The coronavirus disease 2019 (COVID-19) pandemic has caused pronounced strain on global healthcare systems, forcing the streamlining of clinical activities and conservation of health resources. There is a pressing need for institutions to present discipline-specific strategies for the management of COVID-19 patients. We present the comprehensive considerations at the National University Hospital, Singapore from the surgeon’s and anesthetist’s perspectives in the performance of spinal surgery in COVID-19 patients. These are based on national guidelines and overarching principles of protection for the healthcare workers (HCWs) and efficiency in surgical planning. The workflow begins with the emergency department screening that has been adapted to the local epidemiology of COVID-19 in order to identify suspected/confirmed cases. If patient history cannot be obtained, demographic, clinical, and imaging data are used. Designated orthopedic “contaminated teams” are available 24/7 with an activation time of <30 minutes for review. In cases where sub-specialty spine surgeons were required, these professionals were inducted into the “contaminated team” and quarantined until cleared to return to work. Indications for emergency spine surgery were determined pre-emptively. Preoperative surgical considerations included the minimization of manpower, limited dissection, reduced operative time, and judicious use of equipment, leading to reduced aerosolization. Anesthesia considerations include preoperative screening for COVID-19–related concerns that influence surgery, operating room process planning and induction, intraoperative, reversal, recovery, and resuscitation considerations. Focused multi-disciplinary preoperative briefing facilitates familiarization. Surgical, anesthetic, and postoperative workflows were designed to reduce the risk of transmission and protect HCWs while effectively performing spinal surgery. The COVID-19 pandemic has necessitated paradigm shifts in healthcare planning, hospital workflows, and operative protocols. The viral burden does not discriminate between surgeons and physicians, and it is crucial that we, as medical professionals, adapt practices to be malleable and fluid to address the ever-changing developments.

Methods: We conducted a retrospective analysis of 288 patients (246 for final analysis) who underwent MSTS between 2005–2015. Data collected were demographics and peri/postoperative clinical and radiological features. Early and late radiological AsCF were defined as presentation before and after 3 months, respectively. We analyzed patients with AsCF for risk factors and survival duration by performing competing risk regression analyses where AsCF was the event of interest, with SF and death as competing events. Results: We observed AsCF in 41/246 patients (16.7%). The mean time to onset of AsCF after MSTS was 2 months (range, 1–9 months). Median survival of patients with AsCF was 20 and 41 months for early and late failures, respectively. Early AsCF accounted for 80.5% of cases, while late AsCF accounted for 19.5%. The commonest radiologically detectable AsCF mechanism was angular deformity (increase in kyphus) in 29 patients. Increasing age (p<0.02) and primary breast (13/41, 31.7%) (p<0.01) tumors were associated with higher AsCF rates. There was a non-significant trend towards AsCF in patients with a spinal instability neoplastic score ≥7, instrumentation across junctional regions, and construct lengths of 6–9 levels. None of the patients with AsCF underwent revision surgery. Conclusions AsCF after MSTS is a distinct entity. Most patients with early AsCF did not require intervention. Patients who survived and maintained ambulation for longer periods had late failure. Increasing age and tumors with a better prognosis have a higher likelihood of developing AsCF. AsCF is not necessarily an indication for aggressive/urgent intervention.

Background and Objective: Given the rigors of medical training with its high documented prevalence of mental issues as well as the global need to safeguard the well-being of medical students, there is an urgency to assess the well-being of medical students and their perception of support from their respective medical schools during their education. This also applies in the context of public medical school students in the Philippines, where there is still a relative lack of literature. This cross-sectional study investigates the well-being and such perceptions of medical students at the University of the Philippines College of Medicine (UPCM). Methods: The study uses a quantitative approach using a subset of secondary data from a college-wide survey online that was disseminated, through convenience sampling, to medical students from October 3, 2018 to December 3, 2018. A total of 432 responses were included in the analysis, out of the total student population of the included learning unit levels of 809. Participants were grouped based on their entry into medical school, either through the Integrated Liberal Arts and Medicine (INTARMED) program or lateral entry. Exclusion criteria comprised responses from Learning Unit I-II (pre-medical proper) students and incomplete survey sets. Responses were interpreted using established scales such as the World Health Organization Well-Being Index (WHO-5), Perceived Stress Scale-4 (PSS-4), and Oldenburg Burnout Inventory-Medical Student (OLBI-MS). Data analysis involved statistical techniques including one-way ANOVA and independent samples t-test using Statistical Package for the Social Sciences (SPSS). Results: The findings suggest that medical students at UPCM generally find the administrative and academic systems satisfactory, but express concerns about inadequate educational resources and infrastructure, especially as they progress through their studies and engage more with clinical settings like the Philippine General Hospital (PGH). As students advance through the program, there are different patterns for wellbeing outcomes, including decreasing perceived stress and increasing burnout. In particular, LU IV and LU VII students reported lower well-being and higher burnout levels, respectively. This is potentially due to heavier workloads and clinical responsibilities. Lateral entrants, who are older and typically enter with prior degrees, tend to have higher well-being and lower burnout compared to INTARMED students, suggesting age and previous educational experience may play a role in adjustment and coping mechanisms. Conclusion Overall, the study highlights the medical students’ generally satisfactory perception of medical educational aspects, as well as the patterns of wellbeing throughout their medical college experience. Furthermore, it identifies different areas for improvement to ensure effective education and student mental health. By analyzing trends across different year levels, the study provides insights for interventions and program refinements, while also suggesting avenues for further research to assess student experiences over time.
mental health ; students, medical ; philippines