Comparison of beta‑human chorionic gonadotropin‑based prognostic models on the clinical outcomes of gestational trophoblastic disease patients in the Philippines / Philippine Journal of Obstetrics and Gynecology

Objective@#Despite the widespread use and measurement of beta‑human chorionic gonadotropin (β‑HCG) among hydatidiform mole (HM) patients, models derived from this biomarker to predict the remission or postmolar gestational trophoblastic neoplasia (GTN) rarely perform well. The study aimed to generate cutoff points for postevacuation β‑HCG levels and evaluate their performance among women with complete molar pregnancies@*Methods@#A retrospective cohort study composed of women with complete HM underwent bivariate procedures comparing characteristics between the comparison groups. Cut points using Liu’s and Youden’s indices were estimated, and their performance was evaluated using receiver operating characteristic curve analysis. Cox regression to compare time‑to‑progression across these proposed β‑HCG cutoffs was also performed.@*Results@#The incidence of postmolar GTN among the 155 women in the study was 15.5% (95% confidence interval: 10.2%–22.2%). Postevacuation HCG levels had a better prediction of disease status than preevacuation and HCG ratio models (χ2 : 163.07, P < 0.01). A cutoff at 508 mIU/mL the 3rd‑week postevacuation (area under the curve [AUC]: 0.89, sensitivity: 87.5%, specificity: 90.1%) was comparable with the 185 mIU/mL cutoff at the 5th‑week postevacuation (AUC: 0.89, sensitivity: 91.7%, specificity: 87%). The hazards ratio of postmolar GTN was 29.74 (8.53–103.71) and 39.89 (8.82–180.38) for the 3rd and 5th weeks HCG after evacuation adjusting for clinically relevant variables@*Conclusion@#The first 3rd‑ and 5th‑week postevacuation levels of β‑HCG demonstrated potential in predicting postmolar GTN. However, further refinement and adjustment for clinically relevant risk factors are still needed.

Perceptions of incidents and incident reporting among staff nurses in a tertiary Philippine hospital

INTRODUCTION@#The number of injuries and expenses from unsafe delivery of health care has heeded the call for a greater patient safety advocacy. The development of an effective reporting system contributes towards this cause. The study aimed to explore the perceptions of nurses regarding critical incidents and investigate the factors affecting their decision to report a certain event.@*METHODS@#Focus group discussions including 28 nurses working in the service wards of a tertiary hospital, and the data gathered were analyzed using descriptive qualitative approach.@*RESULTS@#Three key themes emerged from the discussions: (1) perceptions of an incident, (2) attitudes, norms, and culture of incident reporting in the workplace, and (3) perceptions and suggestions for management actions and improving the reporting system. The study showed that various factors tend to interplay in the identification of an incident as well as the consideration to perform the behavior.@*DISCUSSION@#The primary practice and education implications focus on changing the workplace culture and proper orientation of the staff, while further research regarding the role of reporting, and appropriate analysis of error reporting among other health care professionals would be recommended.

Propensity score approaches in quantifying effects of treatment from observational data

Introduction@#Despite the growing popularity of utilizing observational studies for determining associations with public health implications, there is limited literature using them for examining and quantifying the effects of exposures or treatments: The study compared traditional regression with scoring approaches in estimating treatment effects considering the noted limitations in the dataset. @*Methods@#We conducted a secondary analysis of previously collected retrospective cohort data derived from maternal-neonatal dyads delivered prematurely in a tertiary hospital. Propensity scores (PS) were estimated using logistic and boosting regression. These scores were implemented into matching, stratification, and weighting models. The estimated measures of effect from traditional regression and PS-adjusted models were compared using certain metrics (i.e., the width of CI, SE, AIC, BIC). Sensitivity analysis was also performed. @*Results@#We included data from 562 patients (123 untreated and 439 treated). Both the estimated scores demonstrated satisfactory fit and reduction in the standardized differences between the groups. However, the logit-estimated scores had better prediction (AUC: 0.71 vs 0.66) and forecasting properties (Brier: 0.15 vs 0.17) than the boosting-estimated scores. All generated statistical models demonstrated a reduction in the occurrence of respiratory morbidity among preterm neonates exposed to a single-dose antenatal corticosteroid (ACS) (ORs ranged from 0.37 to 0.59). The estimated average treatment effects (ATE) and effect among those treated (ATET) from various models suggested a small benefit attributed to the single-dose ACS (ATEs range from -0.09 to -0.41; ATETs range from -0.07 to -0.17). @*Conclusion@#PS estimated using logistic regression performed better than those estimated using machine learning strategies. The matching model using the said scores demonstrated better fit and parsimony over conventional and propensity-adjusted models. Future studies are recommended to improve the application of these analytic techniques in real-world data.

Average treatment effects of a single-dose antenatal corticosteroid on the respiratory morbidity of Filipino preterm neonates

Introduction@#Prematurity-related respiratory disorders are an important public health concern that should be treated efficiently and effectively. Antenatal corticosteroid (ACS) therapy has been recommended to hasten fetal lung maturation in pregnancies at risk but has not been delivered adequately in low to middle-income countries. This study aimed to estimate the treatment effects associated with the use of a single-dose antenatal corticosteroid on the incidence of respiratory-associated morbidity among prematurely delivered neonates. @*Methods@#This was a retrospective cohort study of neonates delivered at 24 to 33 weeks gestation at a tertiary hospital comparing outcomes in those given single-dose ACS with those given no ACS. Association was estimated using logistic and propensity score (PS) analyses, as well as average treatment effect (ATE) and among those treated (ATET). @*Results@#Most neonates (78.11%) received a single dose before delivery (single-dose ACS group) and only a few (21.89%) did not receive any dose (no ACS dose group). The odds ratio of respiratory morbidity in the single-dose ACS group was 0.44 (0.23-0.84) from an adjusted logistic regression model and 0.33 (0.17-0.80) from the PS matching model. The latter model was used to estimate that the average treatment effect from a single-ACS dose on the entire sample was -0.09 (-0.03 to -0.15), while its effect among the actual recipients was -0.08 (-0.02 to -0.15). @*Conclusion@#There is a small benefit attributed to the single-dose ACS, reinforcing the need for dose administration and completion. Future studies are recommended to clarify the estimated association and improve on the methodological constraints encountered.

Age-specific serum anti-Mullerian hormone reference values for infertile Filipino women in a tertiary in vitro fertilization center in the Philippines / Philippine Journal of Obstetrics and Gynecology

Background@#Anti-Mullerian hormone (AMH) levels have been used as an invaluable tool in reproductive medicine for over a decade, especially in predicting ovarian reserve and follicular response during in vitro fertilization (IVF) cycles. Age-specific reference values of AMH levels have been derived from mostly Western and few Asian population groups but none from the Philippines. In this study, we attempted to determine the first age-specific AMH reference values from infertile Filipino women to be able to provide local infertility centers a guide in treating Filipinos and those with similar racial and lifestyle characteristics. @*Materials and Methods@#This was a retrospective cross-sectional study that was conducted at the Center for Advanced Reproductive Medicine and Infertility at St. Luke's Medical Center Global City. Age, serum AMH levels, body mass index (BMI), and cause of infertility of Filipino women who underwent IVF from August 2015 to March 2020 were taken. AMH was assayed using the automated Access AMH Immunoassay (Beckman Coulter). @*Results@#A total of 1463 women who underwent IVF and with valid AMH results were initially found but only 1233 were included in the study. Mean age was 36.67 + 4.35 years and mean BMI was 24.43 + 4.14 kg/m2. There was minimal effect of BMI on AMH levels and increasing age (R2 = 0.0068), but there were significant differences of mean AMH levels among the general causes of infertility. The mean and median AMH values decreased with advancing age (R2 = 0.1391) although the mean values were consistently higher than the median values. The mean level of the AMH was 2.32 ± 1.90 ng/mL with a 0.16 ng/ml (confidence interval: 0.14–0.19 ng/ml) level decrease per year of increase in age. By age category, the following were the derived AMH values (ng/ml) at the 25th to 75th percentiles: 25–29 = 1.52–4.92; 30–34 = 1.60–4.10; 35–39 = 0.95–3.13; 40–44 = 0.44–1.99; 45 = 0.47–1.08. The mean AMH in this study appears to be similar to several but lower than most other reported AMH nomograms from other population groups. @*Conclusion@#The first age-specific AMH reference values for infertile Filipino women are presented and may serve as a useful diagnostic marker in local infertility centers, especially those treating Filipino patients or others with similar characteristics.