Journal of The Department of Medical Services

Innovation of Artifcial Intelligence for the Diagnosis of Cardiovascular Disease

2024-06-21T18:54:52+07:00

Cardiovascular diseases (CVDs) is classified as a group of chronic, non-communicable diseases affecting the cardiovascular system, leading to high mortality rates worldwide, including in Thailand. Delayed diagnoses and non-specialist medical personnel remain major issues in the public health system. The development of artificial intelligence (Al) for managing medical conditions is currently gaining popularity. Developing and applying Al to accurately diagnose cardiovascular diseases from patient data enables significant improvements in disease diagnosis, treatment, and management. This article presented educational information and the application of Al in managing cardiovascular disease. It provides an overview of cardiovascular disease and artificial intelligence (AI) technology, including general information about disease and Al, the role of Al in disease diagnosis using medical imaging and treatment, demand of usage, problems, and obstacles, as well as reports on Al studies in Thailand. The information was searched on Google Scholar for the terms "Cardiovascular diseases" and "Artificial intelligence or Al," and the data and research articles from 2018 to 2023 were randomly selected. This review may be useful for the development of public health systems, particularly in improving diagnostic processes and enhancing the efficiency of disease treatment.

SMARCA4-deficient Sinonasal Carcinoma: A Case Report and Literature Review

2024-07-31T17:55:31+07:00

SMARCA4-deficient sinonasal carcinoma a subtype of SWI/SNF complex-deficient sinonasal carcinomas is a rare, highly aggressive sinonasal malignancy with only 23 cases reported in the literature to date. We present a case of a 70-year-old woman referred to our institution with a preliminary diagnosis of small cell neuroendocrine carcinoma. A computed tomography revealed a nasal cavity mass extending into the sphenoid sinus and nasopharynx, without involvement of the skull base, pterygoid, or orbit. Histologic examination revealed monomorphic, large, undifferentiated neoplastic cells that showed loss of SMARCA4 expression. SMARCA4-deficient sinonasal carcinoma is a rare malignant neoplasm with an aggressive clinical course and poor prognosis. Diagnosis typically relies on a combination of histologic findings and immunohistochemical staining to identify this high-grade malignancy.

Gingivitis Treatment in Autistic Patient: A Case Report

2024-10-07T12:57:55+07:00

Autistic is a neurodevelopmental disorder characterized by impairment in social interactions, communication, repetitive behavioral patterns or restricted interests. Dental management in autistic patient requires an understanding and patient team who can appreciate each patient's uniqueness because manifestations of the disorder vary depending on the developmental level and chronological age of the individual. This case report presented the treatment of gingivitis due to heavy calculus in autistic patient. The treatment could be performed successfully with non-pharmacological behavior management and parental supervision. Patient could clean his teeth and tongue himself and had better oral health after a follow up period of 20 months.

A Case Series of Critical Methanol Poisoning

2025-03-24T14:43:55+07:00

Methanol poisoning commonly causes severe neurological and visual symptoms can be fatal. This study aimed to describe the assessment of severe neurological and visual symptoms in patients with methanol poisoning resulting from the ingestion of traditional herbal liquor. A total of 25 patients who consumed herbal liquor and presented to the emergency department were studied. Among them, 7 patients exhibited severe neurological symptoms and visual disturbances. Most of the affected individuals were male and of working age. Abnormal findings were observed in 5 patients from brain computed tomography (CT) scans, all showing bilateral putamina necrosis. In addition, diffuse cerebral edema and bilateral occipital necrosis were also noted. Visual and ophthalmic evaluations revealed abnormalities in 3 patients. Retinal abnormalities were detected, with some improvement upon follow-up. However, reduced visual acuity was found in others, and optical coherence tomography (OCT) showed retinal nerve fiber layer (RNFL) thinning by 50-70%. Methanol poisoning from traditional herbal liquor, especially when patients present late to the hospital, can result in severe neurological symptoms and death. For survivors with permanent impairments, a referral for a return-to-work evaluation and work modification, based on their health status, is recommended.

Maternal and Neonatal Outcomes of Adolescent Pregnancies at Chana Hospital, Songkhla Province

2024-09-19T15:34:57+07:00

Background: Adolescent pregnancy carries a high risk of complications of pregnancy and childbirths due to physical immaturity and lack of preparedness, affecting quality of life. Objective: This study aimed to analyze maternal and neonatal outcomes of adolescent pregnancies at Chana Hospital, Songkhla Province. Methods: A retrospective cohort study analyzed women who gave birth at Chana Hospital (2019-2022), divided into adolescents (aged 10-19) and adults (aged 20-34), with 107 participants per group. Data from medical records were analyzed using inferential statistics, including log-binomial regression to calculate adjusted relative risks (ARR) with 95% confidence intervals. Results: Adolescent mothers had the first antenatal care visit after 12 weeks and got less than five visits attendance (p = .010), urinary tract infections (ARR =7.76, 95%CI: 1.59, 37.78, p = .011), neonatal complications including respiratory distress syndrome (ARR = 18.56, 95%CI: 3.29, 104.59, p = .001), preterm birth (ARR = 4.30, 95%CI: 1.07, 17.34, p = .040), and low birth weight (< 2,500 grams) (ARR = 2.54, 95%CI: 1.07, 6.01, p = .034) significantly more than adult mothers. They also had lower pre-pregnancy planning and the first six months exclusive breastfeeding rate lower than adult mothers (p < .001). Additionally, adolescent mothers had lower rates of pre-pregnancy planning and exclusive breastfeeding in the first six months compared to adult mothers (p < .001) Conclusion: Adolescent pregnancy is associated with higher risks of urinary tract infections and neonatal complications such as respiratory distress, low birth weight, and preterm birth. Adolescent mothers also lacked pre-pregnancy planning and had significantly lower exclusive breastfeeding rates in the first six months. Therefore, promoting sexual and reproductive health are essential. This requires support from both family and community to promote physical and mental well-being among adolescent pregnancy.

Effect of Using Line Application on Knowledge and Self-care Practices of Liver Cancer Patients Admitted Treatment by Injecting Chemotherapy through the Artery into the Liver

2024-08-14T09:50:25+07:00

Background: Currently, many liver cancer patients receiving treatment through transarterial chemoembolization, while the number of doctors and nurses providing care is limited. This inadequacy results in insufficient knowledge dissemination and self-care guidance to patients and their relatives, leading to complications. Therefore, a method for promoting knowledge and self-care practices through the LINE application was developed to increase access to knowledge and guidance for patients. Objective: To study the effects of knowledge and self-care behaviors before and after using the LINE application and to assess satisfaction with this approach. Methods: This quasi-experimental research employed a one-group pretest-posttest design. The sample consisted of 28 liver cancer patients treated with transarterial chemoembolization at Lopburi Cancer Hospital. The experimental tool was the knowledge and self-care promotion model through the LINE application (TACE Official Line), which was developed by the researcher. Data collection tools was a questionnaire comprising four parts: 1) general information, 2) knowledge assessment, 3) self-care practices questionnaire, and 4) satisfaction questionnaire. Data were analyzed using descriptive statistics (percentage, mean, standard deviation) and inferential statistics (paired sample t-test). Results: The mean knowledge score before the experiment was 6.86±3.42, and after the experiment, it increased to 10.39±2.42. Comparing the mean knowledge scores, it was found that the post-experiment score was significantly higher than the pre-experiment score (p < .001). The average self-care behavior score before the experiment was 22.25±2.35, and after the experiment, it increased to 26.36±1.93 The post-experiment self-care practices score was significantly higher than the pre-experiment score (p < .001). Additionally, participants expressed a high level of satisfaction with the knowledge and self-care promotion model through the LINE application. Conclusion: The knowledge promotion and behavioral guidance provided through the LINE application have resulted in the sample group improving their knowledge and self-care practices.

Effectiveness of Follow-up Care Programs for Readmission among Psychiatric Patients in the Community, Sangkha District, Surin Province: A Quasi-experimental Research

2024-12-20T10:10:27+07:00

Background: Psychiatric patients at Sangkha Hospital have shown an increasing trend of readmission, leading to service improvement through community-based follow-up care which is a proactive service approach. Objective: To study the effectiveness of follow-up care programs for readmission among psychiatric patients in the community, Sangkha district, Surin province. Method: A quasi-experimental study was conducted with 30 psychiatric patients with a history of readmissions, divided into experimental and control groups of 15 patients each. The control group received routine outpatient care at the psychiatric clinic. The experimental group received an 8-week follow-up program consisting of patient classification using The 3-Good 4-Color patient classification system, follow-up of missed appointments via LINE OFFICIAL ACCOUNT, home visits for symptom assessment, and medication adherence monitoring by relatives or volunteers. Outcomes were evaluated using the Brief Psychiatric Rating Scale (BPRS) and the 8-item Morisky Medication Adherence Scale (MMAS-8) by psychiatric-trained nurses at baseline and after program completion. Data were analyzed using descriptive statistics including frequency, percentage, mean, and standard deviation for general information, and paired t-test for within-group comparison and independent t-test for between-group comparison, with statistical significance at .05. Result: After follow-up care, the experimental group showed lower readmission rates (13.33%) compared to the control group (26.67%). The experimental group demonstrated significantly reduced psychiatric symptoms (p < .001) and significantly improved medication adherence (p < .001). Conclusion: The follow-up care programs effectively controlling psychotic symptoms, improved medication adherence and tended to reduce readmission.

The Results of Developing Nursing Practice Guidelines for Postoperative Patients Who Have Received General Anesthesia in the Post-Anesthesia Care Unit (PACU); Nopparat Rajathanee Hospital

2024-12-15T17:05:28+07:00

Background: Complication for post-operative patients receiving general anesthesia in recovery room can be life-threatening. Proper patient care can prevent complication. Objective: To examine the results of developing nursing practice guidelines for postoperative patients who have received general anesthesia in the recovery room at Nopparat Rajathanee Hospital. Method: Action research followed the Clinical Practice Guidelines development principles by the National Health and Medical Research Council, Australia (1999). The research instrument was the guidelines for postoperative patients who have received general anesthesia in the recovery room. Data were collected using a postoperative care outcome scale and a satisfaction scale, both validated by five experts, with each instrument achieving a content validity index (CVI) and an Index of item-objective congruence (IOC) of 1. The sample included 21 nurse anesthetists and 54 patients, divided into two groups of 27 using G*Power based on prior effect sizes and inclusion criteria. The control group was selected from retrospective medical records dated February to April 2023, while the experimental group embraced patients who underwent Post-Anesthesia Care Unit (PACU) services during the same months in 2024. Data were analyzed using content analysis descriptive statistics, the paired-sample t-test and the chi-square test. Results: The patient care guidelines encompassed assessment, monitoring, discharge, and documentation. After development, anesthesia nurses showed greater adherence to the new guidelines, correlating with a significant reduction in patient complications (p < .05), Also, anesthesia nurses exhibited enhanced knowledge (p < .05), and guideline satisfaction was high, with service recipients reporting the highest levels of satisfaction. Conclusion: The developed practice guidelines, used by anesthetists, helped reduce the risk of postoperative complications and ensure the safety of patients in the PACU at Nopparatrajathanee Hospital.

Analysis of ROC Cut-off Value of Staheli Index of Footprint on Harris Mat for The Screening of Pes Cavus

2024-12-16T01:38:11+07:00

Background: Pes cavus (High-arch foot) was rarely found in outpatient department. There was usually diagnosed by history taking and physical examination and combined weight-bearing film. Anywise, diagnosis of pes cavus was still no gold standard and tool for screening. Recently, one study was published about Staheli index in Harris mat footprint for screening flatfoot in population. The aim of this study is finding Staheli index cut-off for screening, help diagnosis pes cavus and looking for correlation between clinical diagnosis, calcaneal pitch angle and lateral Meary's angle. Objective: To study correlation between sensitivity, specificity of weight-bearing film and Staheli index from Harris mat footprint by compared Calcaneal pitch angle, Lateral Meary's angle and Staheli index for diagnosis of cavus foot. Method: 143 participants were included in this study, examined by Foot - Ankle specialist and diagnosed. Afterward They were sent to X-ray department for shooting both feet weight-bearing film in AP, Lateral and oblique. Then, participants were printed their foot by digital footprint at equipment department. Calcaneal pitch angle and lateral Meary's angle were measured by Foot - ankle specialist and concealed. Staheli index was measured from footprint by research resident. The data were concealed from each other and calculated statistically. Result: Calcaneal pitch angle and lateral Meary's angle were very poor (r =- 0.793, p-value = .001) and not correlated with Staheli index (r = -0.096, p-value = .110) consecutively. The cut-off point of ROC curve for diagnosis pes cavus is at 0.5865 when sensitivity and sensitivity are suitable. (Sensitivity = 73.33%; 95%CI: 58.06, 85.40, Specificity = 50.22%; 95%CI: 43.59, 56.84). The accuracy is 53.99%. Conclusion: Calcaneal pitch angle and Lateral Meary's angle were poor correlated with staheli index. Clinical diagnosis was still highest reliable tools for diagnosis. The cut-off point of screening pes cavus is 0.5865 by Staheli index method with highest sensitivity (73.33%).

Symmetry Measurement of Zygomaticomaxillary Complex of the Patients in Rajavithi Hospital

2024-11-14T18:36:13+07:00

Background: The zygomaticomaxillary complex is the main component of the mid-facial skeleton involving functional support of the peri-orbital area and aesthetics of the cheek. Current developments in computer-aid design, computer-assisted surgery, and intraoperative navigation system require knowledge of the three-dimensional landmark to assist preoperative planning and intra-operative performance. Objective: The aim of this study was to assess the symmetry of the cheek bone and study the zygomaticomaxillary complex anatomy in Rajavithi Hospital. Methods: Facial computed tomography data of sixty patients (thirty males and thirty females) were obtained and aligned in iPlan software. Five reference points (i.e., obitale, maxillozygoin, suprajugal curvature, jugale, and zygoin) were marked on the three-dimensional reconstruction. Distances between the nasion and the reference points were measured in the three planes. Differences in the distance between the landmarks and the asymmetrical index were calculated. Two plastic surgeons performed this process to assess interrator reliability. Results: The three-dimensional distance between nasion and four zygomaticomaxillary complex landmarks were not statistically different bilaterally except for the distance at obitale which was only 3.11±3.32 mm different. The asymmetrical index of the five landmarks ranged between 4.89±3.38 mm and 6.31±4.71 mm. Conclusions: The study showed the anatomical location of five landmarks in three dimensions. The anatomical landmarks of the zygomaticomaxillary complex were symmetrical. Thus, knowledge of the three-dimensional locations could aid in computer-aid design, computer-assisted surgery, and navigation-assisted surgery for both restorative, reconstructive, and aesthetic aims.

Correlation between High Risk CTV during CT-based Intracavitary Brachytherapy and Local Control and Disease Free Survival of Cervical Carcinoma after Treatment

2024-12-25T16:29:03+07:00

Background: The current standard of brachytherapy in cervical cancer is a 3D technique using 3D image delineation of high-risk clinical target volume (HR-CTV), which magnetic resonance imaging-based (MRI-based) provides clearer visualization compared to computed tomography (CT) image and benefits in predicting treatment outcomes. Due to cost limitations, MRI cannot be used in common. Objective: This study compiles the treatment outcomes of CT-based brachytherapy performed at Lampang Cancer Hospital and analyzes the HR-CTV delineated by CT to assess whether it could predict treatment outcomes Method: This retrospective study analyzed data from 194 cervical cancer patients who underwent external beam RT combined with CT-based intracavitary brachytherapy using tandem with ovoid or Fletcher applicators. Kaplan-Meier and log-rank tests were used to calculate local control (LC) and disease-free survival (DFS). The relationship between size of HR-CTV at the first brachytherapy session and treatment outcomes was assessed using Cox-regression analysis. Result: The median follow-up period was 26 months. 2-year LC was 85.3%, DFS was 80.5%. HR-CTV sizes were categorized into three groups: < 20 cm³, 20-30 cm³, and > 30 cm³. During the first 6 months, LC rates were 100% for the < 20 and 20-30 cm³ groups, compared to 93.4% for > 30 cm³ group. 2-year LC for three groups were 92.6%, 86.2%, 78.3% (p = .014). 2-year DFS were 88.0%, 77.3%, 74.7%, respectively (p = .027). HR-CTV size < 20 cm³ was significantly associated with better LC (HR 0.222, p = .007) and DFS (HR 0.393, p = .014) compared to > 30 cm³ group. Conclusion: The size of HR-CTV delineated by the CT-based image during the first brachytherapy session was associated with LC and DFS. Within the first 6 months, HR-CTV size < 30 cm³ demonstrated the best treatment response. From univariate analysis, HR-CTV < 20 cm³ group showed a strong association with better LC and DFS compared to > 30 cm³ group.

Survival Rate and Prognostic Factors on Survival of Patients with Oral Squamous Cell Carcinoma

2024-11-29T09:58:02+07:00

Background: Oral cavity squamous cell carcinoma (OCSCC) is a cancer that arises from the epithelial cells in the oral cavity. It is common in adults and has a high incidence in many countries, including Thailand. Objective: To study the survival rate and prognostic factors for survival in patients with OCSCC treated at Roi Et Hospital. Methods: A retrospective cohort study was conducted by collecting data from patient medical records between January 1, 2015, and December 31, 2021, with follow-up until December 31, 2023. Data were analyzed using descriptive statistics, Kaplan-Meier survival method, and Cox proportional hazard model (p < .05). Results: A total of 273 patients were included. The majority were female (69.37%) with a mean age of 66.14 years (±12.78). A total follow-up of 1,116 person-months was completed. There were 222 deaths, with an incidence rate of 19.87 per 100 person-months (95%CI: 12.23, 23.75). The median survival time was 1.66 years. The survival rates at 1, 3, 5, and 10 years were 62.89%, 42.66%, 32.73%, and 19.93%, respectively. Risk factors for death included poorly differentiated histology (adjHR = 2.91; 95%CI: 1.61, 7.22), and cancer stages 2 (adjHR = 1.90; 95%CI: 1.19, 3.00), 3 (adjHR = 2.65; 95%CI: 1.62, 4.32), and 4 (adjHR = 3.71; 95%CI: 2.13, 6.47). Conclusion: Patients with oral cancer at Roi Et Hospital had a median survival time of 1.66 years, with a 5-year survival rate of 32.73%. Poor histology grading and advanced disease stage were significant prognostic factors that reduced the survival rate.

The Effectiveness of the Annual Health Check Model of Using The RCA2 Methodology at the MoPH Clinic, Rajavithi Hospital

2025-01-09T15:15:37+07:00

Background: In the past, there were issues regarding service recipients encountering delayed access to their health examination results, exceeding 15 business days, and misidentification of recipients in the year 2021, which led to missed opportunities for appropriate treatment in time. However, the researcher used RCA² (Root Cause Analysis & Actions) methodology to address the issues. This involved conducting a root cause analysis (RCA) and developing a new service model for the 2023 health examination, using IT systems and Lean (Actions) to prevent the recurrence of these issues. Objective: To evaluate the effectiveness of using the RCA² methodology for analyzing the root cause and developing the new service model. Method: This retrospective descriptive study used a sample of 400 service recipients between January and March 2024. Result: The service recipients identified through RCA² with abnormal test results were able to access their health examination results via the IT system within 5 business working days at rate of 89.25% (95%CI: 86.21, 92.29). When stratified by target group, the service recipients from Institute of Dentistry had the highest access rate (98.53%), followed by those from central offices of Department of Medical Services (94.63%), and Department of Health Service Support (81.42%). Furthermore, in providing the service based on RCA², the two points of identification were implemented to prevent misidentification of service recipients: the Kiosk for issuing guidance forms and medical history talking in examination room using the RHIS (Rajavithi Hospital Information System). Moreover, RCA² helped reduce the number of service steps from 12 to 9 and decreased overall working hours by 1,862 hours (54.41%). Conclusion: The RCA² methodology has effectively helped analyze the issues and developed the health examination service model.

Assessment of Calculated Radiation Dose Via In-house Program and Measured Radiation Dose

2025-01-06T16:18:04+07:00

Background: Treatment planning in radiation therapy is critical to patient recovery and complications. Therefore, the radiation delivery time must be calculated to ensure patients receive the prescribed dose as accurately as possible. The researcher developed a calculation program using Microsoft Excel in three-dimensional treatment planning for patients with pelvic region in the Radiation Oncology Unit of Lop Buri Cancer Hospital. Objective: To evaluate the accuracy of a radiation dose calculation program developed in-house comparing with the actual radiation dose measured using an ionization chamber in a water phantom. Method: This was a quasi-experimental study involving a sample of 100 3D radiation treatment plans for cancer patients. The research instruments included the in-house developed calculation program, Varian Vital Beam linear accelerator, a Farmer-type cylindrical ionization chamber (serial number 0744), radiation measuring cables, a PTW Freiberg Unidos electrometer, a Med Tech MT-DDA water phantom, and a data recording form. Data were collected by recording the calculated radiation doses from the developed program based on the treatment plans and the actual measured radiation doses for each plan between August 1, 2024, and November 30, 2024.The calculated and measured radiation dose values were analyzed using the paired t-test. Result: The calculated radiation doses using the developed program were close to the actual measured radiation doses at all depths and field sizes, with differences not exceeding 1 cGy. Statistical analysis using the Paired t-test revealed no significant differences at a 95% confidence level (p-value > .05). Conclusion: The actual measured doses from the monitor unit settings obtained from the in-house program were found to be comparable to the prescribed doses, with no statistically significant differences at a 95% confidence level. It can be concluded that the accuracy of the radiation dose calculations from the in-house developed program is reliable, precise, and applicable for practical use.

The Predictive Risk Factors of Seizures in Stroke Patients Admitted for Rehabilitation at Sirindhorn National Medical Rehabilitation Institute

2025-01-30T10:51:28+07:00

Background: Seizures are common complications in stroke patients, and impact the rehabilitation process and recovery ability. Objective: To identify the predictive risk factors of seizure in stroke patients admitted to Sirindhorn National Medical Rehabilitation Institute. Methods: Retrospective cohort study in 734 stroke patients who were admitted to Sirindhorn National Medical Rehabilitation Institute from October 1, 2020, through September 30, 2024 was performed. We used a logistic regression model to identify the associated risk factor, including clinical symptoms, laboratory before admission and complications during hospitalization. Results: A total of 734 patients were included, with 450 male (61.3%). The average age was 61.5 years (SD = 14.2) The average age at first stroke onset was 60.1 years (SD = 14.2). A total of 421 patients (57.4%) had ischemic stroke. Sixteen patients (2.2%) had seizures during hospitalization. There were four predictive risk factors for seizure. Firstly, cortical lobe signs: aphasia increased the risk by 5.17 times (95%CI: 1.10, 24.27) and neglect increased the risk by 7.20 times (95%CI: 1.06, 48.88). Secondly, history of craniectomy or craniotomy increased the risk by 6.35 times (95%CI: 1.05, 38.32). Thirdly, admitted patients with less than one year since their last seizure had 43.75 times (95%CI: 8.31, 230.23) higher risk than patients who had never been seizure or had seizure longer than one year. Fourthly, the abnormal serum sodium level during admission increased the risk by 11.89 times (95%CI: 1.19, 118.67). Conclusion: There were four predictive risk factors for seizures in stroke patients who admitted for rehabilitation. 1) cortical lobe signs presented, 2) History of craniectomy/craniotomy, 3) time from last seizure less than one year and 4) The abnormal serum sodium level. Identifying these factors can help medical personnel assess the risk more accurately and plan for preventive and treatment strategies.

Measurement of Leak Volume as a Diagnostic Predictor of Post-extubation Stridor in Pediatric Patients

2025-02-18T15:00:43+07:00

Background: Endotracheal intubation can cause post-extubation stridor (PES). PES can prolong the hospital stay length and is linked to high mortality and morbidity, especially, if re-intubation is essential. Leak volume (LV) test is a simple method to detect upper airway edema. Objective: We aimed to evaluate the effectiveness of percent leak volume (PLV) and LV in predicting PES. Methods: Before extubation, expired tidal volume (VTe) and inspired tidal volume (VTi) were observed for 6 respiratory cycles during positive pressure ventilation. The average of the 6 VTi and 6 VTe values were recorded. LV was the difference between average VTi and average VTe. The conversion of the ratio of LV to average VTi into percentage was defined as PLV. Both LV and PLV were assessed to indicate cut-off values in predicting PES. Results: Among 77 patients, 39 patients (50.6%) developed PES. Both LV and PLV showed a significant decrease in patients with PES. ROC analysis indicated that LV at cut-off value < 18.34 ml gave a sensitivity of 82.1% and specificity of 57.9%, whereas PLV < 13.83% yielded 79.5% sensitivity and 57.9% specificity, for PES prediction. PLV and LV showed an area under the ROC curve of 0.770 (p < .001, 95%CI: 0.665, 0.874) and 0.706 (p = .01, 95%CI: 0.59, 0.821) respectively. Conclusion: LV and PLV could be used as a predictor of PES in pediatric patients.

The Development of Seamless Service System Model for Elderly with Hip Fracture in Yasothon Health Service Network, Yasothon Province

2025-02-06T15:53:00+07:00

Background: As hip fractures among the elderly continue to rise, it is essential to develop an effective treatment system to support these patients in recovering their autonomy. Objective: To develop and study the effectiveness of a seamless care model for elderly patients with hip fractures in the Yasothon Province healthcare network. Methods: This is a research and development study involving 1) 20 healthcare providers who developed the care model, and 2) elderly patients who underwent hip fracture surgery between September and December 2024. Data were collected using a data recording form and a questionnaire with a reliability coefficient of 0.93. Data were analyzed using descriptive statistics and inferential statistics with paired sample t-test. Results: The seamless care model for elderly hip fracture patients consisted of 3 components: Pre-hospital care-Prevention and quality referral systems to reduce the risk of hip fractures. In-hospital care-Timely surgical intervention through the hip fast track surgery system with clinical examinations and online medication management for treatment planning. Post-hospital care- home visits and telemedicine follow-ups for six months after discharge. After receiving care through the system, the majority of patients (63.60%) had a hospital stay of 5-9 days. Post-surgery pain levels decreased continuously, with no complications (88.60%), and there were statistically significant improvements in daily living activities (p-value = .026), overall quality of life (p-value < .001), and physical and mental health (p-value < .001, p-value = .015). Conclusion: The seamless care system for elderly hip fracture patients with hip fractures helps timely surgical treatment, reduces postoperative complications, shortens the length of hospital stay, enables patients to perform daily activities independently, and improves their quality of life.

Chemotherapy Compounding Robot and Chemotherapy Delivery System Innovation by Thai people for Thai people

2025-08-18T13:19:23+07:00

โรคมะเร็งเป็นปัญหาสาธารณสุขที่สำคัญของหลายประเทศทั่วโลก และเป็นปัญหาสาธารณสุขที่สำคัญเช่นเดียวกัน เนื่องจากมะเร็งเป็นสาเหตุการเสียชีวิตอันดับหนึ่งของคนไทย และมีแนวโน้มอุบัติการณ์การเกิดโรคสูงขึ้นอย่างต่อเนื่องทุกปี ซึ่งส่งผลกระทบเป็นวงกว้างทั้งในระดับครอบครัว สังคม รวมถึงเป็นอุปสรรคต่อการพัฒนาเศรษฐกิจและสังคมของประเทศ¹ การเข้าถึงบริการและรับการรักษาอย่างเหมาะสมในเวลาที่รวดเร็ว จึงเป็นหัวใจสำคัญที่จะทำให้ผู้ป่วยมะเร็งมีโอกาสหาย และมีคุณภาพชีวิตที่ดีขึ้นในการเข้าถึงบริการ กระทรวงสาธารณสุขจึงมีนโยบาย "มะเร็งรักษาทุกที่ ที่มีความพร้อม Cancer Anywhere"² การให้ยาเคมีบำบัดเป็นหนึ่งในเครื่องมือสำคัญของการรักษาโรคมะเร็ง และเป็นแนวทางการรักษาหลักที่ให้ผลลัพธ์ การรักษาที่ดีในมะเร็งเกือบทุกชนิด แต่มีความเสี่ยงทั้งต่อตัวผู้ป่วยและบุคลากรทางการแพทย์ที่เกี่ยวข้องในการเตรียมยาเคมีบำบัด เภสัชกรผู้ปฏิบัติหน้าที่ดังกล่าวมีความเสี่ยงสูงที่จะสัมผัสหรือปนเปื้อนยาเคมีบำบัด ซึ่งเป็นอันตรายต่อสุขภาพ กรมการแพทย์จึงได้วางกรอบทิศทางการพัฒนาหน่วยงานให้มุ่งเน้นการสร้างนวัตกรรม และการขยายผลนวัตกรรมที่มีอยู่ไปสู่ ระบบสุขภาพ โรงพยาบาลมะเร็งอุดรธานีร่วมกับสถาบันเทคโนโลยีพระจอมเกล้าเจ้าคุณทหารลาดกระบัง ได้พัฒนานวัตกรรม หุ่นยนต์ผสมยาเคมีบำบัด (AYA Chemotherapy Compounding Robot) ที่มีความแม่นยำสูง ถูกต้อง ปลอดภัย ทำงานด้วย แขนกล ควบคุมด้วยระบบอัตโนมัติในสภาวะปลอดเชื้อตามมาตรฐานการเตรียมยาภายใต้การกำกับดูแลของเภสัชกรผู้เชี่ยวชาญ