DENGUE FEVER

HEALTH PROBLEM

AN INSTRUCTIONAL PROGRAM FOR

PRIMARY HEALTH CARE PHYSICIANS

DESIGNED FOR:

PROBLEM-BASED LEARNING
COMPETENCY-BASED LEARNING
IN- AND OFF- CAMPUS LEARNING

Author:

Reynaldo O. Joson, M.D.

1998
 Preface

Dear Learner,

Mabuhay!

Welcome to a learning experience in becoming a health professional.

This program has been especially designed with you, the learner, and the
principles of effective teaching and learning in mind.

As you go through this learning program, please bear in mind the following:

1. I am treating you as an adult learner which

1.1 Assumes you have learning aspirations and expectations and

therefore, are motivated;
1.2 Gives you the privilege to use other learning strategies in
achieving the objectives in this program;
1.3 Welcomes you to go beyond the learning package as you so
desire; and
1.4 Expects discipline, honesty, and maturity in fulfilling your
learning activities.

2. We shall define learning as a positive observable change (for the

better or improvement) in human behavior, disposition, attitude,
performance, or capability which persists over a period of time.

3. Active learning strategies and activities will be utilized as much as

possible.

4. The program will contain learning materials which I think will be

relevant to your being an effective, efficient, and humane health
professional.

5. The ultimate goal of the learning program is to produce health

professionals who will contribute to the health development in
 the Philippines.

6. When I made this program, I tried my best to facilitate your

learning. Bear in mind, however, that I am not infallible. Thus,
analyze carefully everything in this program. Dont hesitate to
offer disagreements and constructive criticisms for own
learning and for the improvement of the program.

Best wishes for a fruitful learning with the help of this program.

Reynaldo O. Joson, M.D.

1998

The Module Pack

Content and How to Use
Content

The Module Pack on DENGUE FEVER HEALTH PROBLEM consists of seven (7) folders:
 Folder 1: Instructional Design
Folder 2: Hypothetical and Actual Patient Management
Folder 3: Problem-based Learning Issues
Folder 4: Learning Objectives
Folder 5: Learning Resource Materials
Folder 6: Evaluation
Folder 7: Details and Formats

Folder 1: Instructional Design

This folder contains the module plan.

Folder 2: Hypothetical and Actual Patient Management

This folder contains hypothetical patient management exercises which in turn consist of
sequential patient management cases and case studies.
It also contains an instructional plan on Actual Patient Management.

Folder 3: Problem-based Learning Issues

This folder contains the instructions and a form on which a student can write down problem-
based learning issues.

Folder 4: Learning Objectives

This folder contains general and specific learning objectives of the module.

Folder 5: Learning Resource Materials

This folder contains a list of learning resource materials and selected and prepared manuscripts.

Folder 6: Evaluation
This folder contains the end-of-module evaluation form; blueprints of evaluation; and the pretest
written examinations.

Folder 7: Details and Formats

This folder contains details and formats of learning and evaluating activities.

The Module Pack

How to Use

Initial Steps:

Start by reading Folder 1 on Instructional Design.

 For details on specific learning and evaluating activities encountered in Folder 1,
refer to Folder 7 on Details and Formats.

Then, scan the rest of the Folders (2-7).

Subsequent Steps:

This consists of the study and learning proper.

Start with the

Overview and Personal Perspective on the DENGUE FEVER HEALTH PROBLEM.
Note down learning issues. Use the form provided in Folder 3.
Take note that a formal report may be needed for purposes of presentation and
evaluation.

Then tackle the Pretest written examinations.

Note down learning issues. Use the form provided in Folder 3.
Take note that 50% of the questions in Posttest written examinations will be derived
from the Pretest.
Take note also that the Pretest gives a guide on where to focus when studying the course.
Studying the Pretest can also facilitate discussion in the
Hypothetical and Actual Patient Management.

Then tackle the Hypothetical and subsequently, the Actual Patient Management.
Note down learning issues. Use the form provided in Folder 3.
Take note that the exercises on Hypothetical and Actual Patient Management are
useful in preparing for the
practical examinations (clinical examinations) and
case presentation and discussion of Patient Management.

Overall Advice:

During the study proper, be constantly guided by the instructional design, especially the learning
objectives, which shall serve as the steering wheel in whatever that should be done in the module. This includes the
evaluation.

Reynaldo O. Joson, MD
1998
 DENGUE FEVER

HEALTH PROBLEM

INSTRUCTIONAL DESIGN

DENGUE FEVER HEALTH PROBLEM

Dear Learner,

Mabuhay!

Welcome to the course on DENGUE FEVER HEALTH PROBLEM!

WHY STUDY DENGUE FEVER HEALTH PROBLEM (DF-HP)?

DF-HP affects the biopsychosocial well-being of any person who has it. It can lead to death.
 Worldwide, DF-HP is reported from over 100 countries, with approximately two billion people at risk. It
is found throughout the tropical regions of the world. Annually, there are millions of infections and at times tens of
thousands of deaths. Dengue has now become the most important mosquito-borne viral disease in the world. It
affects young and old, rick and poor alike, especially those living in densely crowed urban areas throughout the
tropics (WHO, 1998).

In the Philippines, DF-HP is a leading cause of morbidity. In August, 1998, the concern for
DF-HP as a public health problem has reached the headlines of almost all newspapers in the country. As of
September, 1998, about 200 patients have died from the DF-HP starting January of the same year.

Every primary health care physician should know how to manage any patient with or with possible DF-HP.
He should also know how to handle DF-HP in the community as well as to deal with issues associated with the
problem, such as bioethical, psychosocial, medicolegal and research issues.

GENERAL COURSE OBJECTIVES

At the end of the course, the student must be able to:

1. Write an overview and a personal perspective on the DENGUE FEVER HEALTH

PROBLEM in the community.

2. Manage any patient presenting with DENGUE FEVER HEALTH PROBLEM.

2.1 Demonstrate skills in

2.1.1 Establishing rapport
2.1.2 Clinical diagnostic process
2.1.3 Paraclinical diagnostic process
2.1.4 Treatment process
2.1.5 Giving advice
2.1.6 Making referrals

2.2 Demonstrate qualities of an effective, efficient, and humane physician.

2.3 Discuss/explain the biological foundation and basis of the clinical management of a
patient with DENGUE FEVER HEALTH PROBLEM.

3. Discuss the following issues on DENGUE FEVER HEALTH PROBLEM.

3.1 Clinical management issues

3.2 Psychosocial or behavioral issues
3.3 Bioethical issues
3.4 Medicolegal issues

4. Conduct a public health education program on the prevention and management of

DENGUE FEVER HEALTH PROBLEM.

5. Perform a research activity on DENGUE FEVER HEALTH PROBLEM.

6. Formulate a community health plan on DENGUE FEVER HEALTH PROBLEM.

7. Pass examinations on DENGUE FEVER HEALTH PROBLEM.

CONTENT

I. Overview and Perspective on DENGUE FEVER HEALTH PROBLEM (DF-HP)

in the Community

Concept of DF-HP
Common Types of DF-HP
Common Causes of DF-HP
Magnitude of the DF-HP at the Global, National, and Local Levels
Personal Perspective on Possible Solutions of the DF-HP in the Local Community

II. Biomedical/Individual Domain (Generalities, Basic and Clinical Sciences on DF-HP)

1. Pathophysiology
Concept of DF-HP
Microbiology - Overview
Virology - Overview
Immunology-Overview
Pathophysiology of Viral Infection - Overview
Pathophysiology of Mosquito-borne Infection - Overview
Epidemiology of DF-HP
Types of DF-HP
Pathophysiology of Dengue Fever
Pathophysiology of Dengue Hemorrhagic Fever
Pathophysiology of Dengue Shock Syndrome
Natural History of DF-HP (Untreated and Failure of Treatment)
Prognosis (Recovery, Disability, and Death)
2. Diagnosis
Clinical Cues (Signs and Symptoms)
Cues for DF-HP
Clinical Diagnostic Process
Pattern Recognition and Prevalence
Paraclinical Diagnostic Procedures
Paraclinical Diagnostic Process
Indication
Selection
Benefit, Risk, Cost, Availability
Interpretation
Diagnostic Algorithm
Severity and Staging
3. Treatment
Goals in Treatment
Preventive and Curative
Forms of Treatment
Antiviral Agents
Antipyretics
Analgesics
Blood Transfusion
Selection of Treatment
Benefit, Risk, Cost, Availability
Follow-up Care

III. Social/Population Domain

1. Community Health Management

Epidemiology
 Management Approach to the DF-HP in the Community (Primary
Health Care)
Community Health Program
Dengue Fever Control Program
Prevention and Control of
Outbreaks and Epidemics Program
Public Health Education
Psychosocial Issues
Prevention
Early Detection
Research
2. Issues
Psychosocial Issues
Bioethical Issues
Medicolegal Issues
Legal Medicine
Medical Jurisprudence
Approach to Issues (Prevention and Solution)

III. Special and Related Topics

Microbiology
Virology
Mosquito-borne Diseases
Immunology
Pharmacology
Anti-viral Agents
Insecticides
Clinical Medicine
Laboratory Medicine
Community Medicine

(See also Folder 4 on Learning Objectives)

LEARNING STRATEGIES

PROBLEM-BASED LEARNING
Hypothetical Patient Management
Actual Patient Management
Demonstration-Return Demonstration
Projects
Discussion
Debates
Independent Study

(See Schedule below and Details and Formats in Folder 7)

EVALUATION

LEARNING OBJECTIVES-REFERENCED EVALUATION

A student must pass the following assessment tools:

I. Academic

Written examination
Posttest - MPL of 75%
 Practical examinations
Oral Presentation (PASS)
Clinical Examination - MPL of 75%

Written Reports
Overview and Personal Perspective (PASS) - individual output
Case Presentation and Discussion of Actual or Hypothetical Patient
Management (PASS) - individual output

II. Attitude (PASS)

III. Attendance (PASS)

(See Schedule below, Folder 6 on Evaluation, and Details and Formats on Folder 7)

DENGUE FEVER HEALTH PROBLEM

DURATION OF COURSE: 2 DAYS

SCHEDULE OF LEARNING-EVALUATING ACTIVITIES

PLS. SEE DETAILS AND FORMATS ON

SPECIFIC LEARNING AND EVALUATING ACTIVITIES IN FOLDER 7.

BEST WISHES IN YOUR LEARNING JOURNEY!

Program Director: Dr. Reynaldo O. Joson

Course Coordinator:
 Co-Course Coordinator:

DENGUE FEVER

HEALTH PROBLEM

HYPOTHETICAL AND ACTUAL

PATIENT
MANAGEMENT
 DENGUE FEVER HEALTH PROBLEM

I. Hypothetical Patient Management:

Sequential Patient Management - 2
Case Studies - 2

Sequential Patient Management

Chief Complaints

1. Fever

2. Fever with Nosebleeding

Case Studies (Based on the above Chief Complaints)

II. Actual Patient Management (with case presentation and discussion)

Mininum of 2 patients in the entire course
Priorities:
Dengue Fever
Dengue Hemorrhagic Fever

(See Details and Formats on Actual Patient Management and

Case Presentation and Discussion)

Chief Complaint (The Health Problem)

Template for Discussion

Trigger 1

Patient with complaint of The Health Problem

Questions:

1. What is The Health Problem?

2. What are the possible causes of The Health Problem?

Organs/tissues involved General condition/disorderSpecific condition/disease

(e.g. trauma, cancer, infection)

___________________ __________________________ _____________________

___________________ __________________________ _____________________
___________________ __________________________ _____________________

3. What do you think are the more common/least common general and specific
condition causing the health problem?

General condition/disorderSpecific condition/disease

More common __________________________ _____________________
__________________________ _____________________
Least common __________________________ _____________________
__________________________ _____________________

4. Select one common general or specific condition and diagram the pathophysiology
leading to the health problem.

The Health Problem

Trigger 2

Pertinent history
Age, sex / Chief complaint / When noted / Associated symptoms

Physical examination:

Questions:

1. What is your primary and secondary diagnosis?

Primary diagnosis: _____________________________________________
Secondary diagnosis: ___________________________________________

2. What are the bases for your primary and secondary diagnoses?
Demonstrate use of pattern recognition with pathophysiology and
prevalence.
Signs/Symptoms/Pathophysiology Prevalence data
Primary diagnosis

Secondary diagnosis

3. Do you need more data (sign/symptom) to firm up your primary and secondary
diagnoses?
If yes, what? How will it firm up your diagnosis?

[ Data asked for either not available or normal. Facilitator may supply other data.]

4. Do you need a paraclinical diagnostic procedure?

If yes, why? If no, why?
Demonstrate use of
1. certainty/uncertainty of primary and secondary diagnoses
2. plan of management for primary and secondary diagnoses
3. others

5. If you need a paraclinical diagnostic procedure, what will you recommend? Why?
Give at least 3 options and then compare using benefit, risk, cost, and
availability factors. Then select one demonstrating priority on the primary
diagnosis. Shotgun policy is NOT acceptable.

Benefit Risk Cost Availability

Option 1
Option 2
Option 3

6. Suppose the patient agreed to your recommendation of the paraclinical diagnostic

procedure and suppose it was done.
What results will firm up your primary diagnosis?
What results will make you shift to your secondary diagnosis as the primary
diagnosis?

The Health Problem

Trigger 3.
 A paraclinical diagnostic procedure was done.
[Either utilize the one recommended by the student or the facilitator presents a prepared one.]

A ___________________________________ was done.

[Here is the picture/reading/result of the paraclinical diagnostic procedure.]

Questions (as applicable):

1. Examine the result of the paraclinical diagnostic procedure and then interpret.
Decide whether the result is informative or non-informative.
Informative, why? Non-informative, why?

2. After the paraclinical diagnostic procedure, what is now your primary and secondary
diagnosis? Why?
Demonstrate use of pattern recognition with pathophysiology and
prevalence.
Diagnostic Procedure/Signs/Symptoms/Pathophysiology Prevalence data
Primary diagnosis
Secondary diagnosis

3. Do you need to firm up your diagnosis before you proceed to treatment?

If yes, how?
What data do you need?
History?
Physical exam?
Other diagnostic procedure?
Observation and monitoring?

[Data asked for either not available or normal. Facilitator may supply other data.]

4. What is your pretreatment primary and secondary diagnoses?

5. State the goals of treatment for your primary diagnosis?

6. Decide on a treatment modality after comparing the options based on benefit, risk,
cost, and availability factors.

Benefit Risk Cost Availability

Nonoperative
(Specific procedure in mind)
Operative
(Specific procedure in mind)

8. Describe the things need to be done during the pretreatment, intratreatment, and
posttreatment phase.

7. Decide how you would evaluate the results or outcome of your proposed treatment.
The Health Problem
Trigger 4
 The diagnosis of the patients health problem is

____________________________________________

Questions:

1. Advice the patient and relatives on the pathophysiology of the disease. Use diagram.

2. Advice the patient and relatives on screening of the disease.

3. Advice the patient and relatives on early detection of the disease.

The Health Problem

Trigger 5

A case write-up of a patient with a complaint of The Health Problem.

 DIAGNOSIS IS NOT SPELLED OUT!
Signs and symptoms
Course in the management
Paraclinical diagnostic procedures done
Treatment
Outcome

Questions:

1. Study the case and then decide on the primary and secondary diagnoses.

Give bases for your diagnoses using

pattern recognition with pathophysiology
prevalence

2. Study the case and then

2.1 Comment on the outcome of treatment.

Were the goals of treatment achieved? Yes, why? No, why?

2.2 Describe the prognosis after treatment.

Recurrence, survival, quality of life

Pathophysiology of the disease leading to physical disability and death
 DENGUE FEVER

HEALTH PROBLEM

PROBLEM-BASED

LEARNING ISSUES

Problem-based Learning Issues

Instructions

Given hypothetical and actual patients, pretest questions and any kind of DENGUE
FEVER HEALTH PROBLEM to solve, list down deficiencies and uncertainties in
competences as learning issues and decide on a specific learning plan. Use the form below.
Trigger* Learning Issues Learning Plan**

*Hypothetical Patient Management (HPM)

Actual Patient Management (APM)
Pretest

**Reading - what and which books, journals

Asking - whom, where, when
Doing - what, where, when

DENGUE FEVER
 HEALTH PROBLEM

LEARNING OBJECTIVES

Dengue Fever Health Problem

GENERAL COURSE OBJECTIVES

At the end of the course, the student must be able to:

1. Write an overview and a personal perspective on the DENGUE FEVER HEALTH

PROBLEM in the community.

2. Manage any patient presenting with a DENGUE FEVER HEALTH PROBLEM.

2.1 Demonstrate skills in

2.1.1 Establishing rapport
 2.1.2 Clinical diagnostic process
2.1.3 Paraclinical diagnostic process
2.1.4 Treatment process
2.1.5 Giving advice
2.1.6 Making referrals
2.2 Demonstrate qualities of an effective, efficient, and humane physician
2.3 Discuss/explain the biological foundation and basis of the clinical management of a
patient with a DENGUE FEVER HEALTH PROBLEM.

3. Discuss the following issues on DENGUE FEVER HEALTH PROBLEM.

3.1 Clinical management issues

3.2 Psychosocial or behavioral issues
3.3 Bioethical issues
3.4 Medicolegal issues

4. Conduct a public health education program on the prevention and management of

DENGUE FEVER HEALTH PROBLEM.

5. Perform a research activity on DENGUE FEVER HEALTH PROBLEM.

6. Formulate a community health plan on DENGUE FEVER HEALTH PROBLEM.

7. Pass examinations on DENGUE FEVER HEALTH PROBLEM.

DENGUE FEVER HEALTH PROBLEM

Content
Overview and Perspective on DENGUE FEVER HEALTH PROBLEM (DF-HP)

Basic Sciences on DF-HP

Microbiology
Virology
Pathology
Anatomy and Physiology of Organs and Systems Involved in DF-HP
Pathophysiology
Fever
Viral Infection
Pharmacology
Clinical Sciences on DF-HP

Pathophysiology, Diagnosis and Treatment

Dengue Fever
Dengue Hemorrhagic Fever

Related Topics

Issues

Community Health Management

Epidemiology
Outbreaks
Epidemics

Medicolegal Issues

Bioethical Issues

Psychosocial Issues

Research Issues

DENGUE FEVER

HEALTH PROBLEM
 LEARNING RESOURCE
MATERIALS

DENGUE FEVER HEALTH PROBLEM

Learning Resource Materials

I. Reading Materials:

DOH programs

Textbooks on DENGUE FEVER HEALTH PROBLEMS

Anatomy, Physiology, Pathology, Pharmacology

Microbiology, Virology, Parasitology
Internal Medicine, Pediatrics
Community Medicine

Journal Articles on DENGUE FEVER HEALTH PROBLEM

Handouts and reading materials prepared by facilitators

II. Audiovisual Materials

III. Actual patients with DENGUE FEVER HEALTH PROBLEM

IV. Consultation with DENGUE FEVER HEALTH PROBLEM Specialists

Public Health Specialists

Pathologists
Microbiologists
Parasitologists
Virologists
Infectious Specialists

DENGUE FEVER

HEALTH PROBLEM
 EVALUATION

End-of-Course Evaluation
The philosophy of our medical education calls for an evaluation system that measures a students progress
and development not only in the academic but also in the personal and social aspects. This is consistent with our
goal of providing an integral and wholistic formation to our students.

Reynaldo O. Joson, MD
Program Director

Name of Student: ________________________ Year Level ___ School Year ___________

Course: DENGUE FEVER HEALTH PROBLEM

Course Facilitator: ________________________

I. Academic Assessment
Final Grade
Score Pass/Fail

Written Examination* ( ) _______

 Practical Examinations

Clinical Examination* ( ) _______

Presentation in a Symposium _______

Written Reports

Overview and Personal Perspective _______

Case Presentation and Discussion _______

of Actual or Hypothetical Patient Management

Reports on Symposium _______

*Scores needed within parenthesis.

End-of-Course Evaluation

Name of Student: ________________________ Year Level ___ School Year ___________

Course: DENGUE FEVER HEALTH PROBLEM

Course Facilitator: ________________________

II. Profile of Academic Growth

A. Roles of a Primary Health Care Physician (Pls. assess as observed and then encircle.)

Solver of a Community Health Problem E S F US NO

Primary Health Care Physician

Clinical diagnosis E S F US NO
Paraclinical diagnosis E S F US NO
Treatment E S F US NO
Advice E S F US NO
Referral E S F US NO

Emergency Medicine Physician E S F US NO

 Self-directed Learner E S F US NO
Educator E S F US NO

Researcher E S F US NO

Manager E S F US NO

Potential Board Passer E S F US NO

B. Skills

Interpersonal E S F US NO

Communication
Oral E S F US NO
Written E S F US NO
Handwriting E S F US NO

Critical thinking/analysis E S F US NO

Problem-solving/decision-making E S F US NO

Technical E S F US NO

Group learning E S F US NO
End-of-Course Evaluation

Name of Student: ________________________ Year Level ___ School Year ___________

Course: DENGUE FEVER HEALTH PROBLEM

Course Facilitator: ________________________

III. Profile of Personal and Social Growth

A. Attitude/Trait/Personality (Pls. assess as observed and then encircle.)

Community-oriented A/E O/S F US NO

Teamwork A/E O/S F US NO

Compassionate/Concern A/E O/S F US NO

Responsible A/E O/S F US NO

Hardworking/eager to learn A/E O/S F US NO

Resourceful/innovative A/E O/S F US NO

Humble/accept limitation A/E O/S F US NO

Role model A/E O/S F US NO

 Good health habits A/E O/S F US NO

Show respect to human life A/E O/S F US NO

Show respect to colleagues A/E O/S F US NO

Show respect to authority A/E O/S F US NO

B. Discipline
Number
Absences in class ______
Tardiness in class ______
Late reports ______
Critical incident reports ______

Legend:
E -Excellent A/E - Always observed/excellent
S - Satisfactory O/S - Often observed/satisfactory
F - Fair
US - Unsatisfactory
NO - Not observed

DENGUE FEVER HEALTH PROBLEM

Evaluation

Requirements for Passing the Course:

I. Academic

Written examination
Posttest - MPL of 75%

Practical examinations
Presentation in a Symposium (PASS)
Clinical Examination - MPL of 75%

Written Reports
Overview and Personal Perspective (PASS) - individual output
Reports on Symposium (PASS) - group output
Case Presentation and Discussion of 2 Actual or Hypothetical Patient
Management (PASS) - individual output

II. Attitude (PASS)

III. Attendance (PASS)

 DENGUE FEVER HEALTH PROBLEM

End-of-Course Examinations

Posttest Written Examination

Generalities, Basic and Clinical Sciences on DF-HP 100

Issues 30

Clinical Examination

Written Clinical Exam 50

Pictorial Clinical Exam 50

Patients

Practical Clinical Exam 6

Advice on Selection of Paraclinical Diagnostic Procedure

Advice on Selection of Treatment
Advice on Prevention of Recurrence of Dengue Fever

Prescription of a Medication
Prescription of Blood Transfusion

Referral
 DENGUE FEVER HEALTH PROBLEM
Written Examination Blueprint

Types of Questions:
Multiple Choice
Multiple Response
Matching

Pretest Posttest

I. Generalities, Basic and Clinical Sciences 260 130

Biomedical/Individual Domain 200 100
Pathophysiology
Diagnosis
Treatment
Social/ Population Domain 60 30
Community Health Management
Issues
 DENGUE FEVER HEALTH PROBLEM
Clinical Examination Blueprint
General Content:

Hypothetical Cases/Pictorials (patients, pathology, paraclinical diagnostic procedures)

Decision/interpretation on
Clinical diagnosis
Paraclinical or ancillary diagnostic procedure
Treatment
Advice
Clinical diagnosis
Paraclinical or ancillary diagnostic procedure
Treatment
Referral

Categories of Questions, Content, and Number of Questions per Category:

Category No. of Questions

I. Written Clinical Questions 50

Hypothetical Cases

Management of a Patient with

DENGUE FEVER HEALTH PROBLEM
General Concept and Processes

II. Pictorial Clinical Questions 50

Pictures of Patients, Pathology, and Procedures

Diagnosis/Identification/Interpretation

III. Practical Clinical Questions 7

Instructions

Advice
Prescription
Referral

Presentation in a Symposium

See Details and Format on Presentation in a Symposium

Written Reports

See Details and Format on

Overview and Personal Perspective

Presentation in a Symposium
Case Presentation and Discussion
 DENGUE FEVER

HEALTH PROBLEM

DETAILS AND FORMATS

 DETAILS AND FORMATS OF LEARNING AND EVALUATING ACTIVITIES

Content
PRIMARY HEALTH CARE PHYSICIAN

PROBLEM-BASED LEARNING

ORIENTATION AND INTRODUCTION

OVERVIEW AND PERSONAL PERSPECTIVE

CASE PRESENTATION AND DISCUSSION

ACTUAL PATIENT MANAGEMENT

BIOETHICAL, PSYCHOSOCIAL, MEDICOLEGAL, AND RESEARCH ISSUES

PRETEST AND POSTTEST WRITTEN EXAMINATION

PRESENTATION IN A SYMPOSIUM
 PRIMARY HEALTH CARE PHYSICIAN

Primary Health Care Physician is a physician who practices primary health care.

Definition of Primary Health Care by WHO

Essential health care made universally available to individuals and families in the community by means
acceptable to them, through their full participation and at a cost that the community and country can afford.

Health care system and socioeconomic development

PHC forms an integral part both of the countrys health system of which it is the nucleus and of the overall
social and economic development of the community.

Features

Community participation
vs overdependence on medical doctors

Appropriate technology
vs high-cost and sophisticated technology

Intersectoral linkages
vs. reliance on the government sector or the medical doctor

Partnership Approach

1. active community participation and involvement

2. intersectoral collaboration
3. development and use of appropriate technology to meet local health needs
4. development of support mechanisms to sustain PHC implementation

Essential health care

1. information and education on health

2. proper nutrition
3. water and sanitation
4. maternal and child health
5. immunization
6. prevention and control of endemic diseases
 7. treatment of common diseases
8. provision of essential drugs

Aspects of health care

PHC is concerned with the promotive, preventive, curative, palliative, and rehabilitative aspects of health
care.

PROBLEM-BASED LEARNING

PBL in Medicine
- learning the science and art of medicine
in the functional or clinical context.

Format of PBL in Medicine in Small Group

Session I (2 hours)
1. Facilitator presents a problem (simulated or actual).

2. Students attempt to understand and solve the problem through brainstorming, discussion, and
consensus. They learn from each other as well as discover learning issues
(later converted to students' learning objectives).

3. Students decide on a learning plan with or without the help of the facilitator. The learning plan contain
the following:
Learning objectives
How to attain the learning objectives
Methods
Reading - what and which books, journals
Asking - who, where, when
Doing - what, where, when
Individual work or division of labor
How to assess attainment of learning objectives
Timetable

Independent Study (based on timetable in the learning plan)

Students implement learning plan.

Session II (2 hours)
1. Students report and discuss the learning gained during the independent study in trying to understand
and solve the initial problem.

2. Student may be given another problem to apply what they have just learned for reinforcement purposes.

3. Students are asked to assess their individual and group performance in the learning process.

4. Facilitator gives feedback on the individual and group learning process.

He may also give comments on the content of the learning objectives as well as on the
problem(s).
 Practice and Learning of Medicine - The Process

1. An MD meets a patient without prior knowledge of what the patient's problem is.

2. During the encounter, the MD establishes rapport, diagnoses, treats, and gives
advices with the goal of resolution of the health problem of the patient.

3. In the process of understanding and resolving the patient's problem, the MD

invariably encounters some insecurities, questions, and gaps in competences.

4. The MD fills in the gaps in competences through various means, such as self-study
and learning from other people like consultations, referrals, and enrolling in
a formal course.

5. The new competences acquired are used by the MD on the patient on hand
and on future patients.

PBL in Medicine - The Process

1. The student is presented with a health problem which can be simulated or

actual, without the student having prior study on the problem.
There is no prior teacher's lecture nor prior assignment to study on the
problem.

2. The student tries to understand and to solve the problem.

3. In the process of trying to understand and to solve the problem, the student
will invariably encounter questions, uncertainties, and gaps in
competences, which constitute the so-called "learning issues."

4. The student then decides how to go about settling the "learning issues."

5. The student implements his plan of action.

6. The student applies what he learned to the problem on hand as well as to

future problems or patients.
 Comparison of Lecture and Problem-based Learning

PBL
Lecture Individual/Small Group/Large Group
Retention
of learning + ++ ++ ++
Easy recall + ++ ++ ++
Problem-solving + ++ ++ ++
Critical thinking + ++ +++ +++
Communication x x + +
Interpersonal skills x x + +
Cooperative
learning x x + +
Self-directed
learning x + + +

Competences needed in conducting PBL

1. Proper understanding of whole process of PBL (knowledge).

2. Commitment to use PBL if educator believes it is an effective method in producing

competent physician (attitude).

3. Skills in facilitating learning (skills).

4. Skills in group dynamics (skills).

 ORIENTATION AND INTRODUCTION
DENGUE FEVER HEALTH PROBLEM

Schedule: First Day of a 2-day Course, 7:30 -9:30 am

Specific Activities:

Part I: Introduction to the Course (1hour maximum)

Discussion:

OVERVIEW AND PERSPECTIVE OF

DENGUE FEVER HEALTH PROBLEM

(See Format on Overview and Personal Perspective)

Part II: Orientation to the Course (1hour maximum)

1. Distribution and discussion of:

INSTRUCTIONAL PROGRAM (Course Pack)
with focus on INSTRUCTIONAL DESIGN

2. Distribution and assignment of tasks:

2.1 Reports on Overview and Personal Perspective

(See Details and Format on Overview and Personal Perspective)

2.2 Presentation in a Symposium

(See Details and Format on Symposium)

Part III. Pretest (variable duration to be decided by consensus by both facilitator and students
such as 1 or 2 hours; must be taken in the morning of the first day of the
course)

(See Details and Formats on Pretest)

Things facilitator should prepare prior to meeting the students:

Enough copies of the

INSTRUCTIONAL PROGRAM ON THE

DENGUE FEVER HEALTH PROBLEM

to be given to the students.

 OVERVIEW AND PERSONAL PERSPECTIVE

EXPECTATIONS

1. Each student must submit a typewritten report on an

Overview and Personal Perspective on DENGUE FEVER
HEALTH PROBLEM.
2. Deadline for submission of written reports will be on the last day of the
course.
3. The evaluation criteria that will be used for the written report are:

Clear
Adequate in terms of content
Format followed
Presence of references
FORMAT
Overview and Personal Perspective
on
DENGUE FEVER HEALTH PROBLEM
(Name of Writer)

I. Concept of DENGUE FEVER HEALTH PROBLEM

A. Definition of DENGUE FEVER HEALTH PROBLEM
B. Effect of DENGUE FEVER HEALTH problem on health of the
individual, family, and community

II. Common types of DENGUE FEVER HEALTH PROBLEM (from

general to specific)

III. Common causes of DENGUE FEVER HEALTH PROBLEM (from

general to specific)

IV. Magnitude of DENGUE FEVER HEALTH PROBLEM

Global National Local
N.A./Europe/Australia/Africa/Asia
Incidence Rate
in #/100,000
Mortality Rate
Morbidity Data
( include
quality of life)

* Give the sources of data

IV. Personal perspective on the possible solutions to DENGUE FEVER

HEALTH PROBLEM

*Describe a community health management program which you think can solve DENGUE
FEVER Health Problem. You can utilize existing programs or you can create your own.
Use the following format:
I. Goal /objective:
II. Strategies and Programs:
Note: Utilize the concept of primary health care
Community participation: People
Intersectoral linkages: NGO, Government, Health Care
Providers
Appropriate technology
III. Evaluation Indicators:

V. References
CASE PRESENTATION AND DISCUSSION
 Format
Case Presentation

Present Database

General Data
Minimum: Initials of patient, age, sex
As needed: Occupation, residence, religion

Chief Complaint

History of Present Illness/Condition

As needed:
Past Medical History
Personal Social History
Obstetrical and Gynecological History

Physical Examination

Case Discussion

Must include the following 4 parts:

I. Clinical Diagnosis
II. Paraclinical Diagnostic Procedures
III. Treatment
IV. Prevention and Health Promotion

I. Clinical Diagnosis

1. Identify data from database which can serve as cues for a clinical diagnosis.

Age/Sex
Symptoms
Signs

2. Based on pattern recognition and prevalence, decide on the primary and

secondary diagnoses. Primary diagnosis is what you think is the most likely
diagnosis and secondary diagnosis is the closest second.

Primary Clinical Diagnosis:

Secondary Clinical Diagnosis:

3. Illustrate/explain how you arrive to the primary and secondary clinical

 diagnoses.

Use the clinical diagnostic processes of pattern recognition and prevalence.

Use algorithm as much as possible.
Use pathophysiology to support your primary and secondary clinical
diagnoses.

II. Paraclinical Diagnostic Procedures

1. Restate your primary and secondary clinical diagnosis.

2. Decide on whether you need a paraclinical diagnostic procedure or not.

If YES, why? If NO, why?

Use the processes of certainty and proposed treatment of your

primary and secondary diagnoses as basis.

Certainty* Treatment Modality

Primary Diagnosis
Secondary Diagnosis

*Place figures such as 10%, 50%, 70% certain and basis of

certainty, whether based on signs, symptoms, and
prevalence or just on symptoms and prevalence or
just prevalence.

**If you decide you dont need a paraclinical diagnostic procedure,

proceed to TREATMENT.

3. If you decide to go for a paraclinical diagnostic procedure, select one from at

least two procedures that may be done.

Use the following table:

Benefit Risk Cost Availability

Diagnostic
Procedure 1

Diagnostic
Procedure 2

4. After selecting one paraclinical diagnostic procedure, briefly describe how it is

done and what will be the result that will firm up your diagnosis.

5. Present the paraclinical diagnostic procedure(s) that were done on the patient
starting with the one that you are recommending. Then, interpret the
 results.

III. Treatment

1. State your pretreatment diagnosis - both primary and secondary.

2. State the goals of treatment for the primary diagnosis.

3. Decide on the treatment modality.

Benefit Risk Cost Availability

Nonoperative

Operative

4. Decide how you evaluate the result or outcome of your proposed treatment.

5. If data are available, present the treatment procedures done on the patient and
their outcome.

IV. Prevention and Health Promotion

1. State your final diagnosis.

2. Briefly describe how you will advice patient on prevention of the disease and
health promotion.

Use pathophysiology.
Advice on screening.
Advice on early detection.

Evaluation Criteria:

Clear
Adequate in terms of content
Format followed
Presence of references

ACTUAL PATIENT MANAGEMENT

1. A student will be given at least ONE actual patients with DENGUE FEVER HEALTH PROBLEM
to interview and do physical examination on.
2. After the interview and physical examination, the student will present and discuss the patient using the
format of the case presentation and discussion.

3. In an actual patient management, there will strict supervision and demonstration-return demonstration
on physical examination by facilitator and students respectively.

4. Each student is required to submit a written case presentation and discussion on the actual patients
seen using the prescribed format.

BIOETHICAL, PSYCHOSOCIAL, MEDICOLEGAL, AND RESEARCH ISSUES

1. There will be a 2-hour session on any of the following issues on patients with
DENGUE FEVER HEALTH PROBLEM:

Bioethical
Psychosocial
 Medicolegal
Research

2. The session may be in the form of small group discussion, debate, or role-play, depending on what issue
is to be tackled.

3. The sessions on issues will prepare the students for their practical examination in the symposium.

Guidelines for small-group discussion, debate, and role-play

Small Group Discussion:

In small group discussions, individuals interact with one another to achieve objectives.

Guidelines:

1. Before the session starts, ensure that all needed facts are available.
2. Remind students of how a group discussion works:

The task must be clear.

The leader is to summarize, to help students see the issue, to direct the analysis, to
bring in its relation to theoretical knowledge, and to guide rational
discussion to some conclusion.

The students are to contribute and listen.

3. If a consensus is reached, decide if it is because of the similarity in group members or if others

would also agree. If no consensus is reached, decide what are the basic points at issue.
Will they always be bound in conflicting different moral theories?

The Debate:

The debate is a form of group discussion wherein group members are assigned to argue for two
opposing views of an issue.

Guidelines:

1. Ensure that the topic chosen has enough arguments to favor each side of the issue.

2. Give the students time to prepare for the debate.

3. Establish the ground rules: How many may talk, how long each one may talk, how often
rebuttals will be allowed.

4. Involve the audience in evaluating the issue and in summarizing the main points for each side.

The Role-play:

The role-play is a simulation of a particular situation with individuals assuming specific roles.

Guidelines:

1. Deal with a subject where attitudes, feelings, interpersonal skills or behavior are important.
 2. Warm-up the players: tell them a few minutes before the presentation what role they should
play: who they are and how they feel about the issue.

3. Have no prepared script or rehearsal.

4. After the presentation, have players share how they felt.

5. Have students analyze the players behavior and feelings.

PRETEST AND POSTTEST WRITTEN EXAMINATIONS

PRETEST

1. On the first day of the course, the students will be given a pretest written examination.
The students shall place their answers on both the test paper proper and the answer
sheet. The answer sheet shall be submitted to the facilitator right after the examination.
The student shall keep the test paper proper for future use especially in preparing for the
posttest written examination at the end of the course.

1.1 The pretest answer sheets will be checked by the facilitator using right and wrong
indicators only and these will be given back to the students at the latest on the
 5th day of the course. The answer key will not be shown to the students at this
time. The students have to look for the correct answers on the wrong items.

1.2 At a set time agreed upon by both facilitator and students, anytime before the
posttest written examination, the students submit another answer sheet of the
pretest. The answer sheets are corrected immediately right after submission
and, thereafter, the answer key to the pretest is shown to the students to enable
them to prepare for the posttest examination.

1.3 If a student gets a grade of 50% or more in the initial try at the pretest examination,
he will be given a credit of 5 points in the posttest writen examination at the
end of the course.

1.4 If he gets a grade of 85% or more in the second try (with open books) at the pretest
examination, he will be given a credit of 5 points in the posttest written
examination at the end of the course.

2. The pretest written examinations shall contain unlimited numbers of questions.

POSTTEST

3. The posttest written examination shall contain 130 questions.

4. In the posttest written examination, at least 50% shall be derived from the pretest written
examinations. The remaining 50% may be new questions.

5. The minimum pass level in the posttest written examination is 75%.

See Posttest Blueprint in Folder 6 on Evaluation.

PRESENTATION IN A SYMPOSIUM
1. The symposium is a practical examination that will evaluate the following competencies expected of a
primary health care physician:

Physician- Community Health Problem Solver

Wholistic Physician-Clinician
Physician-Researcher
Physician-Educator
Physician-Learner
Physician- Manager

During the symposium, the students are expected to demonstrate the above competencies.
2. The students shall present the following symposium on the last week of the course:

Symposium on the DENGUE FEVER HEALTH PROBBLEM

Overview and Personal Perspective on the DENGUE FEVER HEALTH PROBLEM

Public Health Education on Prevention of the DENGUE FEVER HEALTH PROBLEM

Community Health Management - DENGUE FEVER CONTROL PROGRAM

Case Presentation and Discussion

DENGUE FEVER

Issues

Psychosocial Issues in Patients with DENGUE FEVER HEALTH PROBLEM

Bioethical Issues in Patients with DENGUE FEVER HEALTH PROBLEM

Medicolegal Issues in Patients with DENGUE FEVER HEALTH PROBLEM

Research Issues in Patients with DENGUE FEVER HEALTH PROBLEM

3. Expectations, format, and evaluation criteria - See Evaluation Form.

4. A written report on the assigned topics in the symposium should be submitted on the last day of the
course.

5. Evaluation criteria of written reports consist of the following:

Clear
Adequate in terms of content
Format followed
Presence of references

Presentation in a Symposium
Evaluation Form

Student: Group No:

Overview and Personal Perspective on the DENGUE FEVER HEALTH PROBLEM
Expectation: Within 10 minutes, the student is expected to present an Overview and Personal Perspective on the
DENGUE FEVER HEALTH PROBLEM using a prescribed format.

Evaluation Criteria:
YES NO E S F US FINAL GRADE
E S F US
Clear
Adequate in terms of content
Concept of DENGUE FEVER
HEALTH PROBLEM (Df-HP)
 Common types of DF-HP
Common causes of DF-HP
Magnitude of DF-HP in the
global, national, and local levels
Personal perspective on possible solution
of the DF-HP using a
primary health care approach
Format followed
Presence of references
Presented within the allotted time

Student: Group:
Public Health Education on Prevention of DENGUE FEVER HEALTH PROBLEM
Expectation: Within 15 minutes, the student/s is/are expected to present a Public Health Education on
Prevention of DF-HP using a prescribed format.

Evaluation Criteria:
YES NO E S F US FINAL GRADE
E S F US
Clear
Adequate in terms of content
Description of the problem
Importance of the problem
Preventive measures
Early detection measures
Format followed
Presence of references
Presented within the allotted time

Legend: E - Excellent
S - Satisfactory
F - Fair
US - Unsatisfactory

Presentation in a Symposium
Evaluation Form

Student: Group:
Community Health Management - DENGUE FEVER CONTROL PROGRAM
Expectation: Within 10 minutes, the student/s is/are expected to present a Dengue Fever
Control Program using a prescribed format.

Evaluation Criteria:
YES NO E S F US FINAL GRADE
E S F US
Clear
Adequate in terms of content
Problem identification
Objectives
 Strategies
Evaluation parameters
Format followed
Presence of references
Presented within the allotted time

Student: Group:
Case Presentation and Discussion
Fever [or any chief complaint of a patient who eventually has Dengue Fever ]
Expectation: Within 15 minutes, the student/s is/are expected to present and discuss a patient with a chief
complaint who eventually has a Dengue Fever using a prescribed format.

Evaluation Criteria:
YES NO E S F US FINAL GRADE
E S F US
Clear
Adequate in terms of content
Management goals
Rapport
Clinical diagnostic process
Paraclinical diagnostic process
Treatment process
Indication for referral
Advice
Format followed
Presence of references
Presented within the allotted time

Legend: E - Excellent
S - Satisfactory
F - Fair
US - Unsatisfactory

Presentation in a Symposium
Evaluation Form

Student: Group:
Psychosocial Issues in Patients with DENGUE FEVER HEALTH PROBLEM
Expectation: Within 10 minutes, the student/s is/are expected to present a discussion of psychosocial
issue/s in patients with a DF-HP using a prescribed format.

Evaluation Criteria:
YES NO E S F US FINAL GRADE
E S F US Clear
Adequate in terms of content
Scenarios or cases
Identification of a psychosocial issue
Influence on health and disease and recovery
 Prevention and promotion
Format followed
Presence of references
Presented within the allotted time

Student: Group:
Bioethical Issues in Patients with DENGUE FEVER HEALTH PROBLEM
Expectation: Within 10 minutes, the student/s is/are expected to present a discussion of bioethical issue/s
in patients with a DF-HP using a prescribed format.

Evaluation Criteria:
YES NO E S F US FINAL GRADE
E S F US
Clear
Adequate in terms of content
Scenarios or cases
Identification of bioethical issue/s
Pros and cons
Decision-making
Format followed
Presence of References
Presented within the allotted time

Legend: E - Excellent
S - Satisfactory
F - Fair
US - Unsatisfactory

Presentation in a Symposium
Evaluation Form

Student: Group:
Medicolegal Issues in Patients with DENGUE FEVER HEALTH PROBLEM
Expectation: Within 10 minutes, the student/s is/are expected to present a discussion of medicolegal issue/s
in patients with a DF-HP using a prescribed format.

Evaluation Criteria:
YES NO E S F US FINAL GRADE
E S F US
Clear
Adequate in terms of content
Scenarios or cases
Identification of medicolegal issue/s
Analysis of issues
Prevention and solution
Format followed
Presence of References
Presented within the allotted time

Student: Group:
Research Issues in DENGUE FEVER HEALTH PROBLEM
Expectation: Within 10 minutes, the student/s is/are expected to present a research protocol on identified
issue/s in DF-HP using a prescribed format.

Evaluation Criteria:
YES NO E S F US FINAL GRADE
E S F US
Clear
Adequate in terms of content
Scenarios or cases
Identification of research issue/s
Importance of issues
Present a research protocol on the
identified issues
Format followed
Presence of references
Presented within the time allotted

Legend: E - Excellent
S - Satisfactory
F - Fair
US - Unsatisfactory

Evaluator:
Date:

General Guidelines in the Formulation of

BIOMEDICAL/INDIVIDUAL DOMAIN
(BIOLOGICAL FOUNDATION AND BASIS OF CLINICAL MANAGEMENT)

EPIDEMIOLOGY - Symptoms and diseases

Definition of the health problem

Incidence and prevalence
Causes of Symptoms and diseases

PATHOPHYSIOLOGY - Symptoms and diseases

Causes of death and disability

DIAGNOSIS

Clinical
Paraclinical
 *Compare paraclinical diagnostic procedures

TREATMENT

Nonoperative
Operative

*Compare treatment procedures

MANAGEMENT PLAN, ALGORITHM, OR PROTOCOL

General Guidelines in the Formulation of

SOCIAL/POPULATION DOMAINS

PREVENTIVE AND PROMOTIVE HEALTH PROGRAM

Personal
Community Level
Public Health Education
Community Health Program

IDENTIFICATION OF ISSUES

Psychosocial
Factors promoting disease
Factors affecting recovery
Bioethical
Medical problems and practices with moral issues
 Medicolegal
Physicians legal responsibilities and liabilities

IDENTIFICATION OF RESEARCH QUESTIONS

Notes

General Guidelines in the Formulation of

BIOMEDICAL/INDIVIDUAL DOMAIN
(BIOLOGICAL FOUNDATION AND BASIS OF CLINICAL MANAGEMENT)

EPIDEMIOLOGY - Symptoms and diseases

Definition of the health problem

Dengue is a serious viral disease transmitted by the bite of the mosquito,

Aedes aegypti.
It occurs in two forms:

1. Dengue fever
severe, flu-like illness that affects older children and
adults but rarely causes death

2. Dengue hemorrhagic fever

more severe form of dengue fever, in which bleeding and
occasionally shock occur, leading to death. It is most serious in children.
 ? Children affected with DHF?
?Adults with DF?

? What is the origin of the word Dengue?

Incidence and prevalence

Causes of Symptoms and diseases

The symptoms of dengue fever vary according to AGE and GENERAL

HEALTH OF THE PATIENT.

Infants and children may have a fever with a measles-like rash which is
indistinguishable from influenza, measles, malaria, infectious hepatitis, and other diseases
with fever.

Older children and adults may have similar symptoms or symptoms ranging from
mild illness to very severe diseases.

IMMUNOLOGY!

Characteristics of Dengue Fever

abrupt onset of high fever
severe frontal headache
pain behind the eyes which worsens with eye movement
muscle and joint pains
loss of sense of taste and appetite
*measles-like rash over chest and upper limbs
nausea and vomiting

Characteristics of DHF
symptoms similar to dengue fever
severe and continuous stomach pains
pale, cold or clammy skin
bleeding from the nose, mouth, gums and skin bruising
?which one is most common?
Frequent vomiting with or without blood
sleepiness and restlessness
constant crying
excessive thirst (dry mouth)
rapid weak pulse
difficulty in breathing
fainting
PATHOPHYSIOLOGY - Symptoms and diseases

The Dengue Mosquito

Female Aedes aegypti which carry the virus
5 mm, black and white insect with stripes on its legs and back

When do they usually bite?

early morning and late afternoon

When do they live?

Indoors - in dark places like closets
Outdoors - cool and shaded places

Female Aedes aegypti lay her eggs in water containers in and around houses.
Egg ---larvae (wigglers) --live in water for about a week
then change to pupa (1-2 days) ----- adult mosquito that can bite

How is dengue spread

bite of an infected female Aedes aegypti mosquito which has got the dengue
virus by taking a blood meal on a person who is illwith dengue.
Bite another person ---dengue viral infection

Causes of death and disability

DIAGNOSIS

Clinical
Paraclinical
*Compare paraclinical diagnostic procedures

TREATMENT

Nonoperative
Operative

*Compare treatment procedures

MANAGEMENT PLAN, ALGORITHM, OR PROTOCOL

 SOCIAL/POPULATION DOMAINS

PREVENTIVE AND PROMOTIVE HEALTH PROGRAM

Personal
Community Level
Public Health Education
Community Health Program

There is no drug to cure dengue

no vaccine to prevent it

2 key measures of prevention of spread of dengue

1. elimination of mosquito breeding places

cover water containers
removal of rubbish
biological control of larva - guppies (larva-eatin fish)
chemical control
larvicides - temephos sand core granules
pesticides
2. prevent mosquito bite
mosquito coils and electric vapor mats
mosquito net
repellents
screens
protection of people sick with dengue

Control of dengue outbreak

need for vector control

insecticides - adults
fogging or ultra-low-volume spraying

Community cooperation
provision of reliable water supply - prevent use of water storage containers
house-to-house inspections to control mosquito breeding
health education camplain
emergency preparedness
garbage clean-up campaign
school campaigns
Patients
Dengue can affect any human being.
Young and old, rich and poor, male and female.

?Any immunity to Dengue?

Resistance to Dengue?

Habitat

Dengue affects especially those living in densely crowed urban areas.

?Rural areas?

Tropical regions in the world

?Other regions?

IDENTIFICATION OF ISSUES

Psychosocial
Factors promoting disease
Factors affecting recovery
Bioethical
Medical problems and practices with moral issues
Medicolegal
Physicians legal responsibilities and liabilities

IDENTIFICATION OF RESEARCH QUESTIONS

Magnitude of the Problem

Dengue is now the most important mosquito-borne viral disease.

What are the other mosquito-borne viral diseases?

or other mosquito-borne diseases other than viral?
 Reported not only in the Philippines
From over 100 countries with approximately 2 billion people at risk.
Annually, millions of infection worldwide with tens of thousands of deaths.

Effect

reduced work productivity

death (as high as 20%)

With proper care, less than 1-2 % of patients with dengue or DHF will die.

Why is dengue epidemics increasing?

increasing urban population

expanding mosquito breeding due to unreliable water supply,
traditional water storage practices, poor garbage collection (creates more mosquito breeding
places, changing lifestyle

rapid transportation: movement of infected humans and spread of dengue mosquitos

other related factor:
inadequate health education
limited financial resources
insufficient mosquito control programs
resistance of mosquitos to insecticides
 Dengue Fever
Questions

What is Dengue?

What is the origin of the word Dengue?

What are the different forms of Dengue Fever?

Are these different forms different stages?

What is the pathophysiology of Dengue Fever?

What is the natural course of Dengue Fever?

What is the pathophysiology of fever in Dengue Fever?

What is the pathophysiology of flu-like symptoms in Dengue Fever?

What is the pathophysiology of bleeding in Dengue Fever?

What is the most common site of bleeding?

What is the earliest symptom of Dengue Fever?

Do all patients with Dengue Fever has fever?

What are reliable clinical cues for Dengue Fever?

What are presumptive diagnostic basis for Dengue Fever?

What is the most reliable basis for the diagnosis of Dengue Fever?

What is tourniquet test?

What is a positive tourniquet test?
What is the role of platelet count in patients suspected of Dengue Fever?

How do you differentiate Dengue Fever from other febrile illnesses?

What is the treatment of patients with Dengue Fever?

Is there a vaccine for Dengue Fever?

Is antibiotics indicated?
Is antiviral indicated?

What will be the indications for blood transfusion?

What and how much?

How do you follow-up patients with Dengue Fever?

How do you avoid Dengue Fever?

How do you control a Dengue Fever outbreak or epidemic?

What are the side-effects of insecticides?

A patient presents with a fever.

When do you strongly suspect dengue-fever?

When do you strongly suspect dengue-hemorrhagic fever?

When do you stronly suspect dengue shock syndrome?

What ancillary procedures will strongly indicate dengue fever?

What ancillary procedures will strongly indicate dengue hemorrhagic fever?
What ancillary procedures will strongly indicate dengue shock syndrome?

How do you monitor patients suspected of dengue fever but with normal platelet counts and with signs of bleeding?

What will be the indications for blood transfusion?

What? How much?

How do you follow-up this patients?

What is the pathophysiology of dengue fever?