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

Hernia of the cord (HOC) is a rare condition that results from failure of the viscera to return to the abdominal cavity by the 10th week of fetal development. It sometimes presents together with a patent omphalomesenteric duct (POMD), another rare condition, which occurs earlier in fetal development. A proportion of POMD cases may also have ileal prolapse (IP) through the POMD lumen. Neonates diagnosed with the combination of these rare clinical conditions require immediate surgical intervention to resect the POMD and non-viable bowel segments, reduce the hernia, and repair the umbilical defect. In this case series, we report two neonates diagnosed with HOC with POMD and IP. One patient who had complete IP was not fit for immediate surgery and died of respiratory distress and sepsis. The other patient had a successful surgical correction of the congenital defects, but succumbed to sepsis postoperatively. Treatment of patients with this combination of clinical conditions should focus mainly on both surgical correction, and infection control and management.
Hernia, Umbilical ; Neonatal Sepsis

The prevalence of non-communicable diseases (NCDs) across the globe has reached epidemic proportions, with more than three quarters of NCD deaths now occurring in low- and middle-income countries (LMIC).1 NCDs encompass a broad range of chronic conditions, which include cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and mental disorders.2 To mitigate the growing global NCD burden and its associated challenges, upscaling high-impact essential interventions for the prevention and control of NCDs has remained a priority, especially in low-resource settings. One such intervention is strengthening self-care strategies or self-management of individuals living with NCDs.3 In the past few decades, the self-management approach to NCD has proven to be a cost-effective strategy to improve a patient’s quality of life by reducing symptom severity and decreasing pain. This approach has also encouraged patients to become key decision makers in the treatment process.4 Self-management includes both technological (e.g. smartphone applications, telemonitoring systems, or wearable devices) and non-technological interventions (social support, educational materials, or in-person training seminars).5 Telemedicine has played several important roles in the whole spectrum of care for patients with NCD. These include promotion of healthy behaviors, prevention of risk factors, prompt recognition and initiation of treatment, disease monitoring and follow-up, rehabilitation, and palliation. Telemedicine not only increases access to health care but also improves the quality of health care especially in rural areas.6 7 The unique challenges resulting from the COVID-19 pandemic has limited patient access to health care, especially in geographically isolated and disadvantaged areas. This literature review aims to determine the effectiveness of telemedicine on clinical and psychosocial outcomes of adult patients diagnosed with NCDs. We conducted a literature search on PubMed, EBSCOhost, ProQuest, Google Scholar, and Gale using the search words “telemedicine,” “adult,” “non-communicable disease,” “self-management,” and “teleconsultation.” We filtered the results to only include randomized controlled trials (RCT). To narrow down the scope of this literature review, only previous studies that compared telemedicine and usual care (non-telemedicine) among adults with non-communicable diseases, and those that report clinical and psychosocial outcomes—i.e., symptom outcomes, laboratory outcomes, knowledge on disease, or behavior outcomes that pertain to self-management of disease—were assessed. We excluded studies if they were done among patients <18 years old, if they included telemedicine that supplemented rather than replaced the usual (face-to-face) care, if they were not able to report outcomes between groups, or if they did not meet the criteria of a RCT. Two reviewers independently reviewed the abstracts yielded from the search strategy and assessed them based on the set criteria. If neither reviewer was able to rule out an article based on the abstract, the full text was retrieved and assessed to determine inclusion into the study. After the final assessment, a total of 9 RCT reports were included in this review. The general characteristics and key findings of the 9 studies included in this literature review are summarized in Table 1. The included studies, published in various journals between 2014 and 2021, were carried out in eight countries—two studies were done in Australia, and one each in Bangladesh, India, Italy, USA, Germany, China, and the Netherlands. The studies enrolled patients who were diagnosed with type 2 diabetes mellitus (DM) (n=3), chronic obstructive pulmonary disease (n=1), type 1 DM (n=1), congestive heart failure (n=1), stroke (n=1), osteoarthritis (n=1), and various non-specific chronic conditions, including type 2 DM, hypertension, coronary artery diseases, heart failure, chronic depression, and schizophrenia (n=1). The sample sizes of the studies included ranged from 29 to 10,815 participants. Follow-up periods ranged from 3 to 36 months. The telemedicine techniques that were used in the studies included mobile phone-based health interventions, telemedicine-based visits, and telephone-based health coaching. In general, most of the studies included in this review reported that telemedicine is as good as, if not better than, usual care approaches in achieving clinical and psychosocial outcomes.
Noncommunicable Diseases ; Chronic Disease

Life-threatening congenital anomalies, which constitute neonatal surgical emergencies, can result in death or severe disability if not treated immediately at birth. Prompt recognition and treatment of these emergencies, which include initial stabilization following birth, can lead to better patient outcomes.1 2 The perioperative period refers to the time interval encompassing the surgical procedure. This includes three stages: preoperative phase (from the time the patient arrives up to surgery), operative phase (the surgical period), and postoperative phase (until either the patient has expired or has been discharged).3 4 Optimizing patient flow is one of the greatest challenges facing health care today. Increased waiting time, delays, and cancellations are frequently encountered by patients, as well as health care workers, that they now believe that these problems are a part of the care process.5 6 Monitoring the perioperative duration, especially for life-saving procedures during neonatal emergencies, is the first step towards providing safe and efficient patient care while maximizing hospital resources.7 Southern Philippines Medical Center (SPMC) currently has a set of time-specific surgical protocols from admission to discharge. However, these protocols are not age-specific. Since SPMC is an end-referral institution in Mindanao for patients requiring neonatal surgery, it is imperative that surgeons gain a thorough understanding of patient flow from admission to discharge, and the occurrence of morbidity and mortality among these patients during admission, in order to effectively implement and possibly improve these protocols in the future. The aim of this study was to describe the perioperative clinical profile of newborn patients who underwent surgical management for congenital malformations of the gastrointestinal (GI) tract. In our institution, neonatal surgery is considered an emergency procedure that is managed accordingly by the Pediatrics, Pediatric Surgery, and Anesthesiology services as soon as the diagnosis is established. The Section of Pediatric Surgery at SPMC caters to an annual average of 89 patients with congenital malformations of the GI tract from 2017 to 2019. For this descriptive study, we collected data retrospectively from the medical records of patients admitted in the neonatal and pediatric intensive care units of SPMC who underwent surgery in the institution from 2015 to 2019 after being diagnosed with a congenital malformation of the GI tract. We excluded patients ≥29 days old, as well as those who were diagnosed with and/or who underwent surgery for multiple congenital anomalies. We were able to gather the data of a total of 60 patients—15 patients each for congenital diaphragmatic hernia (CDH), esophageal atresia (EA), gastroschisis (GS), and imperforate anus (IA)—for this study. From the medical records, we collected data on the patient’s sex, age upon admission, and preoperative diagnosis. We also collected data on the preoperative time (the time interval in hours from admission to surgical cutting), the operative time (the time interval in minutes from surgical cutting to last stitch), the postoperative time (the time interval in days from last stitch to discharge), and the total length of hospital stay (the time interval in days from admission to discharge). Further, we also gathered data on the occurrence of morbidities during admission (neonatal sepsis, health-care associated pneumonia, fungal infection, others) and/or death, as well as the patients’ disposition upon discharge. Among patients who died, we also determined the median time in days from end of surgery (last stitch) to death. Overall, there were 38 males and 22 females included in the study. Specifically, there were 6 males and 9 females in the CDH group, 13 males and 2 females in the EA group, 8 males and 7 females in the GS group, and 11 males and 4 females in the IA group. The overall median age of the 60 patients upon admission was 4.5 (range: 1–28) days. The median ages of the patient groups upon admission were 11 (2–25) days for CDH, 17 (4–28) days for EA, 1 (1–1) day for GS, and 2 (1–24) days for IA. Overall, the median preoperative time was 47.22 (6.27–582.72) hours, the median operative time was 95 (24–350) minutes, the median postoperative time was 9.94 (0.15–39.16) days, and the median total length of hospital stay was 17.16 (0.71–44.42) days. The median preoperative time was 242.25 (31.27–413.88) hours for CDH, 163.58 (39.48–444.77) hours for EA, 13.27 (6.27–30.17) hours for GS, and 32.1 (11.27–582.75) hours for IA. The median operative time was 100 (24–175) minutes for CDH, 140 (88–350) minutes for EA, 64 (35–120) minutes for GS, and 70 (35–133) minutes for IA. The median postoperative time was 8.40 (0.31–31.08) days for CDH, 9.92 (2.12–39.16) days for EA, 14.20 (0.15–38.69) days for GS, and 9.95 (2.85–24.77) for IA. The median total length of hospital stay was 17.30 (2.98–41.26) days for CDH, 22.09 (7.07–47.42) days for EA, 15.40 (0.71–39.72) days for GS, and 12.82 (4.32–29.86) days for IA. Of the 60 patients, 24 had at least one morbidity during admission, and 23 died. There were 5 patients who had morbidity during admission in the CDH group, 8 in the EA group, and 11 in the GS group. There were 5 deaths in the CDH group, 7 deaths in the EA group, and 11 deaths in the IA group. There was no morbidity or death in the IA group. The three most common morbidities during admission were neonatal sepsis 15/60 (25%), ventilator-associated pneumonia 6/60 (10%), and fungal infection 6/60 (10%). Among the patients who died, the median time from end of surgery to death was 6.94 (0.31–11.45) days for CDH, 8.78 (2.35–29.11) days for EA, and 14.56 (0.15–38.69) days for GS. All in all, there were 10 patients whose conditions improved upon discharge in the CDH group, 8 in the EA group, 4 in the GS group, and 15 in the IA group. In this study, we found out that patients with congenital malformations of the GI tract are usually admitted in our institution during their first week of life. Patients stayed in the hospital for 2.5 weeks, 27.84% of which was spent on preoperative care, 0.40% on operative care, and 71.76% on postoperative care. The data presented in this study happened before the WHO declaration of a COVID-19 pandemic in March 2020. During the height of the SARS-CoV-2 infection, and even today, more than two years after the start of the pandemic, the patient flow within our institution for non-COVID-19 cases changed several times to comply with the evolving mandates and regulations related to the pandemic. These changes included the addition of mandatory COVID-19 screening prior to admission or any procedure with patient contact, the mandatory isolation of patients presenting with COVID-19-like symptoms, and the capacity limitations in patient beds and operating theaters, to name a few. The same health care modifications could have affected the outcomes of patients with congenital GI malformations. In the future, a formal comparison of perioperative time intervals and patient outcomes in different health care contexts could point out specific aspects of patient flow that need action for improvement. Further studies focusing on the identification of specific risks and contributory factors affecting delays in perioperative care and patient outcomes would also be useful in addressing the health care needs of these patients. Ensuring an efficient health care pathway should be an essential part of a wider effort to improve the quality care for patients with life-threatening conditions, such as those with congenital anomalies of the GI tract.
Infant, Newborn ; Gastrointestinal Tract

Mental health has profound effects on an individual’s quality of life, and it can also affect the families and the communities of persons with mental illness. In early 2020, the World Health Organization (WHO) Special Initiative for Mental Health in the Philippines recorded at least 3.6 million Filipinos suffering from a mental, neurological, or substance abuse disorder.1 In 2015, schizophrenia was the top mental disorder in the Philippines,2 and it is estimated that 1 million Filipinos (1% of the population) suffer from schizophrenia.3 Schizophrenia, a debilitating mental health condition, is characterized by both positive (e.g., hallucinations, delusions, confused thoughts, etc.) and negative (e.g., lack of pleasure, flattening, withdrawal, etc.) symptoms.4 5 6 The condition can affect the individual’s personal and social aspects of daily life, such as self-care, interpersonal relationships, education, and employment.7 8 9 10 Hospitalization is generally indicated for patients who are actively experiencing delusions/hallucinations, those who pose a serious threat of harm to themselves or others, or those who are unable to care for themselves and need constant supervision and support. Other possible indications for hospitalization include the presence of general medical or psychiatric problems that may render outpatient treatment unsafe or ineffective.11 12 Recent therapeutic advances, especially the introduction of atypical antipsychotic medications that have demonstrated better efficacy rates compared to older generation oral antipsychotic drugs, have allowed the reintegration of persons with mental health disorders (e.g., schizophrenia, other psychotic disorders, major depression, mood disorder, or bipolar disorder) into the society.13 14 15 Yet, despite the availability of such medications, there still exists substantial gaps in the delivery of mental health services. In the Philippines, mental health has remained poorly-resourced, with only 3-5% of the total health budget spent on mental health care.16 Mental health specialists have been in shortage, and a large proportion of these specialists work in urban for-profit services or private practices. 16 Mental health care services are delivered largely in hospital and private clinic settings,16 18 while community-based services remain underdeveloped.17 19 Prohibitive economic conditions and stigma on mental illness20 21 are some of the factors that contribute to low diagnosis and treatment rates. These factors, as well as funding issues that limit patient access, especially to newer innovative drugs, have rendered mental health care relatively inaccessible, leaving many patients undiagnosed and untreated or undertreated.17 In 2015, the Davao Center for Development (DCHD) Mental Health Program facilitated the establishment of Community-Based Mental Health Programs (CBMHPs) and the implementation of the WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in several municipalities in the region. Since their launching, CBMHPs in Davao Region documented annual increases ranging from 10 to 13% in the number of patients availing mental health services in primary and tertiary care facilities from 2016 to 2019. 22 During the program implementation review conducted by the National Mental Health Program in 2019, two Centers for Health Development (CHD)—those in Davao and in CaLaBaRZon—planned to implement a common project for patients with schizophrenia in some areas with CBMHPs in their respective regions.22 This is in accordance with the Republic Act 11036, also known as the Philippine Mental Health Act, which mandates that basic mental health services be provided in community settings.23 The Schizophrenia Project was designed to make mental health services accessible and antipsychotic medications readily available in municipalities with the highest burden of schizophrenia, the most common mental health condition in the region. The project involves community-level assessment, management, and follow up of patients with schizophrenia through the process described in the mhGAP-IG. In Davao, the ongoing Schizophrenia Project implementation has been made possible by the collaboration of primary care providers in rural health units (RHU) with psychiatrist consultants. Johnson & Johnson Philippines, the marketing authorization holder of paliperidone palmitate in the country, conducts training of health care workers involved in the project. DCHD finances the project and provides technical assistance to the RHUs. A pilot phase of the project was planned to run for one year in four implementation sites—Boston in Davao Oriental, Santo Tomas in Davao del Norte, Sta. Cruz in Davao del Sur, and Jose Abad Santos in Davao Occidental—which have been identified by DOH DCHD as having the highest numbers of patients diagnosed with schizophrenia in Davao Region. DCHD purchased paliperidone palmitate needed for project implementation in December 2019. In March 2020, Johnson & Johnson conducted the first training for health workers. Patient enrollment into the pilot phase started in July 2020 and was completed in October 2020. RHUs in the four implementation sites identified patients with probable schizophrenia through a community-based case-finding and referral strategy patterned after the mhGAP-IG. Among the four municipalities, a total of 49 patients—9 from Boston, 10 from Santo Tomas, 11 from Sta. Cruz, and 19 from Jose Abad Santos—were enrolled into the program. The enrolled patients were diagnosed, treated, and monitored at least every six months by the collaborating psychiatrists and RHU physicians. The RHUs were also tasked with setting-up communication lines for emergency consultations with the collaborating psychiatrists during crisis, providing counseling to the patients’ families, and conducting health promotion events to raise awareness on schizophrenia. After the one-year implementation of the pilot phase, health care providers were highly satisfied with the project. After initiation of treatment, most of the patients demonstrated improved symptoms, and some of them were able to perform household chores or return to work within a few months. None of the patients experienced hospitalization or relapse during the pilot phase. Health workers involved in drug dispensing and patient monitoring observed that the intravenous preparation of paliperidone palmitate used in this project facilitates easier supply inventory and patient tracking. DCHD also noted cost savings in expenditure on antipsychotic drugs when paliperidone palmitate was used in this project instead of the oral and conventional depot antipsychotic drugs used in the past. Health workers involved in the project also encountered some challenges during implementation. Many caregivers and families of patients in the project were not very cooperative in complying with the demands of the treatment sessions and social reintegration. After initiation of antipsychotic treatment, many patients could not comply with the regular follow up sessions, mostly because they live very far from the RHUs and could not afford the transportation costs of the visits. The Schizophrenia Project did not have a structured reintegration program, so many patients who were already in remission after a few months of treatment could not be properly reintegrated into their respective families and communities. During the project review after the pilot phase, stakeholders pointed out several good practices of individual municipalities that can possibly be scaled up or replicated by other CBMHPs implementing similar projects in the future. In Boston, the municipal health officer conducted a series of lectures on the social dimensions of mental health disorders to the caregivers and families of patients in the project. Those who attended the lectures have expressed an increased understanding of the nature of their patients’ condition. In Sta. Cruz, the RHU provided food (rice and snacks) and fare reimbursements to the families of patients who came during follow up checkups. The RHUs of Santo Tomas and Sta. Cruz involved the social welfare service units of their respective municipalities in the process of family and community reintegration of patients on remission. The pilot phase implementation of the Schizophrenia Project in the four municipalities in Davao has demonstrated that it is highly possible to integrate mental health services at the primary care and community settings, and achieve positive outcomes for patients, caregivers, health care providers, and the health system.
Quality of Life ; Schizophrenia

In accordance with the Republic Act (RA) 11036, also known as the Mental Health Act of 2017, the Department of Health (DOH) was tasked to "establish a balanced system of community-based and hospital-based mental health services at all levels of the public health care system from the barangay, municipal, city, provincial, regional to the national level." It is also expected that the Local Government Units (LGUs) "promote deinstitutionalization and other recovery-based approaches to the delivery of mental health care services."1 Even before RA 11036 was enacted, the Davao Center for Health Development (DCHD) had already facilitated the establishment of several Community-Based Mental Health Programs (CBMHPs) in rural health units (RHUs) within the region since 2015. These programs are guided by six principles–coordinated level of referral system for better patient care, optimizing the expertise of the regional mental hub to guarantee rational use of drugs, community-based patient care for a more cost-effective treatment, capitalizing family and patient's support groups for better patient outcomes, optimizing innovative long-acting injections for better compliance and decreased relapse, and neutralizing the stigma against schizophrenia to improve mental health.2 The aim of this article is to recommend health care policies based on the report on observations and lessons learned from the implementation of the CBMHPs by the DCHD in four municipalities in Davao Region.
Community Health Services ; Mental Health Services

Newborn screening (NBS) facilitates the early diagnosis and management of congenital metabolic disorders that, if left untreated, may lead to mental retardation or death. Successful medical interventions can bring about normal growth and development of individuals with these disorders.1 Introduced by the Newborn Screening Study Group in 1996, NBS became a routine procedure for newborns in the country through the enactment of Republic Act 9288, or the Newborn Screening Act of 2004,1 with the DOH as the lead implementing agency. The law mandates that all birthing and health facilities must offer NBS, in effect making the procedure accessible to all. The law further stipulates that these birthing and health facilities should be given NBS services and support, thus newborn screening centers (NSCs) were created and located strategically throughout the Philippines. An NSC is a facility equipped with a NBS laboratory that complies with the standards established by the National Institutes of Health - Philippines and provides all required laboratory tests and recall/follow up programs for newborns with heritable diseases.1 Currently, there are seven NSCs in the country. The Newborn Screening Center-Mindanao (NSC-Mindanao), the third NBS center to be built in the country, was established at Southern Philippines Medical Center (SPMC; formerly Davao Medical Center) in 2009 under the stewardship of Dr. Leopoldo J. Vega, then SPMC Chief of Hospital. Headed by Dr. Conchita G. Abarquez, NSC-Mindanao acquired its DOH accreditation and started operations in the same year of its establishment. The NSC-Mindanao started with a workforce of 11 staff, consisting of a full-time unit head, a pathologist as laboratory manager, a program manager, three medical technologists, a follow-up nurse, an encoder, an accountant, an administrative officer and an information technology staff. NSC-Mindanao initially performed screening tests for five disorders, namely, congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, phenylketonuria, and glucose-6-phosphate dehydrogenase deficiency. In its first year of operation in 2009, NSC-Mindanao received and tested 4,187 NBS samples. Screening for maple syrup urine disease was added to the original five tests in 2012. Presently, NSC-Mindanao caters to 1,859 NBS facilities in the six administrative regions in Mindanao—Zamboanga Peninsula (Region IX), Northern Mindanao (Region X), Davao (Region XI), Soccsksargen (Region XII), Caraga (Region XIII), and the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM). As of 2022, NSC-Mindanao employs a workforce of 47 staff,2 consisting of a unit head, a laboratory head, a follow-up head, a laboratory manager, a program manager, 13 medical technologists, three nurse genetic counselors, two follow-up nurses, three project development officers (one medical technologist and two nurses), four nurse demo/encoders, one certified public accountant, two information technology staff, and 14 administrative support staff. All medical personnel are licensed and have completed training on their respective fields of expertise. The NSC-Mindanao laboratory is equipped with modern and top-of-the-line laboratory equipment for NBS. It uses fully-automated neonatal screening platforms, such as AutoDELFIA automated fluoroimmunoassay machines and Genetic Screening Processor machines, for testing endocrine disorders and cystic fibrosis. The center also has several tandem mass spectrometry machines, such as Xevo TQD and TQD Acuity, for screening metabolic disorders, and high-performance liquid chromatography machines for screening hemoglobinopathies. Presently, under the Expanded Newborn Screening Program, NSC-Mindanao tests for 29 panel disorders, including galactosemia, glucose-6-phosphate dehydrogenase deficiency, cystic fibrosis, and biotinidase deficiency, as well as specific endocrine disorders, amino acid disorders, fatty acid disorders, organic acid disorders, urea cycle defects, and hemoglobinopathies. As NBS is essentially a battery of screening tests, positive results need to be confirmed either through repeat collection or various confirmatory tests. Patients with one or more positive test results are recalled by the NSC, the respective health facilities where they were screened, or by their respective DOH regional Centers for Health Development (CHDs), either for repeat specimen collection or for confirmatory testing. The NSC-Mindanao Follow-up Teamㅡcomposed of the Unit Head, the Follow-up Head and five Follow-up Nursesㅡmanages the care of patients with confirmed disorders. The center handles the short-term follow-up of the patients, and provides free medicines and medical supplements to indigent patients. The Newborn Screening Continuity Clinics in SPMC, Cotabato Regional Medical Center, Northern Mindanao Medical Center, and Zamboanga City Medical Center, handle the long-term follow-up of patients with confirmed disorders in Mindanao.3 NSC-Mindanao also provides genetic counseling to patients with confirmed disorders and to their families. A clinical geneticist and three duly-qualified genetic counselor nurses carry out the counseling sessions. NSC-Mindanao, in coordination with the DOH CHDs, also provides NBS training and technical assistance to the NBS facilities. The center also conducts NBS program review and evaluation of these facilities to ensure that their NBS services are always available and at par with set standards, and regularly holds activities to increase public awareness on NBS. To enhance patient support, NSC-Mindanao organizes and participates in public fora and support group sessions among parents of patients with confirmed disorders. NSC-Mindanao undergoes an annual external audit, performed by the University of the Philippines Manila Newborn Screening Reference Center, the DOH technical arm for the NBS program. The audit ensures that the center’s laboratory complies with the set quality standards and assurance program for NSCs. NSC-Mindanao has also engaged the External Quality Assurance (EQA) program of Taiwan’s Preventive Medicine Foundation as third-party internal quality control for the center’s G6PD quantitative tests. NSC-Mindanao also follows the Centers for Disease Control and Prevention’s Newborn Screening Quality Assurance Program for its Expanded Newborn Screening tests, ensuring that the results generated are accurate and reliable. NSC-Mindanao also renews its DOH accreditation every three years. NSC-Mindanao is applying for ISO 15189 Certification for Medical Laboratories and hopes to obtain it by 2023. NSC-Mindanao also anticipates the opening of another NBS center in Cagayan De Oro City. The new NSC will be housed at the Northern Mindanao Medical Center, its host hospital, and will cater to the NBS services and support needs of birthing and health facilities in Region IX, Region X, and BARMM. NSC-Mindanao and the entire NBS program as a whole have been facing several operational challenges. Persuading birthing and health facilities to consistently screen newborn babies at the ideal age has been a demanding task for the center. Timing is essential to successful NBS. Timely screening will lead to timely medical management, which in turn affects the clinical outcomes of patients with confirmed disorders. Ideally, newborns should be screened within 24 to 48 hours after birth, but many birthing and health facilities perform the screening only on, or even beyond, the 5th day from birth. Arranging for a short specimen transit time has also been challenging for the entire NBS system. Transit time should be within two days upon collection, but NSC-Mindanao still receives specimens beyond five days from collection.1 Nationally, the NBS program has yet to achieve its target of 100% NBS coverage. This has been more challenging since the start of the COVID-19 pandemic. For 2021, the NBS program achieved 70% national coverage. Thirteen years after its establishment, NSC-Mindanao has grown exponentially and has become one of the NSCs, if not the NSC, with the widest coverage of NBS in the country. It is committed to fulfill its important contribution to health care, and it will continue the expansion and improvement of the quality of its NBS services in the years to come.
Neonatal Screening

We published in May 10, 2022 a retrospective cohort study comparing the post-radiotherapy (post-RT) hemoglobin levels between patients with breast cancer who underwent intensity-modulated radiotherapy (IMRT) and those who underwent three-dimensional conformal radiotherapy (3D-CRT) in the Radiation Oncology Section of the Department of Radiological and Imaging Sciences of Southern Philippines Medical Center (ROS DORIS-SPMC) from October 2018 to March 2019. It came to our knowledge that the IMRT planning that was done on the patients included in our study was different from the IMRT planning that is currently being done since late 2020. Prior to late 2020, ROS DORIS-SPMC had been implementing forward-planned IMRT, wherein the weight of the multileaf collimator (MLC) segment was preselected at fixed values. In late 2020, ROS DORIS-SPMC started implementing inverse-planned IMRT, wherein the appropriate weights of the MLC segments are determined by an inverse optimization algorithm that creates a more uniform dose distribution throughout the target. Inverse-planned IMRT improves the dose homogeneity within the entire 3D-breast volume, while forward-planned IMRT mainly improves the dose distribution on the inframammary fold.1 Compared to 3D-CRT, however, forward-planned IMRT improves target homogeneity, albeit to a lesser degree than the homogeneity produced by the inverse technique.2 In the original article, we also stated that, for both IMRT and 3D-CRT, each dose fraction is given weekly within a span of 7 to 8 months. We recently confirmed that, among patients with breast cancer, each dose fraction of IMRT or 3D-CRT is given daily within a span of 33 days—28 days for conventional dose and 5 days for boost dose. In this corrigendum, we specify that the IMRT protocol used among the patients in our study was forward-planned IMRT, with all dose fractions given daily for 33 consecutive workdays, excluding weekends and holidays. We also describe here the original statements that we changed or removed because they have become irrelevant in light of the corrections. The table below shows the list of corrections.
Radiotherapy, Intensity-Modulated ; Radiotherapy, Conformal

In this epoch of progress in health care, when systematic generation of knowledge is considered the cornerstone of health development, there is increasing focus on the need to demonstrate the ethicalness of doing research. Stories of harm inflicted on research participants and scientific misconduct in research are rife in the history of science, even within our immediate past.1 The lessons that we have learned from these stories have shaped the ethical research guidelines that we abide by and uphold today.2 3 Within the last 15 years, since the creation of the Philippine Health Research Ethics Board (PHREB) as the country's policy-making body on research ethics, numerous mandates have been issued to ensure human research participant protection and research integrity. Taken together, these mandates push for the ethical review of researches that are proposed to be done among humans or to use human data, the establishment of research ethics committees (RECs) in institutions that produce these researches, and the maintenance of quality standards in the operation of these RECs through accreditation by the PHREB.4 The enactment of Republic Act No. 10532 in 2013, formally institutionalized the Philippine National Health Research System and tied up all these mandates that pertain to research ethics.5 In effect, all institutions that generate human research一hospitals, health facilities, pharmaceutical companies, government and private agencies, universities, colleges, and even high schools一are expected to comply with these mandates. Many institutions that produce research involving humans or human data find it very challenging to set up a series of procedures for the review of these researches. For one, submitting research protocols一after they have gone through several revisions as directed by the technical research committee or panel一to a second committee for ethics review, approval, and implementation monitoring is a relatively new practice. The extra layer of scrutiny, the intellectual disagreements of technical committees and RECs, and the additional time and effort it takes to get an REC approval all figure in the arguments of those who are against the ethics review process. Research offices or training committees may have to put a system in place to incentivize submission or discourage non-submission of research protocols for ethics review. All in all, it takes administrative political will to incorporate a procedural pathway to ethics review into the usual research generation procedures of an institution. The institutions can arrange a mechanism for external ethics committees or, more commonly一and indeed more efficiently一they can create their own in-house RECs. The demands related to the establishment and operation of in-house RECs constitute an altogether different set of challenges for the institution. REC members and staff will have to be trained to competently do ethics reviews and perform administrative tasks within the REC office. There is also the difficulty of coming up with a good roster of trained reviewers who can dedicate time for committee work. The institution will also have to allocate physical space, and finance both the cost of REC operations and the remuneration of office personnel. The REC accreditation process is meant to reduce variation of procedures and maintain the quality of operations by way of recommending certain standards in the structures, processes, and outputs of RECs. On the part of PHREB as the accrediting body, the process requires careful organization of a well-trained accreditation team that can efficiently and scrupulously evaluate the REC operations and produce helpful recommendations. The process is inherently challenging for REC managers as well since, most of the time, it requires meticulous (re)engineering of REC operations. Above all these demands in complying with the mandates on research ethics is the pervasive call for us to generate trustworthy research results in ways that are beneficial and non-harmful to humans. An ethically produced piece of knowledge is a valuable contribution to scientific progress.
Ethics, Research