients, seen by the principal investigator during OPD consults were reviewed, 43 of which had Schizophrenia in Acute Exacerbation and also 43 of patients were in Remission. The mean CRP level of patients in acute exacerbation was 7.05 mg/L (SD=0.23), which was higher than the mean CRP level of patients in remission at 5.30 mg/L (SD=0.30).@*CONCLUSION@#This study demonstrated that a stronger association exists between an acute exacerbation of Schizophrenia and elevated C-Reactive protein, in the absence of another systemic inflammatory disease when compared to the association between levels of Creactive protein in patients with Schizophrenia, in remission. This finding could pave the way for initiation of studies examining whether adjunct treatment of anti-inflammatory drugs with anti-psychotics will improve disease outcome.

Postoperative changes in alignment in patients surgically corrected for Esotropia and Exotropia in a Tertiary Government Hospital

Objective@#To compare the postoperative alignment of patients surgically corrected for esotropia or exotropia 6 weeks and 6 months after surgery.@*Method@#This retrospective study reviewed clinical records of patients who underwent horizontal muscle surgery at the University of the Philippines-Philippine General Hospital from 2010 to 2014. The changes in alignment from 1 week to 6 weeks and from 1 week to 6 months after surgery were compared for overcorrection, undercorrection, and adequate correction groups. ANOVA and Pearson correlation were used.@*Results@#Twenty two esotropia and 10 exotropia patients were included. Overcorrected esotropia patients had an esotropic change in alignment (15.50+13.44 PD after 6 weeks, p=0.026; 25+18.38 PD after 6 months, p=0.008). Under corrected esotropia patients had an exotropic change in alignment (-1.25+5.91 PD after 6 weeks, p=0.026;-4.38+14.16 PD after 6 months, p=0.008). Undercorrected exotropia patients had an esotropic change in alignment (6.67+6.35 PD after 6 weeks, p=0.028; 6+9.85 PD after 6 months, p=0.024). The presence of vertical deviations in esotropia caused an exotropic change in alignment after 6 months (p=0.03).@*Conclusion@#Although an exotropic drift is more commonly reported, fusional vergences may account for postoperative alignment changes towards orthotropia.

Effects of visual impairment on quality of life in children aged 3-7 years

Objective@#The primary goal of this study was to determine the effect of visual impairment (VI) on the quality of life (QoL) in children aged 3-7 years.@*Methodology@#This was a cross-sectional study involving 138 parents or caregivers of children aged 3-7 years from Pediatric Ophthalmology and General Ophthalmology Clinics of a tertiary government hospital. The Filipino version of the Children’s Visual Function Questionnaire (CVFQ3plus), an instrument that measures the impact of visual impairment on the QoL of children aged 3-7 years and their families, was used. It has 6 subscales: general health, general vision, competence, personality, family impact, and treatment. T-test was used to compare the total index QoL score and subscale scores between children with VI (n=69) and the control group (n=69). The multivariate regression model based on the total index QoL score in children with VI was used to assess the effect of other demographic factors.@*Results@#Children with VI had significantly lower total index QoL score (p=0.02), general vision (p=0.04), competence (p=0.00), and personality (p=0.02) subscale scores than the control group. The visual acuity of children with VI had a significant effect on the total index QoL score (p=0.04). Demographic factors like patient’s age and sex, and parental age, sex and educational attainment had no effect on total index QoL score.@*Conclusion@#Visual impairment has a negative effect on the quality of life of Filipino children aged 3-7 years as shown by the use of the CVFQ3plus.

The burden of congenital rubella syndrome in the Philippines: results from a retrospective assessment

Introduction: In line with the regional aim of eliminating rubella and congenital rubella syndrome (CRS), phased introduction of rubella-containing vaccines (RCV) in the Philippines’ routine immunization programme began in 2010. We estimated the burden of CRS in the country before widespread nationwide programmatic RCV use. Methods: We performed a retrospective chart review in four tertiary hospitals. Children born between 1 January 2009 and 31 December 2014 and identified as possible CRS cases based on the presence of one or more potential manifestations of CRS documented in hospital or clinic charts were reviewed. Cases that met the clinical case definition of CRS were classified as either confirmed (with laboratory confirmation) or probable (without laboratory confirmation). Cases that did not fulfil the criteria for either confirmed or probable CRS were excluded from the analysis. Results: We identified 18 confirmed and 201 probable cases in this review. Depending on the hospital, the estimated incidence of CRS ranged from 30 to 233 cases per 100 000 live births. The estimated national burden of CRS was 20 to 31 cases per 100 000 annually. Discussion: This is the first attempt to assess the national CRS burden using in-country hospital data in the Philippines. Prospective surveillance for CRS and further strengthening of the ongoing measles-rubella surveillance are necessary to establish accurate estimates of the burden of CRS and the impact of programmatic RCV use in the future.

Translation and validation of a Filipino version of the children’s visual function questionnaire

Objective@#The objectives of this study were to translate into Filipino the Children’s Visual Function Questionnaire for children 3 years and above (CVFQ3plus), and to validate the translated CVFQ3plus to be used locally to assess the quality of life (QoL) of Filipino children aged 3 to 7 years old with visual impairment. @*Methods@#Study Design: The study was a single-center, non-randomized translation and validation study. Translation: The CVFQ3plus translation into Filipino involved translation, reconciliation, pretesting, and small group discussion, based on the KIDSCREEN Group Translation and Validation procedures. Participants and Sampling: Convenience sampling was done to select the participants of the study. Participants were included in the study if they were parents or primary caregivers of children aged 3-7 years old who were noncompliant with treatment and/or those with non-treatable visual impairment defined as mild, moderate, severe unilateral, and severe bilateral. Procedure: All patients underwent complete ophthalmologic examination, including determination of the visual acuity using either the LEA chart or HOTV chart, prior to the administration of both the Filipino and English versions of the CVFQ3plus to their parents or caregivers. Participants were also asked to do a self-rating of their English proficiency, and their preferred version of the CVFQ. Statistical Analysis: Chronbach’s Alpha with a 95% confidence interval was used to determine the validity and internal consistency of the Filipino version of the CVFQ3plus questionnaire.@*Results@#A total of 122 participants were included in the study. Chronbach’s Alpha score (α=0.86, CI=95%) for the translated Filipino version of the CVFQ3plus suggests high reliability and internal consistency, comparable to the original English version of the questionnaire.@*Conclusion@#This study was able to produce a highly reliable and internally consistent Filipino version of the CVFQ3plus.

Safety culture and safety attitudes of nurses in the National University Hospital

PURPOSE: Patient safety issues pose a great burden worldwide. However, there is still inadequate data on the burden of Patient Safety issues in the Philippines to specifically address institutional and national concerns through directed program, policies, and interventions. This current study aims to describe the safety culture and attitudes of nurses of the National University Hospital in Manila, Philippines.DESIGN: This study used non-experimental design that assessed the safety culture and safety attitudes of nurses from the general units of the National University Hospital (NUH) using two assessment tools: the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (AHRQ-HSOPS) and the Safety Attitudes Questionnaire- Short Form (SAQ). Ethical approval was granted from both the university and the hospital ethics review boards. METHODS: Stratified random sampling was used to ensure representation of staff nurses and nurse administrators. A self-administered survey that included the two tools was translated to Filipino and administered to 200 nurses. Percent of positive responses were obtained to describe the safety culture and attitudes as prescribed by toolkits of AHRQ-HSOPS and SAQ.FINDINGS: The overall survey response rate yielded 86.77%. Nurses from the National University Hospital displayed both positive Safety Culture and Safety Attitudes based on AHRQ-HSOPS and SAQ. Dimensions that garnered the highest positive perceptions in Safety Culture were Organizational Learning and Teamwork while the lowest were Hospital Handoffs and Non-Punitive Response to Error. On the other hand, dimensions on safety Awareness that received the highest positive perceptions were Teamwork and Safety Climate while the lowest was Stress Recognition. Perceptions of nurses also varied significantly across ranks in position titles and work settings. CONCLUSIONS: There are identifiable dimensions that can be improved in both Safety Culture and Safety Attitude that can have a positive impact on nurses and potentially impact nurse-patient and hospital-sensitive outcomes through hospital-wide improvement programs.

Safety culture and safety attitudes of nurses in the National University Hospital

Purpose@#Patient safety issues pose a great burden worldwide. However, there is still inadequate data on the burden of Patient Safety issues in the Philippines to specifically address institutional and national concerns through directed programs, policies, and interventions. This current study aims to describe the safety culture and attitudes of nurses of the National University Hospital in Manila, Philippines.@*Design@#This study used a non-experimental design that assessed the safety culture and safety attitudes of nurses from the general units of the National University Hospital (NUH) using two assessment tools: the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (AHRQ-HSOPS) and the Safety Attitudes Questionnaire- Short Form (SAQ). Ethical approval was granted from both the university and the hospital ethics review boards.@*Methods@#Stratified random sampling was used to ensure representation of staff nurses and nurse administrators. A self-administered survey that included the two tools was translated to Filipino and administered to 200 nurses. Percent of positive responses were obtained to describe the safety culture and attitudes as prescribed by toolkits of AHRQ-HSOPS and SAQ.@*Findings@#The overall survey response rate yielded 86.77%. Nurses from the National University Hospital displayed both positive Safety Culture and Safety Attitudes based on AHRQ-HSOPS and SAQ. Dimensions that garnered the highest positive perceptions in Safety Culture were Organizational Learning and Teamwork while the lowest were Hospital Handoffs and Non-Punitive Response to Error. On the other hand, dimensions on Safety Awareness that received the highest positive perceptions were Teamwork and Safety Climate while the lowest was Stress Recognition. Perceptions of nurses also varied significantly across ranks in position titles and work settings.@*Conclusions@#There are identifiable dimensions that can be improved in both Safety Culture and Safety Attitude that can have a positive impact on nurses and potentially impact nurse-patient and hospital-sensitive outcomes through hospital-wide improvement programs.

Visual outcomes of Amblyopia Therapy

Objective@#To determine the visual outcome of amblyopia treatment and describe the relationship between age of onset and consult, compliance as measured by a patch diary, amblyopia subtype, and severity with the final visual outcome.@*Methods@#Thirty-two consecutive, newly-diagnosed cases of amblyopia, aged 3-8 years on initial consult, with no history of prior amblyopia treatment, were included. Patching was done based on current AAO recommendations and patients were followed up monthly for 6 months. Treatment success was defined as best corrected visual acuity (BCVA) better than 20/30 (0.17LogMAR), or a 3-line improvement from baseline, or stable isoacuity for at least 3 months. Treatment failure was defined as no improvement of BCVA after 3 months of occlusion therapy or a regression of 2 lines. Descriptive and correlation statistics were performed comparing age of onset and consult, amblyopia subtype, severity, and compliance with the main outcome measure of BCVA at 6 months. @*Results@#Sixteen (50%) attained treatment success. Patients seen earlier (age 2-5 years) had higher rates of success (75%) than those seen later (age 6-8 years) (35%). A moderately strong negative correlation (r=-0.48, p=0.01) existed between severity of amblyopia and final BCVA at 6 months. overall compliance to patching was 88±18%, with good compliance in the success group (92%) compared to fair compliance in the failure group (84%) and a moderate correlation between compliance and BCVA (r=0.37, p=0.05). @*Conclusion@#Treatment success was related to severity, compliance, and younger age of treatment. In the presence of good compliance, severity was a strong prognostic variable.

Criteria for the timing of the initial retinal examination to screen for retinopathy of prematurity

Objective@#To determine the applicability of a modified criteria for initiating retinal examinations to screen for retinopathy of prematurity (ROP).@*Methods@#All ROP charts of babies who had initial retinal examination to screen for ROP from January 1, 2005 to December 31, 2008 at the neonatal-intensivecare nursery and eye center of a tertiary hospital were reviewed. Date of birth, sex, age of gestation (AOG), birth weight (BW), postnatal age (PNA), postconceptional age (PCA), and ROP classification were recorded. Descriptive statistics and Student’s t-test were used to analyze the data.@*Results@#A total of 690 eyes of 345 babies, 174 males and 171 females, were included in the study. At the initial retinal exam, the mean AOG was 31.39 ± 2.46 weeks; BW, 1,268.77± 317.12 grams; PNA, 4.56 ± 2.95 weeks; and PCA, 35.94 ± 3.26 weeks. Immature retinas in both eyes were seen in 175 (50.72%) babies, while 113 (32.75%) had ROP of any stage in both eyes and 51 (14.78%) had immature retina in one eye and ROP of any stage in the other eye. Among the 113 babies with ROP, 33 (29.2%) were assessed to have pre-threshold ROP.@*Conclusion@#This study supported the applicability of the modified criteria which are in agreement with the Joint Statements of the American Academy of Pediatrics, American Academy of Ophthalmology and American Association of Pediatric Ophthalmology and Strabismus, and the United Kingdom Royal College of Pediatrics and Child Health for initiating retinal exams to screen for ROP.

Intravitreal bevacizumab for neovascular age-related macular degeneration

Objectives@#Anti-vascular endothelial growth factor (anti-VEGF) drugs delivered intravitreally have been proven effective and safe for the treatment of patients diagnosed with neovascular age-related macular degeneration (ARMD). This study evaluated the short-term biologic efficacy and safety of multiple intravitreal injections of bevacizumab in patients with neovascular ARMD.@*Methods@#A prospective, interventional, placebo-controlled, randomized clinical trial was done involving patients with active subfoveal neovascular ARMD. Excluded were patients with significant media opacity, concomitant retinal/ocular diseases, previous intravitreal injections, recent laser treatment or intraocular surgery, and contraindications to the drug. Demographic data were taken and a complete ocular examination, fluorescein angiogram (FA), and optical coherence tomogram (OCT) were performed. Patients received either 3 monthly intravitreal injections of 1.25mg bevacizumab or sham injections. Best-corrected visual acuity (BCVA) and central macular thickness were recorded at baseline, 2, 4, 8, and 12 weeks follow-up. Ocular/Periocular or systemic drug-related side effects or toxicities and iatrogenic complications were noted.@*Results@#Thirty eyes (15 per group) were included in the final analysis. Both treatment and control groups were comparable in baseline characteristics. There was a significant increase in the mean visual acuity (p < 0.001) in eyes treated with bevacizumab across all time periods. The average gain at the end of the study was 11.6 letters. This paralleled a similar significant decrease in central macular thickness for the treatment group (p < 0.02). No major ocular adverse events were noted.@*Conclusion@#This study supported the growing body of evidence that intravitreal injections of bevacizumab 1.25 mg result in short-term anatomical as well as functional improvement with minimal adverse events in patients with neovascular ARMD.