KNOWLEDGE OF RESIDENT PHYSICIANS & POST GRADUATE INTERNS IN VISAYAS COMMUNITY MEDICAL CENTER ON PERIPHERAL ARTERY DISEASE
BEETHOVEN BONGON, MD and BRETT BATOCTOY, MD
Background: Peripheral Arterial Disease (PAD) is an atherothrombotic syndrome that is associated with anelevated risk of cardiovascular and cerebrovascular events, including death, myocardial infarction (MI), and stroke. Unfortunately, PAD remains to be underdiagnosed and undertreated.
Objective:To determine the knowledge of resident physicians and postgraduate interns in the Visayas Community Medical Center (VCMC) regarding PAD.
Design: Cross-sectional, self-administered survey
Participants:Questionnaires were personally given to 21 resident physicians, four from the Department of Surgery, eight from the Department of Internal Medicine (IM) and nine from the Department of Family Medicine (FAMED). Also included in the study are 18 of the postgraduate interns (PGI) of VCMC. The study is conducted in the month of September to October 2009.
Results: The population scored an average of 58.75% of the questions. The department of Internal Medicine got the highest scoring average of 66.2% followed by the department of FAMED at 65.9%, 52.4% and50.4% by the PGIs and the department of Surgery respectively.
Conclusions: The residents and PGI are less knowledgeable of PAD in terms of its diagnosis, treatment and risk reduction therapy.
“THE OUTCOME OF TREATMENT OF DIABETIC FOOT
AMONG TYPE 2 DIABETES MELLITUS PATIENTS AT
VISAYAS COMMUNITY MEDICAL CENTER”
Nino JN Doydora, MD and Consolacion Cutillar, MD
Objective: To compare outcome of medical treatment and/or surgical treatment in diabetic patients admitted for foot infections.
Design: Retrospective Cohort Study
Setting: Visayas Community Medical Center, tertiary care
Participants: 94 diabetic patients with foot lesions
Outcome Measures: Patients’ age, gender, HBA1C, duration of diabetes and Wagner Classification were determined. Length of hospital stay, FBS, mean post-prandial blood glucose (PPBG) and presence of complications were compared.
Results: Ninety-four patients were studied. The mean age was 63.3+11years, male:female was 1.2:1, mean duration of illness was 8.3+4.5 years. Forty-one percent of lesions was in Wagner Stage I and 37% in Stage 2. Fifty-nine percent had medical treatment while 41% had medical-surgical treatment: 46% debridement, 23% disarticulation, 28% BKA and 3% AKA. There was a significant difference in the length of stay among patients; 84% of the medical treatment group stayed for <7 days compared to the medical-surgical treatment group with 31%, with a p value of 0.000. Both groups have poor glycemic control with mean PPBG >140mg/dl at 69% and 92%, respectively, p value of 0.007. Complications were noted in 9% of the medical treatment group and 3% of the medical-surgical treatment group, with no significant difference. It was noted that majority of those in the medical treatment group were Wagner Grade I.
Conclusion: Using Wagner Grading and its recommended treatment, medical management for diabetic foot leads to shorter hospital stay. There is no significant difference in the outcome and glycemic control of patients given medical treatment or medical with surgical treatment.
* paper submitted for Research Contest December 2009 CIM Medical Congress Waterfront, Lahug
"Knowledge, Attitudes and Practices on Diagnosis and Management of Pulmonary Tuberculosis among Fellows members of the PCP (pulmonologist, Infectious Disease Specialis and General Internists) In Cebu City"
Dr. Jeny Yu (VCMC)
OBJECIVE: To determine the physicians' knowledge, attitudes and practices on diagnlosis, and management of pulmonary tuberculosis DESIGN: Observational study specifically the Survey Type using questionaire PARTICIPANTS: 32 questionaires were distributted to various clinics in Cebu City DATA ANALYSIS: Numerical data were summarized by computing for the percentage, mean and standard deviation. RESULTS: All respondents considered tuberculosis as a serious problem in the country. The rating of the physician-respondents to the National Tuberculosis Program of the country is between fair to good. Most of the physicians (64%) reated the Directly-Observed Therapy Program of TB as "good" while 32% rated it as fair. 91% or 20 out of 22 doctors would request for sputum exam. 27.3% would use chest X-ray alone which was not consistent with the guidelines. For initial treatment, a standard 4-drug regimen was used among respondents (n=19: 84%). At the start of giving treatment to the patients, 100% of the respondents answered they advise the patient regarding the importance of treatment compliance and adverse effects of anti-TB medications. Only 62'% advise follow-up. 36% of the physicians advise their patients to monitor treatment by Chest X-ray alone 100% also uses sputum exam for treatment monitoring. In case of drug resistance, only 9% would add one drug. 23% of the physicians would add 2 drugs to current regimen; 18.2 % wold refer the patients to a pulmonologist for consult. 54.6% of the doctors do not notify authorities if they have TB patients; 27% of the reasons is due to too much paperwork. CONCLUSION: Most respondents who are fellow- members of th ePCP in Cebu City who specialized in pulmonology, Infectious Disease and General Medicine favorably rate the NTP and DOTS. This coud be due to the effective communiation between those implementing national tuberculosis program and physicians especially thosi in private practice. It has been found out that majority of our respondents' KAP in the initial laboratory diagnosis, initial drug regimen and treatment monitoring for tuberculosis did not deviate from the clinical practice guidelines. A negative finding in this study is the over dependence on chest X-ray for initial diagnosis by 27%. The difficulty lies in the management in MDR-TB cases with only 9% of the respondents being knowledgeable of current recommendation.
INCIDENCE OF DIASTOLIC VS DIASTOLIC WITH SYSTOLIC DYSFUNCTION IN CONGESTIVEHEART FAILURE ON 2D ECHOCARDIOGRAM IN PATIENTS AT VISAYAS COMMUNITY MEDICAL CENTER ( 2006-2007)
Dr. Genevieve Elegino
OBJECTIVE: To document the incidence of diastolic vs diastolic with systolic dysfunction in congestive heart failure on 2D Echocardiogram in patients at Visayas Community Medical Center (2005-2006)
DESIGN: Retrospective Research Design encompassing 2 years
PARTICIPANTS: Included all patients admitted at Visayas Community Medical Center diagnosed with Congestive Heart Failure from January 2006-December 2007
DATA ANALYSIS: Numerical data were summarized and compared using Statistical Package for Social Sciences
MAIN OUTCOME MEASURES: Age & sex-specific frequency; co-morbid conditions
RESULTS: The mean age of the subjects of the study is approximately 64 years with a standard deviation of 12 years. Of the 93 patients diagnosed with CHF, 36.8 % are classified as Class IV while only 0.8 %are havingClass I. Female CHF patientsat a later age (>50 years old) are more prone to diastolic dysfunction. .Majority (86%) of the respondents are diagnosed with Hypertension while the remainder (14%) are suffering from Coronary Artery Disease. However, frequency maybe underestimated because of the dependence on the documentation of the Modified Framingham Criteria in hospital records.
CONCLUSION: Congestive Heart Failure is a heterogeneous conditionthat is frequently seen at Visayas Community MedicalCenter and diastolic dysfunction is quite commonin above 50 years of age , mostly females associated with hypertension as compared to diastolic with systolic dysfunction. Further study of the natural history and underlying mechanism ofheart failure should be performed because each require a different treatment.
Most Common Organism Causing UTI Among Diabetic Patients Admitted at VCMC (Jan 1, 06- Sept 1, 08)
Dr. Jesus Bryan Cepedoza
OBJECTIVE: To determine the most common organism causing UTI among diabetic patients admitted to VCMC Jan 1, 2006 to Sept 1, 2008
DESIGN: retrospective-descriptive study
PARTICIPANTS: All patient admitted at Visayas Community Medical Center (VCMC) from January 1, 2006- Sept 1, 2008 with final diagnosis of either type 1 or type 2 diabetes who were 14 to 75 years of age with culture and sensitivity tests result (with-out prior antibiotic treatment) were included.
DATA ANALYSIS: Numerical data were summarized and compared using Statistical Package for Social Sciences
CONCLUSION: The most common organisms causing UTI among diabetic patients admitted at VCMC is E. coli. These are followed by: Proteus mirabilis, Klebsiella pneumonia, Klebsiella oxytoca, and Proteus vulgaris. Of the 22 antibiotics included in the sensitivity test, Amoxicillin, Ampicillin and Trimethoprim sulfamethoxazole has the lowest activity against the common organism causing UTI, while Meropenem and Imipenem has the highest activity
RECOMMENDATIONS: Diabetic patient with UTI should not be prescribed with the following antibiotics: Amoxicillin, Ampicillin and trimethoprim-sulfamethoxazole because organisms are likely resistant to these antibiotics. Reactions to organisms of the following antibiotics: Cefuroxime, Augmentin, Gentamycin, Cefoperazone and Ampi/sulbactam are vague (50-60% sensitive), thus, these antibiotics should not also be given as prescriptions to UTI-diabetic patients. For out-patient management of UTI in diabetic patient, a choice of Chloramphenicol, Cefixime, Ciprofloxacin, Norfloxacin, and Moxifloxacin would be wise. (60-70% sensitive). For emperic in-patient management of UTI in diabetic patient, the choice of antibiotic would largely depend on the meticulous assessment of the hemodynamic status of the patient. Organisms causing UTI in DM patient are 70-80% sensitive to Cefepime, 80-90% sensitive to Amikacin, Netilmicin, Piperacillin+tazobactam, and 93% sensitive to Carbapenem (Meropenem and Imipenem)
A Study on the Prevalence of Excessive Daytime Sleepiness using the Epworth Sleepiness Scale, and the Sleeping Patterns of Residents in Internal Medicine among the different PCP-accredited training institutions in Cebu City.
Dr. Karina Pulido-Lapinid - 1st placer
Objective: To determine the prevalence of Excessive Daytime Sleepiness (EDS)using the Epworth Sleepiness Scale (ESS) and the sleeping patterns of residents using self-administered questionnaires in Internal Medicine among the different training institutions in Cebu City.
Study Design:Multi-institutional, cross-sectional
Study Population:Ninety-six (96) IM residents (77.9% response rate)in Cebu City-based Philippine College of Physicians accredited training hospitals (Cebu City Medical Center, Cebu Doctors University Hospital, Cebu Velez General Hospital, Chong Hua Hospital, Perpetual Succour Hospital, Sacred Heart Hospital, Visayas Community Medical Center, Vicente Sotto Memorial Medical Center).
Data Analysis:Numerical data were summarized and compared using Statistical Package for Social Sciences.
Results:EDS, defined by ESS score >10, has a high prevalence rate of 80.2% in all respondents.However, the difference was not statistically significant.Majority were 1st year residents, with EDS prevalent in all year levels, but was not also statistically significant.Residents who went on every three day duty had a statistically significant higher mean ESS compared to those on every four duty.No significant difference noted on the number of awakenings and sleep duration. Most common reason for waking up was ER/Ward/ICU calls. Majority of the subjects needed no aid to fall asleep, including medications.Subjects claimed they feel refreshed after a nap or a night’s sleep but still feel sleepy during the day.
Conclusion:There is a high prevalence of EDS among residents in Internal Medicine in Cebu City.This is consistent with previous studies in Manila, as well as in western countries. Statistically significant EDS was noted in those with more frequent duty days (every three versus every four days).
Practices and Management of Family Medicine Physicians and Internists on Helicobacter pylori Infection in Cebu City
Dr. Roy Ballaso
Objective: To identify the practices and management of family medicine physicians and internists on Helicobacter pylori infection
Design: Descriptive research design using the survey method
Participants: Purposive sampling technique was employed with a total of 28 physician respondents affiliated at Visayas Community Medical Center
Data Analysis: Numerical data were analyzed by computing the mean, rank, percentage and standard deviation
Results: The physician-respondents considered inability of the patients to buy prescribed medicines (16 out of 28 frequency count) as the number 1 obstacle in the management of H pylori-associated diseases. The majority of physician-respondents would eradicate H pylori infection more so in patients with peptic ulcer disease (22 frequency count). About seventy one percent of the respondents have eradicated H pylori in the practice of their profession. Seventy nine percent of the respondents said that they confirm or double check H pylori infection before they give drug prescriptions. With regards to the initial test used to confirm H pylori infection, majority (64.4%) of the physician-respondents used rapid urease testing. Finally, majority (82.1%) of the physicians used proton pump inhibitor (PPI)-based triple drug regimen as a drug combination to eradicate H pylori-related diseases.
Conclusion:Majority of the respondents would like to be certain of the disease before giving prescriptions to their patients. But, it is also alarming that some doctors do not confirm the existence of the bacteria before giving drug prescriptions. Most of the physician respondents have somehow conform to the international guideline, in terms of standard eradication protocol for H pylori infection. But the major obstacle in the management, still lies on the patient’s inability to buy these drugs.
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List of Resident Physicians
Dr. Francis Christian Cortes
Dr. Shoji Mantilla
Dr. Carla Cabrera
Dr. Jude Bajarias
Dr. Carlo Gallego
Dr. Ella Reyes
Dr. Julie Cinchez
Dr. Charisse Camarote
Dr. Edward Alexis Caballero
MORTALITY & MORBIDITY CONFERENCE
Presentor: Dr. Edward Caballero
Date: November 30, 2009
Time: 8:30 AM
Final Diagnoses: SLE with Nephritis
Venue: VCMC Conference Rm
GRAND ROUNDS and other conferences
Presentor: Dr. Francis Cortes
Case: Obesity and Kidney Disease
Reactor: Dr. Mayo
Date: December 7 2009
Place: VCMC Conference Room
Speaker: Michael Tabaloc, MD, FPCP
November 27, 2009/ 8:30 am
VCMC Conference Room
Dr. Amelita Guangko
Chairman, Department of Internal Medicine
Dr. Leilanie Salgado
Dr. Emma Shiela Jorgio
Dr. Maritzie Eribal
Director, Continuing Medical Education
Dr. Eli AR Belarmino
Visayas Community Medical Center
the Research Winners:
Dr. Karina Lapinid - 1st Placer
Dr. Jennie Yu - 2nd Placer
Dr. Bryan Cepedoza - 3rd Placer