Initial Planning: Statement 1: Develop a Family-focused Care Plan that contains tasks and activities related to the family structure, home environment and processes in order to mitigate the effect of the COVID-19 epidemic Adjustment in the Family Structure and Home Environment: Statement 2: Identify a Family Caregiver who will remind the family to follow and implement the plan. Make sure this person is supported by all the members of the family. Statement 3: Identify a room or area that can be used for isolation in the event that a family member will be exposed to a diagnosed COVID-19 patient. Statement 4: Identify those who are at risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition and advice to take extra precaution. Statement 5: During the declared community quarantine period, all family members should stay at home, limit family celebrations, avoid home parties with outside guests, cancel travels as much as possible and be ready to have more members staying at home Performance of Routine Tasks and Activities : Statement 6: Practice personal hygiene that includes regular and appropriate hand washing, daily bath, cough and sneezing etiquette, minimize hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. Statement 7: Daily cleaning of frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol What to Do When a Member is Exposed Statement 8: Advice an exposed family member to stay home and in the room or area allocated for isolation, wear mask and maintain at least 2 meters physical distance from the other family members. Make sure their clothing, personal belongings and other things that they usually hold is cleaned regularly and not touch by other members. Statement 9: Watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person exposed is low risk and there is difficulty of breathing or worsening of symptoms, consult your family doctor. If the person is high risk i.e. elderly or with exiting chronic disease and symptoms appear, consult your family doctor right away. Call first before going to the clinic or hospital. Statement 10: If the symptoms are mild, continue home quarantine, take over-the-counter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Other family members are encouraged to provide psychological and social support to an exposed and isolated member. Statement 11: Symptoms usually resolved within 14 days, after which home quarantine can be discontinued between 14-21 days. If symptoms persist beyond 14 days consult your family doctor for advice
COVID-19 ; Family

Initial Planning: Statement 1: A Community-oriented Health Care Plan that contains tasks and activities related to the community organization, environment, health care and social processes in order to mitigate the effect of the COVID-19 epidemic on the community should be developed. Statement 2: The plan should also include adjustments needed to continue the delivery of other health services i.e. maternal and child health, immunization, treatment of other communicable and non-communicable disease but with strict COVID-19 transmission precautions. Adjustment in the Community Organization and Environment: Statement 3: A local task force should be organized to develop and implement the community health plan. The task force should be recognized and supported by the whole community. Statement 4: A facility in the barangay that can be used for isolation in case that a member will be diagnosed to have mild COVID-19. A hospital facility for referral of high-risk cases should also be identified and an emergency referral and transport plan should be established. Statement 5: All community health workers should wear appropriate personal protective equipment in the process of performing their community health work. Statement 6: Households in the community who have members at high-risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition should be identified and advised to take extra precautions i.e. personal hygiene, wearing mask and physical distancing. Statement 7: During the declared community quarantine period by the community or higher-level authority, all community members and household should be advised to stay at home, limit celebrations and community gatherings Performance of Routine Tasks and Activities: Statement 8: A community-directed information, education and communication (IEC) plan should be developed and implemented for the following: a) Informing every household in the community on the basic and accurate information about COVID-19 and the community plan. b) Encouraging everyone to practice personal hygiene that includes regular and appropriate hand washing, daily bath, coughing and sneezing etiquette, wearing of mask, minimizing hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. c) Encouraging everyone to clean everyday frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol. d) Encouraging everyone to report and seek help to the community health worker if a household member is exposed and developed mild symptoms of COVID-19 What to Do When a Member or Household is Exposed or Diagnosed COVID-19: Statement 9: If there is a household whose member is exposed to a COVID-19, the person should be encouraged to stay home preferably in a room or area adequate for isolation, wear mask and maintain at least 2 meters physical distance from other family members. Statement 10: Other household members should be advised to watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person is low risk but there is difficulty of breathing or worsening of symptoms or if the person is high risk i.e. elderly or with existing chronic disease and symptoms appear, they encouraged to inform the community health worker and facilitate the necessary referral and transport arrangement to the hospital. Call first before going. Statement 11: If the symptoms are mild, continue home isolation or in the isolation facility identified by the community, take over-thecounter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Family members and community health workers are encouraged to provide psychological and social support to isolated patients. Discontinuation of isolation can be done if symptoms resolve within 14-21 days Epidemiology and Surveillance Statement 12: The municipal or city health office should be provided daily with a situation report of the implementation of communityoriented health care for COVID-19. Situation report should include: a) The number of exposed, number of diagnosed cases, number of mild cases, number of cases referred to the hospital and number of cases recovered or died in the community. b) Brief description of best practices
COVID-19 ; Noncommunicable Diseases ; Quarantine

Readiness of Health Care Staff: Statement 1. Family physicians and their staff should prepare themselves mentally, physically and emotionally before resuming clinic services. Prior to starting every clinic day, physicians and their staff should take their temperature and note respiratory symptoms. Statement 2. All clinical staff should be properly trained on proper use of PPEs, clinic disinfection, infection control and other safety procedures. Statement 3. Family Physicians should design an office management and operations plan that includes triage, patient flow, treatment and other patient care protocols including strict implementation of infection prevention and control procedures, management of PPE supplies and potential staff shortages. Statement 4. The clinic staff must inform their patients of the changes that may result from the new management and operations plan that will be made in the facility Clinic Procedures, Disinfection and Infection Control: Statement 5. After undergoing proper triage, non-COVID 19 patients entering the clinic should use a hand sanitizer, step on a foot bath or pad soaked in chlorine or any approved disinfectant solution at the entrance. All clinic staff, patients and accompanying persons should be wearing at least a mask inside the clinic. They should be instructed to avoid touching their face or mask and perform hand hygiene immediately before and after if cannot be avoided. Statement 6. Appropriate visual alerts or educational posters regarding infection control, proper handwashing, cough or sneezing etiquette should be visible inside the clinic. Statement 7. The clinic facility must have infection prevention and control measures that adhere to international and local standards. Statement 8. After appropriate triaging, a family physician when attending to a patient shall wear mask, single use gloves and eye protection while apron or gown is optional. It is up to the discretion of the family physician to use higher level of protection based on his risk assessment of the clinic environment and if resources are available. Clinical Services Statement 9. As much as possible, family physicians should continue all primary care services in the clinics. However, it is advisable to first limit the service to non-COVID-19 (suspect or diagnosed) patients. Patients needing COVID-19 assessment and management should be referred to appropriate facilities and follow the guidelines set forth by the Department of Health. Statement 10. A patient who consulted and whose symptoms were resolved may choose not come back for follow-up. Patients with chronic diseases may be followed-up at longer intervals if their illness is stable. Statement 11. Referrals for further assessment, diagnostic tests, or other procedures not available in the clinic must first be coordinated with the referral center/site
Personal Protective Equipment ; Triage ; Disinfection

Background: In a low resource setting, strategies to optimize Personal Protective Equipment (PPE) supplies are being observed. Alternative protective measures were identified to protect health care personnel during delivery of care Objective: To provide list of recommendations on alternative protective equipment during this Coronavirus Disease 2019 (COVID-19) pandemic Methodology: Articles available on the various research databases were reviewed, appraised and evaluated for its quality and relevance. Discrepancies were rechecked and consensus was achieved by discussion. Recommendations: The use of engineering control such as barriers in the reception areas minimize the risk of healthcare personnel. Personal protective equipment needed are face shields or googles, N95 respirators, impermeable gown and gloves. If supplies are limited, the use of N95 respirators are prioritized in performing aerosol-generating procedures, otherwise, surgical masks are acceptable alternative. Cloth masks do not give adequate protection, but can be considered if it is used with face shield. Fluid-resistance, impermeable gown and non-sterile disposable gloves are recommended when attending to patients suspected or confirmed COVID-19. Used, soiled or damaged PPE should be carefully removed and properly discarded. Extended use of PPE can be considered, while re-use is only an option if supplies run low. Reusable equipment should be cleaned and disinfected every after use Conclusion In supplies shortage, personal protective equipment was optimized by extended use and reuse following observance of standard respiratory infection control procedures such as avoid touching the face and handwashing. The addition of physical barriers in ambulatory and triage areas add another layer of protection
Personal Protective Equipment ; Triage

Objective: To determine the efficacy of Guava 5% cream compared to Clotrimazole 1% cream in the treatment of Tinea corporis of patients seen at Family Medicine Department of Quezon City General Hospital Design: Randomized therapeutic clinical trial Setting: Department of Family and Community Medicine Out Patient Department of Quezon City General Hospital Study Subjects: Patients, male or female, 19 years old and above who consulted at Family and Community Medicine Department of Quezon City General Hospital Method: The study was done from August- September 2019. Fifty subjects were randomly assigned to either Group A (25) or Group B (25) using systematic sampling method. Patients in Group A were instructed to apply on affected area Clotrimazole 1% Cream twice a day for 2 weeks, while patients on Group B applied Guava 5% cream twice a day for 2 weeks. Patients were instructed follow up on Week 1 for improvement, Week 2 for evaluating outcome of treatment and Week 4 to check for recurrences Results: Total severity scores of both Groups A and B at Week 1, Week 2 and Week 4 were similar with p-values of 0.014, 0.480 and 0.386 respectively. Both groups were comparable as to the treatment outcome for Tinea corporis. Guava 5% cream is shown to be cost-effective considering the equally-effective treatment outcome and the lower average treatment cost Conclusion This study has shown that Guava 5% cream is equally effective as, and cheaper than Clotrimazole 1% cream, thus considered to be a cost-effective treatment for Tinea corporis.
Tinea ; Psidium ; Clotrimazole

Background: Home health care is a system of clinical care provided by skilled practitioners to patients in their homes. These visitations have positive effect on health, quality of life (QOL) and promote independence among elderly Objective: This study aimed to evaluate the Quality of Life (QOL) of geriatric patients rendered home health care and ambulatory care in community-based clinic Subjects and Setting: Older adults from an urban-based barangay in Metro Manila who received medical care from Family Medicine residents and post graduate interns at home and in the community-based clinic. Methods: This cross-sectional study with ex post facto design used purposive sampling. The following tools were administered: WHOQOL-BREF FIL OP, validated for Filipino elderly to measure QOL; Katz’s Index Activities of Daily Living (ADLs) and Lawton’s Instrumental ADLs to determine the functional status. Descriptive statistics were used to summarize all data. Mann–Whitney U test and Pearson’s correlation coefficient were employed Results: A total of 29 patients were recruited. A comparison of QOL between outpatient (n=16) and home health care (n=13) showed that all domains: physical, psychosocial, social and environmental of home-visited patients had higher mean scores compared to ambulatory care patients. However, the difference was not statistically different. QOL was higher in the home care patients (mean 3.3125) versus the ambulatory care patients (mean 3.0000). Same trend was seen in perceived general health. Conclusion Home health patients still had higher mean scores in all domains of QOL than those who seek in outpatient care. They had better scores in perceived overall QOL and general health. These findings though statistically not significant suggest possible benefits of home care and its potential to improve the quality of life of older adults. Inclusion of QOL measures could allow for comprehensive evaluation of outcomes of treatment and home care services provided.
Quality of Life ; Activities of Daily Living ; Community Health Services

Background: Worldwide, smoking cessation interventions and clinic programs were set up to help smokers in seeking assistance and motivation to abstain smoking and eventually become tobacco-free. Objectives: To determine the outcomes and factors influencing outcomes of Southern Philippines Medical Center (SPMC) employees 6 months and 1 year after enrollment to SPMC Smoking Cessation Clinic (SCC). Methodology: SPMC employees enrolled to the program from the period of 2014 to 2017 with written informed consent to participate in the study. Demographic, clinical, and smoking profiles were gathered from the participant’s Smoking Cessation clinic medical record. A one-time interview was done to acquire additional information such as family genogram and Family Apgar Score at the SCC of SPMC. Main Results: This study had a target of 83 participants, but only 29 provided consent which gives a response rate of 34.93%. Majority of the participants are males, have mean age of 36 years old belonging to unattached young adults, nuclear family structure with highly functional Family Apgar scores and living with a mean of 3 family members per household. All participants had no co-morbidities present. The mean age started smoking is at 21 years old with a mean number of 6 cigarette sticks smoked per day and a mean number of 9 years smoking history. Almost all of the respondents were able to quit smoking within 6 months of enrollment to the program while a few have relapsed. All respondents quit after one year in the program. No significant factors identified during 6 months of enrollment and all respondents were able to quit after 1 year. Conclusion The study results showed that the Smoking Cessation Program established in SPMC was effective. Enrollment to the program for a minimum of six-month duration and with regular clinic sessions prove to be effective in increasing the participant’s readiness to quit and eventually becoming smoke-free.

Background: The highly demanding nature of medical education may lead to development of burnout in medical students which may persist beyond medical school. Burnout can be a predictor of psychological impairments and incorrect patient care Objective: This study aimed to determine the prevalence of burnout and its relationship to socio-demographic variables and associated stressors among 1st to 4th year medical students of Cebu Institute of Medicine for school year 2018-2019 Methods: This is cross-sectional study using a self-administered three-part questionnaire composed of socio-demographic data, stressors, and the Copenhagen Burnout Inventory (CBI). Descriptive statistics were taken for all variables. T-test analysis was used for dichotomous independent variables while Analysis of Variance was utilized for independent samples with multiple variables. Multiple regression analysis was done to determine significant relationship between identified stressors and the determinant score on the CBI Results: Participants had high degree of burnout with average CBI score of 71.53. Majority of the respondents (94.88%) showed at least moderate burnout. Only Year Level (p=0.027) was significantly associated with burnout. Stressors associated with burnout were: lack of belief in what you do (p=0.000), insufficient rewards (p=0.007), poor communication (p=0.002), poor leadership (p=0.009), sense of never ending competition (p=0.009) and scoring lower than hoped (p=0.003). Conclusion Students are at risk for burnout as they temporally progress through medical school peaking at 3rd year level. Stressors encompass personal, study, colleague, and teacher related factors. It is important to address these stressors due to their progressive negative effect both on self and others.
Burnout, Psychological

Background: Organ donation (OD) is the major component for transplant programs. The need for the transplants is high and the gap between organs available for transplantation and the number of patients waiting for a transplant is widening globally. Nurses can play a vital role in promoting organ donation process that may influence the decision-making of donors and their families Objective: This study sought to determine the knowledge and attitudes of nurses in Southern Philippines Medical Center on organ donation. Methodology: A descriptive survey design was used in this study. Sample size computation was done in Epi Info version 7.1.4.0. A modified Organ Donor Attitude Questionnaire based on the previous study by Bishop was utilized. Results: The mean score for question pertaining to knowledge of the 268 participants was 6.34 ± 1.99 out of total of 10 points. A total of 138/268 (51.49%) participants have scores above the average score accumulated by the participants of the study. The overall mean attitude of respondents towards organ donation was 3.25 which is interpreted as undecided. Conclusion Nurses do not have adequate knowledge and attitude towards their role in OD process. There is a need to increase the nurses’ level of knowledge by exposing them to nursing courses to improve knowledge and attitudes.
Knowledge ; Attitude ; Tissue and Organ Procurement ; Nurses

Background: This meta-analysis was conducted to synthesize the evidence on the effectiveness of mhealth for vaccination uptake, coverage, and acceptance among children, adolescents, and adults. Methods: Database search was conducted in PubMed, Medline, and Cochrane Library. Studies were included if the following were met: 1) RCTs or CCTs, and 2) with comparison of mHealth on usual care. Studies were excluded if mHealth was not assessed and the data were insufficient to calculate pooled results. The effectiveness was evaluated using Odds ratio with 95% confidence interval in RevMan 5.3. Results: A total of 17 studies were included in the analysis. The pooled analysis showed that mHealth can improve vaccine uptake (OR 1.83, p=0.0005), coverage (OR 1.49, p=0.03), up-to-date vaccination (OR 2.37, p=0.0007), and completion of full vaccine series (OR 1.81, p=0.0002). Subgroup analyses showed that vaccine uptake is significantly improved when text messaging is used as a reminder system (OR 1.73, p<0.001) and when mHealth is employed for children’s vaccines (OR of 2.77, p=0.007). Majority of the pooled studies showed significant heterogeneity. Statistical synthesis on vaccine acceptance was not feasible, but existing studies report positive effects of mHealth on this outcome. Conclusion mHealth can improve vaccine uptake, coverage, up-to-date vaccination, and completion of the full vaccine series. Additional unpublished and rigorous studies may be considered in a future research to fully assess its effectiveness.
Adolescent Health ; Immunization ; Vaccination ; Telemedicine