OBJECTIVES

The current study aimed to evaluate the impact of an interprofessional simulation-based training program on providers' perception, knowledge, and confidence in proning of pregnant patients with Acute Respiratory Distress Syndrome due to COVID -19 or other causes.

A total of 124 healthcare workers who took part in the management of patients in COVID wards and ICUs participated in the study. The simulation workshop was conducted on May 2022 and the participants were divided into interprofessional teams. Standardized patients and mannequins were used to simulate patients with ARDS. Standardized checklists for proning were used. The participants were debriefed after. The participants completed pre- and post-simulation questionnaires.

After the simulation workshop, the participants’ perception on the benefit of prone position in the ventilation of patients with ARDS, level of confidence in handling proning of pregnant patients, comfort in speaking to patient and next of kin regarding prone ventilation, and knowledge on proning significantly improved. Subgroup analysis
showed statistically significant improvements in knowledge scores among registered nurses, resident physicians, and participants with varying degrees of experience managing COVID-19 patients and proning pregnant patients. Majority of participants deemed it was easy to turn patients in the prone position using the supportive pillow as well as expressed confidence in doing the procedure.

Background: The prone position has been seen to benefit patients experiencing acute respiratory distress syndrome. However, performing this position in pregnant patients has been difficult and raises safety concerns. Objective: The current study aimed to test the use of a supportive pillow (Prone Pillow for Pregnant Patients or 4P) to address concerns regarding pregnant patients in prone position. Methods: The study prospectively evaluated the use of the prone pillow for patient comfort and usability among healthcare workers with qualitative and quantitative measures. Results: A total of three patients were recruited alongside 16 healthcare workers assisting pregnant patients to the prone position. Overall, awake pregnant patients found the pillow to be comfortable while healthcare workers perceived the pillow to be useful in improving quality of care among awake and intubated pregnant patients. Conclusion The 4P is a potentially useful and beneficial product in placing pregnant patients in the prone position during episodes of acute respiratory distress. However, due to the limited sample size, more clinical trials are needed to evaluate the impact of this innovation in improving patient and healthcare worker safety.
Covid-19

This paper documents the utility of ultrasound-guided tru-cut biopsy in the diagnosis and subsequent management of a case of occult breast carcinoma presenting with multiple distant metastases in the absence of a primary breast lesion. She was initially diagnosed as primary ovarian malignancy with metastatic disease and subsequently underwent transvaginal ultrasound-guided tru-cut biopsy of the right ovarian mass. Histologic and immunohistochemical studies were consistent with a metastatic adenocarcinoma of breast origin. The patient underwent chemotherapy for primary breast carcinoma and has responded well.
Carcinoma

Background: Unmet need points to the gap between reproductive intentions and contraceptive behavior. This cross sectional study aims at determining the demographic, socioeconomic and other factors underlying the unmet need for contraception among postpartum women. Method: A face-to-face interview was conducted to among postpartum women admitted in a tertiary hospital and logistic regression analysis was performed to determine the significant predictors of unmet need for family planning. Descriptive analysis on their contraceptive use was also determined. Results: After controlling for other respondents’ characteristics, the results indicate that the total unmet need was associated with younger women, those who were in the age range 20-30 years old during their first pregnancy and religion is Roman Catholic. The most significant association was shown in those whose partners disapprove the use of family planning. Majority have heard of contraception but are not using any method. The major sources of contraceptives and contraceptive information on family planning are still the public health sector. Most have contraceptive plans and they prefer oral pills and implants. Conclusion Unmet need for family planning is associated with partner’s approval. With low family planning utilization among postpartum women, future programs on family planning should focus on these problems.
Female ; Family Planning Services ; Sex Education ; Postpartum Period

Uterine inversion is a rare clinical problem. Most cases of uterine inversions are puerperal inversions wherein it is encountered as an obstetric emergency, and sometimes a diagnostic challenge in gynecology. Uterine inversions associated with malignancies such as endometrial carcinoma and sarcoma are even rare. We report 2 cases of this rare condition. A 55 year old diagnosed with endometrial carcinoma and a 60-year-old woman diagnosed with sarcoma (malignant mixed mullerian tumor) presented with mass protruding from the vaginal introitus. The diagnosis of complete uterine inversion was confirmed in both cases during laparotomy. Total abdominal and vaginal hysterectomy and bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissection, paraaortic lymph node sampling was done. It required a challenging surgical procedure to remove the tumor along with the review of literature especially of its association with malignancies.
Female ; Uterine Inversion ; Uterine Neoplasms ; Adenocarcinoma

This paper documents the utility of ultrasound-guided tru-cut biopsy in the diagnosis and subsequent management of a case of occult breast carcinoma presenting with multiple distant metastases in the absence of a primary breast lesion. She was initially diagnosed as primary ovarian malignancy with metastatic disease and subsequently underwent transvaginal ultrasound-guided tru-cut biopsy of the right ovarian mass. Histologic and immunohistochemical studies were consistent with a metastatic adenocarcinoma of breast origin. The patient underwent chemotherapy for primary breast carcinoma and has responded well.
Biopsy ; Carcinoma

Objective: The Department of Health developed a program for Cervical Cancer Prevention and Control in the Philippines and this involves training of health care providers on Visual Inspection with Acetic Acid (VIA). The evaluation of this training program aims to determine the effectivity of the training workshop in increasing the knowledge and skills of healthcare providers in VIA and whether this would translate to practice in their workplaces. Method: The first run of the training program was evaluated and the approach used was Kirkpatrick’s model. Participants were asked to complete an evaluation questionnaire for Level 1 evaluation. A pre-test, post-test and performance checklist were accomplished for Level 2 evaluation. For Level 3 evaluation, randomly selected participants were interviewed via mobile phone. Data analysis involved descriptive methods and inferential statistics (T-test and McNemar test) for Level 2. Results: Level 1 evaluation demonstrated a high over-all satisfaction rating from the participants (x ?=4.59) and the training workshop was found to be relevant and useful to their practice. Level 2 evaluation showed a significant increase in the knowledge of the participants (P=.001) particularly in the core topics of cervical cancer epidemiology (P=.001) and VIA (P=.006). There was likewise a significant improvement in the performance of VIA from the first to the last patient encounter (P=.000). Level 3 evaluation showed that the participants interviewed have realized the importance of VIA Conclusion The training workshop was effective in increasing the knowledge base and clinical skills required of health care professionals who will provide cervical cancer screening services using visual inspection with acetic acid. As a direct effect of the increase in knowledge and skills, the participants have started to incorporate their new learnings into their practice.
Human ; Female