University Of The Philippines-Philippine General Hospital Research Articles

Rate of Diagnostic Change in Surgical Pathology Reports after Mandatory Intradepartmental Peer Review in a Tertiary Hospital in the Philippines: A Retrospective Study.

There is a mandatory intradepartmental peer review algorithm in the University of the Philippines - Philippine General Hospital (UP-PGH) Department of Laboratories wherein specific cases are required to be reviewed by another pathologist before the release of results. The main objective of this study was to determine the rate of diagnostic change in surgical pathology reports after undergoing the said review. All surgical pathology cases which underwent the review from 2015 to 2018 were retrieved from the records of the Section of Surgical Pathology. The cases were classified as concordant or discordant. A case was considered concordant if the reviewing pathologist had agreed with the primary pathologist's diagnosis. A case was considered discordant if the reviewing pathologist had disagreed with the primary pathologist's diagnosis. Out of 5,377 cases included in this study, there were 5,209 concordant cases and 168 discordant cases, with the rate of discordance computed to be 3.1%. Out of the 168 discordant cases, 107 were revised for diagnostic change. Rate of diagnostic change was computed to be 2.0% (107 out of 5,377 cases for review). The most common criterion satisfied for meriting a mandatory review is being under the category of biopsies or cytology cases with malignant or borderline diagnoses (49.4%). The most common category of diagnostic change is change in immunohistochemistry recommendations (24.3%). Most of the discordant cases and cases revised for diagnostic change fall under the categories of gastrointestinal, gynecology, and head & neck pathology. The low rate of diagnostic change in our institution might be attributed to good diagnostic accuracy. However, it is also possible that reviewing pathologists tended to agree with the diagnosis made by their colleagues because of the element of peer pressure. Data from the study may imply that special courses/ lectures or institutional standard practice guidelines on interpreting biopsy and cytology cases as well as on the utility of immunohistochemistry studies, especially those focused on gastrointestinal, gynecology, and head & neck pathology are needed by the pathologists and the doctors training to become pathologists in our institution.

Skin Prick Tests and Enzyme-Linked Immunosorbent Assays among Allergic Patients Using Allergenic Local Pollen Extracts.

Allergic respiratory diseases are prevalent in the Philippines, with allergic rhinitis and asthma occurring at 20% and 8.7% of the population, respectively. The diagnosis of respiratory allergies is achieved by a combination of patient history and different screening tools, especially for the identification of the allergic triggers such as allergy skin prick test (SPT) and serum-specific IgE enzyme-linked immunosorbent assays (sIgE ELISA). The Philippines, being a tropical country, have a wide variety of plant species with potential to produce allergenic pollen grains. Knowledge of the sensitization profiles of Filipino allergic patients to our local pollen allergens is currently limited. The aim of this study is to determine the sensitization profile of patients with respiratory allergies (allergic rhinitis and/or asthma) through the allergy skin prick test (SPT) using allergenic local pollen extracts. It also aimed to determine if there is a positive agreement between the SPT and sIgE ELISA positivity rate and whether the results have relationship with the pollen purity and the protein content of the extracts. Pollen allergens were extracted from Amaranthus spinosus (pigweed), Mimosa pudica (makahiya), Tridax procumbens (wild daisy), Imperata cylindrica (cogon), Oryza sativa (rice), Pennisetum polystachion (foxtail grass), Sorghum halepense (Johnson grass), Albizia saman (acacia), Cocos nucifera (coconut), Leucaena leucocephala (ipil-ipil), and Mangifera indica (mango). SPT was performed at the Allergy Clinic of the University of the Philippines-Philippine General Hospital on patients with allergic rhinitis and/or bronchial asthma. Blood samples were collected from patients who developed wheal diameters of 3 mm or more than the negative control. Sera were tested against the same pollen extracts using ELISA. Of the one hundred sixty-five (165) patients who submitted for skin prick test, 129 showed positive SPT results to the pollen extracts. Weeds were the most sensitizing (51.9%-58.1%). Blood samples were collected from these patients and tested for sIgE ELISA and among them, 71 were positive in the sIgE ELISA. Highest sensitization rates in sIgE ELISA were found in coconut, pigweed, Johnson grass, and rice. The highest positive agreements or the proportion of patients with positive sIgE ELISA among those with positive SPT were in coconut, followed by Johnson grass, pigweed, and rice. Most of the pollen sensitized patients on SPT are polysensitized. SPT is a safe, simple, and rapid method for the diagnosis of IgE-mediated allergy. The lower number of positive patients in sIgE ELISA may be attributed to the low serum IgE levels and low quantities of effectual allergen components in extracts. Results of both SPT and ELISA must be correlated with a patient's clinical history, particularly the patient's exposures, and physical examination.

Epidemiologic Profile and Clinical Outcomes of Patients with Pheochromocytoma in the University of the Philippines Philippine General Hospital (UP-PGH)

Objective. This study aims to describe the epidemiologic profile and determine the clinical outcomes of patients with pheochromocytoma at the University of the Philippines Philippine General Hospital (UP-PGH). Methodology. We reviewed the medical records of 30 patients with histopathology-proven, clinical, and biochemical diagnosis of pheochromocytoma. Demographic, clinical characteristics, and clinical outcomes were collected for each patient. Results. The median age at diagnosis of pheochromocytoma was 37.5 years (IQR 28-55) and the most common metabolic comorbidities were glucose intolerance (60%) and hypertriglyceridemia (23.3%). Majority of the patients were hypertensive (90%). Two third of the patients presented with classic features of pheochromocytoma while the remaining third presented as adrenal incidentaloma. Recurrence was found in 17% of subjects, who were significantly younger (25 years vs 46.5 years P = 0.0229), and had higher rates of bilateral pheochromocytoma (0 vs 75%), p = 0.002). Metastatic pheochromocytoma was found in 10% of the subjects. Conclusion. Our study demonstrated that patients with pheochromocytoma in our setting exhibit great variability in terms of clinical behavior. Although majority of the patients presented with symptoms related to catecholamine excess, almost one-third of the patients were only incidentally discovered. Incidence of pheochromocytoma recurrence and metastasis in our setting are comparable with current available foreign studies.

Strategic Optimization of Patient Flow and Staffing Schemes during the COVID-19 Pandemic through Operations Management in a Neonatal Intensive Care Unit.

The COVID-19 pandemic posed challenges in making time-bound hospital management decisions. The University of the Philippines -Philippine General Hospital (UP-PGH) is a tertiary COVID-19 referral center located in Manila, Philippines. The mismatch of increasing suspected or confirmed COVID-19 infected mothers with few documented cases of infected infants has caused significant patient overflow and manpower shortage in its NICU. We present an evaluated scheme for NICU bed reallocation to maximize capacity performance, staff rostering, and resource conservation, while preserving COVID-19 infection prevention and control measures. Existing process workflows translated into operational models helped create a solution that modified cohorting and testing schemes. Staffing models were transitioned to meet patient flow. Outcome measurements were obtained, and feedback was monitored during the implementation phase. The scheme evaluation demonstrated benefits in (a) achieving shorter COVID-19 subunit length of stay; (b) better occupancy rates with minimal overflows; (c) workforce shortage mitigation with increased non-COVID workforce pool; (d) reduced personal protective equipment requirements; and (e) zero true SARS-CoV-2 infections. Designed for hospital operations leaders and stakeholders, this operations process can aid in hospital policy formulation in modifying cohorting schemes to maintain quality NICU care and service during the COVID-19 pandemic.

Determination of emergency department patient utilization and staffing at the University of the Philippines-Philippine General Hospital (UP-PGH)

Objective: In developing staffing plans for emergency departments (EDs), a multifaceted approach must be considered without compromising quality of care, patient safety and personnel satisfaction. This study aims to determine the temporal trend of patient attendance and staffing in a major tertiary hospital ED to assist in establishing an optimal staffing pattern.
 Methods: A 1-year retrospective ED census review of adult patients at the University of the Philippines-Philippine General Hospital (UP-PGH) was undertaken. One-way analysis of variance (ANOVA) with post hoc Fisher-Hayter pairwise comparisons were utilized to determine if the ED consults and admissions were significantly (P<0.05) associated with the month of the year and day of the week.
 Results: A total 43,632 consults at the UP-PGH ED, averaging of 3,636 per month or 121 per day, were seen in 2019. Results indicated statistically significant differences between monthly [F (11,353) =16.45; P<0.0001] and between daily means [F (6,358) =4.19; P=0.0004]. The most number of consults occur during August, September, October and November while admissions were highest during April and October. It was busiest during Mondays and afternoon shifts (1400-2200 hours) with majority arriving as urgent in acuity. Mortality was also highest during the afternoon shifts. 
 Conclusion: The temporal variations in patient visits and acuity described in our study can be used as a template for workforce scheduling and resource allocation to meet the demands in the provision of care at the ED.

The Utilization Pattern of Psychiatric Consultation Services at the University of the Philippines-Philippine General Hospital (UP-PGH) from 1999-2008

Objective. This study describes the utilization pattern of psychiatric consultation services at the UP-PGH from 1999 – 2008 by reviewing the demographic data of patients referred, describing the Axis I (Clinical Disorders and Other Disorders That May Be a Focus of Clinical Attention) and Axis III (General Medical Conditions) diagnoses of referred patients, and by identifying the sources of, and reasons for the different referrals.
 Methods. Relevant data from the annual census of the Consultation – Liaison (CL) Psychiatry Section from 1999 – 2008 was reviewed according to age, sex, civil status, reasons for referral, DSM-IV TR Multi-axial diagnoses and sources of referrals.
 Results. The percentage of referrals to consultation psychiatry has increased from 1.03% in 1999 to 1.77% in 2008. There is equal distribution between males and females. Majority of the consultation referrals were married and belonged to the 21-40 age group. The top five referring services were general medicine, surgery and trauma, obstetrics-gynecology, otorhinolaryngology and orthopaedic departments. The top three reasons for referring patients were mood problems, agitation and restlessness, and suicide attempts/behaviour. Majority of the axis I diagnoses were adjustment disorder, depressive disorders, and psychological reactions to illness. According to Axis III diagnoses, majority of the referrals were associated with poisoning and injury, neoplasms, and endocrine, nutritional, metabolic and immunity disorders.
 Conclusion. The referral rate to the CL-Psychiatry Section at the UP-PGH has increased throughout the period studied. This may be attributed to programs and activities that improve efficiency in the delivery of psychiatric knowledge and skills, and better personnel supervision. The referral rate of 1.03% to 1.82% was consistent with those in other countries.

Diagnostic Validity of Point-of-Care Breast Ultrasound for Females with Palpable Breast Masses

IntroductionWith breast cancer as one of the frequent causes of cancer mortality today, the importance of ultrasound in its early detection has been apparent. It has been a valuable addition to the surgeon's diagnostic skills, contributing a vital role in clinical practice. We set out to determine the accuracy and value of breast ultrasound for primary imaging in women presenting with a clinically palpable mass in our outpatient clinic. Materials and MethodsThis is a retrospective cross-sectional study of a point-of-care breast ultrasound among patients who consulted at the University of the Philippines-Philippine General Hospital (UP-PGH) Breast Care Clinic for a palpable breast mass without prior histopathologic diagnosis. The overall diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Sonographic features were also identified, and multiple logistic regression analysis was performed to determine significant predictors of malignancy. ResultsEighty patients were reviewed and compared with their histopathology results. The overall accuracy of a surgeon-performed breast ultrasound was 86.2%, sensitivity of 91.4%, specificity of 82.2%, PPV of 80% and NPV of 92.5%. Indistinct borders, posterior enhancement, unilateral shadowing, heterogeneous echo pattern and deeper than wide anterior-posterior ratio are sonographic features associated with malignancy. ConclusionThis study showed that a point-of-care ultrasound for a palpable breast mass is reliable with a relatively good accuracy rate. Performing breast ultrasound in the clinic will help the surgeon evaluate the extent of disease preoperatively and be guided as to the optimal surgical management for the patient.

A descriptive retrospective study on HIV care cascade in a tertiary hospital in the Philippines.

The HIV care cascade is a model used to examine the engagement of people living with HIV (PLHIV) in medical care from the time of diagnosis to sustained viral suppression. This study describes the stages of the cascade from linkage to care, antiretroviral therapy (ART) initiation, retention in care, and virologic suppression- at the University of the Philippines-Philippine General Hospital (UP-PGH) STD/AIDS Guidance and Intervention Prevention (SAGIP) treatment hub in the context of existing cascades with similar demographics. We retrospectively reviewed the medical records of patients enrolled at the UP-PGH SAGIP treatment hub from June 2015 to December 2017. Baseline demographic and clinical data were collected, relevant to each stage of the cascade. Descriptive statistics using Microsoft Excel version 16.0 was used to characterize data and cumulative and conditional proportions were reported. Of the 584 patients included in the cohort, majority were male (91.1%), with a median age of 29 years (range, 0.17 to 68 years). Male-to-male sex was the most common mode of transmission (325/584, 55.6%). Among all patients enrolled at the UP PGH SAGIP treatment hub, 99.5% were linked to care, 95.0% initiated ART, 78.8% were retained in care and maintained on ART, 47.9% were tested for HIV viral load, and 45.5% achieved viral suppression. A high proportion of patients enrolled at the UP-PGH SAGIP treatment hub are linked to care and initiate ART, exceeding the set goal of 90%, which is higher than reported nationwide. However, there is a substantial decrease in the number of patients who are subsequently retained in care, tested for HIV viral load, and achieve viral suppression. Gaps in the cascade related to healthcare delivery need to be investigated further and addressed by future studies. We recommend implementation of a community-based, patient-centered approach in order to reach the goals of the HIV cascade, with particular focus on young, MSM-PLHIV.

Healthcare Encounters and Outcomes of Filipino Patients with Systemic Lupus Erythematosus Managed at a Tertiary COVID-19 Referral Center.

The coronavirus disease 2019 (COVID-19) pandemic has limited healthcare delivery for patients with chronic diseases, including Systemic Lupus Erythematosus (SLE). This study aims to describe the outcomes of patients with SLE in a national COVID-19 referral center in the Philippines. A review of records of all adult patients with SLE seen in the University of the Philippines-Philippine General Hospital (UP-PGH) from March 2020 to December 2021 was done. Data about patient characteristics, health encounters, and outcomes before and after the first visit during the study period were extracted. Descriptive statistics were employed. Our population of 403 patients was predominantly young (mean age 34.53 ± 11.14 years), female, and unemployed. This consisted of 370 known cases of SLE, 92 were diagnosed in institutions outside UP-PGH, and 33 new patients. Over the 22-month study period, there were 2,093 medical encounters, most of which were teleconsultations (81.70%). During an average gap of 53.6 ± 26.7 weeks between the last consultation and the first visit within the pandemic study period, 84 patients (22.70%) discontinued at least one of their SLE control medications, 68 (18.38%) patients developed a lupus flare, and 79 (21.35%) were hospitalized for various reasons. On their return to the rheumatology clinic during the pandemic, 37.47% were in lupus flare, 28.29% needed to be hospitalized, and 20 died. However, 86.75% of flares were controlled. During subsequent health encounters, 48 patients had a new flare (43 of these were controlled) and 20 died. The most common reason for hospitalization (n=160) was lupus disease flare and the most common cause of death (n=40) was pneumonia. Sixty patients acquired COVID-19 infection from which most recovered and four died. Audio teleconsultation was the most common method used by our lupus cohort to interact with their doctors during the pandemic. There was an average of a year-long interruption in medical care for 62.70%. More than a third developed a disease flare and 15% acquired COVID-19 but outcomes were good in more than 85%. Despite the challenges posed by the pandemic, the majority of our lupus cohort who were able to continue their treatment had favorable outcomes.

Predictors of 30-day Unplanned Hospital Readmissions among Maintenance Dialysis Patients.

Patients on dialysis are twice as likely to have early readmissions. This study aimed to identify risk factors for 30-day unplanned readmission among patients on maintenance dialysis in a tertiary hospital. We conducted a retrospective, unmatched, case-control study. Data were taken from patients on maintenance hemodialysis admitted in the University of the Philippines-Philippine General Hospital (UP-PGH) between January 2018 and December 2020. Patients with 30-day readmission were included as cases and patients with >30-day readmissions were taken as controls. Multivariable regression with 30-day readmission as the outcome was used to identify significant predictors of early readmission. The prevalence of 30-day unplanned readmission among patients on dialysis is 36.96%, 95%CI [31.67, 42.48]. In total, 119 cases and 203 controls were analyzed. Two factors were significantly associated with early readmission: the presence of chronic glomerulonephritis [OR 2.35, 95% CI 1.36 to 4.07, p-value=0.002] and number of comorbidities [OR 1.34, 95% CI 1.12 to 1.61, p-value=0.002]. The most common reasons for early readmission are infection, anemia, and uremia/underdialysis. Patients with chronic glomerulonephritis and multiple comorbidities have significantly increased odds of early readmission. Careful discharge planning and close follow up of these patients may reduce early readmissions.

Factors Affecting Outcomes of Percutaneous Transluminal Angioplasty for Central Vein Occlusive Disease in the University of the PhilippinesPhilippine General Hospital: A 10-Year Experience

Factors Affecting Outcomes of Percutaneous Transluminal Angioplasty for Central Vein Occlusive Disease in the University of the PhilippinesPhilippine General Hospital: A 10-Year Experience

Exposure of reproductive-aged pregnant and nonpregnant women to common environmental pollutants and endocrine-disrupting chemicals: A cross-sectional survey at the University of the Philippines-Philippine General Hospital

CONTEXT: Exposure to environmental pollutants (EP) and Endocrine-disrupting chemicals (EDCs) is associated with several general negative health effects which compromise women's reproductive health, maternal, and neonatal outcomes. Unfortunately, many nonpregnant and pregnant women are unaware of their active exposure to these potentially slow-acting toxic substances, EPs, and EDCs. At any stage of life, and in the long-term minute exposures, there is no established safe level of exposure to these substances. Due to the potentially harmful effects on women in general, and to the pregnant and her unborn child in particular, it is important to establish the prevalence of their exposure.AIMS: The aim of this study was to determine the magnitude (prevalence) of exposure among nonpregnant and pregnant women aged 18–49 years to common EPs/EDCs such as bisphenol A, pesticides, phthalates, and perfluorinated compounds among others.SETTINGS AND DESIGN: This study was conducted at the Philippine General Hospital, University of the Philippines Manila.SUBJECTS AND METHODS: The study participants were nonpregnant and pregnant women, with low-risk singleton pregnancy, and had a prenatal checkup and eventual delivery at the Philippine General Hospital. After consent, women were asked to answer a survey focused on their sociodemographics and frequency of exposure to EP- and EDC-containing items.STATISTICAL ANALYSIS USED: Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Null hypotheses were rejected at 0.05 α-level of significance. The computer software STATA 13.1 was used for data analysis.RESULTS: One hundred and fifty-nine survey responses by women were analyzed. Possible EDC-containing household items (carpets, linoleum, upholstered, and stain-resistant furniture) are more prevalent in the homes of pregnant women compared to nonpregnant women. Pregnant women are also exposed to wallpapers compared to nonpregnant individuals. Nonpregnant women were 1.5 times more exposed to lotions. Unexposure to hand sanitizers is 1.3 times higher among pregnant individuals.CONCLUSIONS: There are differences in the prevalence of exposure to household EDC-containing items between pregnant and nonpregnant women, with pregnant women having a higher prevalence of exposure.

Primary Breast Sarcoma

Introduction Primary sarcomas of the breast are <0.1% of all malignant tumours of the breast. To date, there are 13 major breast sarcoma series in English literature. This study adds to these series characterizing primary breast sarcoma among Philippine patients. Methods All breast biopsies from the pathology records of the University of the Philippines-Philippine General Hospital (UP-PGH) were searched for breast sarcoma cases from January 2000 to December 2010. Metaplastic carcinomas and phyllodes tumors were excluded. Results There were 52 patients (45 female, 7 male) ranging in age 25-83 years (median 46 years). Majority had lump, ten cases with pain. No history of previous cancer was given. No history of prior radiation was found. Histopathological diagnoses were spindle cell sarcoma (n=13), fibrosarcoma (n=6), liposarcoma (n=6), MPNST (n=5), stromal sarcoma (n=5), angiosarcoma (n=4), MFH (n=4), leiomyosarcoma (n=3), rhabdomyosarcoma (n=3), chondrosarcoma (n=2), and synovial sarcoma (n=1). Tumors were with grade 1 (n=18), grade 2 (n=8), and grade 3 (n=10). Necrosis was noted in 6 cases. Simple mastectomy was done in 19 cases (37%), MRM in 31 cases (59%), while 2 far advanced had no surgery (3%). None had adjuvant radiotherapy or chemotherapy. The duration of follow-up for 45 patients ranged from 1 – 117 months, excluding those who were lost to follow-up. All 15 deaths were due to progressive disease. Recurrences were observed in 9 patients. The disease-free survival (DFS) and overall survival (OS) was 73%and 75%, respectively. On multivariate analysis, DFS and OS were significantly correlated with size (HR=113.63; p=0.019 and HR=77.36; p=0.037), grade (HR=20.73 ; p=0.003andHR= 39.57; p= 0.004), and having a histology of angiosarcoma (HR=35.20 ; p=0.005and HR= 50.74; p=0.007), respectively. Conclusion Sarcoma remains an important clinical entity among primary breast cancers.

Perceptions on Susceptibility to Exposure to the COVID-19 Virus: A Qualitative Study on Pregnant and Non-pregnant Adult Women, their Partners, and Healthcare Workers in Metro Manila

Introduction. The World Health Organization (WHO) reported that special populations are more susceptible to the COVID-19 virus. There is little information on whether COVID-19 affects women of reproductive age and their fertility, pregnancy status, and offspring give: We aimed to assess the knowledge, practices, and perceptions (KPP) on the risk and susceptibility to COVID-19 of women of reproductive age.Methods. We conducted a qualitative exploratory descriptive study using the triangulation method. The studyconsisted of in-depth interviews (IDIs) with women of reproductive age and their spouses, focus group discussions (FGDs), and key informant interviews (KIIs) with health care professionals (HCP) in University of the Philippines-Philippine General Hospital. We assessed KPP using structured, open-ended interview guides. Interview responses were recorded and transcribed verbatim, and thematic analysis was performed using NVivo 12.Results. Eighty participants, 20 women of reproductive age, 20 spouses, 20 non-pregnant women, and 20 HCPsin UP-PGH were included in the study. All participants were knowledgeable about COVID-19. Pregnant womenwould consult their physicians when they felt symptoms related to COVID-19. Spouses of pregnant women andnon-pregnant women observed health measures to prevent the spread of the virus. Both pregnant and non-pregnant patients with COVID-19 felt shamed and stigmatized while the husbands worried that the exposure to the infection will pose a burden to their families. HCWs provided services through teleconsultation and found it challenging to refer patients to other facilities.Conclusion. The study provided insights on KPP of women with reproductive-age to COVID-19 and views of HCWs in providing care to these patients during the pandemic. The effects of COVID-19 are still detrimental and highly evident from the micro to the macro level.

Outcomes of Kidney Transplants Under the Philippine Health Insurance Corporation's Z Benefit Package at the University of the Philippines-Philippine General Hospital from 2015 to 2021

End-stage renal disease is one of the most burdensome diseases, particularly in developing countries such as the Philippines, with dialysis and kidney transplant commonly being a source of out-of-pocket expenditure among patients. To address the burgeoning health inequity, the Philippine Health Insurance Corporation (Philhealth) launched in 2012 its Z Benefit Package for kidney transplantation providing a substantial amount to subsidize the transplant with the aim of increasing financial risk protection of its members, especially the marginalized sector. The University of the Philippines-Philippine General Hospital is a government hospital that was one of the contracted hospitals to provide this benefit package since 2015. Herein we report our initial experience with 29 primary, low immunologic risk, living donor kidney transplants. Recipients mostly had chronic glomerulonephritis with a median discharge creatinine of 1.04 mg/dL. One, 3-, and 5-year graft survival was 100%, 96%, and 85%, respectively, with a median graft survival of 65 months. Donors were mostly male with a median discharge creatinine of 1.0 mg/dL. One, 3-, and 5-year patient survival was 100%, 91%, and 81%, respectively. Complications were mostly urinary tract infections. In conclusion, the Philippine Health Insurance Corporation Z Benefit Package for transplant seems to be achieving its goals of providing quality care particularly for the poor with catastrophic diseases such as end-stage renal disease. Optimal patient selection and management are essential in attaining excellent graft and patient outcomes. Furthermore, it is hoped that with this program, there will be increased awareness of the at-risk population, transplanting them preemptively, ensuring a better overall survival.

MO22-4 Impact of the COVID-19 pandemic on the treatment schedules of cancer patients receiving systemic treatment

To determine the impact of the COVID-19 pandemic to the treatment schedules of adult cancer patients receiving systemic treatment at the Cancer Institute of the University of the Philippines-Philippine General Hospital.

UP- PGH Division of Cardiovascular Medicine Fellowship Training and COVID-19: Opportunities and Innovations

BACKGROUND: The COVID-19 pandemic greatly affected training programs because of changes in patient load and service assignments. This posed certain challenges in the implementation of the pre–COVID-19 training curriculum recommendations by the Philippine Heart Association Specialty Board on Adult Cardiology. OBJECTIVE: This article describes the challenges, training adjustments and innovations, and the impact on the training program of these changes instituted by the University of the Philippines–Philippine General Hospital (UP-PGH) Division of Cardiovascular Medicine (DCVM) during the COVID-19 pandemic. METHODS: This is a descriptive article based on review of changes and improvements of the UP-PGH DCVM training manual and guidelines adopted during the COVID-19 pandemic. FINDINGS: The COVID-19 pandemic challenges provided opportunities for innovation of the training program. The program emphasized focus on maximizing team-based learning from every clinical encounter toward achievement of learning outcomes and competency. The training committee closely monitored the learning environment and trainee’s learning progress to achieve outcomes beyond the traditional metrics such as census and procedural numbers. It adopted online clinical encounters, conference, and case discussion. To enhance learning, virtual engagement supplemented physical encounters between consultants and training fellows assigned to various clinical rotations. Real-world research results on the impact of COVID-19 on cardiovascular health were utilized to enhance knowledge. Risk mitigation and transmission reduction strategies were adopted to ensure safety of all staff. The division also incorporated a strong wellness program to provide holistic approach to trainees’ and trainers’ health. New competencies were developed such as telemedicine, infection prevention and control, and creation of virtual patient education programs. CONCLUSION: The training institution met the challenges posed by the COVID-19 pandemic with resiliency and unity. The adjustments and innovations in training instituted by PGH DCVM proved useful in addressing the challenges posed by the pandemic. The situation was viewed as an opportunity to innovate and pursue a better program adaptive of the ever-changing environment, toward forming competent future cardiologists by enhancing focus not only on numbers but rather on the process of achievement of learning outcomes, embracing virtual and online strategies, institutionalization of wellness program, and development of new guidelines in the approaching patient management cognizant of both health care provider and patient safety and new competencies such as patient virtual education and telemedicine in cardiology.

Jacob S. Matubis, MD (1950-2022) “Bye, Jake!”

Jacob S. Matubis, MD (1950-2022) “Bye, Jake!”

MICROBIAL CARRIAGE OF HOSPITAL UNIFORMS AMONG EMERGENCY MEDICINE RESIDENTS AT THE UNIVERSITY OF THE PHILIPPINES – PHILIPPINE GENERAL HOSPITAL (UP-PGH)

The aim of this research is to identify the microbial flora and pathogen of hospital uniforms (HUs) among emergency medicine (EM) residents at the University of the Philippines – Philippine General Hospital (UP-PGH) and to determine factors affecting their presence. A prospective, cross-sectional design that sampled and cultured bacterial contaminants on hospital uniforms of EM residents at UP-PGH over a 10-day period from 13-23 April 2021 was utilized. Frequency distribution, z-test and chi-square test at p <0.05 statistical significance were used for the data analysis. A total of 22 EM residents, with a mean age of 30 (± 2.77) years participated in the study; more than half were females (54.5%) and went on evening (1900-0700hrs) duty shift (63.6%). Handwashing was done by 45.5% and 77.3% prior to and after seeing a patient respectively. Increases in the proportion of bacterial isolation in the after-duty samples were significantly noted for S. epidermidis at the right pocket (p<0.01), torso (p<0.01), and sleeve (p<0.01). Moderate growth of the bacteria was significantly associated with the morning shift (0700-1900 hours). Hospital uniforms can harbor pathogens and other harmful microorganisms as it is regularly exposed to the hospital environment. Given the growing number of nosocomial infections and increasing bacterial resistance to antibiotics, it is recommended to enforce infection control hospital policies that emphasize the importance of wearing HUs only at the workplace and prohibit its usage in public places. This should include regularly providing freshly laundered HUs, related sterilization services and proper storage.

Surgical Site Infection (SSI) Surveillance Program for Mastectomy in the Department of Surgery of the University of the Philippines-Philippine General Hospital

Background. Mastectomy is a common surgical procedure done worldwide. Surgical site infection (SSI) is a common healthcare-associated infection. Mastectomy SSIs are frequently under-reported.
 Objectives. The study aimed to determine the incidence of SSI among mastectomy cases of the Department of Surgery, University of the Philippines – Philippine General Hospital (UP-PGH) during one year of full implementation of the Surgical Site Infection Surveillance Program and evaluate the program’s surveillance follow-up rate.
 Methods. This study was an observational practice audit research that included all adult patients who underwent a mastectomy in UP-PGH from January 1, 2018, to January 31, 2019, when the SSI Surveillance Program was fully implemented. SSI was monitored and assessed during the patient’s hospital stay, on the day of hospital discharge, and at 30 days (± 2 days) after surgery, either during an outpatient visit or via phone call by a nurse navigator. SSI frequency for mastectomy was computed both during the in-hospital stay and at 30 days after surgery. Surveillance follow-up rate, defined as the proportion of patients who could follow-up up to 30 days after surgery, was determined.
 Results. The 30-day SSI rate for mastectomy was 6.8% (19/279). All 279 patients were followed up to 30 days after surgery. Of the 279 patients, 277 (99.3%) were through clinic visits, one was through phone calls, and one was still admitted to the hospital.
 Conclusion. Full implementation of the SSI Surveillance Program for mastectomy in UP-PGH for one year showed a higher SSI rate than in published international literature. The program had a complete 30-day patient follow-up, contributing to more accurate SSI reporting. Implementing an SSI surveillance program with standardized protocols, dedicated personnel, patient education component, and the analysis of the information derived from such programs can improve an institution's quality of surgical care.