Risk factors that patients should avoid

@#A risk factor increases a person’s susceptibility to developing a disease. This can be a particular patient characteristic (e.g., obesity for heart disease), patient behavior (e.g., cigarette smoking for lung cancer), or a specific drug intervention (e.g., steroid intake for myopathy). Observational studies like case-control or cohort study designs are commonly used when evaluating the harmful effect of an exposure. Family and community medicine practitioners should always take the opportunity to advice patients regarding these risk factors to promote wellness and enhance primary care.

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.

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.

Recurrent headache as a post-COVID-19 sequela: A case report

@#Post-COVID condition is the presence of new, recurring, or ongoing signs and symptoms for greater than four weeks after a SARS-CoV-2 infection. Persistent headache as a neurologic sequalae of COVID-19 infection is a common prolonged symptom with limited characterization in the literature. This was a case of a 27-year-old female diagnosed with mild COVID-19 who presented with fever, colds, fatigue, headache, decreased hearing, sore throat, dry cough, pleuritic chest pain, anosmia, ageusia, myalgia, and severe low back pain. Headache was described as remitting, frontally located, squeezing and moderate to severe in pain intensity. She was admitted in a tertiary COVID referral hospital for 8 days and was managed supportively. On the 10th day of illness, symptoms had resolved except for an on and off headache. The residual recurrent headache lasted for more than 5 months after being tested negative for SARSCOV2 on repeat reverse transcriptase-polymerase chain reaction (RT-PCR). The possible pathophysiologic mechanisms for neurologic manifestations and prolonged headache were hypoxia, endothelial damage through angiotensin converting enzyme receptor, and cytokine reactions. The characteristics of the symptoms remained unclear despite the proposed mechanisms for prolonged headache among COVID-19 patients.

Antibody monitoring six months post-COVID-19 vaccination in four healthcare workers: A case series

@#This case series described four healthcare workers with exposure to patients and co-workers, who were potential or confirmed cases of COVID-19. They had negative nasopharyngeal swab reverse transcriptase polymerase chain reaction (RT-PCR) tests at different time points and had zero IgG antibodies on VITROS Anti-SARS-CoV-2 IgG Antibody test prior to CoronaVac inoculation on March 1, 2021. The levels of antibody titers, which showed increasing then declining trends of immunoglobulins, were measured at different time points. Although the antibody levels are not proof of immunity against SARS-CoV-2 and the protective quantity is yet to be determined, the titers are evidence that vaccines do elicit an immune response and may have a role in the fight against infection