Introduction. The COVID-19 pandemic has not only resulted in a public health crisis but has also strained hospital services. The provision of surgical care should therefore also be guided by ethical, and whenever applicable, also legal, principles. Methods. An integrative approach that covers clinical and ethical dimensions, as well as spans the spectrum of surgical care, is therefore necessary. This action research involved three key steps: 1) identification of ethical dilemmas related to the provision of surgical care during the COVID-19 pandemic; 2) preparation of clinical scenarios that highlight these dilemmas; and 3) determination of the appropriate options for the said scenarios, based on the best available evidence as well as most applicable ethical principles. Results. Ethical theories included utilitarianism, human rights, and communitarianism. Ethical principles included non-maleficence, justice, autonomy, and beneficence. Values considered were duty, reciprocity, human life, efficiency, fairness, fidelity, ownership, social value, and fair innings. Also incorporated were informed consent, allocation principles, resource allocation, and triage. In terms of operational issues and surgical technical concerns, the following were considered: phased standards of care, categorization of interventions, prioritization, surgical approaches, infection control, diagnostics, patient welfare, staff welfare, operations protocols, surgical training, and communication. Key points derived from the ethical and technical considerations of surgical care delivery during the COVID-19 pandemic are presented. Conclusion. This action research involving a review of the literature and stakeholder engagement has provided a concise ethical and technical resource for surgical administrators, practitioners, and trainees.
COVID-19 ; Pandemics

Humans ; COVID-19 ; Pandemics

Objective: The purposes of this study were to (1) describe the perceptions and practices of telemedicine among ophthalmologists in a tertiary hospital; and (2) evaluate knowledge, satisfaction, and perceived patient outcomes in using telemedicine to provide eye care in a time of a global pandemic. Methods: This was a descriptive, cross-sectional study using a self-administered online survey. Thirty-two (32) ophthalmology consultants and residents-in-training in a single tertiary, private hospital who practiced telemedicine participated in this study. Descriptive statistics was used to summarize the data. Responses to open-ended questions were analyzed thematically Results: The respondents were somewhat knowledgeable (75%) and somewhat confident (72%) in using telemedicine. Respondents strongly conveyed their satisfaction with telemedicine outcomes (56%). Majority also believed that their patients were satisfied with teleconsults (69%). Majority agreed that telemedicine can be effective for select types of care [i.e., chronic condition management (66%), follow- up care (62%), and acute non-emergency care (53%)]. Telemedicine also proved to be a boon during a pandemic due to its convenience (59%) and efficiency (63%). However, it is limited by the imperative need for face-to-face consults (69%) and technological constraints (44%). Conclusions Telemedicine was perceived to be a valuable solution during the present pandemic due to its convenience, safety, and ability to provide remote diagnosis and management of urgent and non-urgent cases. Although the current practice of telemedicine still has plenty of room for improvements in the standardization of training, connectivity and technological constraints, and addressing liability concerns, it can serve as an adjunct to face-to face consultations to provide optimal care for patients.
Telemedicine ; COVID-19 ; Pandemics

Objective: To present a case of a 37-year-old man presenting with craniofacial impalement injury from a screwdriver that happened during the early stages of the COVID-19 pandemic. Methods: Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One. Results: During the early stages of COVID-19 pandemic a 37-year-old man was brought to the emergency room with a screwdriver embedded in his right eye. A multidisciplinary team observing available recommendations (level IV PPE, carefully planned operative directives) successfully performed endoscopic endonasal transsphenoidal surgery with application of a nasoseptal Hadad flap and abdominal fat obliteration. Aside from medial gaze limitations of the right eye, there was no CSF leak or rhinorrhea and no neurologic sequelae on follow up. Conclusion Endoscopic skull base surgery for such an impalement injury as this is a formidable multidisciplinary challenge, even in normal times. The early stages of the COVID-19 pandemic presented additional challenges. Observing evolving guidelines minimized the high risk of exposure for health care workers while maximizing care for the patient.
COVID-19 ; Pandemics

Objective: To describe the use of commercially available, non-medical grade USB cameras in a non-contact examination of simple cases involving the ears, nose and oral cavity of patients during the COVID-19 pandemic Methods: Design: Instrument innovation. Setting: Tertiary Government Training Hospital. Participants: Patients who consulted at the ENT-HNS outpatient department during the COVID-19 pandemic. Results: Commercially available USB cameras were able to provide basic visualization of the ears, nose and oral cavity. The non-medical grade USB cameras captured lower quality images when compared to the medical grade endoscopes but provided enough visualization to aid in the examination and diagnosis of simple cases. There was a learning curve in using the set-up but patients were able to adjust well, taking an average time of 2.7 minutes to complete the examination. Conclusion Non-medical grade USB cameras may play a role in aiding otolaryngologists in examining simple cases during the COVID-19 pandemic. Integration of this system into current examination practices may offer an extra layer of protection for otolaryngologists and patients alike. However, the use of these instruments as part of regular ENT practice may be controversial and will need further study.
COVID-19 ; Pandemics ; Outpatients

Background: The COVID-19 pandemic has caused a global public health emergency. High levels of fear and limited access to cancer treatment may jeopardize the delivery of optimal oncologic care, potentially influencing treatment outcomes. This study aimed to identify patients’ and their caregivers’ perception of safety and accessibility of cancer care during the COVID-19 pandemic. Methods: A cross-sectional survey of patients and caregivers at the Benavides Cancer Institute, University of Santo Tomas Hospital was performed from August to October 2020 using a 20-item investigator-developed questionnaire. Results: A total of 207 participants answered the survey. Frequency of hospital visits varied from none to more than ten times in the previous month; but having multiple postponements were uncommon. Eighty-two percent, 77%, 62%, and 55% of participants reported being afraid of contracting COVID-19 from other patients, hospital surroundings, hospital staff, and doctors, respectively. Twenty-six percent and 12% had difficulty finding transportation and passing through checkpoints, respectively. Twenty-eight percent strongly expressed financial limitations in prioritizing cancer care. Participants were amenable to the use of telemedicine and stringent protocols to reduce in-hospital transmission risk, but had some reluctance to spend out of their pockets for screening tests. Conclusion The perceived safety of cancer care was influenced by fears of contracting COVID-19; and accessibility was influenced by limited transportation and financial constraints. Despite these, multiple postponements and cancelled hospital visits were uncommon. Institutional approaches targeting these concerns will be crucial to ensure safe and timely delivery of cancer care during the COVID-19 pandemic and further mitigate its impact on oncologic outcomes.
COVID-19 ; Pandemics ; Safety

The Covid-19 pandemic challenged every healthcare system, and the disruption of clinical trials was not the least of it. Many clinical trials halted or did not activate as sponsors and investigators grappled with the risk of infection if patients involved in clinical trials visited trial sites. The clinical studies that managed to continue and complete were those that immediately adopted decentralized clinical trials (DCT) technologies such as eSource. Patients were engaged from the comfort and convenience of their homes during the clinical trials with the use of DCT technologies. The flexibility in recruitment, engagement, and monitoring of clinical trial participants are among the reasons why DCTs are here to stay.
Covid-19|pandemics

Background: The impact of online learning during internal medicine rotation among graduating medical students was evaluated during COVID 19 pandemic. Objectives: The study aimed to gauge acceptability of a self-directed learning, recognize frustrations, identify coping mechanisms, assess rate of learning, evaluate study habits and appraise level of readiness in handling actual patients later in practice among graduating medical clerks. Methodology: An ambispective cohort design study involving both retrospective and prospective follow-up of respondents. The retrospective component involved blended learners with clinical experience (Group 1). The prospective component included online learner with clinical experience (Group 2) and online learner without clinical experience. Results: Group 1 showed that they favor pure traditional learning over pure online learning in contrast to the other 2 groups which rated acceptability of online learning high. All groups had high levels of frustration with their inability to experience actual patient exposure, had moderate to high level of coping mechanisms, and rated high the traditional learning and blended learning methodologies. In contrary, all groups rated low to moderate contributions of online learning to their learning. Group 3 had a significantly higher mean overall readiness score compared to the two other groups. Conclusion The study showed the different levels of impact of online learning to the different population of medical clerks in terms of its acceptability as an alternative way of learning. Actual patient exposure is of main concern while different coping mechanisms maximize knowledge acquisition.
Covid-19 ; Pandemics

Background: With the increasing number of COVID positive cases still being reported in the country, coupled with the possible vulnerability of pregnant patients to the disease, aggressive measures must be taken by all institutions to ensure safety of the patients. Objective: This study aimed to the determine the clinical profile and pregnancy outcome of patients who were admitted at a tertiary private hospital in Metro Manila from March 16, 2020 to June 15, 2020 in relation to the protocols that were implemented in response coronavirus disease 2019 pandemic. Methods: The protocols and guidelines implemented by the Department of Obstetrics and Gynecology of a private tertiary hospital in Metro Manila from March 16, 2020 to June 15, 2020 were retrieved. The case record of patients who were admitted and delivered during this period were retrieved and reviewed for pertinent data, which were recorded in a patient data collection form. Results: During the 3-month study period, COVID positive pregnant patients were effectively separated from COVID negative patients from admission to discharge based on a health declaration form and universal reverse transcriptase polymerized chain reaction (RT-PCR) testing. Discharge was facilitated after 12–48 h for uncomplicated deliveries and post partum follow-up was done via telemedicine. Conclusion The separation of COVID positive from COVID negative patients based on symptoms and RT-PCR results were effective in ensuring the safety of patients.
COVID‑19 ; Pandemics ; Quarantine

Introduction: The emergence of the COVID‑19 pandemic has left the vulnerable members of the society at risk, most especially pregnant women. This event has caused anxieties on their pregnancy journey. Their main concerns are the effects and transmissibility of the infection to them and to their unborn child. COVID‑19 significantly affects their mental health status Objectives: The purpose of this study is to determine the fears, perceptions, and common concerns of pregnant women during COVID‑19 in a tertiary hospital in Manila Materials and Methods: This is a prospective, cross‑sectional study design that uses a pretested and validated questionnaire, which directly asks about the fears, perceptions, and common concerns on COVID‑19 among pregnant women. The survey proper was conducted among singleton, term pregnant women aged 18 year old and above Results: The analysis included 313 respondents with a mean (± standard deviation) age of 31 ± 6 years. The three most common fears relayed by the pregnant women were (1) losing their babies if they get COVID‑19 (67.41%); (2) dying if they get the infection (58.79%); and (3) getting a positive test result for COVID‑19 (54.95%). Most of these patients (99.04%) were aware of the changes on their prenatal consultation and health care services. Majority of the participants (53.35%) raised their concerns on the in utero transmission of the virus and nosocomial COVID infection on their newborn from the hospital personnel (42.81%). Conclusions This study showed that fear is a common emotion among pregnant women. With the emergence of the COVID‑19 pandemic, it exacerbated their fears and raised concerns on the harmful effects that may bring on their well‑being and on their unborn child. This pandemic had caused a significant impact on their mental health
COVID‑19 ; Pandemics