Sustaining quality education and practice learning in a pandemic and beyond: 'I have never learnt as much in my life, as quickly, ever'.

The context of healthcare and of healthcare education has radically changed as a result of the Covid-19 pandemic. To identify positive strategies for midwifery education in this context, five case studies from the UK and beyond were conducted using an appreciative enquiry approach, from the perspectives of students, the maternity services, cross-university collaboration, and digital learning. A health system analysis was used to identify strategies to cope, adapt, and transform for the future, at the levels of individuals, teams, and the whole system. Findings showed that the implementation of effective responses was possible. Responding effectively and rapidly to a shock as profound as this pandemic requires courageous, respectful, evidence-based, innovative, collaborative, cross-sectoral working and leadership across education institutions, practice settings, the regulator, government, and with students themselves. Pre-existing trusting relationships and collaborative systems supported rapid responses. Effective digital learning requires a pro-active, student-centred approach, and addressing the problems of inequitable access to equipment and space. Joint problem-solving and focussing on the key outcomes that matter contribute to developing successful strategies and robust processes. The pandemic provides an opportunity for student midwives to be re-imagined as essential members of midwifery teams and not 'just students'. Transformative actions identified include whole-system working, tackling longstanding problems including racism, poverty, prejudice, and systemic discrimination, and keeping students at the heart of the education system.

The incidence of Mycobacterium other than tuberculosis isolated in specimens suspected of tuberculosis in a tertiary hospital in the Philippines: A retrospective study

INTRODUCTION: In the Philippines, a diagnosis of pulmonary tuberculosis  is  very  common  especially  in  the  presence of sputum findings positive for Acid Fast Bacilli (AFB).  But it should be kept in mind that not all Mycobacterium are tuberculosis(TB).A  previous  study  done  at  the  University of Santo Tomas (UST) Hospital from 2003 to 2009 showed a 2.17% incidence of Mycobacterium other than tuberculosis (MOTT). However, due to its growing correlation with the Human Immunedeficiency Virus (HIV), updated incidence rates  are  warranted.Likewise,the importance of culture in  the  right  diagnosis  of  diseases  should  always  be  emphasized.OBJECTIVES: The study aimed to determine the incidence of  MOTT  in  a  tertiary  hospital  in  Manila  among  patients  suspected of having TB.  MATERIALS AND METHODS: This is a retrospective study done at the UST Hospital, a quality-assured referral center for TB in  Manila,  with  a  TB  Directly  Observed  Short  Course  (TB-DOTS) Clinic. Laboratory records of specimens submitted for  culture  and  sensitivity  studies  for  Mycobacterium tuberculosis  (MTB)  for  which  isolates  of  MOTT  grew,  using  BACTECTM(Becton-Dickinson)  method  and  Mycobacteria  Growth  Indicator  Tube  (MGITTM),  from  January  2003  to  December 2014, were reviewed. RESULTS: A total of 6,886 specimens were submitted for MTB culture and sensitivity studies. Results showed 157 cases of MOTT with an incidence of 2.28%. Majority of the specimens with MOTT were from pulmonary sources (85%), most common of which was from sputum. Non pulmonary sources (15%) were mostly from urine, cerebro-spinal, and gastrointestinal tract. were isolated for MOTT. These find-ings are consistent with the previous local available data. Correct identification of this organism influence eventual decisions for treatment.CONCLUSION: The incidence of positive culture for MOTT in our institution remains to be low. However, there is an increasing trend in the number of specimens which are turning out to be positive for MOTT. A future study on the correlation with the patients' clinical profile is recommended.

First line anti-tuberculosis drug resistance pattern in Mycobacterium tuberculosis isolates at the University of Santo Tomas Hospital from 2003-2013

INTRODUCTION: Development of drug resistance is one of the most important barriers in achieving global control of tuberculosis (TB). Continuous surveillance, such as observation of susceptibility and resistance patterns to anti-TB drugs, together with nationwide programs aimed at TB case identification, treatment and control, physician and patient education, is a valuable tool in the goal towards reducing TB prevalence and mortality.OBJECTIVE: It is the aim of this study to determine the prevalence rate and resistance pattern of  first line anti-tuberculosis drugs in a tertiary hospital in Manila, PhilippinesMATERIALS AND METHODS: Records of specimens submitted for Mycobacterium tuberculosis (MTB) culture and sensitivity, using BACTEC TM MGIT TM 960 SIRE Kit and PZA Kit, at the Section of Clinical Pathology, University of Santo Tomas Hospital, were reviewed. Isolates cultured for MTB were subjected to sensitivity studies to rifampicin (R),isoniazid (H), ethambutol (E), pyrazinamide (Z) and streptomycin (S).RESULTS: A total of 546 specimens were cultured for MTB and sent for sensitivity studies. Majority of the specimens were from pulmonary sources (77%). Overall resistance rate was 52.38% (n=286). One-drug resistance was 23.26% (n= 127; highest with R followed by H); two-drug resistance was 15.38% (n=84; highest with H-R); three-drug resistance was 8.61% (n=47; highest with H-R-E and H-R-S); four-drug resistance was 4.58% (n=25; highest with H-R-E-S) and five-drug resistance (H-R-E-S-Z) rate was 0.55% (n=3).  CONCLUSION: The University of Santo Tomas Hospital, as a referral facility, is encountering an increasing number of drug-resistant tuberculosis from 2003 to 2013.