Journal of The Department of Medical Services

การผ่าตัดมะเร็งต่อมลูกหมากด้วยหุ่นยนต์ เทคโนโลยีที่เข้าถึงได้

ธเนศ ไทยดำรงค์ — 2025-12-16

ในปัจจุบันประเทศไทยเริ่มเข้าสู่สังคมผู้สูงอายุ เนื่องจากอายุไขเฉลี่ยของคนไทยเริ่มสูงขึ้น ดังนั้นคุณภาพชีวิตของผู้สูงวัยจึงมีความสำคัญ เช่นเดียวกับโรคมะเร็งต่อมลูกหมากมีอุบัติการณ์เพิ่มขึ้นตามอายุที่มากขึ้น และในอดีตมะเร็งต่อมลูกหมากมักพบในระยะลุกลามแล้ว จนกระทั่งเทคโนโลยีทางการแพทย์ที่พัฒนามากขึ้น ทำให้มีการตรวจคัดกรองมะเร็งต่อมลูกหมากจากการตรวจเลือด (ค่า PSA) และตรวจร่างกาย ทำให้สามารถคัดกรองมะเร็งต่อมลูกหมากในระยะเริ่มแรกได้เพิ่มมากขึ้น อุบัติการณ์การตรวจพบมะเร็งต่อมลูกหมากระยะลุกลามลดลง ส่งผลให้สามารถรักษาได้ทันท่วงที และมีอัตรารอดชีวิตที่สูงกว่าระยะลุกลาม

Case Series: Appendiceal Mucocele and Literature Review

Pinyaphan Putkham — 2025-12-16

Appendiceal neoplasms are rare, with an incidence of 0.12 cases per 1,000,000 population per year. Most cases are asymptomatic and discovered incidentally after imaging studies. The World Health Organization classification includes non-invasive epithelial lesions (low-grade mucinous neoplasms, high-grade mucinous neoplasms), invasive epithelial adenocarcinomas (mucinous or non-mucinous), and non-epithelial neuroendocrine tumors. Early diagnosis of appendiceal mucocele is challenging due to lack of symptoms, often found incidentally intraoperatively or on imaging. Ultrasound may demonstrate a cystic appendiceal lesion with "onion skin" appearance. CT shows a well-defined cystic lesion with mural calcification, differentiating it from abscess. Colonoscopy may reveal a "volcano sign" mass at the appendiceal orifice. Though rare, appendiceal mucocele requires surgical resection for treatment once diagnosed. Early detection through vigilant imaging interpretation is crucial for appropriate management of these neoplasms.

Ergonomic Approaches for the Well-Being of the Elderly: Integrative Review

Wanpen Leungnarutai — 2025-12-16

Ergonomics is a scientific discipline that examines the interaction between humans and their environments, with the aim of optimizing both performance and quality of life. It systematically applies principles that align human capabilities and mobility constraints with environmental design. As individuals age, they experience progressive declines in physiological and cognitive functions, increasing their susceptibility to accidents and highlighting the need for appropriate support systems. This integrative review synthesizes evidence from scholarly databases, including PubMed, Scopus, and Thai academic repositories, covering publications from 2000 to 2024. The review employed keywords related to ergonomics, aging, and holistic well-being. The analysis identifies three essential ergonomic components that significantly impact the optimal performance and functions of older adults. First, biomechanical and functional mobility considerations address postural stability, dynamic equilibrium regulation, transitions between foundational body positions (e.g., sit to stand), load-handling mechanics (lifting/carrying), and ambulation safety protocols. Second, contextual environmental determinants encompass illumination adequacy, chromatic contrast optimization for visual accessibility, acoustic regulation, particulate-free ventilation parameters, and thermal equilibrium maintenance. Third, architectural ergonomic elements focus on habitation design features, such as spatially optimized configurations in sanitary facilities, sleeping quarters, culinary zones, and communal spaces, which integrate ergonomic spatial configurations to enhance accessibility while ensuring safety for independent mobility. The integrated application of these ergonomic principles has been shown to reduce the risk of falls, enhance functional autonomy, and promote holistic well-being across physical, mental, social, and spiritual dimensions. This paper provides specific, evidence-based recommendations for healthcare providers, architectural professionals, and caregivers to implement ergonomic strategies that support a sustainable and high-quality life for the aging population.

Multidisciplinary Weaning Protocol for Prevention of Extubation Failure in Lerdsin Hospital

Rittigorn Apinhapanit — 2025-12-16

Background: Weaning protocol by doctors is widely used in general hospitals. However, there are extubation events still occur. Therefore, we generated the multidisciplinary weaning protocol (MDP) which focused on patient pathophysiology assessed by doctor and holistic care by medical term including nurse and physiologist, to study for improve successful extubation, reduce reintubation rate and mortality. Objectives: The primary objective is the effectiveness of the MDP for successful extubation, risk factors for reintubation, survival at 90 days and risk factors for mortality. Methods: We retrospectively studied intubated patients with mechanical ventilator whom admitted to Lerdsin Hospital from January 1, 2022 to December 31, 2022 and using MDP. Statistical significance was used at p < .05 and risk ratio with 95% confidential interval Result: A total of 147 intubated patients, average age of 62 years, 96 males and 51 females. There were 143 patients had been successfully extubation (97.3%). Univariate regression analysis showed no significant risk factor affect successful extubation. Survival rate at 90 days was 88.4%. Multivariate regression analysis including age > 60 year-old, intubation period >7 days, PaO₂/FiO₂ < 150, PaCO₂ > 45 mmHg and pH < 7.35 showed sepsis and PaO₂/FiO₂ < 150 increase risk for death (OR 6.3, P = .01 and OR 3.58, P = .035 respectively). Conclusion: The use of the MDP has high successful extubation rate and survival at 90 days without significant risk factor which affect successful extubation

An Evaluation of the Effectiveness of Conventional Complete Dentures versus Implant-retained Overdentures in the Mandible: A Study in Khon Kaen Province

Chutima Wongsinudom — 2025-12-16

Background: The 9^th Thai National Oral Health Survey (2023) reported that elderly individuals aged 60-80 years had an average of 15.65 remaining teeth. Of these, 14.65% were completely edentulous and received complete dentures, with 10% experiencing poor mandibular denture retention. Recognizing the significance of this issue, the Ministry of Public Health launched "The Dental Implants in Celebration of His Majesty the King's 72^nd Birthday Anniversary Project, July 28, 2024." Objective: To evaluate the effectiveness of Thai-innovated implant-retained mandibular overdentures by comparing oral health-related quality of life, chewing ability, satisfaction and pain perception, before and after participation in the project. Method: This was a quasi-experimental study. Data were collected through interviews with 71 patients participating in the project from 9 healthcare facilities in Khon Kaen Province. Results: The average score of oral health-related quality of life (OIDP index) before treatment was 20.90%. The average chewing efficiency score was 34.21%, and the average satisfaction score was 56.80%. After treatment, the average OIDP index decreased to 0.59%, and the average chewing efficiency increased to 97.07%, which both values were statistically significantly different (p-value < .001). The average satisfaction score after treatment was 97%, indicating the highest level of satisfaction. Pain scores during dental implant surgery were significantly lower than the pain experienced during tooth extraction, with a statistically significant difference (p-value < .001). Conclusion: The use of Thai-innovated dental implant-retained overdentures in this project resulted in an average improvement in chewing efficiency by 2.84 times and enhancing oral health-related quality of life.

Development of Psychiatric Care Process on the Psychiatric Ward for Service Area, Surin Province

Yoottanasak Tongdee — 2025-12-16

Background: Psychiatric disorders are a major public health problem, especially emergency psychiatric patients with an increasing trend in the Northeast Region. Psychiatric inpatient care still faces challenges of a psychiatrist shortage, lack of standardized tools and guidelines, and inefficient referral and information linkage systems. Objective: 1) To develop a psychiatric care process on the psychiatric ward for service area in Surin Province 2) To evaluate the developed psychiatric care process on the psychiatric ward for service area in Surin Province. Method: This participatory action research study was conducted in three phases: situation analysis, development and implementation, and evaluation. The sample consisted of 24 healthcare personnel who voluntarily participated in the healthcare service system and 39 psychiatric patients' relatives. Data were analyzed using frequency, mean, standard deviation, and statistical significance was tested using paired sample t-test. Result: It was found that general hospitals and community hospitals in Surin Province still lack resident psychiatrists, causing the practical guidelines for psychiatric patient care in hospital wards to not meet standards as they should, and the referral information linkage between networks remains inefficient. Five key measures were developed for psychiatric care : 1) Fast pass admission system, 2) Psychiatric severity staging, 3) Training programs for network, 4) Psychiatrist network, 5) Telepsychiatry. After system implementation, access to services for schizophrenic patients increased from 65.22% to 70.54% (5.32% increased). The monthly psychiatric bed occupancy rate decreased by 18.94%, the readmission rate decreased by 6.52%, and the referral rate decreased by 10.09%. Following the system development, both staff and patients' relatives reported significantly increased satisfaction across all aspects (p < .001). Conclusion: The development of a comprehensive psychiatric care process on the ward, utilizing technology, diverse strategies for staff development, seamless care system, and emphasizing participation, helps improve the quality of psychiatric inpatient care.

Malignancy Risk Stratification of Thyroid Nodules: Comparison between the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and the American Thyroid Association (ATA) Management Guidelines

Sarawadee Chatchavan — 2025-12-16

Background: Ultrasonography is the best choice to initially evaluate and stratify the malignancy risk of thyroid nodules. This study gives information and suggestion for further management for physicians. The two standard reporting systems are the ACR TI-RADS and ATA Management Guidelines. Objective: To compare the reliability of two ultrasonographic malignancy risk stratified systems and evaluate ultrasonographic features of benign and malignant thyroid nodules. Method: This diagnostic accuracy study were performed in Lampang Hospital. There were 83 patients who had thyroid neck masses. They were referred for evaluation and stratified for malignancy risk by using ultrasonogram. Both ACR TI-RADS and ATA Management Guidelines were applied and compared. These nodules were examined by cytology or pathology using FNA or thyroidectomy. The baseline characteristics, hormonal status and ultrasonographic features were recorded and reviewed. Results: 83 nodules were evaluated: malignant nodules = 20, benign nodules = 63. There was predominant in female patients. The range of age was 18-82 years old. The chi-square test of homogeneity of the two groups was in perfect agreement at 60.2%. The AuROC of ACR TI-RADS = 84.7%, log likelihood of ACR TI-RADS = -28.18 and the AuROC of ATA = 82.3%, log likelihood of ATA = -33.15. Both were great for detection and to differentiate malignancy nodules in TI-RADS 5 (LHR of positive = 10.24, 95%CI: 2.68, 46.72, p-value < .001) and ATA-High suspicious (LHR of positive = 4.9, 95%CI: 1.66, 14.72, p-value < .001). Conclusion: The two malignant risk stratification systems are useful when applied to evaluate malignancy risk in the thyroid gland, especially in highly suspicious nodules (ACR TI-RADS 5 and ATA high suspicion). The ACR TI-RADS is more beneficial when applied to the small size thyroid nodule (< 1.5-cm.), due to early detection, follow up management for small size cancer.

The Effect of Innovative Choking Simulated Vest on Self-Effcacy and Skills in Choking First Aid among Public Health Volunteers, Bangkok

Penwadee Rojruangnon — 2025-12-16

Background: Choking is a life-threatening emergency that can lead to airway obstruction and fatality if not addressed promptly. Effective first aid is critical in increasing survival rates. To enhance choking response training, this study developed a novel choking simulation vest. Objective: To compared the effects of the choking simulation vest on self-efficacy and first aid skills in choking management among Bangkok's public health volunteers. Methods: A quasi-experimental study included 64 participants, divided into two groups of 32. The control group received standard choking first aid training, while the experimental group received the same training with the addition of a choking simulation vest. Data was collected between August and September 2024 using three instruments: a general information questionnaire, a self-efficacy assessment, and a choking first aid skills evaluation checklist. Pre- and post-training assessments were conducted. Data were analyzed using descriptive statistics, and hypothesis testing was performed using the independent samples t-test with a significance level of .05. Results: After the intervention, the experimental group demonstrated significantly higher mean scores in self-efficacy for choking first aid, self-administered first aid skills, and assisted first aid skills compared to the control group (mean difference =2.88, p < .001; MD=1.06, p < .05 and MD=1.28, p < .001, respectively). Conclusion: The choking simulation vest enhances self-efficacy and first aid skills in choking management. Therefore, it should be utilized as a learning tool for choking response training to increase the confidence of trainees, ultimately enabling them to provide safe and effective first aid for choking victims.

The Effectiveness of Repeat Suicide Surveillance and Prevention in Sikhoraphum District

Nuntida Somsap — 2025-12-16

Background: Suicide in Thailand has shown an increasing trend and represented a severe mental health problem. In Sikhoraphum District, cases of suicide attempt and completed suicide have been continuously rising, while the existing surveillance and prevention system for repeated suicide has not been sufficiently effective. Objective: To study the effectiveness of repeated suicide surveillance and prevention in Sikhoraphum District. Method: This quasi-experimental research included 56 individuals with a history of suicide attempts and 48 district mental health workers. The research tools comprised the 9Q depression screening form, 8Q suicidal assessment form, and home visit surveillance form. The surveillance program consisted of 8-week continuous care activities: Week 1-assessment and screening at mental health clinic, Week 2-proactive home visits, Week 3-telemedicine follow-up, Week 4-clinical follow-up at mental health clinic, Weeks 5-7- assertive community treatment, and Week 8-outcome assessment. Results: The majority of participants were female (82.14%) with a mean age of 21.08±13.89 years. The main precipitating factor was alcohol consumption (32.14%), and the primary trigger was family problems (60.71%). The most important protective factor was access to necessary healthcare services. After the intervention, depression screening scores significantly decreased from 13.92±4.15 to 7.76±5.07, and suicidal assessment form decreased from 15.66±11.91 to 6.46±5.71 (p < .001). Conclusion: The repeated suicide surveillance and prevention program effectively reduced suicide risk. However, long-term continuous monitoring system development is still needed.

Development of Care System for a Severe Mental IlIness with High Risk to Violence (SMI-V) in Sikhoraphum Hospital: The SIMPLE Model

Nuntida Somsap — 2025-12-16

Background: A severe mental illness with high risk to violence (SMI-V) has shown an increasing trend and impacts the mental health of family members and close contacts. In Sikhoraphum district, the existing surveillance and prevention system for SMI-V lacks sufficient effectiveness. Objective: To develop a care system for SMI-V patients and study the effectiveness of the SMI-V patient care system in Sikhoraphum District. Methods: This study employed a research and development approach. The sample consisted of 101 psychiatric patients at Sikhoraphum Hospital, 101 patient caregivers, and 48 personnel in the community mental health network of Sikhoraphum District between October 1, 2023 - December 31, 2024. The instruments included a data record form, Overt Aggression Scale (OAS), community patient follow-up form, and satisfaction assessment form. The project steps were divided into 3 phases: 1) studying the situation, 2) developing a care system, and 3) evaluating outcomes. Data were analyzed using descriptive statistics and Wilcoxon signed rank test. Results: The SMI-V patient care system called the "SIMPLE Model" was developed, consisting of 6 main components: Screening (S), Immediate intervention (I), Monitoring (M), Promoting community participation (P), Locating patient homes (L), and Educating patients and relatives (E). After development, warning signs before exacerbation clearly decreased. The rate of patients with severe recurrent exacerbations decreased to 21.78%, the missed appointment rate decreased to 7.92%, and the percentage of patients with controlled symptoms who could live in the community increased to 86.14%. All indicators met the set criteria. The 10 aspects of patient follow-up in the community significantly improved after development (p < .001). Satisfaction with using the new system was high in all aspects. Conclusion: The developed SMI-V patient care system is effective. It can reduce exacerbations, reduce missed appointments, increase patients living in the community, and increase practitioners' satisfaction in caring for this patient group.

Comparison of Occlusal Contact Assessed by Intraoral Scanning and T-scan System

Nathasorn Pengsuwan — 2025-12-16

Background: Currently, intraoral scanning is commonly used to simulate the details of the oral cavity, including the recording and assessment of occlusion. However, there is limited evidence regarding the accuracy of occlusal contact and the relationship with occlusal force. Objective: To investigate the relationship between occlusal contacts obtained from intraoral scanning and those identified using Arti-Fol, the gold standard method for occlusal assessment. Additionally, to assess the relationship between interocclusal space from intraoral scanning and occlusal force measured by the T-Scan system. Method: A cross-sectional study was conducted in 22 volunteers. Occlusion was recorded at the canines, premolars, and first molars using Arti-Fol, intraoral scanning, and the T-Scan system. Relationships between occlusal contact from intraoral scanning and Arti-Fol were analyzed using Pearson's chi-squared test and diagnostic test. The relationship between interocclusal space and occlusal force was analyzed using Spearman's correlation coefficient and linear regression (p-value < .05). Result: The occlusal contact from intraoral scanning showed a statistically significant association with Arti-Fol. The predictive performance, including sensitivity, specificity, positive predictive value, and negative predictive value, was 69.8%, 89.3%, 83.1%, and 79.8%, respectively. The area under the curve (AUC) was 0.796. Moreover, interocclusal space and occlusal force on the first molar showed a significant inverse correlation. Conclusion: The occlusal contacts obtained from intraoral scanning were similar to those obtained by the standard method, with accuracy ranging from fair to good. Additionally, a statistically significant inverse correlation was found between interocclusal space and occlusal force on the first molar. Therefore, intraoral scanning is a viable method for recording and assessing occlusion in clinical practice.

Factors Related to Electronic Health Literacy of Older Persons in Nonthaburi Province

Supat Jensuksathitpaisal — 2025-12-16

Background: Electronic health literacy (e-Health literacy) plays a pivotal role in the delivery of health care in the digital era, particularly among older persons who are increasingly gaining access to health- related information. Objective: To study the level of e-Health literacy and factors related to e-Health literacy among older persons in Nonthaburi Province. Method: Data were collected from 363 older adults (aged 60-79 years) during March and April 2024 using a two-part questionnaire. Result: Approximately half of the older adults in Nonthaburi Province (50.41%) demonstrated a moderate level of e-Health literacy. Conclusion: The elderly in Nonthaburi Province continue to require improvement in their ability to assess the credibility of health-related information and utilize it effectively. Priority should be given to fostering key target groups, including individuals aged 70-79 years, those with an education level below a bachelor's degree, residents living outside municipal areas, individuals with internet usage experience, and those who spend limited time online.

Intrathecal Morphine Effects in Knee Arthroplasty Patients Receiving Spinal Anesthesia, Distal Femoral Triangle Block and Periarticular Infiltration: A Retrospective Cohort Study

Passorn Ratanaphruthakul — 2025-12-16

Background: Knee osteoarthritis (OA knee) is one of the major causes of pain, disability and activity limitation in elderly. Although knee arthroplasty eases the suffering in the long run, moderate to severe pain is commonly experienced in early postoperative phase. There are many options to lessen this pain. The aim of this study is to study the effects of intrathecal morphine in knee arthroplasty patients receiving spinal anesthesia, distal femoral triangle block and periarticular infiltration. Objective: To evaluate effects of intrathecal morphine on incidence of postoperative moderate to severe pain in knee arthroplasty patients receiving spinal anesthesia, distal femoral triangle block and periarticular infiltration. Method: Retrospective cohort study was done in 205 communicable patients (n = 205) who underwent knee arthroplasty under spinal anesthesia, distal femoral triangle block and periarticular infiltration in Rajavithi 2 (Rangsit) Hospital from July 2023 to July 2024. Data collected were demographic data, site and type of operation, operation time, intrathecal morphine, max numeric rating pain score (NPRS) in first 18 hours post operation, type of postoperative analgesia both around the clock and recruitment, and time to first recruitment analgesia. Results: Incidence of moderate to severe pain in patients underwent knee arthroplasty under spinal anesthesia, distal femoral triangle block and periarticular infiltration is 20 percent. Patients, who received intrathecal morphine, experienced moderate to severe pain 10.2% which is statistically less than those who did not receive (39.7%). Conclusion: Intrathecal morphine is able to decrease incidence of moderate to severe pain in patients underwent knee arthroplasty under spinal anesthesia, distal femoral block and periarticular infiltration. However, the downside is more nausea/ vomiting.

The Prevalence of High-grade Cervical Intraepithelial Neoplasia (CIN2+) in Women with Primary High Risk Human Papilloma Virus (hrHPV) Test Positive

Kittisak Petchsila — 2025-12-16

Background: In Thailand, the current cervical cancer screening program is the primary high risk human papillomavirus (hrHPV) screening test, this method has a high sensitivity for the disease but a low specificity. Therefore, women who test positive for hrHPV infections must be referred for a colposcopy to identify precancerous lesions. Objective: The aim of this study is to determine the prevalence of precancerous lesions CIN2+ and to evaluate the performance of colposcopy in women who have tested positive for hrHPV. Method: We retrospectively reviewed women who tested positive for hrHPV and were referred for colposcopy at the Lopburi Cancer Hospital between 2021 and 2024, to evaluate the prevalence of high-grade cervical intraepithelial neoplasia (CIN2+) in women referred to colposcopy with persistent hrHPV, as well as to determine the positive predictive value of colposcopy in detecting CIN2+ lesions from various types of hrHPV infections. Result: A total of 176 women were referred. Prevalence of CIN2+ was 32.9% and the highest prevalence for persistent HPV type 16 infections 20.5% Additionally, women aged 25-34 showed a significantly higher prevalence of CIN2+. The positive predictive value for colposcopic impression of CIN2+ was 82.7%, (95%CI: 72.4, 93.0). Conclusion: The present study confirms that primary hrHPV cervical cancer screening test increases the detection of CIN2+ but has low specificity as a result, women with hrHPV infection are referred for colposcopic examination to assess precancerous lesions.

Sterility Test of Reconstituted Ganciclovir Solution for Injection

Pennapa Muangsri — 2025-12-16

Background: Ganciclovir is an antiviral medication used to treat and prevent of cytomegalovirus (CMV) infection. The manufacturer recommended using it within 24 hours after dilution to reduce the risk of bacterial contamination. However, the dosage used for infant with infection at the Queen Sirikit National Institute of Child Health involves small amounts of the drug, resulting in a large amount of leftover medication. Therefore, a study was conducted to examine the stability of the drug after dilution to extend its shelf life and reduce the loss of drug value. Objective: To study the sterility of the preparation of ganciclovir injection at concentration 5 mg/ml Method: This is an experimental study preparing in a negative pressure isolator inside a cleanroom. Ganciclovir 500 mg was dissolved in 10 ml of sterile water for injection, then further diluted in normal saline for injection up to 100 ml final concentration of 5 mg/ml. The solution was stored in polypropylene bags, sealed with parafilm, and in polypropylene syringes placed in sterile peel pouches. It was stored at temperature 2-8 °C. Sterility was tested using the direct inoculation method, the pH of the solution was measured with a pH meter, and the physical stability was observed visually on days 0, 7, 14, 21, 28, and 35 after preparation. Result: The ganciclovir injection at concentration 5 mg/ml in normal saline solution (NSS) remained free from bacterial, yeast, and mold growth over the 35 days period. The pH value ranged from 10.10 to 10.19, and the physical appearance did not change from the freshly prepared solution. Conclusion: The ganciclovir injection at concentration 5 mg/ml in NSS was prepared in a negative pressure isolator, set up inside a cleanroom. The solution was stored at temperature 2-8 °C in a polypropylene bags or syringe, remaining sterile for at least 35 days.

Accuracy of Intraoral Scanner Compare with Conventional Impression Technique on Dental Implant in Complete Edentulous Area: A Systematic Review and Meta-analysis

Kanyarat Suksamlan — 2025-12-16

Background: Intraoral scanner (IOS) provides digital impression offer advantages like reduced time, patient comfort, and improved communication but may be less accurate than conventional impression technique for multi-unit of fixed prosthesis, long-distance between dental implants on full-arch restorations or fully edentulous areas. Recent advancements aim to improve IOS accuracy. Objective: To synthesize research on the comparative accuracy of IOS versus conventional impression technique for dental implants in fully edentulous areas. Methods: Systematic search of PubMed, Google Scholar, and manual searches for English or Thai articles (2016-2023) using PICO methodology. Results: 8 meta-analyses were included. Overall, Conventional impression techniques demonstrated significantly better accuracy than IOS (SMD = 0.68; 95%CI: 0.33, 1.03; p < .01) with high heterogeneity (I² = 88.9%). Subgroup analyses revealed: 1) Short-distance measurements: Conventional impression technique showed better accuracy than IOS but not statistically significant (SMD = 0.22; 95%CI: -0.32, 0.75; p = .273) with high heterogeneity (I² = 84.1%) 2) Long-distance measurements: Conventional impression technique showed significantly better accuracy than IOS (SMD = 1.46; 95%CI: 0.86, 2.06; p < .01) with high heterogeneity (I² = 88.2%) 3) 3D measurements: Conventional impression technique showed better accuracy than IOS but not statistically significant accuracy (SMD = 0.35; 95%CI: -0.28, 0.98; p = .273) with high heterogeneity (I² = 90.4%) Conclusion: While conventional impression technique demonstrated significantly better overall accuracy than IOS for dental implants in fully edentulous areas, the differences were not statistically significant for short- distance and 3D measurements. This suggests Intraoral scanner can be clinically viable despite slightly lower accuracy. However, the high heterogeneity indicates limited evidence, necessitating further high-quality research.

The Impact of Tele-pharmaceutical Care on Medication Adherence in Elderly Patients at the Neurological Institute of Thailand

Theresa Asawutmangkul — 2025-12-16

Background: Older adults are at high risk of medication errors, often experiencing difficulties in understanding medication instructions or demonstrating poor adherence. These issues can negatively impact treatment outcomes. Objective: To investigate the effects of tele-pharmacy interventions on medication adherence, satisfaction with pharmaceutical care services, and medication-related problems encountered in a sample of older adults receiving care at the Neurological Institute of Thailand. Methods: This is a quasi-experimental study with a prospective data collection approach. A sample size of all participants will be recruited from patients aged 60 years - 80 years who self-medication and voluntarily agree to participate in the study between June and August 2023 and have no prior experience with tele-pharmacy interventions. The study will involve a video call interview via the DMS application, with video and audio recording. The interview will be conducted using three questionnaires: a medication adherence assessment form focusing on medication-taking behavior (specifically, forgetting to take medication), a medication information tracking form and a satisfaction assessment form, Participants who receive tele-pharmacy care only once will be assigned to the comparison group, while those who receive the service twice will be assigned to the intervention group. Results: Repeated tele-pharmacy interventions significantly reduced problems with forgotten medication intake and issues with medication non-adherence among patients (p < .05). Tele-pharmacy interventions were highly satisfactory among service recipients. The afternoon service time slot was preferred over the morning slot. Conclusion: Tele-pharmacy services for older adults at the Neurological Institute of Thailand contributes to reducing medication non-adherence among patients and enhancing their satisfaction with healthcare services, represent a novel approach to pharmaceutical care, improving patient access and enabling the identification and resolution of specific medication-related problems. Enhancing the ease of use of the communication system, along with using appropriate timing and communication strategies, will further improve tele-pharmacy services.

Factor Determining Circumferential Resection Margin of Rectal Cancer: Operation in Pranangklao Hospital

Prinya Santichatngam — 2025-12-16

Background: The incidence of colorectal cancer in Thailand ranks as the first most common cancer in males and the second most common cancer in females. The incidence increases in individuals over 50 years of age. Regional lymph node metastasis is observed in 27% of cases. Treatment outcomes for rectal cancer are generally less favorable than those for colon cancer. Total mesorectal excision (TME) remains the standard treatment. Objective: This study aimed to analyze the factors associated with positive circumferential resection margin (CRM) (≤ 1 mm) in patients with rectal cancer after surgery. Methods: This study retrospectively analyzed data from medical records of patients with rectal cancer (ICD 10th: C19, C20) who underwent definitive surgery (ICD 9th: 48.50, 48.51, 48.51, 48.62, 48.63) between 2019 and 2024 (5 years) at Pranangklao Hospital (n = 85). Univariate, univariable, and multivariable statistical analyses were performed to assess risk factors. Results: The main statistically significant risk factors (p < .05) identified were anterior tumor location, T4 lesion, and stage III disease (lymph node metastasis). The overall positive CRM rate was 31.8% of all patients. Conclusion: This study demonstrated that anterior tumor location, T4 lesion, and stage III disease are statistically significant factors associated with positive CRM in patients with rectal cancer. Identifying these factors will enable surgeons to plan treatment through interdisciplinary care and reduce the risk of positive CRM, which will ultimately improve overall survival and long-term quality of life for patients.