BACKGROUND

Patient experience is the interaction with the healthcare system and is one of the three pillars of quality in healthcare. Its assessment provides an opportunity to assure quality of care, meet patients’ expectations, direct strategic decision making, and document benchmarks for healthcare organizations.

The onset of the pandemic pushed the employees’ clinic to institute new processes and focus on COVID-19 screening and monitoring of affected employees. The clinic used patient feedback to improve its services.

A survey tool was developed and released by the clinic in June 2020 to elicit feedback and improve its services. Most items were yes/no questions and patients were asked to rate based on a Likert scale of 0-5 for the other items. They were also given space for their additional comments/feedback.

The study described the experience of patients utilizing the COVID-19 services of the employees’ clinic of a tertiary hospital.

This was a cross-sectional study that involved a retrospective review of all data retrieved from the feedback forms from those who availed the COVID-19 services of the employees’ clinic, namely consultation, swabbing, and/ or telemonitoring, from June 2020 to December 2021.

A total of 4,136 feedback forms were retrieved from the employees’ clinic. There were 1,598 forms from consultation, 1,268 forms from swabbing and 1,270 forms from telemonitoring. A total of 456 comments were positive and 275 were negative. Most forms listed receiving an introduction from their physician/nurse (92.74%) and received instructions for swabbing (90.43%) during consultation. For swabbing, most received information regarding their schedule (95.43%). Almost all forms listed receiving SMS or calls (98.74%) and information regarding returnto- work or admission (96.14%) from the telemonitoring service. Only about half were able to discuss fears and anxieties (48.76%) during consultation and about twothirds (68.93%) received information regarding their RT-PCR results. Feedback stated that the clinic staff were respectful and courteous, and the service hours were convenient. However, concerns with data privacy were apparent.

Overall patient experience was generally positive despite the rapidly changing processes of the clinic.

BACKGROUND

Infection from SARS-CoV-2 have transient and long-term complications. Persistent symptoms postrecovery with perceptions of overall physical and mental health status are crucial information to construe on follow-up care.

To describe the clinical profile, general, and mental health outcomes of hospital staff who recovered from COVID-19 at follow-up 12 weeks or more post-convalescent.

This was a cross-sectional study on follow-up of hospital staff who recovered from COVID-19. Study population included staff or health care workers of a COVID-19 referral tertiary hospital, who had laboratoryconfirmed COVID-19 via RT-PCR. Informed consent was obtained through phone calls and google forms. Data collection was through a self-administered, on-line google form or voice-call interviewer-assisted questionnaire. Analysis was done with Stata 17 using frequencies, proportions, and cross-tabulations.

Persistent symptoms reported several months post-recovery from COVID-19 included fatigue (25%), difficulty of breathing (23%), muscle weakness (16%), nasal congestion (12%), cough (10%), sore throat (5%), anosmia (3%), and ageusia (2%). Symptoms of physical and mental fatigue post-COVID-19 were reported by 25% (N = 93) with extreme fatigue reported by four staff. Fifteen percent (N = 57) reported that they feel that their workload or schedule needed modification after recovery. Feelings of isolation, depression, and anxiety were the most common mental health issues reported. Screening using validated tools showed that depressive symptoms were present in 45% (N = 145) and anxiety in 18% (N = 53).

Healthcare workers who recovered from COVID-19 for at least 12 weeks or more described their health status as comparable to their overall health one year before the infection. Physical and mental health symptoms reported 12 weeks post-recovery include fatigue, breathlessness, anxiety, and depression and were described in various levels of severity.

COVID-19 commonly manifests with respiratory symptoms but is reported to involve other organs including the skin. This is a case of a 58-year-old male diagnosed with mild COVID-19 infection via reverse transcriptase polymerase chain reaction (RT-PCR) nasopharyngeal swab (NPS). He initially presented with symptoms of fever, cough, colds, sore throat, anosmia, ageusia, myalgia, and diarrhea. Maculopapular cutaneous lesions appeared on the extremities on the 3rd day of illness and were described as pruritic and blanching. The patient was managed conservatively with oral hydration and vitamin supplementation. During home isolation, symptoms were monitored via telemedicine. He recovered and was asymptomatic 36 days from the onset of symptoms. During the early part of the pandemic, further diagnostic testing was challenging due to the restrictions that were implemented. However, careful history, modified physical examination, and monitoring through teleconsultation proved to be very useful. Documenting the course and outcome of COVID-19 patients with skin manifestations would help facilitate timely diagnosis and treatment, as well as anticipate the possible prognosis of patients who present with a similar clinical pattern.

OBJECTIVE

To describe the treatment outcomes of patients who underwent tube pericardiostomy for all etiologies of non-traumatic massive pericardial effusion or tamponade during the COVID-19 pandemic and determine the association between patient profile and treatment outcomes.

Data were obtained from patients with massive pericardial effusion or cardiac tamponade who underwent surgical drainage from January 1, 2020, to September 1, 2022, in the University of the Philippines – Philippine General Hospital (UP-PGH). These patients’ demographic and clinical profiles, and treatment outcomes were evaluated using frequencies and percentages. Chi-squared and Fisher’s tests determined the differences between COVID (+) and (-) groups. Odds Ratio was used to assess the risk of complications and mortality.

The study population comprised 90 patients with a mean age of 45 years. 54.4% were females. Fifteen (16.67%) were COVID-19 (+) and 75 (83.33%) were COVID-19 (-). Most of the patients were of O+ blood type (34.4%), with no smoking history (67.8%) and no COVID-19 vaccination (76.7%). Common comorbidities were cancer (70%), tuberculosis infection (32.2%), and hypertension (25.6%). No significant difference was found between the two study groups. The presentation was subacute (one week to three months) (62.2%), with the most common symptoms of dyspnea (81.1%), orthopnea (61.1%), and cough (52.2%). Tachycardia (80%) and tachypnea (57.8%) were the most common presenting signs. Hypotension was found more frequently among COVID-19 (+) patients (46.7% vs. 12.0%, p = 0,003, 95% CI). Most patients had abnormal WBC, coagulopathy, elevated inflammatory markers, and cardiac biomarkers. Sinus tachycardia, regular sinus rhythm, ST-T wave changes, and low voltage QRS were common ECG findings. The most common chest X-ray results were pleural effusion (80%), pneumonia (71.1%), and enlarged cardiac border (42.2%). Majority of echocardiographic findings were large effusion (>2 cm) (97.8%), RV collapse (40%), and RA collapse (23.3%). An average of 628 ml of pericardial effusion was drained, predominantly serous and exudative. One specimen yielded a positive AFB culture. 6.7% showed carcinoma cells on fluid cytology. The pericardium was normal in 78.9%. 10.0% of the pericardial biopsy specimen had carcinoma, with metastatic cancer being the most common etiology. The most common cancers were lymphoma (22.7%), breast (25.8%), and lung (16.7%). Hospital length of stay was 18 days in COVID-19 (+) patients and 12 days in COVID (-). The complication and in-hospital mortality rate in the COVID-19 (+) compared to the (-) group (86.7% vs. 73.3% and 46.7% vs. 41.3%, respectively) were not statistically significant. The most common complications were respiratory failure (60%), shock (53.3%), and nosocomial pneumonia (40%). There was no association between clinical factors and the risk for complications. Any complication increased the risk for mortality (OR 15.0, 95% CI 3.2-19.7, p=0.002). The presence of hypertension (OR 0.08, 95% CI 0.02 to 0.4, p=0.001) and subacute duration (OR 0.3, 95% CI 0.09 -0.9, p=0.045) decreased the mortality risk.

Profiles were similar in both groups. There was no association between patient profile and complications. Having COVID-19 did not affect patient outcome. The presence of any complication increases the risk of mortality. In-hospital mortality was high at 42.2%.

Rationale. COVID-19 pandemic disease, can be transmitted during gastrointestinal procedures, via aerosolized droplets, and via fecal shedding. Both international and local endoscopy societies have issued strategies to alleviate the risk to endoscopy personnel. However, several barriers against the implementation of these recommendations exist thus individual center’s policies are employed whenever applicable. Objectives. This narrative study aims to describe the current experience and set-up in the endoscopy unit of a COVID referral center, discuss the stratification of patients for endoscopy, the operational management of the personnel and endoscopy unit in line with the adapted local and international guidelines and offer endoscopists a quick reference guide to adapt endoscopy practice during the pandemic in a resource-limited setting. Methodology. This paper reviews and consolidates current endoscopy guidelines and describes the single-center experience of Philippine General Hospital. Results. In resource-limited settings, with uncertainties of prolonged COVID-19 impact to healthcare, modification of practice, adherence to strategies and recommendations, empowerment of workforce, establishing the sustainability of resources, training, and service to patients, are essential components to combat current dilemma brought about by this pandemic. Conclusion. Integration of current local and international guidelines encompass all aspects of endoscopy practice during the pandemic. The recommendations cited are aimed to guide other resource-limited endoscopy units for potential changes and guidance in the overall practice.
COVID-19

Background: The global economy has been severely affected by the COVID-19 pandemic which proved to be more than a public health crisis. Volume and gross income have also declined in the health service sector including the diagnostic imaging and radiotherapy divisions of the radiology departments in other countries. Objective: This study determined the change in volume and gross income of the Radiology Department of a tertiary hospital which was designated as a COVID-19 referral center in the Philippines. Methodology: Monthly records of the profit centers of the Radiology Department were reviewed noting the volume and gross income one year before and during the first year of the pandemic. Results: Records were successfully retrieved for the volume of procedures and revenue for each profit center from one year before the pandemic (from March 1, 2019 to February 28, 2020) and the first year of the pandemic (from March 1, 2020 to February 28, 2021). There was a total reduction of 120,046 procedures conducted and Php 84,837,614.16 in revenues generated between the two periods. This is equivalent to a 61.98% (range: 47.92% to 83.37%) decrease in the volume of procedures and a 45.02% (range: 31.08% to 77.86%) decrease in revenue. These changes were found to be statistically significant. Conclusion The COVID-19 pandemic caused a decline of all profit centers in the Radiology Department. The decline was associated with changes in quarantine restrictions. Data from this study may help the administration of the institution or other institutions to conduct their own studies and cope with future pandemics of similar magnitude or further surges of the current pandemic on decisions regarding budget and resource allocation.
COVID-19

The Philippine COVID-19 Living Clinical Practice Guidelines (CPG) is a set of guidelines that provides up-to-date evidence-based recommendations on COVID-19 treatment, diagnosis, infection prevention and control. This living guideline follows the Department of Health’s Manual for Clinical Practice Guideline Development1 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Approach.2 The diagram below is a summary of the treatment regimens gathered from the Philippine COVID-19 Living Recommendations website. The recommendation for each drug regimen is based on the assessment and literature review done by the Living CPG Task Force (LCTF).3 The LCTF follows the classification of quality of evidence enumerated and described in Box 1.
COVID-19

The Republic Act No. 11494, also known as the "Bayanihan to Recover as One Act," mandates the allocation of funds and provides guidance for the procurement of COVID-19 vaccines.1 However, with the limited availability of COVID-19 vaccines, the Department of Health (DOH) established different policies and guidelines for the selection, access, and deployment of these vaccines throughout the country.2 3 4 5 To date, the Philippine Food and Drugs Authority (FDA) has granted emergency use authorizations for eight COVID-19 vaccines, namely: Pfizer-BioNTech COVID-19 Vaccine, COVID-19 Vaccine AstraZeneca, CoronaVac, Sputnik V, Janssen COVID-19 Vaccine, Covaxin, COVID-19 Vaccine Moderna, and COVID-19 Vaccine BIBP/Sinopharm.6 One of the guidelines established by the DOH is the implementation of a prioritization scheme, wherein citizens are categorized into different prioritization groups based on risk of exposure to the virus and risk of mortality from COVID-19.4 In Davao City, the COVID-19 vaccination roll out started last 5 March 2021 among health care workers at Southern Philippines Medical Center. 7 Aiming to vaccinate 1,200,000 individuals in Davao City,8 the City Government of Davao, DOH Davao Region, and other participating sectors established 59 vaccination sites throughout the city.9 We gathered online data posted in the official facebook pages of DOH Davao Region and the City Government of Davao. According to the DOH Davao Region reports, as of 27 July 2021, a total of 742,710 doses of COVID-19 vaccines were allotted for Davao City. From the total allotted doses, the City Government of Davao City has successfully administered a total of 330,954 first doses, and 149,122 second doses of COVID-19 vaccines.10 According to the City Government of Davao, as of 25 July 2021, Davao City has administered a total of 85,260 doses (1st dose - 47,332 doses, 2nd dose - 37,928 doses) of COVID-19 vaccine among individuals in the A1 prioritization group, 103,837 doses (1st dose - 76,472 doses, 2nd dose - 27,365 doses) among those in the A2 prioritization group, 179,479 (1st dose - 101,833 doses, 2nd dose - 77,646 doses) among those in the A3 prioritization group, 98,502 doses (1st dose - 97,446 doses, 2nd dose - 1,056 doses) among those in the A4 prioritization group, and 12,998 doses (1st dose - 7,871 doses, 2nd dose - 5,127 doses) among those in the A5 prioritization group.11 All in all, as of 27 July 2021, 149,122 individuals out of Davao City's target of 1,200,000 individuals (12.43%) have received complete COVID-19 vaccination. In addition, 181,832 individuals have already received the first dose of a two-dose COVID-19 vaccine.8
COVID-19

As the biggest COVID-19 facility in Mindanao, Davao City’s Southern Philippines Medical Center (SPMC) rolled out its first doses of COVID-19 vaccines to some of its frontline health care workers (HCW) last March 5, 2021. The COVID-19 vaccination program in the Philippines is an extensive and comprehensive immunization campaign to help curb the spread of SARS-CoV-2 and protect the people against severe COVID-19. To expedite the vaccine procurement and administration process, the Republic Act 11525 or the “COVID-19 Vaccination Program Act of 2021” was enacted into law on February 26, 2021.1 The Department of Health (DOH) and the National Task Force against COVID-19 (NTF), in partnership with local governments, have been tasked to implement, facilitate, and monitor the COVID-19 vaccination program.2
COVID-19

In the Philippines, the coronavirus disease 2019 (COVID-19) pandemic has accorded a tremendous challenge to health care in terms of protecting frontline staff from contracting the virus and providing optimal medical management to patients with or without COVID-19. Across the globe, even countries with well-developed healthcare systems are battling COVID-19 with great difficulty. In terms of local response, on March 15, 2020, Davao City was placed under community quarantine1 to limit the movement of people and curb the spread of SARS-CoV-2, the virus that causes COVID-19. Further restrictions on work, businesses, transportation, and other daily activities were imposed during an enhanced community quarantine (ECQ) from April 4, 2020 to May 15, 2020,2 3 4 5 followed by a 15-day general community quarantine (GCQ).6 7 Patients from Davao City who are suspected of having COVID-19 began to be referred to the Southern Philippines Medical Center (SPMC) starting in early March 2020. The SPMC Laboratory Unit also started processing reverse transcription polymerase chain reaction (RT-PCR) tests for the diagnosis of COVID-19 as a subnational laboratory late in March. Being the only subnational laboratory in the southern Philippines during the first few weeks of community quarantine, SPMC processed most of Mindanao's COVID-19 RT-PCR tests.
COVID-19