Journal of The Department of Medical Services

Root Canal Retreatment and Intracoronal Bleaching in Maxillary Anterior Tooth: Eight-Year Follow-Up Case Report

Chulamanee Sookprome — 2026-09-15

Signs and symptoms of root canal treatment failure include pain, discomfort, discoloration, swelling or sinus formation in the surrounding soft tissue. Causes of failure are related to the quality and completeness of the initial root canal treatment, including inadequate cleaning, shaping and obturation of the root canal system. Discoloration in anterior region teeth can cause considerable cosmetic problems. Not only crown or veneer options for whitening discoloration problem, but also intracoronal bleaching. This method preserves tooth structure more than crown and veneer. Intracoronal bleaching technique is a valuable, minimally invasive procedure and effective esthetic treatment that provides predictable and satisfactory results. This case report presents a discolored and infected maxillary central incisor that had been previously treated with root canal therapy. The treatment plan included nonsurgical root canal retreatment, complete root canal filling by using lateral condensation technique and thermo-plasticized gutta-percha injection technique, followed by intracoronal bleaching to improve the appearance of discolored tooth. Although some studies have reported color relapses within two years following intracoronal bleaching, this case demonstrated successful apical healing, stable and esthetically acceptable tooth appearance over long-term follow-up period.

Terminal Lucidity in Terminal Illness

Araya Khoka — 2026-09-15

Terminal patients may include those who have been bedridden for an extended period, have a poor prognosis, or suffer from chronic illnesses that render them incapable of self-care. They often receive close palliative care from relatives or caregivers. When patients are in the final stages of life, caregivers may report that the patient’s condition has improved, they woke up and talked, their memory has returned, they walked, sat on the bed, ate food, sang, and laughed. This is a desirable for relatives and caregivers. Although terminal lucidity occurs in only a small number of cases and is not universal among all terminal patients. However, if these symptoms occur in terminally ill patients and unexpectedly arise. This may refer to the terminal lucidity, which occurs due to physiological stress response or tissue hypoxia. Resulting in increased neurotransmitter release in the brain or alterations in brainwave activity. As a result, the patient becomes alert, memory recall, and increased perception. This phenomenon is typically observed during a brief period. Subsequently, the patient's condition deteriorates and eventually leads to death, causing family members to face grief and loss. However, there is limited academic discussion on this phenomenon. To enable relatives, caregivers, and healthcare professionals to understand the scientific information about terminal lucidity, accurately assess its symptoms, and effectively prepare families for the impending loss of their loved ones. Therefore, this article is a narrative review that aims to describe the characteristics of terminally ill patients, the symptoms of terminal lucidity, the pathophysiological mechanisms underlying this phenomenon, cope with grief and loss of relatives when patients are in the state of terminal lucidity, and the role of nurses in providing care for end-of-life patients and their families.

โรคมากับน้ำ

พัณณ์ชิตา วงศ์ธนู — 2026-09-15

ประเทศไทยมีความเสี่ยงน้ำท่วมในพื้นที่ราบลุ่ม โดยเฉพาะช่วงปลายฤดูฝน (กันยายน-ตุลาคม)¹ ทำให้เกิดการปนเปื้อนของแหล่งน้ำ น้ำท่วมพื้นที่อยู่อาศัย ประชาชนบางส่วนต้องอพยพมาอาศัยในศูนย์พักพิงชั่วคราว เกิดสภาวะที่เอื้อต่อการแพร่กระจายของโรคติดต่อ รวมถึงอุบัติเหตุ เช่น ไฟดูด หรือจมน้ำ² จากข้อมูลการเฝ้าระวังโรค พบกลุ่มโรคที่พบบ่อยในสถานการณ์น้ำท่วม 5 กลุ่ม ดังนี้

Effectiveness of Hyperbaric Oxygen or PENTO/PENTOCLO Protocol for the Treatment of Osteoradionecrosis of the Jaw: A Systematic Review and Meta-analysis

Kanticha Lantomrattana — 2026-09-15

Background: Osteoradionecrosis (ORN) severe post-radiation therapy complication in head and neck cancer patients. Current non-surgical treatments include hyperbaric oxygen therapy (HBOT) and PENTO/PENTOCLO protocol, but empirical evidence of their effectiveness remains limited. Objective: To systematically analyze the effectiveness of HBOT and PENTO/PENTOCLO protocol in treating mandibular osteoradionecrosis. Method: A systematic review and meta-analysis were conducted via Cochrane Library, PubMed, Google Scholar and hand search, compiling studies on the effectiveness of HBOT or the PENTO/PENTOCLO protocol in treating mandibular ORN. Only studies published in English or Thai up to May 31^st, 2024. The quality of the studies was assessed, and outcomes were analyzed using a random-effects model. Results were reported as proportions and 95% confidence intervals of recovered patients. Subgroup analyses and association between outcome and treatment methods or disease stages were also examined. Result: 20 studies were identified, comprising 695 participants (HBOT=222, PENTO/PENTOCLO = 473). Most studies showed low to moderate bias risk. Overall patient recovery was 0.51 (95%CI: 0.34, 0.67, I²=97.21%). HBOT group recovery was 0.43 (95%CI: 0.27, 0.59), while PENTO/PENTOCLO group was 0.56 (95%CI: 0.44, 0.69). Furthermore, the proportion of patients who recovered in Notani I, II, III group was 0.50 (95%CI: 0.32, 0.69), 0.48 (95%CI: 0.35, 0.61), 0.39 (95%CI: 0.19, 0.59) respectively. No statistically significant differences were found between treatment methods (p = .231) or Notani staging criteria (p = .358) Conclusion: From the meta-analysis result, after receiving treatment, approximately half of the patients recovered with complete tissue coverage. Neither the treatment method nor the Notani staging significantly associated with treatment outcomes. However, due to data heterogeneity and limited study samples, a definitive conclusion about the effectiveness of HBOT or PENTO/PENTOCLO protocol in mandibular ORN treatment cannot be established.

The Effectiveness of Semantic Feature Analysis for Speech and Language Ability in Aphasia Patient: Systematic Review

Somjit Ruamsuk — 2026-09-15

Background: Stroke patients have a high incidence. Aphasia is a co-occurring condition in approximately 25-50% of stroke patients. Patients with anomic aphasia present impairments in their semantic network. Semantic feature analysis (SFA) is a technique that improves the connections in the semantic system by adjusting the deficit. However, due to various factors in studies, such as differences in patient groups, comparisons of different techniques, study durations, participant, or rehabilitation procedures, it is necessary to investigate the patterns and effectiveness of SFA. Objective: The primary objective is to conduct a systematic review of the effectiveness of language and speech in stroke patients with aphasia, contrasting the SFA with other approaches. Method: A comprehensive search was conducted across MEDLINE, CENTRAL, and Embase up to September 27^th, 2023. Eligible studies included randomized controlled trials (RCTs), quasi-experimental studies, or clinical trials. Risk of bias was evaluated using the Cochrane Collaboration's tool, and data synthesis was performed using Review Manager (RevMan) version 5.4. Result: Out of 60 relevant studies identified, 6 met the inclusion criteria, and 2 were suitable for meta-analysis Data was synthesized with Review Manager (RevMan) version 5.4. The meta-analysis focused specifically on naming tasks and indicated no statistically significant difference in outcomes between the SFA and other methods. This applied both immediately post-training (SMD = 0.18, 95%CI: –0.19, 0.55, p = .34) and at the 3-month follow-up (SMD = 0.36, 95%CI: –0.01, 0.72, p = .06). The I² value of 0% indicates no inconsistency between the studies analyzed. Conclusion: SFA effectively improves language and speech skills in stroke patients with aphasia, yielding outcomes comparable to other speech-language therapy techniques. Professionals can confidently utilize SFA to support patients' naming abilities. However, due to limitations regarding the risk of bias in the included literature, further high-quality studies are required.

Assessment of 3D Imaging Regenerated from Cerebrovascular Imaging Data from External Healthcare Facilities for Cerebral Aneurysm Clipping: Strategies to Reduce Repeat Cerebrovascular Examinations at the Neurological Institute of Thailand

Yutthana Netwong — 2026-09-15

Background: Surgical clipping of cerebral aneurysms at the Neurological Institute of Thailand (NIT) relies on the three-dimensional volume rendering technique (3D VRT) for vascular reconstructions from computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA) to facilitate preoperative planning. Frequently, patients referred from other hospitals have already undergone vascular imaging; however, repeat studies were often required due to the absence of 3D reconstructions or inadequate image quality. Objective: To evaluate the clinical utility of 3D reconstructions generated from cerebral angiographic data provided by referring hospitals, using CT post-processing software (Siemens syngo.via and INSPACE) installed at the department of radiology, Neurological Institute of Thailand, in facilitating aneurysm clipping without the need for repeat angiographic imaging. Methods: This retrospective study included patients who underwent aneurysm clipping at the NIT. Eligible cases had 3D images reconstructed from external imaging data using CT post-processing software. Patients were categorized into two groups: those for whom the reconstructed images were sufficient for surgery, and those who required additional angiographic imaging prior to the surgery. Results: A total of 42 patients were included, consist of 28 men and 14 women, with a mean age of 55 years. Vascular reconstruction images from referring hospitals were available in 41 patients (98%) and no vascular reconstruction was available in 1 patient (2%). After 3D VRT reconstructions, surgical clipping could be performed immediately without additional angiography in 33 patients (79%), while 9 patients (21%) required repeat angiography at NIT before surgery. Conclusion: Reconstruction of a 3D VRT image of a cerebral aneurysm can assist surgeons in performing aneurysm clipping without the need for cerebral angiography at the NIT in 79% of cases. This results in reduced costs, lower radiation dose, and less contrast agent administration for patients.

Prevalences and Associated Factors for Falls Among Elderly People: Health Area 7

Sadudee Phuhongsai — 2026-09-15

Background: Thailand has entered an aging society, where falls are a common and serious health concern among older adults. Falls can significantly impact physical health, mental well-being, and the quality of life of both older individuals and their families. Objective: This study aimed to assess the risk of falling, the prevalence of falls, and associated factors among older adults in “Fall-Free Healthy Elderly Model Subdistricts” within Health Region 7. Method: A cross-sectional descriptive study was conducted between January and February 2022. Data were collected from 4,040 elderly individuals across four subdistricts in four provinces. Trained village health volunteers screened participants using the Health Assessment Test. Descriptive statistics and binary logistic regression were used for analysis, with a significance level of p < .05. Results: The prevalence of falls was 9.9% within the past six months. Mobility impairment (Adjusted OR 2.00, 95%CI: 1.52, 2.64) polypharmacy (Adjusted OR 1.72, 95%CI: 1.31, 2.25) urinary incontinence (Adjusted OR 1.63, 95% CI: 1.26, 2.10) visual problems (Adjusted OR 1.41, 95%CI: 1.10, 1.82) and abnormal blood pressure (Adjusted OR 1.01, 95%CI: 1.00, 1.02) were significant associated with falls. Conclusion: These findings highlight the need for an integrated, community-based approach to fall prevention in older adults. Health promotion strategies and environmental modifications tailored to the context of each community are essential for reducing fall risk and improving the well-being of the aging population.

Comparison of Low-dose versus High-dose Radioiodine-131 Efficacy in Achieving Disease-free Status in Patients with Intermediate-risk Differentiated Thyroid Cancer

Sangrawee Laddachayaporn — 2026-09-15

Background: Thyroid cancer is the most common endocrine malignancy, with differentiated thyroid cancer accounting for 90-95%. For intermediate-risk patients according to the 2015 American Thyroid Association Management Guidelines (ATA 2015), treatment can begin with either low-dose 30 mCi or high-dose 100-150 mCi. Objective: To compare cumulative radioiodine-131 doses required to achieve disease-free status and time to achieve disease-free status between low-dose and high-dose radioiodine-131 groups. Methods: A retrospective study of 177 intermediate-risk differentiated thyroid cancer patients at Lampang Cancer Hospital between 2018-2022. Inclusion criteria were: age 18 years or older, diagnosed with differentiated thyroid cancer, and intermediate-risk level according to ATA 2015 criteria. Exclusion criteria were patients with low-risk or high-risk differentiated thyroid cancer and patients who had not yet achieved disease-free status. Data collection was performed using case record forms. Data analysis was conducted using Stata version 18.0 (StataCorp, College Station, TX, USA) with statistical significance set at .05. Results: The low-dose iodine-131 group (30 mCi) included 91 patients, and the high-dose group (100-150 mCi) included 86 patients. The high-dose iodine-131 group had significantly higher total cumulative iodine-131 dose until achieving disease-free status compared to the low-dose group (237.21±148.71 mCi vs. 135.27±132.27 mCi, p < .001). After controlling for confounding factors, the mean difference was 111.063 mCi (95%CI: 66.426, 155.699, p < .001). However, treatment duration until achieving disease-free status was not significantly different (577.24±443.35 days vs. 537.35±341.01 days, p = .502). Conclusion: Low-dose iodine-131 treatment can achieve disease-free status using lower cumulative radiation dose with similar treatment duration compared to high-dose treatment. Therefore, it should be considered as the first-line option for intermediate-risk differentiated thyroid cancer patients.

Application of Sigma Metrics for Evaluation and Improvement of Quality Control in the Clinical Chemistry Laboratory of Udon Thani Cancer Hospital

Duangjai Kamlap — 2026-09-15

Background: Currently, the Six Sigma metrics are utilized across various professions, including the medical field, where they have been effectively implemented. This approach has particularly proven beneficial in assessing the efficiency of laboratory processes. Objective: To evaluate the performance of biochemical parameters by calculating their sigma metrics of Udon Thani Cancer Hospital. Method: This is a retrospective data study covering six months (January to June 2024). Collected data from internal quality control (IQC) and external quality assessment (EQA) assessments of 26 parameters. Calculated the %CV from IQC and %Bias from EQAS. Sigma metrics were calculated from CV, percentage bias, and total allowable error for 26 parameters. Sigma metrics serve as a tool for quality control planning by selecting the appropriate rules for each parameter. Result: From the application of Sigma metrics in testing 26 items, it was found that 58% were at an excellent level (≥ 6-Sigma), including BUN, TP, TBIL, triglyceride, calcium, ALP, LDH, HDL, LDL, Mg, DBIL, LIP, phosphorus, CO2, and Chol. 8% are at an excellent level (≥5-Sigma), including glucose and amylase. 15% are at a good level (≥ 4-Sigma), including CRE, uric acid, AST, and ALB. Poor levels (< 4-sigma) include Na, K, Cl, ALT, and HbA1c (19%). Conclusion: The Cobas 6000 C501 automatic analyzer in the clinical chemistry laboratory of Udon Thani Cancer Hospital has an analysis efficiency with a high level of Sigma metrics, ranging from good to excellent. It is possible to plan appropriate quality control to monitor errors that are easy for personnel to perform, thereby reducing the workload. At the same time, actions should be taken to improve the performance of the analysis parameters with a value of < 3-sigma.

Cost-Effectiveness Analysis of Pediatric Prescribing Total Parenteral Nutrition Programin Queen Sirikit National Institute of Child Health (QIPT Program)

Krittiya Stonsaovapak — 2026-09-15

Background: Prescribing total parenteral nutrition (TPN) is a complex process that carries a risk of medication errors. Queen Sirikit National Institute of Child Health has developed a pediatric TPN prescribing program to assist in calculations and provide alerts for appropriate formula selection. Objective: To evaluate the cost-effectiveness of Queen Sirikit National Institute of Child Health Intelligent Prescribing TPN program (QIPT Program) compared with the classical prescribing program, from the healthcare provider’s perspective. Methods: The study assessed effectiveness based on the reduction of medication errors in TPN orders, alongside an evaluation of TPN operational costs in pediatric wards at the Queen Sirikit National Institute of Child Health during fiscal years 2019–2021. The cost analysis included three components: 1) TPN production cost, calculated using the conventional method, 2) TPN prescribing and administration cost, calculated using activity-based costing, and 3) development cost of the QIPT Program, calculated using activity-based costing. Results: The operational cost per TPN bottle using the QIPT Program and the classical program was 1,120.75 THB and 1,124.44 THB, respectively. The percentage reduction in medication errors with the QIPT Program compared with the conventional method was 85.37%, with a relative risk of 0.146, indicating a protective effect. The incremental cost-effectiveness ratio (ICER) was –33.58, meaning a cost saving of 33.58 THB per medication error prevented. Sensitivity analysis identified labor cost for TPN production as the key factor influencing cost-effectiveness. Conclusion: Compared with the classical program, the QIPT Program demonstrated a negative ICER, reflecting its effectiveness in reducing medication errors while incurring lower costs.

Incidence of Delirium in Patients with Acute Ischemic Stroke in the Medical Intensive Care Unit at Chiang Mai Neurological Hospital

Nichapha Nortui — 2026-09-15

Background: Delirium is a psychiatric syndrome characterized by an altered level of consciousness, commonly observed in patients with acute ischemic stroke. Its incidence is highest in intensive care units, particularly among elderly patients and those with infections. Delirium leads to deterioration in cognitive function, perception, and memory. Symptoms typically occur within 24-72 hours (2-3 days) after hospital admission and may persist for hours, days, or weeks. In some cases, confusion continues even after discharge. Early assessment of delirium enables timely nursing interventions, preventing complications and minimizing adverse outcomes. Objectives: To determine (1) the incidence of delirium in acute ischemic stroke patients admitted to the medical ICU, (2) associated risk factors, and (3) complications related to delirium. Methods: This descriptive study included patients aged 60 years and older diagnosed with acute ischemic stroke and admitted to the medical ICU at Chiang Mai Neurological Hospital between October 2022 and December 2023. A total of 146 participants were assessed using CAM-ICU, RASS, and a complication recording form. Results: The mean age of participants was 70.27 years, with the majority being male (51.4%). Delirium was observed in 7.5% of patients, occurring during initial admission in 6.2% and within 24 hours in 7.5%. Complications were noted within 72 hours in 2.1% Significant risk factors included male sex (13.3% vs. 1.4% in females), age > 80 years (25%), followed by age 70-79 years (8.2%, p = .003), comorbidities (8.3%), smoking (11.3%), and abnormal hematocrit (8.0%). Age showed a statistically significant association, whereas comorbidities did not (p = .730). Conclusion: Delirium is more prevalent among males and patients aged over 80 years with acute ischemic stroke. Routine delirium assessment and monitoring for at least 72 hours after admission are recommended to enable timely management and prevent complications.

Efficacy of Continuous Positive Airway Pressure (CPAP) 5 cmH2O during Cardiopulmonary Bypass (CPB) on Partial Pressure of Oxygen in Elderly Patients Undergoing Cardiac Surgery

Pamila Saengsup — 2026-09-15

Background: The number of elderly patients undergoing open-heart surgery is rising due to increase in life expectancy. Despite advances in surgical techniques and perioperative care, postoperative pulmonary complications (PPCs) remain common, often indicated by reduced arterial oxygen levels influencing ventilator weaning. Oxygenation decline may result from pulmonary collapse during Cardiopulmonary Bypass (CPB), ischemia-reperfusion injury, inflammation, and impaired alveolar-capillary function. Objective: To evaluate the effect of Continuous positive airway pressure (CPAP) at 5 cmH₂O during CPB on arterial oxygenation and postoperative pulmonary complications (PPCs) in elderly patients. Method: This single-center randomized controlled study included 110 elderly patients undergoing open-heart surgery with CPB. Patients were assigned to one of two intraoperative ventilation strategies: 1) no mechanical ventilation and no oxygen supplied during CPB (control group) or 2) CPAP at 5 cmH₂O during CPB (CPAP group). Arterial blood gas samples were collected at multiple consecutive stages throughout the surgery. Postoperative outcomes included mechanical ventilation duration, intensive care unit (ICU) stay, and PPCs incidence. Results: The CPAP group showed significantly higher PaO₂/FiO₂ ratios and PaO₂ at 5 minutes post-CPB (403.53±104.43 mmHg and 403.5±104.42 mmHg in control group vs. 445.20±85.31 mmHg and 445.19±85.30 mmHg in CPAP group, p = .024) and after sternal closure (361.90±139.48 mmHg and 353.33±149.30 mmHg in control group vs. 417.42±117.90 mmHg and 413.07±125.87 mmHg in CPAP group, p = .026 and p = .025 respectively), but not after ICU admission. No differences were found in PPCs incidence (42% control versus 31% CPAP), ICU stay (p = .78) and extubating time (p = .26). Conclusions: Appling CPAP 5 cmH₂O during CPB was associated with better oxygenation in early stage and did not reduce the incidence of PPCs in elderly patients undergoing cardiac surgery.

High Blood Eosinophil Count and Hospital Length of Stay Duration in Hospitalized Patients with COPD Exacerbation

Nuttaya Panichdee — 2026-09-15

Background: Chronic obstructive pulmonary disease (COPD) is a significant public health burden in Thailand. Acute exacerbations of COPD (AECOPD) often require hospitalization, lead to increased healthcare costs, and are associated with worse clinical outcomes. Blood eosinophil count (BEC) has emerged as a potential biomarker for predicting treatment response and disease prognosis. Objective: To evaluate the association between blood eosinophil levels and length of hospital stay in patients hospitalized with AECOPD. Methods: A retrospective cohort study was conducted on 531 patients with AECOPD admitted to Kalasin Hospital between January 2022 and July 2024. Patients were categorized into two groups based on BEC: high eosinophil group (≥ 300 cells/μL) and low eosinophil group (< 300 cells/μL). Data were analyzed using t-test and chi-square test. Results: Of the 531 patients (85.5% male, mean age 69.1±11.4 years), 172 (32.4%) had high eosinophil counts. The high eosinophil group had a significantly shorter hospital stay (3.80±0.27 days vs. 5.27±0.37 days, p = .01), received a lower total dose of dexamethasone (42.67±2.04 mg vs. 50.37±2.24 mg, p = .03) and had lower rates of endotracheal intubation (25.8% vs. 74.2%, p = .004). Conclusion: In AECOPD patients, those with blood eosinophil levels ≥300 cells/μL had shorter hospital stays than those with low eosinophil levels. Blood eosinophil level determination may aid in treatment planning and allocation of medical resources.

The Effect of Pharmacist-led Prescription Screening on Prescribing Errors in Outpatients Pharmacy, Rajavithi 2 (Rangsit) Hospital

Satawat Kulworahathai — 2026-09-15

Background: Medication errors can occur at any point in the patient care process, including ordering, transcribing, dispensing, and administering medications, potentially resulting in patient harm. Among these, prescribing errors are widely recognized as key indicators for assessing the quality of care in hospitals, as they directly impact the effectiveness of treatment and patient safety. To address this issue, the Pharmacy Department implemented a prescription screening system aimed at preventing prescribing errors and enhancing medication safety. Objective: To determine the incidence of prescribing errors identified through pharmacist screening and to explore associated factors. Method: A retrospective descriptive study was conducted using outpatient prescription data from Rajavithi Hospital 2 (Rangsit) between November 2022 and December 2023. Result: A total of 19,053 prescriptions screened by pharmacists, 156 prescribing error events were identified across 145 prescriptions, incidence rate of 8.19 per 1,000 prescriptions. Most errors were categorized as severity level B (96.79%), meaning they did not reach the patient. The most common error types were unclear prescriptions (28.24%), duplicate prescribing (18.24%), and wrong direction (16.47%). The most frequently involved drug groups were musculoskeletal and joint disease medications (24.12%), immunological products and vaccines (21.18%), and cardiovascular medications (15.88%). Errors were predominantly found in prescriptions from the Family Medicine Department (67.31%). Pharmacist interventions were accepted by physicians in 97.44% of cases. A statistically significant association was found between a history of drug allergy and prescribing errors (OR = 1.87, 95%CI: 1.31, 2.67, p = .001). Conclusion: Prescription screening by a pharmacist could detect and prevent medication errors. Furthermore, prescription screening could reduce medication errors and ensure that patients receive the correct and safe drug.

The Effects of Sit-to-Stand Training with Lateral Asymmetrical Foot Placement on Postural Balance, Sit-to-Stand Performance, and Weight-Bearing in Individuals with Chronic Stroke: A Pilot Randomized Controlled Trial

Kamolrat Jalernsiriwongthana — 2026-09-15

Background: Patients with chronic stroke often experience postural instability and difficulty in performing sit-to-stand, which can impact their functional independence. The lateral asymmetrical foot placement sit-to-stand method has been shown to enhance muscle activation and weight-bearing on the affected limb, which may be beneficial for rehabilitation. Objective: This pilot study aimed to explore the effects of lateral asymmetrical foot placement sit-to-stand training, compared with normal foot placement, on postural balance, sit-to-stand performance, and weight-bearing in individuals with chronic stroke. Methods: Twenty participants were randomized into the intervention group (n = 10) or the control group (n = 10). The intervention group practiced sit-to-stand with the unaffected foot placed laterally one foot length outward, while the control group used normal shoulder-width foot placement. Training was conducted three times per week for four weeks. Outcome measures included Berg Balance Scale, 5 Times Sit-to-Stand Test, and weight-bearing assessment were measured pre- and post-training. Results: No significant between-group differences were found in any outcomes. Only the intervention group showed a significant improvement on Berg Balance Scale (mean change = 4.20, 95%CI: 1.75, 6.65, p = .001). Conclusion: Lateral asymmetrical foot placement sit-to-stand training did not show superior results compared to normal foot placement. The small sample size is a limitation and should be considered in future.

Efficacy of Bowel Preparation in Patients Undergoing Colonoscopy by Providing Low-fiber Semi-finished Food at The Gastrointestinal Endoscopy Center Rajavithi Hospital

Pim-on Cheenthra — 2026-09-15

Background: High-fiber diet is a factor contributing to poor bowel preparation in patients undergoing colonoscopy. The Gastrointestinal Endoscopy Center, Rajavithi Hospital, in collaboration with the Food Product Research and Development Institute, Kasetsart University, developed a prototype of a ready-to-eat, low-fiber semi-finished food product: ready-to-eat chicken and egg rice porridge. Objective: To compare colon preparation quality between patients who received low-fiber semi-finished food and those who did not, and to evaluate patient satisfaction with the low-fiber semi-finished food. Method: A quasi-experimental study in patients undergoing colonoscopy at Rajavithi Hospital between January 2021 and September 2022. The calculated sample size was 50 patients per group. The quality of bowel preparation was assessed using the Boston Bowel Preparation Scale (BBPS) guidelines. A BBPF score of ≥ 6 points were considered adequate for colonoscopy. Result: Comparison of the bowel cleanliness score in each location found that the group receiving the low-fiber bowel preparation foods had significantly higher scores for bowel cleanliness than those not receiving the low-fiber bowel preparation foods. The patients’ satisfaction with the overall food product was at the highest level (mean = 4.36, SD = 0.90), while the smell of the food was at a high level (mean = 3.92, SD = 1.05). Patients in the low-fiber bowel preparation diet group were able to follow the instructions at 94%, 6% were unable to follow the instructions, 28% felt hungry between meals, 26% felt tired, and 6% had side effects. Conclusion: Bowel preparation with low-fiber semi-finished food instead of liquid diet on the second day of bowel preparation significantly reduced the fatigue and hunger of the patients and the level of bowel cleanliness was good. A BBPS score ≥ 6 points or more, helped to clearly see lesions or abnormalities in the large intestine, thereby lead to effective diagnosis and treatment.

Effects of a Self-Efficacy Promotion Program on Health Behaviors and Disease Severity in Patients with Moderate-to-Severe Psoriasis

Jirawan Sommai — 2026-09-15

Background: Psoriasis is a chronic inflammatory skin disease that affects patients’ quality of life, particularly in moderate to severe cases. Promoting appropriate health behaviors is crucial for disease control. Self-efficacy, a key psychosocial factor, can influence behavioral change and help reduce disease severity. Objective: To examine the effects of a self-efficacy promotion program, developed based on Bandura’s concept, on health behaviors and disease severity among patients with moderate to severe psoriasis. Methods: This quasi-experimental one-group pretest–posttest study was conducted among 145 psoriasis patients receiving treatment at The Regional Hospital for Tropical Dermatology. Inclusion criteria were patients aged 18–65 years diagnosed by dermatologists with moderate to severe psoriasis, able to communicate in Thai, and willing to participate. Exclusion criteria included participation in other studies during the same period, severe psychiatric or neurological disorders, and other skin diseases interfering with assessment (e.g., fungal infections or allergic dermatitis). The program consisted of five components: role modeling, perceived capability, health belief patterns, social support, and health-related behaviors triggered by stimuli. Outcomes were assessed before and after the program, including health behaviors, Body Surface Area (BSA), and disease severity. Data were analyzed using descriptive statistics, paired t-test, and Stuart-Maxwell test. Results: After participation, patients showed significant improvements in health behaviors (p < .05). Bland diet adherence increased from 22.0% to 97.7% (+75.7), smoking and alcohol consumption decreased by 5.5% and 3.5%, respectively, and medication adherence increased by 10.4%. The average BSA decreased from 22.58% to 12.49% (p < .0001). The severe disease group decreased from 22.8% to 4.8%, while the mild group increased from 0% to 60.7%. Conclusion: The self-efficacy promotion program effectively improved health behaviors and reduced disease severity among patients with moderate to severe psoriasis, supporting its integration into specialized dermatology clinics to enhance patients’ quality of life.

Factors Associated with Prehospital Delay in Patients with Acute Ischemic Stroke in Mueang District, Uthai Thani Province, Thailand

Pinyo Rutthongjan — 2026-09-15

Background: Acute ischemic stroke is a major public health concern in Thailand. Prehospital delay reduces opportunities for timely treatment, contributing to increased morbidity and mortality. However, evidence regarding factors associated with prehospital delay in Mueang Uthai Thani District remains scarce. Objectives: To evaluate the prevalence and factors associated with prehospital delay among patients with acute ischemic stroke in Mueang District, Uthai Thani Province, Thailand. Methods: This cross-sectional study included patients with acute ischemic stroke who received care at Uthai Thani Hospital between August 2024 and May 2025. Participants were interviewed using a questionnaire to collect demographic data (age, sex, marital status, education, occupation, income, underlying diseases) and details regarding the stroke and prehospital period, including time of symptom onset, recognition of symptoms as stroke, severity perception, emergency awareness, initial actions, transportation, and prehospital treatment. Factors associated with prehospital delay, defined as arrival more than 4.5 hours after symptom onset, were analyzed using descriptive statistics and Multivariable logistic regression. Results: Among 106 patients (mean age 65.5 years and 54.7% male). The prevalence of prehospital delay was 76.4%. Factors significantly associated with prehospital delay were gradual or fluctuating symptom onset (OR 21.96, 95%CI: 2.91, 166.07, p = .003) and initially choosing to observe symptoms or self-medicate (OR 20.82, 95%CI: 1.69, 255.32, p = .018). Conclusion: Awareness of stroke symptoms and patients’ initial response at symptom onset are significantly associated with prehospital delay.