DEPARTMENT OF NATIONAL DEFENSE PHILIPPINE VETERANS AFFAIRS OFFICE VETERANS MEMORIAL MEDICAL CENTER

Accomplishment Report January to June 30, 2012

I.

Mandate Provide hospitalization, medical care and treatment to the veterans and their dependents pursuant to: R.A. No. 9396, March 18, 2007 An act redefining the term Veteran R.A. No. 6948, April 9, 1990 Known as Veterans Code E.O. No. 292, July 25, 1987 Known as the Administrative Code of 1987 Public Law 865, 80th U.S. Congress, July 1, 1948 An Act for the construction and equipping of the Veterans Memorial Hospital in the Philippines to provide medical care to the World War II veterans.

II.

Mission Patient Care to provide quality health care to the veterans and their dependents. Education and Training to provide an integrated, comprehensive and progressive educational training program in medical and allied fields not only for its staff and personnel but also to fellows, residents, interns and undergraduate students. Research to develop and muster the research capabilities and potential of the Medical Center by initiating, encouraging and promoting basic clinical and laboratory research. Civic Action and Outreach Program to provide basic medical services to nearby communities and to support the civic action program of the national government.

III.

Major Thrusts Update medical equipment and improve hospital facilities. Enhance medical support to the veterans and their dependents by providing the needed medicines and diagnostic services.

IV.

Major Final Output Hospitalization and medical care and treatment for the veterans and their dependents and to a limited number of civilian paying and PHILHEALTH member patients.

V.

Performance Indicators, Targets and Accomplishments

Accomplishment Jan to June 2012 Program Actual

Performance Indicators 1. In-Patient Health Care Service Total In-patient Days % of Total Discharged vs Total In-patient Census Average Length of Hospital Stay 2. Out-Patient Health Care Services Total Out-patient Cases or Visits

63,526 90% 12 to 14 days

66,964 82% 15 days

91,000

105,649

VI.

Resources
1. Manpower
Category Administrative Group Professional Group Sub-total Training Residents TOTAL Authorized Plantilla Positions 353 1,002 1,355 135 1,490 Actual Filled-Up of Dec. 31, 2010 286 or 81% 976 or 97% 1,262 or 93% 121 or 90% 1,383 or 93% As of Dec 31, 2011 As 286 or 81% 992 or 99% 1,278 or 94% 130 or 96% 1,408 or 94% As of June 30, 2012 264 or 75% 987 or 99% 1,251 or 92% 128 or 95% 1,379 or 93%

2. Financial (in peso)

Expense PS MOOE CO Total Utilization Rate Jan to June 2012 Allotment Received P455,790,476.00 387,652,499.84 80,109,474.00 P923,552,449.84 Obligations Incurred P247,727,211.67 226,044,207.82 46,590,040.00 P520,361,459.49 56%

3. Selected Equipment Received As of May 2012 (Refer to Annex E for selected photos)
Specification Donation: USDVA Photo coagulator Portable Laser System, with accessories, ALCON 532NM, for Clinical and Operating Room use the of Department of Ophthalmology, Php6,224,125.00 Operating Microscope, LEICA M844 F20, with complete accessories, SN:210212004, for Cataract, Anterior segment and Retinal Surgery, Department of Ophthalmology, Php3,214,285.71 Perimeter Machine HAAG-STREIT, OCTAPUS 900, for Diagnosis, Screening and Follow-up of Glaucoma, Department of Ophthalmology Php6.4M Use of Income Drop Light for use of Department of OB-Gyne Php78,960.00 Pneumatic Compression Pump, SN:0900028837, Department of Rehabilitation Medicine (DRM) Php116,480.00 Patient Monitor, ADVANCE Model: AM-2000E, Department of Anesthesiology, Php161,356.00 Chair, Hemodialysis, Single, Reclining, Fixed Type, Manual Operated, for use of Ward 4, Php138,800.00 Positioning Laser, Cobalt-60, for use of Department of Rediology and Radiotherapy, Php1,287,000.00 Sphygmomanometer, Aneroid Type, Non-Mercurial, with Stand, for use of Specialty Clinic (MACC), Php14,100.00 Sphygmomanometer, Non-Mercurial, Table Top, for use of the Department of Family Medicine and Out-Patient Services, Php35,000.00 Common Fund Autoclave Microprocessor PID Controller, Model: WACS-1080, Floor Standing, Fully Automatic, Brand: DAIHAN SCIENTIFIC, SN:007080311BA002 & 00708312B003, for use of Department of Pathology, Php648,780.00 Processor, Tissue, SLEE Brand, MDL: MTP (Digital) with AVR for use of the Department of Pathology, Php1,010,000.00 Defibrillator with Monitor, MINDRY BENEHEART D3, for use of the Department of Anesthesiology, Recovery Room, Pulmonary Intensive Care Unit, and Medical Intensive Care Unit, Php1,020,200.00 Electric Simulator Machine< METRON VECTOSURGE 5,Combine Inferential & TNS Electrotherapy Unit, for use of DRM, Php330,000.00
eff/ 6/22/2012

Unit Ea Ea Ea

Quantity 1 1 1

Pc

Ea Ea Set Ea Ea

2 8 1 2 10

Ea Ea Ea Ea

2 1 4 2

VII.

Assessment and Evaluation The Veterans Memorial Medical Center provided quality health care services to the veterans and their dependents both under the In-patient and Out-patient Health Care Program. For the period January to June 2012, the VMMC In-patient Health Care Program treated 4,884 inpatients, with an average hospital stay of 15 days. The actual total in-patient days served is 66,964 which is 3,438 or 5.41% more than the target of 63,526. The average daily in-patient load is 368 and the average rate of bed occupancy is 55% of the 667 actual operating beds. Only 82% of the 90% projected percentage of total discharges within 12 to 14days of confinement against the total in-patient census was attained because some of the patients have multiple diseases that needed longer confinement of more than 14 days to complete their medication. As of June 2012, there are seventeen (17) veterans and dependents confined in this

institution for more than a year, one patient since September 1995, one since FY 2000, one since FY 2005, one since FY 2008, nine since FY 2009, three since FY 2010 and one since FY 2011. Most of these patients have cardio vascular diseases (CVD), chronic pulmonary obstructive diseases (COPD), etc. The Out-patient Health Care Program treated 105,649 cases which is 14,649 or 16% more than the target of 91,000. The average daily out-patient cases treated is 835. The increased is attributed to the free hospitalization privileges such as consultation, medical procedures both diagnostic and therapeutic (laboratory and radiology examinations, dialysis, chemotherapy, cobalt, rehabilitation, psychiatric treatment, dental services, etc.), provision for free maintenance medicines of up to one month. With the improved medical technology, some of the medical procedures formerly done in the inpatient are now available in the out-patient care program. For the period January to June 2012, the OPD Dialysis Center provided 2,768 treatments to 130 veterans and their dependents, 5 civilian patients and 2 VMMCP dependents or a total of 137 patients. Twenty-one (21) veterans and dependents has been undergoing dialysis treatment since FY2008, 8 since FY2009, another 9 since FY2010, 41 since 2011 and 56 new patients for 2012. For the renal dialysis, 7,748 treatments were given to 37 veterans and dependents and 1 civilian patient. To meet the increasing demand for quality health care of the veterans and their dependents, the Medical Center has on-going projects on the Renovation of the OPD Main and Annex Building, and the Extension and Renovation of the OPD Dialysis Center. The Medical Center continuously support the civic action program of the national government to provide quality health and nutrition services to depressed areas not only within the Quezon City but also to nearby communities, as necessary.

VIII.

Conclusion The Veterans Memorial Medical Center attained its mandate to provide hospitalization and medical care and treatment to the veterans and their dependents pursuant to R.A. 6948, An Act Standardizing and Upgrading the Benefits of Military Veterans and their Dependents and R.A. No. 9396, An Act Redefining the Term Veterans Thereby Amending Further R.A. No. 6948, as Amended. The Medical Center shall continue to pursue its vision to render premium medical services to the increasing number of veterans and their dependents.

IX.

Recommendation The following are the concerns of the Medical Center: 1. Maintenance and Other Operating Expenses particularly the cost of operation of new equipment, for the upgrading of its 56 year old facilities, and for the acquisition of new equipment necessary to facilitate early detection and treatment of illnesses. At present, hospital income is being use to augment the limited funds for the maintenance and other operating expenses. However, it may reach a particular time when it may no longer be enough to sustain the increasing demand on quality health care of the veterans and their dependents. 2. Full implementation of The Magna Carta of Public Health Workers pursuant to R.A. No. 7305.

ctc/ eff/7-9-12

Annex A

Health Care Services January to June 2012 Authoriz ed Nonveterans 9

Indicator A. In-patient Health Care 1. Total number of in-patients a. In-patient census as of midnight of December 31, 2011 b. Total Admissions, Jan-Jun 2012 Total In-patients Treated 2. Total In-patient Days 3. Average Daily Patient Load (Ward) 4. Operating Beds 5. Total Bed Days 6. Total Bed Days Utilized 7. Average Bed Occupancy Rate 8. Average Length of Hospital Stay 9. Discharges a. Alive* b. Dead Total Discharges 10. Percentage of Total Discharges* vs. Total Hospital In-patient Census B. Out-patient Health Care 1. Out-patient Cases/ Visits 2. Scheduled Treatment: a. Dialysis Treatment b. Rehabilitation Therapy c. Chemotherapy d. Psychiatric Treatment e. Cobalt Exposures Sub-total 3. Emergency Ward Total

Veterans & Dependents 211

CP 43

Total 263

3,331 3,542 54,894 302 17 days

198 207 1,642 9 9 days

1,092 1,135 10,428 57 10 days

2,853 412 3,265 81%

71,985

Working days 123.5; calendar days - 182

10,431 1,800 216 493 1,791 14,731 6,500 93,216

4,350

87%

180 11 191

953 70 1,023 2,474 84%

4,621 4,884 66,964 368 667 121,394 66,976 55% 15 days 3,986 493 4,479 82%

12 400 1 20 433 432 5,215

73 1,439 84 2,222 3,818 926 7,218

10,516 3,639 301 493 4,033 18,982 7,858 105,649

78,809

Annex B

Medical Education and Training Program January to June 2012

I.

Training Residency Program A. Training Residents 1. Supported by VMMC 2. Supported by Other Institutions B. Fellows Total 113 6 15 134

II.

Internship and Student Affiliation Program A. Medical Interns B. Paramedical Interns 1. Physical Therapists 2. Occupational Therapists 3. Speech Pathologists 4. Pharmacy Interns 5. Nursing Affiliates 6. Medical Technology Interns 7. Dietetic Affiliates 8. Social Worker Affiliates 9. 4th Year Medical Students (Clerkship) Total 157 34 524 223 59 19 25

III.

A. Training In-house Training/ Number of participants Outside Training/ Number of participants B. Orientation No. of Orientation conducted/ Number of participants C. Coordinated trainings and seminars with other agencies No. of participants

Note: 1 medical intern graduated April 2012 and a total of 186 medical technologists graduated April and May 2012

1,016 1,041

Staff Development and Training Program

7 96

691 504 50 -

Annex C

List of On-going Research Protocol CY 2012

Status (on-going; complete w/ grade; discontinue, etc.)

April 2011

Approval Date

2 3

4 5 6 7 8 9

May 2009

June 2009 January 2010 January 2010 January 2010 May 2009

A Perspective, Randomized Multicenter Open Label Phase III Study of Active Specific Immunotherapy with Racotumumab plus Best Support Treatment versus Best Support Treatment in Patients with Advanced Non-Small Cell Lung Cancer Relationship of the Level of Depression and Family Function with Glycemic Control among Patients in VMMC Out-patient Department Protocol No. 8021977 Emilia Study A Randomized Multicenter, Phase III Open-Label Study of the Efficacy and Safety of Transfugeemab MCC DMI versus Capacitabine + LApatinib in patients with her 2 positive locally advanced on Metastatic Breast Cancer who have reclined prior Trastuzumab-based therapy Clinical Profile of Elderly Patients with Ischemic versus Hemorrhagic Stroke admitted at VMMC

Title of Research

Dr. Domingo Ganzon

Author

Dr. Christine Yap et al Dr. Paul Francis Pua

10

Comparison of Lipid Parameters and In-hospital Outcomes of Elderly ACS Patients A survey on the knowledge and perception of patients on risk factors and prevention of stroke The Efficacy of N. Acetylcysteine in the Prevention of Cisplastin Induced Nephrolotoxity Among VMMC Patients with Solid Organ Tumor Adequacy of Glycemic Control in Dialysis Patient with Diabetes Mellitus in VMMC: A Cross-sectioned Study Quality of Life of Patients with Chronic Heart Failure Receiving Treatment at the VMMC Prevalence and Knowledge of

Dr. Sharon Michelle Bentero, 3rd yr. Resident Dr. Rudy Boy Natividad, 3rd yr. Resident Dr. Pamela Joy Vidal, 2nd yr. Resident Dr. Jeoffrey Dalao Dr. Lily Ann Madlangsakay, 2nd yr. Resident

Dr. Mary Lauren Europa, 3rd yr. Resident Dr. Desrei Balla,

11 12 13 14 15 February 2011 16 April 2010

17 March 2011 18 July 2010 19 February 2011 20 February 2010 22 January 2011 23 21 August 2009

Osteoporosis Risk Factors Among Patients at the OPD of the VMMC Comparing the Effect of Bleeding time of Aspirin versus garlic on patients with Coronary Artery Disease at VMMC Randomized Controlled Trial in Integrating the Management of Defusion in Glycine Control among Depressed Diabetes The Effect of Education Intervention on the Level of Patients Knowledge, Treatment Adherence and Blood Pressure Control among Hypertensive Patients at the OPD of the VMMC Efficacy of Ascorbic Acid and Iron Supplementation in Improving the Hemoglobin, Hematocrit and Reticulocyte Counts of Children in Brgy. Vasra: An Open Label Study A Randomized Controlled Trial on the Efficacy of Mirror Therapy on the Improvement of Motor Control and Functional Capacity of the Paretic Hand in Sub-acute Stroke Patients of VMMC A Randomized Controlled Trial in the Efficacy of Neuromuscular Electrical Stimulation in the Recovery of Upper Limb Function After Stroke Prevalence of Dysphagia in Speech & Language Section of VMMC Department of Rehabilitation Medicine from 2008-2009 A Randomized Controlled Trial on the Efficacy of Body Weight Support Overground Ambulation vs. Body Weight Support Treadmill Training Among Post Stroke Patients of VMMC The Diagnostic Value of a Third Spectrum Smear Examination in the Diagnosis of Pulmonary Tuberculosis in Patients at the VMMC Relationships between Red Blood Cell Distribution Width and Myocardial Infarction Prevalence of Blood-Borne Diseases among Voluntary Blood Donors and Replacement Donors at the VMMC Pregnancy complications and Birth Outcomes in Pregnant Women with Prenatal Lower Genital Tract Infections A comparative study on the

MO 3

Dr. Jacqueline Ivy Chua, MO 3

Dr. Christine Aquino Yap, MO 3 Dr. Czarina Lim, MO 3

Dr. Charisse Marie Tayao, MO 3 Dr. Cheryl de Jesus et al

Dr. Christy Ann Quilino, MO 3 Dr. Benedicto Cruz et al.

Dr. Sherwin Gan Dr. Jennifer Torres Dr. Jennifer Torres Dr. Christina Jovida Dr. Rina

Dr. Maricel Bayocot, 3rd yr. Resident

24

25 March 2011 26 April 2011 27 28 April 2011 29 January 2011 30 31 32 March 2011 33 34 February

chemoprotective role of Nacetylcystecine on Cisplatin Induced Nephrotoxicity, Administered Before, During and After Chemotherapy Among Cervical Cancer Patients in VMMC Accuracy of Papanicoulao smear in Diagnosing Bacterial Vaginosis in Asymptomatic Women The Efficacy of Spirulina as Treatment Mild and Moderate to Severe - Allergic Rhinitis in Children Azithromycin as Adjunct for Management of Acute Asthma Exacerbation in Pediatric Patients ages 6-17 yrs. Old: a Randomized Controlled Trial The Impact of Different Doses of Iron Supplementation Given Weekly with Deworming & Vitamin A in the Anthropometrics and Hemoglobin Level of Children ages 1-5 years old, A Randomized Controlled Trial A randomized double blind controlled trial on the effect of Racecadotril in the treatment of acute diarrhea among children 1-5 years old with some to severe dehydration Comparison of Distilled Water and Normal Saline Solution as Irrigant used as Transurethral of the Prostate in Patients with BPH at the VMMC Selective Screening for Histopathology of Normal Looking Gall Bladder after Cholecystectomy a Retrospective and Prospective analysis at VMMC Prevalence of Avascular Neurosis (AVM) of the Femoral Head Patients with Displaced Femoral Neck Fractures at the VMMC-based on Hepatologic Examination Comparison of Undecyclamide Propyl Betadine and Polihexanide and Normal Saline as Wound Bed Preparation Agent of Patients with Pressure Ulcers in VMMC A Comparative Study on the Efficacy of Ofloxacin given orally vs. Intravenously as Prophylactic Antibiotics to prevent Urinary Infection in Patients Undergoing TURP Functional Outcome of resection

Reburiano Dr. Ma. Theresa Layug, 3rd yr Resident Dr. Adrian Gutierrez et al

Dr. Sara Campos Dr. Sara Campos et al Dr. Yeennah Lopo

Dr. Martin Reyes et al Dr. Nordevince R. Legaspi

Dr. Christopher Chan et al Dr. Ma. Celine Nieva et al

Dr. Clyde Depaynos et al Dr. Peter

35 March 2011 36 37 38 39 February 2011

2011

40 March 2010 41

42 February 2011 43 February 2011 44

45 January 2011 46 47

aretheroplasty following PHA failed hip arthroplasty Prevalence of avascular of the Femoral Head in Patients with Displaced Femoral Neck Fractures at the VMMC Based in Histopathologic Examination The Prevalence of Thigh pain in Elderly Patients with Cemented and Uncemented Hemiarthroplasty in VMMC Nutritional parameter associated with prolonged hospital stay in surgical patients in VMMC A Comparative Study in the Efficacy of 0.25% Beta Sitosterol vs. Normal Saline Solution as Treatment for Sacral Decubitus Ulcers after Surgical Debridgement at VMMC A Randomized Controlled Study on the Effects of Low-Dose Mobile Epidural Analgesic in Natural Labor and Delivery Outcome Predicting Maternal Hypotension at Ceasarean Delivery under Spinal anesthesia using the Pre-operative Supline Stress Test A Randomized Controlled Trial on the Efficacy of Low Dose Epidural Analgesia and Prolonged Ambulation on Maternal Labor and Delivery Correlation of Serum Creatinine Level with Ultrasound Measured Renal Length and Parenchymal Thickness in Geriatric Patients with Chronic Renal Disease A Correlation between the Common Radiographic & CT Findings Among Clinically Diagnosed Patients with Bronchiectasis in VMMC: A 2 - year Prospective Study Association of Sonographic Features of the Pancreas with Demographic Characteristics and Diabetes Mellitus Validation of Ultrasound in the Diagnosis of Dengue Fever The Correlation of Varying Urinary Bladder Volumes in the Estimation of Prostatic Volume Measured Thru Transabdominal Ultrasonography among the VMMC Patients An 8-week, placebo-controlled, double-blind, randomized, fixed-dose efficacy and safety trial of asenapine

Pacheco et al

Dr. Christopher Chan et al Dr. Nichols Bolintiam et al Dr. Edward de Leon et al

Dr. James Beringuela et al Dr. Hannah Gutierrez et al

Dr. Russell Samuel Ramiro, 2nd yr. Resident Dr. Joseph Gautane

Dr. Hannah Gutierrez, 2nd yr. Resident

Dr. Trinidad Dolores Lukban Dr. Aileen Fullante

Dr. Niezer delas Armas Dr. Charyl P. Escaro Dr. Georgina G. Oliver

48 49 August 2007 50 October 2008 51 52 53 54 56 57 58 59

55 January 2011

60

in adolescent subjects with schiyophrenia A 52-week, multicenter, open-label study to evaluate the effectiveness of aripiprazole intramuscular depot as maintenance treatment in patients with schizophrenia Prevalence rate of dementia among RPV/RPVD patients seen by psychiatry service from 2007-2010 Determination of Caregiver Fatigue among caregivers of schizophrenia patients of VMMC Ward 5 Profile of Suicide Deaths in the Philippines from 2004-2008 Anxiety Level among Medical Interns in Psychiatry Department in VMMC The Prevalence of Pressumed Ocular TB Among Diagnosed Ocular TB patients in Tertiary Government Hospital Intraocular Pressure Changes Pre and Post Phacoemulsification in Short vs. Normal Length Eyes Glycemic Control in Hemodialysis Patients with Diabetes Mellitus 2 in VMMC A Prospective Multicenter, Open label, Single-arm Observational Study of Concor Treatment in Asian Patients with Essential Hypertension Prevalence of TB Effusion Among the Elderly at the Veterans Memorial Medical Center The Use of SOAR (Septolic Blood Pressure Oxygenation Age and Respiratory Rate) Criteria in predicting clinical outcome of elderly patients with community acquired pneumonia Protocol No. D3720C00002 Ceftaline Fosamil Study A Phase III Multicenter Randomized Double Blind Comparative Study to Evaluate the Efficacy and Safety of Intravenous Fosamil vs. Intravenous Ceftriazone in the Treatment of Adult Hospitalized Patients with Community Acquired Bacterial Pneumonia in Asia. Association of Hypercapnea on Admission with the Frequency of Hospital Re-admission and Hospital days of Patients with Chronic Obstructive Pulmonary Disease

Dr. Ponciano Jerez

Dr. Carolyn Pia Bagain, MO 3

Dr. Edessa Laguidao, MO 3

Dr. Orville Jess Pandes, MO 3 Dr. Karen Cabigas MO 3 Dr. Leon Paolo Lara 2nd yr. Resident Trainee

Dr. Adrienne Garcia 1st yr. Res. Trainee Dr. Lily Anne Madlangsakay et al Dr. A. Ferrolino Dr. Ma. Regina Calimag Dr. Ma. Yvette Ragotero et al Dr. Atienza

Dr. Yvette Almoro

61 February 2011 62 February 2011 63

64 65

The Efficacy of Pulmonary Conjunctional Closure in Minimizing Recurrence of Pterygum An Investigation on the Prevalence of PTB Effusion Among Elderly at the VMMC A randomized double blind placebo controlled parallel group multinational trial to assess the prevention of thrombotic events with ticagrelor compared to placebo on a background of acetyl salicylic acid (ASA) therapy in patients with history of myocardial infarction The effect of educational intervention on patients knowledge about hypertension, treatment adherence and BP control among hypertensive in VMMC OPD Heparin and Saline Solution flushing in maintaining internal jugular potency in hemodialysis patients in VMMC a prospective controlled clinical trial.

Dr. Zedrick Alava et al Dr. Regina Calimag et al Dr. Arthur Ferrolino

Dr. Czarina Garcia et al

Dr. Ismael Paulino Alonzo Go et al

Annex D

Civic Action Program January to June 2012 One of the four missions of the Veterans Memorial Medical Center is to support and participate in the civic action program of the government. Hence, accomplishments are as follows:

a. Three-day per week visit at Barangay Vasra, Quezon City to instill health awareness and provide medical check-ups to its residents. c. Provided Medical Missions to the following areas: Date January 20 February 28 March 29 April 21 May 19 Sponsor FILVETS

b. VMMC Consultant assigned at the Office of the Secretary of National Defense attends to about 15-20 DND and PVAO employees and their dependents every morning, Mondays thru Fridays. Area Last Watering Hole Association, Camp Aguinaldo Taguig City Muntinlupa City VMMC Compound VMMC Compound

d. Provided free harelip operation for the 51 patients under the Philippine Band of Mercy (PBM). e. Continuous Operation Lifeline of the Department of Pathology. Blood Consumption Extended Donor Recruitment Program Local Network Total

FILVETS FILVETS GMA Kapuso Operation Tuli GMA Kapuso Operation Tuli Part II

999 1,716 224 2,939

Annex E

Selected Medical Equipment Acquired As of May 2012

Photo coagulator Portable Laser System - for Clinical and Operating Room use of the Department of Ophthalmology

OPERATING MICROSCOPE - for Cataract, Anterior Segment and Retinal Surgery of the Department of Ophthalmology

PERIMETER MACHINE HAAGSTREIT, OCTOPUS 900 - for Diagnosis, Screening and Follow-up of Glaucoma, Department of Ophthalmology

TISSUE PROCESSOR - for use of the Department of Pathology

AUTOCLAVE MACHINE - for use of the Department of Pathology

ELECTRICAL STIMULATOR MACHINE - for use of the Department of Rehabilitation Medicine

ULTRASOUND THERAPY MACHINE for use of the Department of Rehabilitation Medicine