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RATIONALE Sepsis is the leading cause of mortality among medical patients in the Philippine General Hospital (PGH). A previous study illustrated variations in sepsis management. The Department of Medicine developed a sepsis pathway based on the Surviving Sepsis Campaign bundles to standardize care and improve outcomes. We determined the coverage and compliance with the pathway, the barriers to compliance and sepsis-related mortality. METHODS This was a single-center mixed methods study on the pilot implementation of the sepsis pathway (April 8 to July 7, 2019) in the medical service areas, i.e. emergency department (ED), medical wards and medical intensive care unit (MICU), of a tertiary level teaching hospital. We tracked all medicine charity admissions with infections to determine coverage. Compliance and patient outcomes were assessed through chart reviews. Focus group discussions and interviews were done to identify barriers to implementing the sepsis bundle. RESULTS Among 296 admissions with infections (49% female, mean age 51.4 years), there were 422 patient-days eligible for pathway coverage but only 199 patient-days (47.16%) were covered. The ED had the highest coverage rate. Overall mortality rate among the admissions was at 39.2%. Among septic patients who were covered, 40% died. Missed cases were associated with increased odds of in-hospital death (adjusted odds ratio [aOR]: 1.42, 95% CI: 1.13 to 1.88) on multivariate analysis. Compliance with recommended diagnostics was high except for lactate and bilirubin. Blood cultures were sent 98% of the time. Only 35% of patients received antibiotics by one hour after activation. Fluids recorded over 6 hours were inadequate (mean 4.77 mL/kg, standard deviation: 2.82 mL/kg). Of 73 patients with hypotension needing fluid resuscitation, only 12 had blood pressure documented 30 minutes post-activation. Stakeholders identified inadequate human and physical resources, hospital policy changes and pathway form construction as barriers to compliance. Fellows, nurses, and students reported lack of orientation on their roles.

Objectives. To determine the overall diagnostic yield of bronchoscopy-guided sampling methods in detecting lung cancer at the University of the Philippines, Philippine General Hospital. The diagnostic yield, equivalent to sensitivity, is defined as the number of bronchoscopic sampling or biopsy procedures with a diagnosis of malignancy divided by the total number of confirmed malignant cases.Methods. This is a cross-sectional, retrospective sensitivity study involving bronchoscopy procedures from January 2014 to December 2018. Surgical Pathology and Cytology Reports of eligible cases were accessed through the institutional Laboratory Information System. Sensitive patient information was omitted, and each case was assigned a unique code. The overall diagnostic yield/sensitivity of bronchoscopy and the diagnostic yield/sensitivity of each technique were calculated.Results. A total of 100 patients satisfied the inclusion and exclusion criteria. Primary lung malignancies are more common in males and the elderly. The most common primary lung cancer is adenocarcinoma (33%). Bronchoscopy, regardless of whether single or multiple techniques were used, has a diagnostic yield of 86% (CI: 77.6-92.1%). Of the individual techniques, those that obtain solid tissues (endobronchial and transbronchial biopsies; 88.2% [CI: 78.1-94.8%] and 80.0% [CI: 28.4-99.5%], respectively) have higher yields compared to techniques that obtain cytologic samples (bronchial washing and brushing; 54.2% [43.7-64.4%] and 70.1% [58.6-80%], respectively).Conclusion. Bronchoscopy, as a diagnostic procedure for pulmonary malignancies, has relatively high sensitivity and may be used for lesions located centrally and can be inspected visually. A multidisciplinary approach to patient selection for bronchoscopy helps improve the utility of the various bronchoscopic techniques.

The background characteristics of the patients were as follows: median age, 65 (range: 36-81); male/female ratio, 40:36; and performance status, 0-1/2-4:56/20. The clinical stages were as follows:, 49; recurrence, 20; and other, 7. The pathological diagnosis was adenocarcinoma, 62 (81.6%); squamous cell carcinoma, 8 (10.5%); and other, 6 (0.8%). A total of 29 (46.8%) patients with adenocarcinoma were positive for EGFR mutation. The median D-dimer level was 5.63 (0.2-63.3) lg/ml. A total of 48 (77.4%) patients had an onset of TE while receiving chemotherapy. Patients who received chemotherapy followed the regimens mentioned below: CDDP (11), EGFR-TKI (18), DTX (6), PD-1 antibody (5), CBDCA (4), ALK-TKI (3), and other (2). About 63.2% of patients presented with symptoms at the diagnosis of TE. Among 28 (36.8%) of the asymptomatic patients, TE was diagnosed by routine computed tomography in 11, whereas the coagulation test increased in 16. The recurrence rate of TE in the DOAC group was not different from the warfarin group (13% vs 26.4%, p ¼ 0.199), and there was no significant difference in the incidence of major bleeding events (0% vs 1.9%, p ¼ 0.507). Conclusions: The efficacy and safety of DOAC and warfarin in lung cancer patients with TE were not significantly different in both groups.Legal entity responsible for the study: The Cancer Institute Hospital of JFCR. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.