Background: Corona Virus 2019 (COVID-19) challenged the delivery of medical education and training, especially to the 4th year medical students. Medicine's signature pedagogy, the ward rounds in the hospital, was put on hold in compliance with safety precautions during this pandemic and the Commission on Higher Education’s (CHED) suspension of face-to-face classes in all levels. How the University of Santo Tomas Faculty of Medicine & Surgery (UST FMS) Cardiology Rotation was delivered despite these restrictions is described. Using Google Classroom, Blackboard Collaborate, and Zoom, a 7-day online Cardiology Clerkship rotation was delivered to UST FMS 4th year students (clerks) using the synchronous and asynchronous mode of delivery. It consisted of the following: 1) Cardiovascular (CV) Ward Rotation with 3 cases using Google Classroom's adaptive release to create a vicarious experience of taking care of a patient and doing all the tasks that a clerk is supposed to do; 2) Virtual Ward Rounds by a consultant; 3) Outpatient Department (OPD) / Ambulatory Care Services (ACS) case discussions with a consultant and a 4) Heart Station Rotation for training in electrocardiogram (ECG) interpretation. Conclusion The advances in technology and software provided just-in-time resources that made possible the creative delivery of Medicine's signature pedagogy.
Cardiology

BACKGROUND: Coronavirus disease 2019 (COVID-19) has drastically changed lives, challenging all to adapt new norms and survive. Safety guidelines for physician have been set, yet fear for health and safety hounds the physician. OBJECTIVE: The aims of this study were to segment cardiologists’ viewpoints according to perceived stressors and coping mechanisms in their clinical practice during the COVID-19 pandemic and to draw implications to coping in the light of the model of salutogenesis. METHODS: Q methodology, a mixed-method type of research, was used after approval from the UST Hospital Research Ethics Committee. Using convenience sampling, 30 adult cardiologists were included in this study. Following an informed consent to participate, they ranked-order 33 statements that answer the questions: “What are the stressors has this COVID-19 pandemic brought in your clinical practice of cardiology? How did you cope?” This was done on a Q grid with two “most agree” statements and two “most disagree” statements (Q-sort). A short interview followed the sorting to understand their most agree and most disagree statements. Q-sorting and interview were done via teleconferencing and in person. The Q sorts were then entered into a web-based PQMethod software (http://schmolck.org qmethod/downpqdos.htm). Typologies were generated through inductive approach. RESULTS: Three typologies were generated: the profession-driven cardiologists, the protocoldriven cardiologists, and the faith-driven cardiologists. CONCLUSION This study painted different personas of cardiologists as they conduct their practice in this pandemic. These typologies enabled the formulation of individual and group salutogenic measures that can help health care providers cope in this COVID-19 pandemic.
Cardiology ; COVID-19

INTRODUCTION

Coronary artery disease (CAD) is one of the leading causes of death globally. Studies have shown association of CAD and its risk factors; however, data on association of these risk factors and severity of CAD as seen in angiography in our local setting are still limited.

The aims of this study were to determine the clinical and angiographic profile of patients who underwent coronary angiography, to correlate cardiovascular risk factors to their angiographic findings, and to compare the trend of risk factors and angiography findings between decades.

This is a retrospective observational study of patients aged 18 years or older, of either sex, who underwent coronary angiography at a tertiary hospital from 2001 to 2019. Pertinent risk factors were correlated with angiography findings to determine predictors for significant CAD.

The mean age of the patients was 58.6 years. There were more males (66%) than females. The risk factors for the likelihood of significant CAD are older age (4.98% more for every year increase in age), male sex (2.63 times), and diabetes mellitus (47.64%). The majority of the patients had right dominant circulation, and significant lesions were more commonly seen in the left anterior descending artery. There were statistically significant more patients with hypertension, diabetes, and obesity in the present decade compared with the past.

Increased age, male sex, and diabetes are associated with significant CAD in the local setting. Diabetes must be aggressively controlled early to prevent the development of significant CAD.

Background: Adding to the current available evidence on the efficacy of exogenous corticosteroids as an adjunct to standard of care in improving the clinical outcomes of COVID-19 patients. This meta-analysis examined the experimental and clinical data supporting this therapeutic intervention in improving clinical outcomes. Objectives: This meta-analysis aimed to assess the efficacy of corticosteroids in improving outcomes in COVID-19 patients. Search methods: Literature searches of electronic databases (PubMed, Cochrane Library, Science Direct, Google Scholar) were performed to identify relevant studies. Data Collection and Analysis: Meta-analysis was performed using Review Manager (RevMan) software, version 5.4.1. Intervention effects were expressed in terms of mean differences and risk ratios for continuous and dichotomous variables, respectively. Fixed-effect or random-effects model was adopted according to heterogeneity. Main Results: A total of seven studies were included in the quantitative synthesis. Analysis of pooled data showed a 12% reduced risk of mortality in COVID patients given corticosteroids (RR 0.88, 95% CI 0.81 to 0.95). Patients who were administered with corticosteroids also had 22% decreased risk of requiring invasive ventilation support (RR 0.78, 95% CI 0.64 to 0.95). Number of adverse events were similar between the two groups (RR 1.10, 95% CI 0.49 to 2.46). Conclusion Adjunct corticosteroid therapy provided improvements in clinical outcomes such as decreased deaths and decreased need for invasive ventilation support. There was no sufficient evidence of a significant adverse effect, hence it is relatively safe and beneficial to use in COVID19 patients.
Adrenal Cortex Hormones ; COVID-19 ; Meta-Analysis

Background: The seafarers' poor mental health has been associated with significant morbidity, inefficiency, and accidents on board. Mental and physical health is largely dependent on the way seafarers handle stressors.
Anchored on the Transactional Model of Stress and Coping, this study aimed to identify the typology of Filipino merchant marine ratings according to their coping strategies to stressors on board vessels.

Methods: Thirty-seven (37) Filipino merchant marine ratings participated in this study. They were chosen by purposive sampling. They rank-ordered 25 opinion statements on various stressors and coping mechanisms. The rank-ordered sorts were subjected to by-person factor analysis with Varimax rotation using the PQ Method version 2.32. The resulting factors were interpreted using the inductive approach, aided by the interview done after Q sorting.

Results: Four factors were generated: solution-focused seafarers, stressor-focused seafarers, self-management- focused seafarers, and the social milieu-focused seafarers. There is a consensus on the supplication-focused seafarers who ask for God's help in times of stress.

Conclusion: The generated typology provides a better understanding of seafarers' outlook on stress and coping and may help the stakeholders craft individualized strategies to help improve their coping mechanisms and overall mental health. Occupational health research must continue to focus on understanding the role of culture and adaptation on stress and coping behaviors to retain quality seafarers and promote a healthier workplace.

This clinical pathway for the diagnosis and risk stratification of patients presenting with acute chest pain, including acute coronary syndromes, provides recommendations and algorithms for clinicians to diagnose, risk stratify, and manage acute chest pain in adult patients. The writing committee reviewed existing international and local guidelines. Modifications to the algorithm following face-to-face and virtual meetings resulted in expert decisions written as recommendations and presented in a flow diagram format. The USTH Chest Pain Pathway provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities. We recommend its use to ensure quality patient care in the hospital.
Acute Coronary Syndrome|critical Pathways