Engagement and resource considerations in developing and implementing mobile health technologies for COVID-19 Pandemic: Filipino developers’ perspectives

Objective@#This paper aims to provide a better understanding of the different engagement, cost, and resource considerations in developing and implementing mHealth solutions in the Philippines during the COVID-19 pandemic. @*Methods@#First, six participants completed a form to document the estimated costs of developing a pseudo mobile application with features to mitigate the pandemic. Second, ten key informant interviews determined the facilitators, barriers, and resource requirements in developing mHealth tools. @*Results@#The average cost estimate to develop and roll out a mobile application with public health and epidemiology features is Php 4,018,907 (US $78,650). The analysis of the interviews resulted in 12 themes organized in three domains: 1) facilitators and barriers in developing and sustaining mHealth solutions; 2) costs of sustaining mHealth technologies; and 3) factors affecting the costs of development and maintenance of mHealth technologies. @*Conclusion@#While differences in the cost estimates are evident, it provides a ballpark figure and the different factors that implementers need to sustain and maintain an mHealth solution. This paper hopes to inform policies and practices in engaging technology solution partners and in scaling up mHealth technologies.

Filipino translation and validation of the University of Washington – Quality of Life Questionnaire (Version 4) for patients with head and neck tumors in the Philippine General Hospital

Objectives@#This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability. @*Methods@#This was a cross sectional mixed methods study comprised of two parts. The first part consisted of Filipino translation of the UW-QOL version 4 questionnaire. The second part validated the internal consistency and testretest reliability through statistical analysis. @*Results@#The Cronbach’s coefficient was high (0.88) which denotes good internal consistency. Pearson’s correlation coefficient was obtained to determine the test-retest reliability of the translated questionnaire. A p value of <0.05 indicates that the questionnaire has good test-retest reliability. The p value was high in most of the items of the questionnaire. @*Conclusion@#The internal consistency of the translated questionnaire is high and comparable to other translations of the same questionnaire. The test-retest reliability is low owing to the interventions done between the test and retest.

Determination of factors affecting stone free rates of Primary Percutaneous Nephrolithotripsy (PCNL) in a tertiary government hospital

INTRODUCTION AND OBJECTIVES@#Percutaneous nephrolithotripsy (PCNL) is the first-line treatment for stone burden >2 cm. The aim of this study was to determine factors that would affect stone free rates after PCNL. Preoperative and intra-operative variables were correlated to the patient’s post-operative outcomes to find a link, or lack thereof, to stone-free outcomes.@*METHODS@#A retrospective study of patients who underwent primary PCNL was done over a 1-year period. The association of the stone characteristics (based on Guy stone score), stone burden, operative time, lithotripsy time, number of access tracts, and location of access tracts to the stone-free status were analyzed.@*RESULTS@#One hundred thirty patients who underwent PCNL were included in this study. Stone free rate was 77.69% (101/130) while 23 of the 29 patients with residual stones (22%) (29/130) required further treatment. The 30-day overall morbidity rate was 8.46% (11/130). Guy stone score (GSS) and stone burden were found to be significantly associated with stone-free status. Patients with GSS grade I had the highest stone-free rate of 95.45% while patients with GSS Grade IV had the lowest stone-free rate at 30.00%. After multivariate analysis, stone burden (OR 1.176; 95% CI 1.084- 1.275; p 0.00) and GSS 4 (OR 15.374; 95% CI 1.164- 202.980; p 0.04) were significant independent risk factors for stone-free status.@*CONCLUSION@#Stone clearance and complication rate after PCNL of the present study were 78% and 8.5%, respectively, comparable with published data. A higher Guy’s stone score and a higher stone burden were significantly associated with retained stones post-PCNL.

The impact of the Implementation of a Surgical Antibiotic Use Guideline in the Practice of Antibiotic Use in the Department of Surgery, Philippine General Hospital

@#Objective. This study aimed to assess compliance with current best practice guidelines on the use of antibiotics in the Department of Surgery in the Philippine General Hospital and to determine the impact of the dissemination of an institution-based guideline on compliance and on patient outcomes. Methods. Two antibiotic use surveys were performed 4 weeks before and 4 weeks after the implementation and dissemination of the PGH Surgical Antibiotic Use Guidelines in the Department of Surgery. The medical records of eligible patients were reviewed regarding patient and case characteristics, details on the administration of antibiotics and the collection of specimen for culture studies. Data relating to the occurrence of surgical site infection within 30 days of the operation was extracted. Compliance with antibiotic use guidelines was assessed for each case. The compliance rates in the pre- and post-intervention periods were compared. Results. The study included a total of 477 patients, 213 in the pre-implementation and 264 in the post-implementation period. Compared with the pre-intervention period, rates of compliance with guidelines improved for all parameters in the post-implementation period except for correct dosing. The greatest improvement was seen in the selection of the recommended drug, and proper duration. There was modest improvement in the timing of the preoperative drug administration. There was poor compliance with recommendations for appropriate specimen collection for culture studies, with marked improvement in collection in the pediatric group post-intervention. Overall, the in-hospital SSI rate was reduced from 6.8% to 1.1%, while there was little change in the 30-day SSI rate, post-intervention. Conclusion. A simple intervention to raise awareness of institutional guidelines on antibiotic use in the surgical setting lead to a modest improvement on overall compliance, although rates of total compliance with all relevant guidance on antibiotic use, choice, dose, timing and duration remained low. The impact on surgical site infection rates based on such compliance was modest.

Development of ethical and operational guidelines for the delivery of surgical care in a COVID-19 referral hospital

@#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.

Are vaccines effective and safe for the prevention of COVID-19 infections? A living systematic review

@#Introduction. In the attempt to control the spread of the disease and the pandemic, numerous COVID-19 vaccines are in development. A review of the evidence on their efficacy and safety are critical. Methods. A search for trials was done using the COVID-19 Living OVerview of Evidence (L·OVE) platform. We also searched for relevant authorization documents and trial reports for COVID-19 vaccines of the US-Food and Drug Authority (US-FDA), the European Medicines Agency (EMA), the United Kingdom Medicines and Health Products Regulatory Agency (MHRA), and the WHO website. We included studies that fulfilled the following inclusion criteria: population – humans; intervention – COVID-19 vaccines; comparison – control or placebo; outcomes – efficacy and adverse events; methods – phase 3 randomized trials. Two reviewers independently screened the reports, assessed the methodological quality, and extracted the data on the trial characteristics and results on vaccine efficacy and safety. The date of last search was March 11, 2021. Results. Interim results of trials investigating five vaccines were identified and included in the review. All five vaccines demonstrated satisfactory vaccine efficacy (VE) against symptomatic COVID-19 infection among adults in the short term with moderate certainty of evidence: BNT162b2, VE 95% (95% CI 90.3, 97.6); mRNA-1273, VE 93.6% (95% CI 88.6, 96.5); ChAdOx1, VE 66.7% (95% CI 57.4, 74.0), Gam-COVID-Vac, VE 91.1% (95% CI 83.6, 95.1); and Ad26.CoV2.S, VE 67.2% (95% CI 59.3, 73.7). Data on the efficacy against severe COVID-19 infection and asymptomatic COVID-19 infection are still inconclusive, except for Ad26.CoV2.S, which demonstrated good efficacy in preventing moderate and/or severe COVID-19 infection and acceptable protection against asymptomatic COVID-19 infection 28 days after vaccination (moderate certainty of evidence). Efficacy data on preventing death from COVID-19 infection are still inconclusive. Very limited phase 3 trial data is available to inform vaccine efficacy against the different variants of SARS-CoV-2. Vaccination with these five vaccines was associated with higher adverse reactions compared to control. These adverse events, due to reactions to the vaccines, were mild to moderate and of short duration. Available evidence on vaccine efficacy and safety is limited, mainly due to the short follow up and the small sample size of specific populations. Conclusion. BNT162b2, mRNA-1273, ChAdOx1, Gam-COVID-Vac and Ad26.CoV.S vaccines demonstrated satisfactory vaccine efficacy against symptomatic COVID-19 infection among adults in the short term with moderate certainty of evidence. Data on the efficacy against severe COVID-19 infection, asymptomatic COVID-19 infection, and death from COVID-19 infection are still inconclusive. Long-term efficacy and safety data, and data on the efficacy against variant strains of SARS-CoV-2 are still lacking.

Philippine Surgical Infection Society 2020 Consensus Guidelines on oral hygiene for the improvement of surgical outcomes

@#Nosocomial infections significantly contribute to a patient’s morbidity and mortality, increasing healthcare costs. While previous research has assessed the effect of oral hygiene on the prevention of nosocomial infections and postoperative complications, few guidelines exist that offer evidence-based recommendations on pre- or peri-operative oral hygiene in the surgical setting. The Philippine Surgical Infection Society set out to develop a set of guidelines that provide evidencebased recommendations on oral hygiene for improving surgical outcomes for adoption in the Philippines. Six clinical questions defined the scope of the guidelines. A systematic review was performed to provide the evidence base to develop the recommendations. A consensus meeting participated by 15 representatives from 13 specialty surgical societies and societies concerned with infection control was conducted using the modified Delphi technique to finalize the set of recommendations. A consensus guideline with sixteen recommendations on the use of oral hygiene to improve surgical outcomes is presented for adoption and implementation.

Surgical Site Infection (SSI) Surveillance Program for mastectomy in the Department of Surgery of the University of the Philippines-Philippine General Hospital

@#<p style="text-align: justify;"><strong>Background:</strong> Mastectomy is a common surgical procedure done worldwide. Surgical site infection (SSI) is a common healthcare-associated infection. Mastectomy SSIs are frequently under-reported.</p><p style="text-align: justify;"><strong>Objectives:</strong> The study aimed to determine the incidence of SSI among mastectomy cases of the Department of Surgery, University of the Philippines - Philippine General Hospital (UP-PGH) during one year of full implementation of the Surgical Site Infection Surveillance Program and evaluate the program's surveillance follow-up rate.</p><p style="text-align: justify;"><strong>Methods:</strong> This study was an observational practice audit research that included all adult patients who underwent a mastectomy in UP-PGH from January 1, 2018, to January 31, 2019, when the SSI Surveillance Program was fully implemented. SSI was monitored and assessed during the patient's hospital stay, on the day of hospital discharge, and at 30 days (± 2 days) after surgery, either during an outpatient visit or via phone call by a nurse navigator. SSI frequency for mastectomy was computed both during the in-hospital stay and at 30 days after surgery. Surveillance follow-up rate, defined as the proportion of patients who could follow-up up to 30 days after surgery, was determined.</p><p style="text-align: justify;"><strong>Results:</strong> The 30-day SSI rate for mastectomy was 6.8% (19/279). All 279 patients were followed up to 30 days after surgery. Of the 279 patients, 277 (99.3%) were through clinic visits, one was through phone calls, and one was still admitted to the hospital.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Full implementation of the SSI Surveillance Program for mastectomy in UP-PGH for one year showed a higher SSI rate than in published international literature. The program had a complete 30-day patient follow-up, contributing to more accurate SSI reporting. Implementing an SSI surveillance program with standardized protocols, dedicated personnel, patient education component, and the analysis of the information derived from such programs can improve an institution's quality of surgical care.</p>

Bacteriology and antibiotic sensitivity pattern of isolates in patients who underwent Percutaneous Nephrolithotripsy (PCNL) at the Philippine General Hospital: A retrospective cohort study

@#<p style="text-align: justify;"><strong>Background.</strong> Despite being a clean-contaminated procedure, performed only in patients with sterile urine preoperatively, percutaneous nephrolithotripsy (PCNL) is associated with significant infectious perioperative complications. A local antibiogram is of paramount importance in optimizing antibiotic prophylaxis in PCNL because of the substantial variation in bacterial distribution and antibiotic sensitivity worldwide.</p><p style="text-align: justify;"><strong>Objectives.</strong> The incidence of post-PCNL infectious complications, microorganism distribution, and antibiotic sensitivities from patients admitted for PCNL was determined. The risk factors associated with positive cultures and the development of fever and bacteremia were also analyzed.</p><p style="text-align: justify;"><strong>Methods.</strong> A retrospective study of 102 patients who underwent PCNL under a surveillance protocol was done. The susceptibility of isolates from different specimens was evaluated against the most common antibiotics in the hospital. Chi-square and Student's t-test were used to determine differences in the frequencies and means for other risk factors for those who developed fever and urosepsis and those who did not.</p><p style="text-align: justify;"><strong>Results.</strong> The incidence of fever and urosepsis was 25% and 4%, respectively. The most common organism on urine specimens was Escherichia coli which showed high sensitivity to aminoglycosides. The most common isolate on stones was Pseudomonas aeruginosa, which showed higher sensitivities to the fluoroquinolones. The isolates showed nearly consistent resistance to ceftriaxone. No significant association was found between the clinical variables studied and the occurrence of infectious complications.</p><p style="text-align: justify;"><strong>Conclusion.</strong> There are comparable rates of infectious complications to published literature. A change in antibiotic prophylaxis was warranted, given the high resistance to ceftriaxone and the predominance of Pseudomonas aeruginosa on stone isolates. Further surveillance is required to identify significant risk factors for the development of post-PCNL infectious complications.</p>

Risk factors and interventions: Fournier gangrene in a tertiary hospital: A 10-year experience

@#<p style="text-align: justify;"><strong>Objective.</strong> The study aimed to describe the patient demographic characteristics, clinical factors, surgical interventions, and quality of care parameters in non-survivors and survivors of Fournier's gangrene (FG).</p><p style="text-align: justify;"><strong>Methods.</strong> A total of 131 cases of Fournier's gangrene (FG) were included in a retrospective chart review in the Philippine General Hospital over 10 years using the Department of Surgery research database. We collected data for various direct and derived variables from the identified population. The primary outcome was mortality rate, while other factors studied were genital and colorectal manipulation, bowel diversion, laboratory parameters (white blood cell count, creatinine, hemoglobin).</p><p style="text-align: justify;"><strong>Results.</strong> The mortality rate was 15%. Diabetes mellitus was common comorbidity among patients with Fournier's disease. The following were statistically more common in the non-survivor group: female sex, concomitant bowel diversion surgery. Admission data in the non-survivor group showed a lower serum hemoglobin, a higher serum creatinine, and an increased percentage of patients with an abnormal white blood cell count; these did not statistically differ between cohorts, however. The median time to first antibiotic infusion was six hours. The median time to surgery was 13 hours.</p><p style="text-align: justify;"><strong>Conclusions.</strong> Among patients with Fournier's gangrene, the proportion of women and those undergoing bowel diversion was higher in those who did not survive. The time of infusion of antibiotics or time to surgery did not differ significantly between survivors and non-survivors.</p>

Genitourinary involvement in colorectal cancer: pre-operative diagnostic utility of CEA, computed tomography and cystoscopy in predicting surgical involvement

OBJECTIVE@#This study aims to describe the demographics, clinical characteristics of patients, and the sensitivity and specifity of the clinical, laboratory, radiologic, diagnostic parameters in detecting histopathologically-proven urinary tract involvement in primary colorectal cancer patients referred to the urology service in the Philippine General Hospital. @*METHODS@#This was a retrospective, cross-sectional study. The study included patients referred to the Division of Urology from the Division of Colon, Rectal and Anal Surgery January 1, 2018 to December 31, 2018. All patients diagnosed with colorectal malignancy and referred to the Urology service were included in the study, including their cystoscopy, axial tomography, CEA and symptom assessment scores.@*RESULTS@#Fifty-eight patients were included in the study and, 43% were rectal cancers and 33% were sigmoid cancers. Sensitivities and specificities were as follows. Symptoms 40%, 84%, Cystoscopy, 45%, 100%; Axial tomography 75%, 79%. Surgical involvement correlated with histopathologic involvement with a specificity of 52%. CEA did not discriminate between cohorts of positive or negative involvement.@*CONCLUSION@#Cystoscopy, axial tomography and symptom assessment had high positive predictive values. All diagnostics had low negative predictive values when taken in isolation. Surgical assessment correlated with histopathologic findings in half of the population. CEA did not discriminate between those with surgical involvement and those without. A multi-modality assessment strengthens detection of surgical involvement preoperatively.

Filipino translation and validation of the University of Washington - Quality of Life Questionnaire (Version 4) for patients with head and neck tumors in the Philippine General Hospital

Objectives@#This study aims to develop a Filipino translation of the University of Washington Quality of Life Questionnaire (UW-QOL) version 4, and determine its internal consistency and test-retest reliability. @*Methods@#This was a cross sectional mixed methods study comprised of two parts. The first part consisted of Filipino translation of the UW-QOL version 4 questionnaire. The second part validated the internal consistency and testretest reliability through statistical analysis. @*Results@#The Cronbach’s coefficient was high (0.88) which denotes good internal consistency. Pearson’s correlation coefficient was obtained to determine the test-retest reliability of the translated questionnaire. A p value of <0.05 indicates that the questionnaire has good test-retest reliability. The p value was high in most of the items of the questionnaire. @*Conclusion@#The internal consistency of the translated questionnaire is high and comparable to other translations of the same questionnaire. The test-retest reliability is low owing to the interventions done between the test and retest.

Incidence and risk factors of postoperative bacteriuria after transurethral resection of the prostate using distilled water as irrigating fluid: A retrospective cohort study

OBJECTIVE@#To establish the incidence of postoperative bacteriuria (PBU) in patients after undergoing transurethral resection of the prostate (TURP) using sterile distilled water as irrigating fluid, and determine the possible risk factors for its development.@*METHODS@#A retrospective cohort study of patients who underwent TURP using distilled water as irrigating fluid from 2014-2018 at a tertiary government hospital was performed. Included were patients who had urine culture results upon admission, treated with antibiotics or received antibiotic prophylaxis within 24 hours prior to operation, as appropriate, and had a repeat culture prior to discharge. PBU was defined as the presence of significant (≥ 105 CFU/mL) bacteriuria upon catheter removal in patients with either no growth on preoperative urine culture or growth of a different organism from that of the preoperative culture. Chi-square and Student’s T-test were used to compare those with and without PBU and attributable risk (AR) values were determined for identified risk factors.@*RESULTS@#Eighty-four patients with a mean age of 65 (± 6.32) years were included. Sixteen (19%) patients developed PBU. Preoperative catheterization and resection time of more than 30 minutes were found to be associated with the development of PBU (p=0.020 and 0.047, respectively), with AR of 24.24% (95% CI [13.90,34.58]) and 22.86% (95% CI [13.02,32.69]). Age, resected prostate weight, and diabetes mellitus were not found to be associated with PBU.@*CONCLUSION@#Postoperative bacteriuria rate of 19% was noted with the use of distilled water as irrigant during TURP. Significant risk factors for its development included preoperative catheterization and prolonged resection times.

Fungal pneumaturia: A case report on a large urinary bladder fungal bezoar in a young diabetic male

@#Fungal bezoars or fungus balls are extremely rare cases especially when they occur within the urinary tract. Reported here is a 26-year old diabetic male presenting with pneumaturia, passage of debris per urethra and lower urinary tract symptoms. He was initially managed as a case of enterovesical fistula. Further work-up revealed a urinary bladder fungal bezoar. The patient was managed by endoscopic morcellation and evacuation of the fungal ball from the bladder and anti-fungal therapy. Awareness of this rare clinical entity and its presentation will aid in its proper diagnosis and management.

Psychosometric properties of the Filipino version of the international consultation on incontinence questionnaire-male lower urinary tract symptoms and female lower urinary tract symptoms

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The purpose of this study was to translate the International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) into Filipino and determine its psychosometric properties mainly feasibility, internal consistency (reliability), and stability (test-retest reliability).<br /><strong>METHODS:</strong> This was an observational, non-interventionist study, which recruited 100 male and 100 female patients seeking consult at the Philippine General Hospital for lower urinary symptoms. The questionnaires were completed in a single visit with the exception of 20 patients who were asked to answer the questionnaire again after 2 weeks to evaluate test-retest reliability. The ICIQ-MLUTS Filipino questionnaire is a 14-item self-administered questionnaire while the ICIQ-FLUTS Filipino questionnaire is a 13-item self-administered questionnaire.<br /><strong>RESULTS:</strong> There was an 81% completion rate for the ICIQ-MLUTS questionnaire and 100% completion rate for the ICIQ-FLUTS questionnaire. Reliability testing revealed Cronbach's alpha coefficient of 0.949 for the ICIQ-MLUTS and 0.956 for the ICIQ-FLUTS questionnaire while test-retest reliability showed intraclass coefficient values above 0.9 for individual items of both questionnaires.<br /><strong>CONCLUSION:</strong> The Filipino versions of the ICIQ-MLUTS and ICIQ-FLUTS questionnaires show adequate feasibility, reliability and validity.</p>