Nursing shortage in the Philippines: Dissecting an entanglement of issues

@#The banning of new nursing schools in the Philippines was imposed in 2010 to mitigate the failing compliance of schools with various competency standards set forth by the Professional Regulation Commission (PRC), in addition to the burden of students in paying their affiliations with hospitals. In the midst of the shortage of nurses in the country that was magnified by the COVID-19 pandemic, the Commission on Higher Education (CHED) decided to lift the moratorium. This paper draws on the narratives of nursing leaders and professionals on the phenomenon of nursing shortage and the issues that can arise with the reopening of nursing schools. The verbatims highlight the historical and contemporary entanglement of various issues that contributed to the problem of nursing shortage. In addressing these issues, this paper looks into some of the problems in Philippine nursing that may conform with the broad contemporary problems identified by philosopher Alain Badiou. Viable solutions may be found in the exploration of emerging research methodologies, consideration of systems thinking using technological advances, and incorporating political competency among Filipino nurses.

Cutaneous metastasis as a diagnostic prelude in a 48-year-old female

@#Cutaneous metastasis (CM) describes the spread of a distant primary tumor into the skin. The overall incidence of CM ranges from 5% to 10% with breast cancer having the highest rate in women. CM of breast carcinoma origin may manifest as erysipelas-like erythema on the chest, having distinct raised borders and edema due to lymphatic obstruction termed as carcinoma erysipeloides. In most cases, CM is recognized after the initial diagnosis of primary internal malignancy. However, in 0.6–1% of cases, CM served as the first presenting sign of malignancy. A 48-year-old female presented with multiple, erythematous patches, and plaques with clear-cut raised margins, some topped with violaceous pinpoint papules and nodules on the chest, abdomen, and back. No palpable breast mass was appreciated. There was noted nipple retraction and axillary lymphadenopathy. A 4-mm skin punch biopsy revealed nests of large pleomorphic cells on the papillary dermis admixed with mitotic figures and attempts of ductal formation. CK7 and CEA were positive. Results of ultrasonography and mammogram were highly suspicious of malignancy. Core needle biopsy of the breast mass revealed an invasive ductal carcinoma. In the context of an eczematous presentation on the chest area without palpable nodules or mass on breast examination, a diagnostic challenge is expected. Interestingly, our patient represents a small group of CM having cutaneous lesions as their primary manifestation. A high index of suspicion supplemented with proper clinicopathologic and radiologic correlation is crucial for the diagnosis of CM. A multidisciplinary referral is required for adequate management and overall survival rate.

High and low frequency repetitive transcranial magnetic stimulation in smoking cessation: A systematic review

Abstract@#Repetitive Transcranial Magnetic Stimulation is a non-invasive brain stimulation process popularly used to treat psychiatric disorders. Multiple evidence shows effectiveness of rTMS in treating addiction, particularly in tobacco or cigarette users. This study consisted of review of current published literatures on repetitive transcranial magnetic stimulation following predefined eligibility criteria. The studies included evaluated at least one of the epidemiological parameters: (i) the meaning of repetitive transcranial magnetic stimulation (ii) Effectiveness of the Repetitive Transcranial Magnetic Simulation Over Behavioral therapy (iii) rTMS-associated adverse events among tobacco users@*Methodology@#We included published studies discussing rTMS in smoking cessation which examined if these interventions were effective and identified whether it has a severe negative effect on the patients. A total of 104 related studies were identified through database searches (Pubmed, Elsevier, Cochrane). Of which, 53 duplicate studies were removed. Five studies were then excluded with more than 10 years in publication. A total of 28 papers were then included in the study.@*Conclusion@#We conclude that rTMS is more effective in treating addiction in terms of smoking compared to behavioral therapy and rTMS affects triggered desired circuit which may be crucial among tobacco users. Individual neuronal excitability in the specific region’s subsequent induction may impact the therapeutic outcomes. With this, the high-frequency rTMS sequentially applied to the left superior medial frontal cortex and dorsolateral prefrontal cortex may be an effective tool for improving the cessation rate.

Online learning in nursing: Concept analysis

@#Online learning in nursing is a controversial idea that is viewed as a hindrance to the holistic learning of an individual, however, it was the only solution to prioritize the safety of students during the COVID-19 pandemic. This concepts aims to give a clear approach to how online learning will occur successfully in nursing education. The method used in intellectualizing the concept was Walker and Avant’s approach. The attributes of online learning involve: 1.) platform with the use of devices to create a classroom community; 2.) virtual schooling at home; 3.) entertainment and leisure activity; and 4.) enhanced with synchronous online classes and asynchronous video instruction. Apart from these attributes, the schema of nursing students needs to be addressed and enhanced through the delivery of learning by giving importance to visual, audio, read and/or writing, and kinesthetic learning styles fueled with the right attitude and technological competency.

Nurses adaptation to technology towards quality care

@#Concept analysis on adaptation to technology was done to give emphasis to its use in the nursing profession towards quality care. The constant changing environment not to mention the sudden existence of COVID-19 surprised the world alongside with arising technology that led to the idea of adaptation of nurses to meet the patient and/or client's needs. The method used in the concept was the Walker and Avant's approach. This approach is achieved through eight phases: choosing a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case, identifying borderline, related, and contrary cases, identifying antecedents and consequences, and defining empirical referents. The attributes of adaptation of nurses were successful interaction of nursing population with the technological environment and changes in function of the Nurse as to get used to daily routine and technology.

Prevalence and determinants of long‑acting reversible contraception initiation among teenage mothers in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Background@#According to the WHO, about 16 million girls at the age of 15–19 years give birth each year. In the Philippines, 600 live births a day are registered under teenage mothers. At Mariano Marcos Memorial Hospital and Medical Center, 12% of all obstetric admissions yearly are teenagers. The American College of Obstetricians and Gynecologists recommends long‑acting reversible contraception (LARCs), in the form of intrauterine device and progestin subdermal implant as pregnancy prevention options for young mothers. The objective of the study was to identify the prevalence and determinants of long‑acting reversible contraception (LARC) initiation among teenage mothers in Mariano Marcos Memorial Hospital and Medical Center.@*Methodology@#Prospective observational study: A self‑administered questionnaire was given to the respondents wherein they ranked determinants involved in their selection of a contraceptive method on a scale of 1–4 (1 being the most important, and 4, the least important.@*Results@#A total of 162 teenage mothers participated in the study. Majority of the respondents were 17–18 years old, enrolled up to high school, single, unemployed, and primiparas. Eighty‑seven percentage of all teenage mothers admitted at Mariano Marcos Memorial Hospital and Medical Center from December 2020 to December 2021 used long‑active reversible contraception. Ranked from most (1) to least (4) important, the respondents considered: (1) Effectivity, (2) Long duration, (3) Family influence, and (4) Peer influence as their determinants for initiating LARC method. The high effectiveness and long duration of LARC were the primary reasons for initiation, while the least factors they considered were that of peer and family influence.

Geographic information system-based spatial modelling of soil-transmitted Helminth Infections among preschool-aged children in Masbate, Philippines

Objectives@#Since the effectiveness of the Zero Open Defecation (ZOD) program as a scaling-up approach in lowering the rates of soil-transmitted helminth (STH) infections has not yet been locally explored, this study aimed to (1) describe the association between environmental determinants and STH cumulative prevalence, and (2) to predict the 2020 STH cumulative prevalence. @*Methods@#A generalized linear regression (GLR) model was used to determine the association of 2014–2015 environmental determinants and observed 2015 STH cumulative prevalence, while a geographically weighted regression (GWR) model was used to produce predicted 2020 STH cumulative prevalence. @*Results@#ArcGIS’ GLR tool with R2 of 63% found that statistically significant environmental determinants include distance near to water bodies, forest land use, access to sanitary toilet, level one water source, and ZOD status, while the ArcGIS’ GWR tool found that barangays, Cabangcalan, Matalangtalang, Talabaan, and Talib in Aroroy hypothetically met the national target below 30% for 2020 STH cumulative prevalence. @*Conclusion@#This study showed that barangays with a moderately low percentage of area with freshwater bodies, a moderately high percentage of households with sanitary toilet and level one water source, and a 100% status of ZOD have lower rates of STH cumulative prevalence in preschool-aged children in the selected municipalities in Masbate.

Depression among physicians in a government-designated COVID-center hospital during the Coronavirus Disease-19 pandemic

OBJECTIVES@#This study aimed to determine the prevalence, most common symptoms and sociodemographic factors associated with depression among physicians in a government COVID-Center i.e. Southern Philippines Medical Center-Institute of Psychiatry & Behavioral Medicine in Bajada, Davao City@*METHODOLOGY@#This cross-sectional, survey-based study collected socio-demographic data and PHQ-9 scores using Google Forms, from resident physicians from July 1 to August 31 2020. Multinomial logistics regression analysis was used to identify risk factors of depression.@*RESULTS@#Two hundred fifty-one (251) out of 376 physicians responded (68.39% response rate). The average age was 30 years old, majority were female (58.57%, 147), single (78.88%,198), frontliners (77.29%, 194), with average hospital experience of 2.0 years. Ninety six (38.26%) were assigned in surgical departments while 155 (61.75%) worked in nonsurgical departments. There were twelve respondents (4.78%) who had a history of psychiatric illness and 31 (12.35%) had previous psychiatric intervention, while 66 (26.29%) had a history of medical illness. Eighty-five (33.86%) had depression using PHQ-9; 57 (22.71%) as mild, 19 (7.57%) moderate, 7 (2.79%) moderately severe and 2 (0.8%) severe. Out of 85 residents who were depressed, the most common symptoms were: low energy (81, 95.29%); anhedonia (76, 89.41%); and feeling depressed (72, 84.70%). Medical illness was associated with higher levels of depression. Physicians with a history of psychiatric illness, psychiatric intervention and medical illness had significantly higher levels of depression.@*CONCLUSION@#More than a third (33.86%) of physicians screened positive for depression. Current mental health programs must be strengthened and made specific, to prevent and address depression especially among those who have a history of psychiatric and medical illness.

Factors Associated with Treatment Outcome of Patients with Pulmonary Tuberculosis in the Philippines, 2015 to 2016

Objective@#The study aims to determine the factors associated with unsuccessful treatment outcome among patients who have undergone tuberculosis treatment.@*Methods@#An analytic cross-sectional study was employed through secondary data analysis of administrative data collected by the National Tuberculosis Control Program from October 2015 to September 2016. Using multiple logistic regression analysis, factors associated with unsuccessful treatment outcome were determined. @*Results@#Multiple logistic regression analysis revealed that belonging to age groups 25 to 34 (aOR=0.73; 95%CI 0.54-0.99) or 35 to 44 (aOR=0.75; 95%CI 0.56-0.99), being male (aOR=1.30; 95%CI 1.03-1.64), doing crafts and related trades work (aOR=0.66; 95%CI 0.46-0.94), living in either a 4th class city (aOR=0.46; 95%CI 0.26-0.82), 1st class municipality (aOR=0.75; 95%CI 0.57-0.98), 4th class municipality (aOR=0.59; 95%CI 0.38-0.93), having a positive sputum smear result (aOR=1.60; 95%CI 1.29-2.00), having rifampicin-resistant/ multidrug-resistant tuberculosis (aOR=9.32; 95%CI 7.28-11.93), being a treatment after lost to follow-up case (aOR=1.84; 95%CI 1.37-2.47) or a case with previously unknown treatment outcome (aOR=1.42; 95%CI 1.00-2.01) were significant correlates of unsuccessful treatment outcome. @*Conclusion@#The study found that age, sex, occupation, residence, sputum smear results, drug resistance, and history of previous treatment were associated with unsuccessful treatment outcome.

An appraisal of the school health programme in primary schools in a rural community in Nigeria

Background:In a developing country with a large population and a high childhood mortality rate, it is important to have a good and properly organized School Health Programme to cater for the health needs of school children. Objectives: This study aimed at assessing the quality and efficacy of the School Health Programme in public primary schools in a rural community in Nigeria. Methods:A cross-sectional study was carried out in all the five public primary schools in Ilishan-Remo, Ogun State. An observational checklist was used, adapted from a similar study by Kuponiyi et al.A scoring system was used to grade the schools as good, fair or poor. Descriptive statistics were generated using SPSS version 21.Results:The public primary schools had good healthful school environments and school feeding services,but poor skill-based health education and school health services. Conclusions:From the assessment of the School Health Programme in these schools, it was seen that overall,the schools had a fair School Health Programme in place,although they were deficient in some vital facilities. It is necessary for all stakeholders in these schools to provide the materials and human resources needed to achieve an effective School Health Programme

Cutaneous cytomegalovirus infection presenting as persistent plaque on the nose in an HIV-AIDS patient

Cytomegalovirus (CMV) rarely manifests as cutaneous lesions in immunocompromised patients. Only 25 cases have been reported since 1991. It causes latent infection among exposed individuals but reactivation may occur in immunocompromised patients causing encephalitis, pneumonitis, colitis, retinitis and congenital fetal infection. Cutaneous manifestations of CMV infection usually present with various skin lesions such as ulcers, erosions, erythematous morbilliform rash, vesicles and bullae. We report a case of cutaneous CMV infection in an HIV-AIDS patient presenting as a persistent ulcerated plaque on the nose. The lesion slowly evolved into a plaque which partially destroyed the right alar rim. Skin punch biopsy showed perivascular giant cells with large eosinophilic inclusions resembling an owl's eye consistent with CMV infection. He was subsequently diagnosed with CMV retinitis because of blurring of vision and findings of retinal necrosis on fundoscopy. Oral valganciclovir 1800mg/day was given for 21 days. Significant thinning and drying of the plaque with no further progression of ulceration of the alar rim were noted.

Safety and tolerability assessment of insulin glulisine as part of an insulin regimen in the management of Filipino diabetics

BACKGROUND: Insulin glulisine  is a  new  rapid-acting insulin  analogue.  Currently,  few  data   are   available on its safety and tolerability among patients in the Asia-Pacific   region.OBJECTIVES:Primary Objective: To assess the safety and tolerability of insulin glulisine as part of an insulin treatment   regimen   in   Filipinos   with   diabetesSecondary  Objectives:1.    To compare the change in glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) levels at baseline and after  three  and  six months on an insulin treatment regimen with insulin  glulisine2.    To measure patients' level of  satisfaction  in  using   the   Insulin   glulisine  penMETHODS: This was a multicenter, observational, post- marketing  surveillance  study   of   adult   patients   (18   to Results: Among 1,805 patients included, 132 (7.31%) experienced hypoglycemia. The overall incidence of adverse events other than hypoglycemia was 0.78%. There  was  a  significant  reduction  in   baseline  levels   of HbA1c,  FBG  and  PPBG  during  the  follow-up  visits  at third and sixth months (all pCONCLUSION: This post-marketing surveillance study demonstrates the safety and tolerability of  insulin  glulisine  when  used   as   part   of   an   insulin   regimen in an actual clinical setting for the management of diabetes among Filipino  patients.  Insulin  glulisine  as  part of  a   diabetes  treatment  regimen  was   effective  in improving glycemic  parameters.  The  glulisine  pen  was   also   well   tolerated   and   accepted   by patients.

Valuation for cigarettes among University of the Philippines Manila students through stated preference methods

OBJECTIVE:The study aimed to assess the valuation for cigarettes among UP Manila students aged 18-24 through direct and indirect stated preference methods.METHODS: Direct (iterative bidding) and indirect (discrete choice experiment) stated preference methods were utilized to determine the smokers' Willingness-to-Pay (WTP) and non-smokers' Willingness-to-Accept (WTA). Median and interquartile range were used in describing both WTP and WTA. Fisher's Exact Test and T-test were performed using STATA v12 to determine the association between the identified factors.  RESULTS: Of the 212 respondents, 21 (9.91%) were smokers. The smokers' direct and indirect WTP for a cigarette stick were PhP 6.00 and PhP 12.43, respectively. There was a significant difference (p=0.01) between the results of the two methods. Meanwhile, 40.84% of the non-smokers could be induced to smoke with PhP 0.00 as their WTA. No significant association was found between the smokers' stated preference and their smoking status and allowance. The WTP of the smokers was higher than the December 2013 retail prices of cigarettes.CONCLUSION: The increased cigarette prices brought about by the Sin Tax Law were insufficient in stopping the selected UP Manila students to smoke. In addition, forty percent of non-smokers in the study could be induced to smoke. Thus, further price increase of cigarettes, as well as other tobacco control measures, is recommended to discourage smoking among the youth such as college students, specifically in UP Manila.

Treatment outcomes of patients with superior vena cava syndrome who received high dose radiotherapy at UP - PGH from 2009 - 2011

BACKGROUND: 85% of cases of Superior Vena Cava Obstruction (SVCO) are caused by malignancy. Radiation therapy (RT) is an effective therapeutic modality for SVCO localized in the thorax, especially for obstructive causes. OBJECTIVE: To determine the clinical profile and outcomes of patients who received radiation treatment at UP-PGH from January 1, 2009 - December 31, 2001. METHODS: Records of patients with SVCO were reviewed. The patient's demographic profiles were collected. Outcomes were labaled as recovered, improved, not improved and died based on standard definitions. STUDY DESIGN: Retrospective, descriptive study. STUDY SETTING: Philippine General Hospital STUDY POPULATION: UP-PGH patients with SVCO from 2009-2011. RESULTS: The majority of the referrals were from general medicine (50%) and the most common symptom was dyspnea (73%); however, it took the patients 2-4 weeks from the onset of symptoms to seek consult. 36% of patients had lung adenocarcinoma with disseminated disease at diagnosis. The majority (73%) showed symptomatic response after receiving the SVC dose. CONCLUSION: The importance of multidisciplinary approach to patient care cannot be overemphasized. Improvement in signs and symptoms, particularly with that of dyspnea, was noted in 72.5% of patients after receiving radiation therapy. Of the 8 patients who followed up for completion therapy, 5/8 of them reported significant improvement.

Therapeutic effect of ethanolic extract of Hygrophila spinosa T. Anders on gentamicin-induced nephrotoxicity in rats.

Therapeutic effect of ethanolic extract of Hygrophila spinosa in gentamicin-induced nephrotoxic model of kidney injury in male Sprague-Dawley rats was studied. Rats were administered with gentamicin at a dose of 80 mg/kg intraperitoneally (ip) to induce nephrotoxicity. Kidney function was assessed by measuring serum creatinine and urea. Kidney superoxide dismutase, lipid peroxidation, catalase and reduced glutathione were also measured in control and treated rats. H. spinosa extract showed free radical scavenging activities at doses of 50 and 250 mg/kg with a predominant activity at 250 mg/kg. The ethanolic extract also caused a reduction in serum creatinine and urea levels. Histopathological studies were conducted to confirm the therapeutic action of the plant extract. The results demonstrated that the ethanolic extract of whole plant of H. spinosa evinced the therapeutic effect and inhibited gentamicin-induced proximal tubular necrosis.