University of the Philippines Manila

About: University of the Philippines Manila is a education organization based out in Manila, Philippines. It is known for research contribution in the topics: Population & Medicine. The organization has 2218 authors who have published 2357 publications receiving 88781 citations. The organization is also known as: UPM.

A pragmatic multicentre randomised controlled trial comparing stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease: the eTHoS study.

Abstract: Background Haemorrhoids are a benign anorectal condition and are highly prevalent in the UK population. Treatments involve clinic-based procedures and surgery. The surgical procedures available include stapled haemorrhoidopexy (SH) and traditional haemorrhoidectomy (TH), and over 25,000 operations are performed for haemorrhoids annually in the UK. The disease is therefore important both to patients and to health service commissioners. Debate remains as to which of these surgical procedures is the most clinically effective and cost-effective. Objective The aim of this study was to compare the clinical effectiveness and cost-effectiveness of SH with that of TH. Design A large, open two-arm parallel-group pragmatic multicentre randomised controlled trial involving 32 UK hospitals and a within-trial cost–benefit analysis. A discrete choice experiment was conducted to estimate benefits (willingness to pay). Participants Patients with grades II–IV haemorrhoids who had not previously undergone SH or TH were included in the study. Interventions Participants were randomised to receive either SH or TH. Randomisation was minimised at 1 : 1, in accordance with baseline EuroQol-5 Dimensions, three-level version (EQ-5D-3L) score, haemorrhoid grade, sex and centre, via an automated system. Main outcome measures The primary outcome was area under the quality-of-life curve measured using the EQ-5D-3L descriptive system over 24 months, and the primary economic outcome was the incremental cost-effectiveness ratio. Secondary outcomes included disease-specific quality of life, recurrence, complications, further interventions and costs. Results Between January 2011 and August 2014, 777 patients were randomised (389 to receive SH and 388 to receive TH). There were 774 participants included in the analysis as a result of one post-randomisation exclusion in the SH arm and two in the TH arm. SH was less painful than TH in the short term. Surgical complications were similar in both arms. EQ-5D-3L score was higher for the SH arm in the first 6 weeks after surgery, but over 24 months the TH group had significantly better EQ-5D-3L scores (–0.073, 95% confidence interval –0.140 to –0.006; p = 0.0342). Symptoms and further interventions were significantly fewer in the TH arm at 24 months. Continence was better in the TH arm and tenesmus occurred less frequently. The number of serious adverse events reported was 24 out of 337 (7.1%) for participants who received SH and 33 out of 352 (9.4%) for those who received TH. There were two deaths in the SH arm, both unrelated to the eTHoS (either Traditional Haemorrhoidectomy or Stapled haemorrhoidopexy for haemorrhoidal disease) study. Patient preference did not seem to influence the treatment difference. SH was dominated by TH as it cost more and was less effective. The net benefit for the TH arm was higher than that for the SH arm. Limitations Neither the participants nor the assessors were masked to treatment assignment and final recruitment was slightly short of the total target of 800. There were also substantial missing follow-up data. Conclusions While patients who received SH had less short-term pain, after 6 weeks, recurrence rates, symptoms, re-interventions and quality-of-life measures all favoured TH. In addition, TH is cheaper. As part of a tailored management plan for haemorrhoids, TH should be considered over SH as the surgical treatment of choice for haemorrhoids refractory to clinic-based interventions. Future work Perform an updated meta-analysis incorporating recently conducted European trials [eTHoS, HubBLe (haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids) and LingaLongo (Cost-effectiveness of New Surgical Treatments for Haemorrhoidal Disease)]. Trial registration Current Controlled Trials ISRCTN80061723. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 70. See the NIHR Journals Library website for further project information.

A Novel Patient-Specific Drill Guide Template for Pedicle Screw Insertion into the Subaxial Cervical Spine Utilizing Stereolithographic Modelling: An In Vitro Study.

Abstract: STUDY DESIGN Cadaveric study. PURPOSE The purpose of this study was to assess the accuracy and feasibility of cervical pedicle screw (CPS) insertion into the subaxial cervical spine placed using a patient-specific drill guide template constructed from a stereolithographic model. OVERVIEW OF LITERATURE CPS fixation is an invaluable tool for posterior cervical fixation because of its biomechanical advantages. The major drawback is its narrow corridor that allows very little clearance for neural and vascular injuries. METHODS Fifty subaxial pedicles of the cervical vertebrae from five cadavers were scanned into thin slices using computed tomography (CT). Digital imaging and communications in medicine images of the cadaver spine were digitally processed and printed to scale as a three-dimensional (3D) model. Drill guide templates were manually moulded over the 3D-printed models incorporating pins inserted in the pedicles. The drill guide templates were used for precise placement of the drill holes in the pedicles of cadaveric specimens for pedicle screw fixation. RESULTS The instrumented cadaveric spines were subjected to CT to assess the accuracy of our pedicle placement by an external observer. Our patient-specific drill guide template had an accuracy of 94%. CONCLUSIONS The use of a patient-specific drill guide constructed using stereolithography improved the accuracy of CPS placement in a cadaveric model.

Oral cholera vaccine development and use in Vietnam.

Abstract: Vietnam is the first and only country in the world to regularly use oral cholera vaccines (OCVs) in their cholera control program. From 1998 to 2012, more than 10.9 million doses of the locally produced OCV were deployed in the country through its public health system. We present an overview of cholera epidemiology in Vietnam and the development and deployment of the OCV. Since 1997, the number of cholera cases in Vietnam has declined, in association with increased OCV use as well as improvements in socioeconomic and water and sanitation conditions. It is not possible to establish the relative contributions of each of these to the reduction in cholera rates. Hue, the only province to use OCVs consistently every year, has not reported any cholera case since 2003. As WHO organizes a stockpile of OCV for use in emergencies and recommends the use of OCVs together with traditional means of control, the experience in Vietnam will be helpful to other at-risk countries as they look towards adopting the vaccine in their cholera control programs.

Health Data Collection Before, During and After Emergencies and Disasters-The Result of the Kobe Expert Meeting.

Abstract: In October 2018, the World Health Organization (WHO) convened a meeting to identify key research needs, bringing together leading experts from WHO, WHO Thematic Platform for Health Emergency and Disaster Risk Management (Health-EDRM) Research Network (TPRN), World Association for Disaster and Emergency Medicine (WADEM), the Japan International Cooperation Agency (JICA), and delegates to the Asia Pacific Conference for Disaster Medicine (APCDM) 2018. The meeting identified key research needs in five major research areas for Health-EDRM. One of the five major research areas was “Health data collection during emergency and disaster”. Experts for this research area highlighted WHO Emergency Medical Team Minimum Data Set (EMT MDS), a standardized medical data collection method during and after disasters, as an example of substantial progress, with knowledge gaps and challenges in implementation in some regions and countries (i.e., information collection methodology in medical facilities of affected local areas, seamless and practical connection between acute phase data collection and post-acute phase local surveillance). The discussion on this research area also identified key research needs in standardization of broader health-related data to inform effective Health EDRM (i.e., community vulnerabilities, hospital functional status, infrastructure, lifelines and health workforce).