Telemedicine services in the University of the Philippines Health Service during the COVID-19 Pandemic: A two-week process documentation and analysis

@#Background. Telemedicine provides access to health care services during pandemics. It can be utilized to screen asymptomatic persons, follow up close contacts of confirmed cases, monitor individuals with symptoms, conduct specialty consultations, and offer health services to patients during pandemics. Objective. To describe the telemedicine processes, good practices, and areas for improvement in the University of the Philippines Health Service (UPHS) during the COVID-19 pandemic. Methods. This was a cross-sectional study to document telemedicine processes in UPHS. All teleconsultations of employees and students of Philippine General Hospital (PGH) and UP Manila (UPM) during the two-week study period in October 2020 were included. Quantitative data was collected from different modes of patient entry into the UPHS telemedicine services: email, Online Consultation Request and Appointment (OCRA) System, and phone hotlines. Qualitative information was gathered as narrative descriptions of observations in the clinic’s service delivery areas. A focus group discussion was also conducted to illustrate the different steps of the pathway used for telemedicine. Results. The telemedicine services of UPHS consisted of virtual triage, COVID-19/non-COVID-19 consultation, and telemonitoring. The UPHS virtual triage received patient concerns through OCRA or the hotline numbers. On the other hand, the COVID-19 teleconsultation service provided care to employees and students who contacted the clinic regarding symptoms or exposure via email. The non-COVID-19 service had teleconsultation for patients with other medical concerns. Coordination among staff and presence of a consultant were identified as good practices, while the areas for improvement include the lack of written protocols in issuing fit-to-work clearance for difficult cases and the optional use of OCRA for UPHS consult. Conclusion. Telemedicine services at the UPHS included tele-triaging, teleconsultations, and telemonitoring with use of phone calls, short messaging service (SMS), emails, and OCRA. Timely coordination, on-site duty consultants, and use of technology were identified as good practices. Lack of protocols and inconsistent OCRA use are areas for improvement.

Patient flow, health delivery processes, and areas for improvement in the UP Health Service (UPHS) during May to June 2020 of the COVID-19 Pandemic

@#Background. Workplace or employees’ clinics play a vital role in disease outbreaks as there could be an influx of sick personnel. Processes and patient flows during pandemics should be documented to identify good practices and sources of operational inefficiencies. Objective. To describe the patient flow, health delivery processes, and areas for improvement at the UPHS during the early phase of the COVID-19 pandemic from May to June 2020. Methods. This was a cross-sectional study involving patient flow analysis of processes at the employees’ clinic of the University of the Philippines-Philippine General Hospital. The study was divided into two major components: clinic process time measurement and process flow mapping. Data collection involved time elements and narrative descriptions of good practices and problems in the process flow. Results. The UPHS staff attended to 1,514 employees’ visits during the 15 working days from May to June 2020. The total UPHS service time from arrival to end of consultation of an employee with a COVID-19-related concern was an average of 1 hour 3 minutes (SD±39 minutes) with a mean total waiting time of 46 minutes (SD±37 minutes). Good practices identified were personnel flexibility in doing other tasks, good communication, and infection control measures. Areas for improvement included symptom screening, implementation of physical distancing, and disinfection practices. Conclusion. The process flows in the UPHS clinic consisted of COVID-19 related consultations, non-COVID-19 related concerns, and swabbing services. Good communication, staff flexibility, infection control measures, and leadership were identified as good practices. Occasional lapses in symptom screening at triage, physical distancing among employees in queuing lines, and inconsistent disinfection practices were the areas for improvement.

Summary recommendations on the various disinfection strategies in the community

Background@#Local government units conduct community – based responses to control spread of COVID-19 infection. Initiatives include city-wide disinfecting operations on streets and establishments, and mist spraying outside houses, vehicles, and even directly on persons.@*Objective@#To provide a list of recommendations on the different disinfection strategies applicable for use in the community@*Methodology@#Articles and guidelines about community disinfection were searched in various research databases. All evidencebased recommendations were reviewed, appraised, evaluated and summarized@*Recommendations@#General disinfection in households and community recommends use of diluted bleach solution of 75ml Sodium hypochlorite in 3.8L or 1 gallon of water (1000ppm). It is recommended to clean and disinfect frequently touched surfaces such as tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks and electronics. In disinfecting local quarantine facilities, all surfaces must be regularly cleaned using damp cleaning cloth and mops. Ethyl alcohol (70%) is used for small surfaces and well-ventilated spaces while diluted household bleach is used for surface disinfection. Spraying or fogging with ethyl alcohol or bleach disinfectant may be hazardous and has no proven benefit on disease prevention and control@*Conclusion@#The use of properly diluted household disinfectant solution for direct surface cleaning is an effective infection control measure in the community setting. Available evidence, however, recommends against the use of spraying, misting or fogging

Summary recommendations on the use of protective equipment for health care personnel involved in triage and ambulatory consult of patients in COVID-19 pandemic

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

Development and validation of a sunlight exposure questionnaire for urban adult Filipinos / 한국역학회지

OBJECTIVES: To develop and validate a self-reported sunlight exposure questionnaire (SEQ) for urban adult Filipinos.METHODS: The study included adults (19–76 years old) in Metro Manila, Philippines, well-versed in the Filipino (Tagalog) language and had resided in Metro Manila for at least 1 year. Exclusion criteria included pregnancy, active skin disorders, and immunocompromised states. An expert panel created a questionnaire in Likert-scale format based on a conceptual framework and 4 existing instruments. The study proceeded in 4 phases: questionnaire item development, translation and back-translation, pretesting, and construct validity and reliability testing using factor analysis, the Cronbach alpha coefficient, and the paired t-test.RESULTS: A 25-item, self-administered, Filipino (Tagalog) SEQ answerable using a 4-point Likert scale was created. The questionnaire was administered to 260 adult participants twice at a 2-week interval, with all participants completing both the first and second rounds of testing. All questionnaire items possessed adequate content validity indices of at least 0.86. After factor analysis, 3 questionnaire domains were identified: intensity of sunlight exposure, factors affecting sunlight exposure, and sun protection practices. Internal consistency was satisfactory for both the overall questionnaire (Cronbach alpha, 0.80) and for each of the domains (Cronbach alpha, 0.74, 0.71, and 0.72, respectively). No statistically significant differences were observed in the responses between the first and second rounds of testing, indicating good test-retest reliability.CONCLUSIONS: We developed a culturally-appropriate SEQ with sufficient content validity, construct validity, and reliability to assess sunlight exposure among urban adult Filipinos in Metro Manila, Philippines.

Development and validation of a sunlight exposure questionnaire for urban adult Filipinos / 한국역학회지

OBJECTIVES: To develop and validate a self-reported sunlight exposure questionnaire (SEQ) for urban adult Filipinos. METHODS: The study included adults (19–76 years old) in Metro Manila, Philippines, well-versed in the Filipino (Tagalog) language and had resided in Metro Manila for at least 1 year. Exclusion criteria included pregnancy, active skin disorders, and immunocompromised states. An expert panel created a questionnaire in Likert-scale format based on a conceptual framework and 4 existing instruments. The study proceeded in 4 phases: questionnaire item development, translation and back-translation, pretesting, and construct validity and reliability testing using factor analysis, the Cronbach alpha coefficient, and the paired t-test. RESULTS: A 25-item, self-administered, Filipino (Tagalog) SEQ answerable using a 4-point Likert scale was created. The questionnaire was administered to 260 adult participants twice at a 2-week interval, with all participants completing both the first and second rounds of testing. All questionnaire items possessed adequate content validity indices of at least 0.86. After factor analysis, 3 questionnaire domains were identified: intensity of sunlight exposure, factors affecting sunlight exposure, and sun protection practices. Internal consistency was satisfactory for both the overall questionnaire (Cronbach alpha, 0.80) and for each of the domains (Cronbach alpha, 0.74, 0.71, and 0.72, respectively). No statistically significant differences were observed in the responses between the first and second rounds of testing, indicating good test-retest reliability. CONCLUSIONS: We developed a culturally-appropriate SEQ with sufficient content validity, construct validity, and reliability to assess sunlight exposure among urban adult Filipinos in Metro Manila, Philippines.

Attitudes, behaviors and beliefs of urban adult Filipinos on sunlight exposure: A qualitative study / Journal of the ASEAN Federation of Endocrine Societies

Objective@#To explore the attitudes, behaviors, and beliefs of urban adult Filipinos on sunlight exposure as an initial step in the development and validation of a culturally-appropriate questionnaire.@*Methodology@#Focus groups were conducted among urban Filipinos 19 years old and above (n=38). The transcribedresults underwent qualitative content and thematic analyses and were used to develop a conceptual framework.@*Results@#Qualitative analysis revealed four main themes of sunlight exposure: internal influences, external influences,perceived benefits, and perceived risks. Both internal and external influences lead to perceived risks and benefits.Consequently, the perceived benefits (or lack) of sunlight exposure influence an individual’s attitude towards vitamin D supplementation; whereas the perceived risks of sunlight exposure influence an individual’s attitude towards the needfor sun protection@*Conclusion@#The attitudes, behaviors and beliefs of urban adult Filipinos on sunlight exposure are influenced by bothinternal and external factors, that in turn lead to perceived risks and benefits. An increased awareness of these factorsis necessary to establish future recommendations on proper sunlight exposure in this population. The study results willbe used to develop and validate a culturally-appropriate sunlight exposure questionnaire.

Development and validation of a sunlight exposure questionnaire for urban adult Filipinos / 한국역학회지

OBJECTIVES@#To develop and validate a self-reported sunlight exposure questionnaire (SEQ) for urban adult Filipinos.@*METHODS@#The study included adults (19–76 years old) in Metro Manila, Philippines, well-versed in the Filipino (Tagalog) language and had resided in Metro Manila for at least 1 year. Exclusion criteria included pregnancy, active skin disorders, and immunocompromised states. An expert panel created a questionnaire in Likert-scale format based on a conceptual framework and 4 existing instruments. The study proceeded in 4 phases: questionnaire item development, translation and back-translation, pretesting, and construct validity and reliability testing using factor analysis, the Cronbach alpha coefficient, and the paired t-test.@*RESULTS@#A 25-item, self-administered, Filipino (Tagalog) SEQ answerable using a 4-point Likert scale was created. The questionnaire was administered to 260 adult participants twice at a 2-week interval, with all participants completing both the first and second rounds of testing. All questionnaire items possessed adequate content validity indices of at least 0.86. After factor analysis, 3 questionnaire domains were identified: intensity of sunlight exposure, factors affecting sunlight exposure, and sun protection practices. Internal consistency was satisfactory for both the overall questionnaire (Cronbach alpha, 0.80) and for each of the domains (Cronbach alpha, 0.74, 0.71, and 0.72, respectively). No statistically significant differences were observed in the responses between the first and second rounds of testing, indicating good test-retest reliability.@*CONCLUSIONS@#We developed a culturally-appropriate SEQ with sufficient content validity, construct validity, and reliability to assess sunlight exposure among urban adult Filipinos in Metro Manila, Philippines.

"Expecting" A family case discussion

@#The practice of family medicine extends from womb to tomb and provides opportunities to care for not just one but all members of the family. Regardless of the complaint that brings a patient to the clinic, a family physician's role is to provide comprehensive care for the patient, the family, to go beyond the biomedical approach, not just to treat the disease but also to address the impact of the illness, and to have a continuing plan for promoting the family's wellness. Families are greatly affected by the pres- ence of chronic illnesses in any of its members. How then does a family physician address the potential problems of a chronic disease in the family especially if the sick member is one of the parents, with an unborn child? This paper aims to discuss the circumstances and situational relationships of a family with pregnant mother with a newly diagnosed kidney disease that would require hemodialysis