Functional outcome of stroke in the young patients undergoing rehabilitation at the Philippine General Hospital

OBJECTIVES: Because of the growing concern for stroke in the young, this study was done to determine functional outcome among patients seen at the out-patient clinic of the Department of Rehabilitation Medicine, Philippine General Hospital. METHODS: Twenty-two patients diagnosed to have stroke in the young, who were referred for comprehensive rehabilitation and satisfied the inclusion criteria participated in this prospective study. The patients were evaluated using the Institute of Rehabilitation and Restorative Care-Long Range Evaluation System. The scores were analyzed using paired t-test, repeated measures ANOVA and linear regression at 95% confidence level. RESULTS: Significant changes across time in all variables tested: communication, motor function of the affected extremity, the unaffected extremity, proficiency in self-cafe activities, family cluster, social cluster, resources, outlook in life and work status. Significant changes were also noted between the first and second, and between the second and third evaluation periods. Family cluster, resources and the motor functional outcome of the patients. CONCLUSION: The present study suggests that it is not the improvement in motor recovery alone but also increased psycho-social support that determine functional outcome for stroke in young patients.

The gait, arms, legs and spine (GALS) locomotor screen teaching-learning package: Has it achieved its intended learning outcome?

INTRODUCTION: Clinicians rarely screen their patients for musculoskeletal disorders during routing physical examination. Reasons vary, but inadequate teaching of musculoskeletal medicine is cited as a major factor. To address the above issue, the Section of Rheumatology, Department of Medicine, College of Medicine, and Philippine General Hospital, University of the Philippines Manila recently adopted the Gait, Arms, Legs and Spine Locomotor Screen (GALS) as the central focus of instruction for musculoskeletal conditions. OBJECTIVES: A total of 189 medical interns participated in this descriptive study to determine whether GALS is deemed useful and can be readily applied in the outpatient clinics. METHODS: Data was gathered using a questionnaire, key informant interviews, and chart review. The data was analyzed using measures of central tendency, percentages and qualitative evaluation. RESULTS: Only 26% claimed to routinely perform the musculoskeletal screening examination and only 21% claimed they used the GALS technique. The medical interns emphasized that they were adequately taught to perform the GALS technique but felt that the routine of GALS was time consuming. Emphasis on musculoskeletal screening was done only during clinical rotations in specialties like rheumatology, rehabilitation medicine or orthopedics, but not in other specialties. In addition, only the Section of Rheumatology used the GALS technique. CONCLUSION: The findings of this study suggest that while medical interns feel competent in performing the GALS technique, its application in the clinics leaves much room for emphasis and that there is a need to standardize instruction on musculoskeletal screening.

The gait, arms, legs and spine (GALS) locomotor screen teaching-learning package: Has it achieved its intended learning outcome?

INTRODUCTION: Clinicians rarely screen their patients for musculoskeletal disorders during routing physical examination. Reasons vary, but inadequate teaching of musculoskeletal medicine is cited as a major factor. To address the above issue, the Section of Rheumatology, Department of Medicine, College of Medicine, and Philippine General Hospital, University of the Philippines Manila recently adopted the Gait, Arms, Legs and Spine Locomotor Screen (GALS) as the central focus of instruction for musculoskeletal conditions. OBJECTIVES: A total of 189 medical interns participated in this descriptive study to determine whether GALS is deemed useful and can be readily applied in the outpatient clinics. METHODS: Data was gathered using a questionnaire, key informant interviews, and chart review. The data was analyzed using measures of central tendency, percentages and qualitative evaluation. RESULTS: Only 26% claimed to routinely perform the musculoskeletal screening examination and only 21% claimed they used the GALS technique. The medical interns emphasized that they were adequately taught to perform the GALS technique but felt that the routine of GALS was time consuming. Emphasis on musculoskeletal screening was done only during clinical rotations in specialties like rheumatology, rehabilitation medicine or orthopedics, but not in other specialties. In addition, only the Section of Rheumatology used the GALS technique. CONCLUSION: The findings of this study suggest that while medical interns feel competent in performing the GALS technique, its application in the clinics leaves much room for emphasis and that there is a need to standardize instruction on musculoskeletal screening.

Comparison of abbreviation usage practices in two Philippine tertiary hospitals and perceived effects on medical training

OBJECTIVES:To (1) compare abbreviation usage practices in the Doctors' Orders and History Sheet in two tertiary hospitals in Cebu City, namely, Cebu Velez General Hospital (CVGH) and Vicente Sotto Memorial Medical Center (VSMMC); (2) determine why medical students and physicians use abbreviations and (3) determine the perceived effects on medical student training. METHODS:This is a descriptive cross-sectional study utilizing medical chart reviews as well as group and key informant interviews. Stratified Random Sampling with Proportionate Allocation was used to select 100 charts each from CVGH and VSMMC. Purposive sampling was done for key informants. RESULTS: All patients' clinical history, physical examination and doctors' orders in all departments of both hospitals contained abbreviations. First initialization was the most common form, e.g. BP (blood pressure). Non-universally-accepted abbreviations were common, e.g. HFD (heredofamilial disease). Potentially dangerous abbreviations were noted, e.g. d/c, D/C. Abbreviations were used to maintain patient-doctor confidentiality, save space and time, and for convenience. Perceived effects on medical training included speeding up of task performance. CONCLUSIONS: Use of abbreviations in medical charts among medical students and physicians in both private and public tertiary hospitals in the Philippines is a prevalent practice. While such has its perceived benefits, it also poses potential danger to patients because not all abbreviations are understood and used the same way. Medical schools and their training hospitals must initiate moves to standardize the use of abbreviations in medical education and promote awareness of their potential dangers. The authors suggest that potential dangers/benefits of abbreviations be formally introduced in medical school as a separate topic.

Evaluation of the Master of Science in Epidemiology (Clinical Epidemiology) curriculum

OBJECTIVES: To evaluate the relevance, usefulness, applicability, responsiveness, acceptability, efciency, overall impact and sustainability of the Master of Science in Epidemiology-Clinical Epidemiology (MSE-CE) curriculum. METHODS: The context, input, process and product evaluation (CIPP) design was used. Of 106 alumni and students, 100 were contacted and 80 participated in a survey. Key informant interviews, direct observation and focus group discussions with faculty members, present and past administrators, selected alumni and students, and review of data were done. The results were analyzed using descriptive statistics and content analysis. RESULTS: Context evaluation revealed that MSE-CE responded to the need to train physicians to use research evidence in clinical decision-making. Despite some reservations among other UP colleges, the program pushed through due to support from local and international sponsors. Alumni and students appreciated the effectiveness of their teachers and complementing instructional resources. The range of work by its graduates, the networks established, and the expansion of the Department of Clinical Epidemiology (DCE, the UP department ofering the MSE-CE program) prove that the MSE-CE is a sustainable post-graduate program. CONCLUSION: The MSE-CE institutionalized clinical epidemiology as a distinct discipline among medical colleges in the Philippines.