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OMMC Surgery 2002 Research Forum

The 2002 Research Forum of the Department of Surgery of Ospital ng Maynila Medical Center (OMMC) was held on August 13, 2002, from 8-12 am, at the Department's Conference Room. The forum was supported by the North Texas Association of Philippine Physicians with a $1000 grant. Eight papers were presented by the surgical residents, 4 action research papers, 3 case reports, and 1 clinical practice guidelines. Four consultants of the department served as judges, reactors, and editors of the papers.

All the papers presented and their respective findings and results have utility in improving patient care and in fact, are now being implemented in OMMC. Below are the summaries of the papers:

1. Selective as against mandatory preoperative work-ups in patients for thyroidectomy was documented to be safe, cost-effective (no significant difference in mortality, morbidity, and schedule of operation cancellation rate with savings of at least PhP 5,000 per patient) and associated with reduced number of preoperative visits (from usual 6 to 2). This is being practiced in OMMC since September, 2001 and will be adopted in other kinds of operations and in other surgical departments like OB-GYN.

2. Using a G-19 needle in the aspiration biopsy of palpable breast masses compared to G-21 and G-23 needles was found to be the best in terms of sampling adequacy rate, conclusive report rate, and accuracy reading rate.

3. Recumbent plain abdominal x-ray without the need for an upright film was found to be sufficient in the paraclinical diagnostic evaluation of patients with acute intestinal obstruction. If this practice is adopted, it will save a charity hospital and a paying patient one unnecessary x-ray film which costs about PhP 200.

4. Significant discrepancy in the clinical and pathological tumor and node evaluation in patients with breast cancer exists in the Philippines. In the preliminary report, communication between the surgeons and the pathologists and a structured training for the surgeons using report cards seemed to be effective strategies in reducing such discrepancy with an impact of improved quality in patient care.

5. The clinical practice guidelines on inguinal hernias gave guidelines on diagnosis and treatment on 4 clinical questions - what is the most reliable diagnostic signs of inguinal hernia; what to do when there is no inguinal bulge at time of examination in patients complaining of such; what is the most cost-effective paraclinical diagnostic procedure when there is a question of inguinal hernia or mass; and what is the most cost-effective surgical treatment for indirect inguinal hernia in a young adult. As to treatment, open herniorrhapy without mesh grafting is recommended for small indirect inguinal hernias while open herniorrhapy with mesh grafting is recommended for large indirect inguinal hernias. Laparoscopy herniorrhaphy presently remains an option which is not being recommended when the primary health care approach (particularly on the aspect of ready availability and affordability) is invoked.

The 3 case reports are intended to promote awareness to the public and health care providers on the prevention and early diagnosis and treatment of tetanus in necrotic soft tissue sarcoma of the extremity, swallowed santol seeds, and swallowed barbeque sticks causing surgical abdomen.

The findings of the papers presented in the 2002 Research Forum will be disseminated to the public and health care providers not only for purpose of sharing of information but also in the hope of extending their utility in improving the quality health care in other parts of the country. Two of the papers (nos. 3 and 4) were done through a multicenter cooperative and collaborative action research study (MCCCARS) involving at least 6 hospitals located in Luzon, the Visayas, and Mindanao. The MCCCARS is an assurance that the utility of the research papers will not be confined to OMMC but will reach out to other parts of the country.

For more information on the 2002 Research Forum and the papers, visit http://mcccars.tripod.com and http://ommcsurgery.tripod.com/research/researchdisc.htm