Journal of The Department of Medical Services

การส่งเสริมการมีบุตรเพื่อเด็กเกิดคุณภาพ

2024-08-15T09:11:18+07:00

ประเทศไทยกำลังเผชิญกับปัญหาเด็กเกิดใหม่มีแนวโน้มลดลงอย่างต่อเนื่อง จากเดิมเคยมีเด็กเกิดไม่ต่ำกว่าปีละ 1 ล้านคน ในช่วงปี พ.ศ. 2506 - 2526 ลดลงเหลือ 517,934 คน ในปี 2566¹ และอัตราการเจริญพันธุ์รวม (total fertility rate; TFR) ของประเทศลดลงจาก 6.29 ในปี พ.ศ. 2508 ลดลงมาอยู่ที่ 1.1 ในปี พ.ศ. 2565²การลดลงของเด็กเกิดใหม่ส่งผลต่อการลดลงของประชากรวัยแรงงาน ประกอบกับจำนวนผู้สูงอายุที่เพิ่มขึ้น มีผลกระทบต่อความมั่นคงทางเศรษฐกิจของประเทศในอนาคต สาเหตุที่ทำให้เด็กเกิดน้อยมาจากหลายปัจจัย ได้แก่ 1) นโยบายประชากรที่ลดอัตราการเพิ่มประชากรมาอย่างต่อเนื่อง 2) การขยายตัวของเมือง ทำให้เกิดการย้ายถิ่นฐานเข้ามาสู่สังคมเมือง อัตราค่าครองชีพสูงขึ้น ส่งผลให้ค่าใช้จ่ายในการเลี้ยงดูบุตรสูงขึ้น ระบบการดูแลสุขภาพดีขึ้น ทำให้อัตราการเสียชีวิตลดลง 3) การมีส่วนร่วมในตลาดแรงงาน ผู้หญิงเข้าสู่ตลาดแรงงานเพิ่มขึ้น มีการศึกษาสูงขึ้น นิยมอยู่เป็นโสดมากขึ้น 4) การเปลี่ยนแปลงทางสังคมและวัฒนธรรม ทำให้พ่อแม่ให้ความสำคัญกับคุณภาพของบุตรแต่ละคนมากกว่าจำนวนบุตร ความเหลื่อมล้ำทางเพศในครอบครัว ทำให้คนแต่งงานช้าลง ชะลอการมีบุตร การมีบุตรส่งผลต่อหน้าที่การงาน และส่วนหนึ่งเกิดจากภาวะมีบุตรยาก การแก้ปัญหาเด็กเกิดน้อยต้องดำเนินการในหลายมิติ ได้แก่ สังคม เศรษฐกิจ การศึกษา สุขภาพ และสิ่งแวดล้อม หลายภาคส่วนจึงได้ร่วมกันผลักดันประเด็นส่งเสริมการมีบุตรให้เป็นวาระแห่งชาติซึ่งกำลังอยู่ในระหว่างดำเนินการ โดยมีมาตรการสำคัญได้แก่ 1) การปรับสภาพแวดล้อมให้เอื้อต่อการมีบุตร 2) เสริมสร้างความรู้และปรับเปลี่ยนทัศนคติ และ 3) ผู้ตัดสินใจมีบุตรได้รับการดูแลอย่างครบวงจรและมีคุณภาพ

Caring for an End-of-life Cancer patient with Pressure Sores Receiving Continuing Care at Home with the Caregiver’s Participation through the Tele-nursing System: A Case Report

2023-12-20T15:46:10+07:00

Pressure sores that are large and deep in the muscles among end-of-life cancer patients can cause risk of infection and death in a short time. Suffering also affects quality of life and results in higher costs because the treatment is complicated. Continuing care at home by caregivers also requires the assistance of a multidisciplinary team. This study aimed to investigate the efficiency of pressure ulcer care by a caregiver, provide guidelines for preventing infection, compare costs and the caregiver’s state of distress. A patient with end-of-life cancer with large pressure sores (the PPS level = 20%) was studied. The study was conducted between 1^st September and 10^th November 2023 by a multidisciplinary team, consisting of doctors, community practice nurses, and nurses specializing in nutritional therapy and wounds. The Tele-nursing system was employed. The tools included the PUSH assessment form (3.0), the temperature recording form, the wound dressing cost comparison form, the distress thermometer, the 2Q depression screening form, and the care burden assessment form. This study is results revealed that the caregiver was able to care for the patient according to standard quality. The wound healing score decreased from 14 points to 3 points. Infection was not found. It can save costs by 4.6 times compared to hospital stays. The caregiver’s distress score decreased from 9 points to 4 points on the distress thermometer. The caregiver was confident and proud of providing better care to the patient. To sum up, large pressure sores can be cared at home by caregivers, but the knowledge about wound dressings, wound healing promotion, nutrition, use of medical supplies to accelerate tissue regeneration, infection prevention and control and close supervision is required in helping caregivers to administer wound dressings effectively.

Outcome of Hemoperfusion in Severe COVID-19 Pneumonia

2023-11-10T09:17:02+07:00

Background: Respiratory tract infection COVID-19 endemic is a major public health problem. Critical ill patients need ventilator support and have high mortality rate. The clinical severity associates with immune hyperresponsiveness (cytokine storm). Clinical improvement by hemoperfusion therapy which decreased cytokines level were reported but few data was acquired. Objective: This study aimed to reveal the outcome of hemoperfusion theryapy in severe COVID-19 pneumonia. Methods: We conducted retrospective study in severe COVID-19pneumonia patients who were treated by hemoperfusion at Nopparat Rajathanee Hospital between June 15^th, 2021 and July 15^th , 2021. Clinical and laboratory data were obtained by chart review. Results: There were 7 severe COVID-19 pneumonia patients treated by hemoperfusion; 2 were males and 5 were females, aged 40-64 years. Of these patients, 6 need ventilators and another needed only high flow nasal cannula. 2 days after hemoperfusion, 5 patients had respiratory conditions improvement (71.5%) and needed lower oxygen concentration delivery. 3 of these were dead (3/5, 60%) from nosocomial pneumonia and recurrent acute MI. 2 patients which had no clinical improvement after hemoperfusion died within 3 days. Conclusions: hemoperfusion seems to have clinical improvement of respiratory system but mortality rate is still high from other complication. So, cost-effectiveness of hemoperfusion needs further studies.

Type of Bladder Management in Neurogenic Lower Urinary Tract Dysfunction (NLUTD) Associated with Upper Urinary Tract Deterioration (UUTD): A Retrospective Study

2022-10-19T16:20:46+07:00

Background: Vary bladder management options for neurogenic lower urinary tract dysfunction (NLUTD) including intermittent catheterization (IC), spontaneous voiding, and indwelling catheterization were used in spinal cord injury patients (SCI). A urological checkup is performed regularly to assess upper urinary tract deterioration (UUTD) and to give proper management. The goal is to reduce renal failure in the long term. Objective: To report the upper urinary tract deterioration in patients were performed different bladder management methods, including the involvement factors. Methods: This retrospective study included 3 bladder management methods and upper urinary tract follow-up from May 2012 to September 2020, 176 people totaled 812 times. General data were analyzed with descriptive statistics. We analyzed the association of factors associated with management that were likely to influence changes in the upper urinary tract. Result: The 176 patients, mostly male (131 persons, 76.6%) were included in this study. Total number of examinations was 812 times, mostly managed by indwelling catheterization. The primary outcome showed incidence of upper urinary tract deterioration found in intermittent catheterization groups (36.23%) more than those who indwelling catheter group (27.97%) or self-voiding patients (12.12%). In most follow-up studies, the results showed a stable trend. However, when adjusting for differences in variables based on many factors, it was found that patients managed with the intermittent catheterization program were more likely to develop upper urinary tract deterioration less than spontaneous void and indwelling catheterization patients. (19.3%, 23.7% and 26.5% respectively) Conclusion: Intermittent catheterization method is less likely to cause upper urinary tract deterioration than indwelling urinary catheterization. Therefore, if patients are unable to return to void by themself, the patients should be trained to do a self IC program to reduce the risk of long-term upper urinary tract complications.

Effect of Cold Honey with Normal Saline Solution and on Oral Mucositis in Patients Head and Neck Cancer Undergoing Radiation or Concerrent Radiation and Chemotherapy

2023-07-13T10:33:16+07:00

Background: Oral mucositis is a common problem in patients with head and neck cancer who have received radiation therapy or combined radiation and chemotherapy treatment. Objective: To examine the effect of cold honey with normal saline solution on oral mucositis among head and neck cancer patients undergoing radiation or radiation combine with chemotherapy. Method: This was an experimental research conducted using a controlled trial design. The experimental group consisted of head and neck cancer patients who gargle with cold honey and saline solution. The control group comprised head and neck cancer patients who gargle with saline solution only. The sample size for each group was 42 individuals. Research tools used included general data recording forms, symptom assessment forms, severity assessment, and duration of oral mucositis. Data analysis was performed using descriptive statistics, Fisher's exact test, and Mann-Whitney U test. Result: The occurrence of oral mucositis symptoms in the experimental group was 81.0%, whereas it was 100% in the control group (p = .005). The severity of oral mucositis symptoms differed significantly between the experimental and control groups (p < .001). The duration of occurrence of oral mucositis symptoms was longer in the experimental group compared to the control group, and this difference was statistically significant (p = .022). Conclusion: The combined use of cold honey and saline solution for mouth rinsing helped prevent and reduce the occurrence of oral cavity ulcers. This approach can be applied to head and neck cancer patients undergoing radiation or chemoradiotherapy to reduce the incidence of oral mucositis.

Effectiveness of Utilizing Social Networks in Follow-Up for Lost to Follow-up Patients with Cleft Lip and Palate at Queen Sirikit National Institute of Child Health

2023-08-16T13:52:18+07:00

Background: Cleft lip and cleft palate are abnormalities or deformities of the face, lips, base of the nose and palate, affecting children physically, mentally, and socially. These conditions also place a significant burden on caregivers and families, as parents often need to take time off work and bear travel expenses to facilitate treatment. Due to the long treatment and healing period, patients are at high risk of being lost to follow-up during the treatment process. Social workers have played a crucial role in following up with patients who missed appointments. However, out of 310 patients, only 55 could be contacted, while the remaining 255 were unreachable. Therefore, social networks were utilized to assist with the follow-up of patients who had missed appointments for more than one year. Objective: The objective of the study was to investigate the effectiveness of social networks in following up pediatric patients with cleft lip and cleft palate who had lost contact or missed appointments for over one year at the Queen Sirikit National Institute of Child Health. Method: A cross-sectional study was conducted using record forms to investigate social network utilization for appointment follow-up among 255 pediatric patients with cleft lip and cleft palate who have missed appointments for over a year. The study was conducted by the Medical Social Work Department at the Queen Sirikit National Institute of Child Health. Result: It was found that the primary government healthcare networks achieved the highest success rate in patient follow-up, at 95.7%. Meanwhile, the community healthcare networks achieved the highest success rate in patient follow-up, at 65.7%. Conclusion: The effectiveness of social networks in both government healthcare networks and community healthcare and administrative networks can reintegrate the patients into the treatment system by at least 80 percent.

Risk Factors of Complication from Hip Fracture Surgery in Nan Hospital

2023-09-20T16:10:22+07:00

Background: Nowadays operative treatment is the main treatment of fragility hip fracture. But in elderly people are usually osteoporotic and they have multiple comorbidities are high risks of postoperative complications. It is important to identify risk factors for incidence and complications after hip fracture surgery to improve outcomes and postoperative functioning in daily life. Objective: To study incidence rate, type of complications and their risk factors after hip fracture surgery. Method: This retrospective cohort study included consecutive patients who sustained fragility hip fracture and underwent operation at Nan Hospital relevant to the period between January 1^st, 2020 to December 31^st, 2022. The inclusion criteria were those who aged >50 years old, received operative treatment for hip fracture including neck, intertrochanteric, or subtrochanteric femoral fractures and were admitted to this hospital in the study period. Patients who were sustained hip fractures due to pathologic fracture and incomplete or missing data were excluded from this study. Result: From 698 patients were men 176 and women 522 and mean age of 80 years. The incidence of at 1 least complication was 27.4%, the risk factors were BMI <20 kg/m² and male sex. At least two complication was 2.3%, the risk factors were age >80 years, male, fever unknown origin and coagulopathy before surgery. Conclusion: Patients with BMI < 20 kg/m² and male sex were associated with 1 or more types of complications from post-operative hip fracture surgery that increased the risks by 1.6 and 2.9 times respectively. Patients aged >80 years, male, have fever unknown origin and have coagulopathy before surgery were associated with 2 or more types of complications that increased the risks by 5.2, 3.3, 6.8 and 32.7 times respectively

Antifungal Susceptibility of Dermatophytes and Non-dermatophytes to Amphotericin B, Terbinafine HCL, Griseofulvin, Ketoconazole and Itraconazol at Institute of Dermatology

2023-10-18T14:54:39+07:00

Background: Superficial Fungal infections are showing an escalating resistance to existing antifungal drugs. Effectively choosing an antifungal treatment for a persistent infection relies on identifying the infectious organism(s) and conducting susceptibility testing of the organism(s) to antifungal medications. Objective: The study was aimed at evaluating the susceptibility of dermatophytes and non-Dermatophytes, isolated from patients at the Institute of Dermatology in Thailand, to antifungal agents including amphotericin B (AMP B), terbinafine HCL (TER), griseofulvin (GF), ketoconazole (KCZ), and itraconazole (ITR). Method: The research was conducted following the protocols of Clinical and Laboratory Standards Institute (CLSI), USA. A total of 50 isolates were examined using ITS-PCR sequencing to identify fungal species, including 17 from tinea corporis/cruris, 6 from tinea pedis, and 27 from onychomycosis. Result: The minimal inhibitory concentration (MIC) of AMP B, TER, GF, KCZ, and ITR against dermatophytes ranged from 0.25-4, 0.015-16, 0.06-8, 0.03-8, and 0.007-4 µg/ml, respectively. The minimal fungicidal concentration (MFC) ranges of AMP B, TER, GF, KCZ, and ITR were 0.5-4, 0.015->16, 0.06-16, 0.03->16, and 0.015-8 µg/ml, respectively. For non-dermatophytes, the MIC of AMP B, TER, GF, KCZ, and ITR ranges were 0.003->16, 0.03->16, 16->64, 0.125->16, and 0.25->16 µg/ml, while the MFC ranged from 0.03->16, 0.03->16, 16->64, 0.125->16, and 0.25->16 µg/ml, respectively. Conclusion: The findings suggest that non-dermatophytes, particularly Neoscytalidium dimidiatum, necessitate higher antifungal concentrations than dermatophytes. Terbinafine HCL may be a suitable choice for treating tinea infections caused by both dermatophytes and non-dermatophytes. The correlation between MIC and clinical outcome still needs to be determined for optimal laboratory results interpretation.

Factors Related to Survival Rate in Breast Cancer Patients Undergoing Treatments at Lampang Cancer Hospital

2023-10-17T15:45:43+07:00

Background: Breast cancer is the most common cancer among Thai women and worldwide, as well as the main treatment options for breast cancer, rapidly and accuracy diagnosis to improving survival rates for breast cancer patients. Objective: This study aimed to evaluate overall survival (OS) of breast cancer and to determine prognostic factors of survival in breast cancer patients undergoing treatments at the Lampang Cancer Hospital. Method: This study was a retrospective cohort study. The data of patients diagnosed with breast cancer from 2010 to 2015 were derived from breast cancer databased of Lampang Cancer Hospital. The vital status of patients was followed-up until 31^st December 2021. Kaplan Meier method was used to estimate the 5-year and 10-year survival. Cox proportional hazard regression model was to determine the prognostic factors affecting survival for univariate and multivariate analyses (at a significance level of .05) using R program. Results: Among 1,841 patients, 1,397 was included in survival analysis. The 5-year and 10-year overall survival in breast cancer patients were 75.4% and 63.8%, respectively. The 5-year survival by stages I, II, III, and IV were 93.4%, 83.7%, 64.1%, and 25.6% respectively, and the 10-year survival were 85.3%, 76.4%, 47.6%, and 8.7% respectively. The results from multivariate analysis found that increasing of stage, tumor size, and occupation had significantly increased risk of breast cancer death (p-value < .001). While the positive ER receptors, surgery type (wide excision), and complete treatment factor had significantly decreased risk rate of breast cancer death (p-value < .001). Conclusion: Breast cancer treatment plans that consider both clinical and patient factors are essential for improving survival outcomes for patients.

Activities-based Cost Analysis of the Speech Therapy Program at Speech Therapy Unit of Sirindhorn National Medical Rehabilitation Institute

2023-11-27T11:37:14+07:00

Background: About 4-20 percent of acute stroke patients are found to experience communication disorders known as aphasia. Therefore, it is crucial that these patients receive proper assessment and interventions. According to the Speech Therapy Unit of Sirindhorn National Medical Rehabilitation Institute, no study has yet been conducted on the unit cost of speech therapy activities for these patients in Thailand. So, this study aimed to gather data for optimizing resource management and informing policy development. Objectives: The objectives of this study were to conduct a cost analysis and to examine the cost recovery of speech therapy activities for stroke patients with aphasia at the Speech Therapy Unit, Sirindhorn National Medical Rehabilitation Institute. Methods: The research design was descriptive, with data collected retrospectively for the fiscal year 2020. The economic assessment method used was cost analysis from the perspective of the healthcare providers. The term ‘unit cost’ in this study referred to the cost incurred for one speech therapy session for a stroke patient. The cost analysis was conducted using the activity-based costing (ABC) method, and the calculation of cost recovery for both outpatients (OPD) and inpatients (IPD), as well as charge recovery. Results: The cost analysis revealed that the unit cost for individual speech therapy sessions was 305.48 Baht, while the cost for group sessions was 132.99 Baht. However, the service charge for both speech therapy sessions was uniformly set at 300 Baht per session. For OPD patients, the cost recovery was at the rate of 74.54 percent while the charge recovery was at the rate of 98.20 percent. For IPD patients, the cost recovery was at the rate of 74.31 percent while the charge recovery was at the rate of 98.20 percent. Overall, the cost recovery rate for patients receiving the service was 74.47%, while the charge recovery rate was 98.20%. Conclusion: Given that labor costs are the highest but the service charge falls short of covering these costs, this indicates a loss for individual speech therapy sessions. However, group speech therapy sessions continue to generate profits. Therefore, to achieve cost recovery, it is recommended that the service charge for individual speech therapy sessions be increased to match the actual unit cost. Additionally, greater emphasis should be placed on promoting group speech therapy sessions. It is also important to consider each patient's condition and select the most appropriate therapy to ensure safety and effectiveness in treatment.

Apoptotic Effects of Oryza Sativa L. Extract in Human Melanoma Cell

2023-11-21T19:17:13+07:00

Background: Malignant melanoma, originating from melanocytes, is the most dangerous type of skin cancer. Melanoma treatment includes surgery and the combination of surgery and chemotherapy, immunotherapy, targeted therapy and radiation therapy due to stage of melanoma. Oryza sativa Linn (OS) is a type of black rice found in various regions across Southeast Asia. The main bioactive components of OS extracts are anthocyanins, which have anti-tumor effects. Objective: In this study, we conducted cell viability, the cell cycle, and apoptosis analysis of a human melanoma A375 cells following treatment with OS extract. Methods: The effects of different OS concentrations treatment on human melanoma A375, cell cycle, and apoptosis were assessed by Flow cytometry. The identity of the protein was confirmed through SDS-PAGE and Western blotting. Results: We demonstrated from cell cytotoxicity assay that OS decreases cells viability after OS treatment at concentration 1.25, 2.5, 5 and 10 mg/ml. Flow cytometry showed that OS extract concentration at 2.5 mg/ml induces A375 cell cycle arrest at S phase and 5 and 10 mg/ml OS induces sub-G1 cell cycle arrest. OS extract concentration 2.5, 5 and 10 mg/ml induced A375 cell apoptosis. Apoptosis induction was accompanied by up-regulation caspase-8 and p53 expression. Conclusion: Our data show that the OS disrupted melanoma cell proliferation and induced apoptosis.

Effect of Implementing a Palliative Cancer Care Guideline on Patient Care Outcomes and Caregiver Satisfaction

2023-12-01T15:32:36+07:00

Background: Cancer is a major public health problem and a chronic disease that requires long-term and continuous treatment. This group of patients needs to receive supportive management of uncomfortable symptoms. In addition, patients and caregivers should be prepared during treatment for home-based continuing care. Objective: The study aimed to evaluate the effect of a palliative care guideline for cancer patients on the outcomes of care and caregiver satisfaction. Method: The study was a quasi-experimental study using the World Health Organization's palliative care framework for end-stage cancer patients, which consists of six domains: 1) Patient and family-centered care, 2) Comprehensive care, 3) Continuous care, 4) Interdisciplinary care, 5) System-strengthening care and 6) Quality of life promotion for patients and families. The sample consisted of 100 cancer patients diagnosed with a need for end-of-life palliative care and 100 caregivers. The research instrument was the Guideline for Palliative Cancer Care of Lampang Cancer Hospital. The data collection instruments were the Palliative Care Outcome Scale (POS) and the FAMCARE-2 caregiver satisfaction survey. The content validity index (CVI) was 0.98. The reliability of the questionnaire was assessed using Cronbach's alpha coefficient of 0.932. Data were analyzed using content analysis, descriptive statistics, and the Wilcoxon signed-rank test to compare the palliative care outcomes of the patients. Results: The study found that after using the palliative care guidelines, the outcomes for patients were significantly better than before using the guidelines (p-value <.001). Additionally, caregivers were highly satisfied with the care (mean = 4.52, SD = 0.34.). Conclusion: This palliative care guideline has led to improved care outcomes and caregiver satisfaction. It should be disseminated to other organizations so that it can be used to benefit the care of cancer patients.

The Results of Using Denosumab in Patients with Osteoporosis at Samut Sakhon Hospital over a Period of 2 Years

2023-11-23T19:46:52+07:00

Background: After the continuous administration of 60 mg, denosumab subcutaneously every 6 months in patients diagnosed with osteoporosis, it was observed that some patients experienced a decrease in kidney function, and in some cases, hip fractures occurred while receiving denosumab. Objective: To study the effects of denosumab on the lumbar spine, hip bones, and kidney function in osteoporosis patients. Method: This research was retrospective study. Result: 70 cases were studied. It was found that after patients received 60 mg denosumab injections subcutaneously every 6 months for a period of 2 years, bone mineral density and T-score of the lumbar spine significantly improved (p < .05). The bone mineral density of the lumbar spine at L1, L2, L3, L4, and L1-4, increased by 6.10%, 7.77%, 7.02%, 6.40%, and 7.55%, respectively. However, the bone mineral density and T-score of the hip did not change. There was a significant decrease in kidney function (p<0.05) from the initial average value of 72.34 to 67.08, an average of reduction was 7.27%. The decrease in kidney function was associated with age of the patients (p = .020), patients with diabetes (p = .011), hypertension (p < .001), collapsed spines (p = .046) and hip fracture (p = .002) diagnosed before treatment. Conclusion: Caution should be exercised in the use of denosumab, especially in patients with underlying risk factors as mentioned. BMD of hip did not change after 2 years of treatment but BMD of spines statistical significantly increased.

Factors Associated with Acute Exacerbation Among COPD Patients Leading to Visit Emergency Room of Banhong Hospital, Lamphun Province

2024-01-24T10:24:42+07:00

Background: Chronic Obstructive Pulmonary Disease (COPD) stands as the third leading global cause of mortality. Banhong Hospital contends with an alarming 160% acute exacerbation rate, incurring substantial treatment costs, diminished quality of life, and heightened mortality risk. Objective: To study the risk factors that associated with acute exacerbation among COPD patients leading to visit emergency room. Method: A case-control study was conducted on COPD patients visiting the emergency room due to acute exacerbation (AECOPD) were compared with no exacerbation from January 1^st to June 30^th, 2022. A sample of 30 individuals in each group was selected through simple random sampling. Data were collected through interviews from August 1^st to December 31^st, 2022, and analyzed using logistic regression. Result: Statistically significant factors associated with AECOPD by multivariate logistic regression method was only severity as GOLD C up (adjOR 57.85, 95% CI 3.10 - 1080.09, p – value .007), by univariate method included inappropriate perception of disease (adjOR 13.5, 95% CI 3.33 – 54.67, p – value < .001), respiratory infections (adjOR 11.77, 95% CI 2.92 – 47.46, p – value .001), improper inhaler technique (adjOR 10.55, 95% CI 1.22 – 90.66, p – value .032), inability to avoid triggers (adjOR 5.70, 95% CI 1.72 – 18.94, p – value .004), perception of disease as moderate level up (adjOR 5.55, 95% CI 1.84 – 17.49, p – value .003), and inadequate awareness of the frequency of emergency bronchodilator use (adjOR 4.03, 95% CI 1.37 – 11.84, p – value .011). Conclusion: The factors associated with AECOPD that should be modifiable included inappropriate perception of disease, improper inhaler technique, inability to avoid triggers, and inadequate awareness of the frequency of using emergency bronchodilators.

Development and Validation of a Clinical Prediction Model for Axillary Lymph Node Metastasis in Patients with an Early-stage Breast Cancer

2024-01-10T11:14:27+07:00

Background: Thailand has a high incidence of breast cancer, leading to the development of screening programs to detect the disease at an early stage. Surgery is the main treatment option during this stage. Advanced techniques, such as minimally invasive procedures like breast-conserving surgery, oncoplastic surgery, and sentinel lymph node biopsy, have been introduced to enhance breast cancer surgery, aiming to reduce complications and improve cosmetic outcomes. However, the shift towards favoring sentinel lymph node biopsy over axillary lymph node dissection presents challenges due to resource limitations in many hospitals, particularly the absence of expert pathologists and modern equipment. Therefore, there is a need for reliable tools or scoring systems to identify suitable candidates for this surgery. Objective: To develop and validate a clinical prediction model for predicting the probability of axillary lymph node metastases in patients with early-stage breast cancer. Methods: This study involved analyzing data from 132 early breast cancer patients at Ubonratchatani Cancer Hospital to develop a prediction scoring system. The system was created using a multivariable logistic regression model. Results: Tumor size, size of axillary nodes, and presence of lymphovascular invasion have been shown as significant factors in predicting the probability of axillary lymph node metastasis. The performance of our model was excellent as evidenced by an AuROC score of 0.88. Furthermore, the positive predictive values (PPVs) for low, moderate, and high risks were 2.30%, 30.80%, and 75.90% respectively. Conclusions: This scoring system assists surgeons in confidently selecting early-stage breast cancer patients for either sentinel lymph node biopsy or axillary node dissection, which is important in hospitals that lack expert pathologists.

Breakthrough COVID-19 infections, Hospitalization, and Mortality after Two CoronaVac shots at Thailand CVC

2024-01-05T15:51:00+07:00

Background: Vaccination against COVID-19 plays a pivotal in combating the pandemic. in Thailand, large-scale population-based studies are limited. The Central Vaccination Center Thailand (CVC) has a vaccination record system linked to the national database, enabling a comprehensive study of vaccine efficacy. Objectives: To determine the incidence of COVID-19 infections, hospitalization, and mortality among individuals who received two doses of the CoronaVac (SV) vaccine. Additionally, to study the time to infections, hospitalization, and mortality after the first and second doses. Methods: A retrospective study was conducted from June to September 2021, involving 145,417 individuals who received the CoronaVac vaccine, totaling 291,415 doses. Results: We found 3,818 cases of COVID-19 infections (2.63%), 2,352 hospitalizations (1.62%), mostly mild (asymptomatic), and 3 deaths (<0.01%). After the second dose, there were 3,325 infections (2.31%), with an incidence rate of 0.025 (95% CI 0.0241, 0.0258) per 1,000 person-days; 2,186 hospitalizations (1.51%), with an incidence rate of 0.0163 (95% CI 0.0156, 0.0170) per 1,000 person-days; and 3 deaths, with an incidence rate of 0.0222 (95% CI 0.0072, 0.0688) per 1,000 person-days. Conclusion: The vaccine recipients were primarily Thai service provider such as public transport workers, postman, and courier, vaccinated during a period of high incidence and limited vaccine availability. The study indicates that a two-dose regimen of CoronaVac, administered as recommended to boost immunity, can reduce the incidence of infection, hospitalization, and mortality, thereby reinforcing the healthcare system.

Nature of Medication Adherence in Patients with Non-communicable Diseases in Tertiary Care

2024-05-09T09:58:53+07:00

Background: The treatment of non-communicable diseases (NCDs) aims to control symptoms and prevent complications through a combination of medication use and behavior modification. Successful treatment relies on the cooperation of patients in adhering to medication regimens. Non-adherence with medication usage is a major cause of unused medication, which in turn has implications for the country's healthcare expenditure. Objectives: To estimate the prevalence rate of medication non-adherence and assess the value of unused medication. Methods: This study employed a cross-sectional descriptive observational study from October 2020 to July 2021. The inclusion criteria were patients with at least one of the following conditions: hypertension, diabetes, and/or dyslipidemia, who were treated as outpatients in the Department of Medicine at Rajavithi Hospital. Exclusion criteria included: 1) age younger than 18 years; 2) brain abnormalities; and 3) inability to provide information. Systematic sampling was used to select patients for the study. Patients were interviewed using a developed questionnaire that had been validated by experts. Data were analyzed using descriptive statistics. Results: The study included 286 patients with NCDs. The prevalence rate of medication non-adherence in patients with NCDs was 29.72%. There were 11,341 tablets of unused medication due to medication non-adherence, with a total value of 46,339.14 Baht, averaging 545.16 Baht per patient. Atorvastatin 40 mg was the medication with the highest value of unused medication, amounting to 12,337.50 Baht, while Metformin 500 mg had the highest quantity of unused medication with 1,141.50 tablets. Conclusions: Non-adherence to medication is a considerable in patients with NCDs in tertiary care. Policymakers should plan solutions to address medication non-adherence issues in patients with NCDs, especially medication expenses, and promoting medication adherence aligned with the social and cultural context of Thai patients.

Results of Long-Term Treatment and Rehabilitation of Drug Addicts "Mini Thanyarak" Case study of Akat Amnuay Hospital, year 2023

2024-05-06T21:15:35+07:00

Background:. According to policies and strategies towards drugs, the perspective towards addicts has changed from viewing them as addicts to patients who require treatment. Patients’ access to rehabilitation and treatment leads to a shortage of hospital beds. Therefore, a concept of developing a long-term treatment and rehabilitation model has been introduced under the name “Mini Thanyarak”, which can be applied to community hospitals. Objective: To study the results of long-term treatment and rehabilitation of drug addicts “Mini Thanyarak” model, which was a case study at Akat Amnuay Hospital. Method: This research was evaluation research. The sample group was a group of 13 people who received treatment and rehabilitation between August and November 2023.. The tools used were guidelines for the implementation of long-term rehabilitation of drug and narcotic users in community hospitals, using the Mini Thanyarak model, and a manual for cognitive and behavioral therapy in drug and substance addicts in the rehabilitation period by Saengdueanchai S, et al. Data were collected from individual records, activity records and observations. Data analysis was done by using qualitative data with classification to inductively analyze and interpret meanings, draw conclusions, and explain the phenomena. Quantitative data were collected by using frequency, percentage and average analysis. Results: The recipients remained in the treatment and rehabilitation system for 90 days without any complications. When using psychosocial therapy, there were positive behavioral changes and self-defense skills. Follow-up results 3 months after treatment were excellent; it was found that 84.6% did not return to drug use again. Conclusion: The Mini Thanyarak model results in no relapse into addiction and behavioral changes. Thus, the model could be used to stop drug addiction.