Region 11 Medical Journal

Development of revenue collection system for community hospitals in Surat Thani Province

Jiaranai Bualoi — Mon, 24 Jun 2024 00:00:00 +0700

Background: The separation of the roles of purchasing services from the provision of services by the Ministry of Public Health, by allocating budgets to service units according to registered population, has resulted in hospitals having insufficient budgets for administration. Therefore, it is necessary to develop more efficient revenue collection.

Objective: To study the problems, development guidelines, and evaluate the development guidelines of the revenue collection system for community hospitals.

Methodology: This study is a research and development endeavor that involves examining historical data using geographical data from various documents related to revenue collection systems in community hospitals from fiscal year 2018 to 2022. It follows a systematic development approach, including the stages of system planning, requirements analysis, system development, and implementation. Data is analyzed through content analysis, and the progress is assessed using risk scoring.

Study results: The development of the revenue collection system should be comprehensive in all aspects: 1) Human resources: There should be enough personnel in terms of both number and capacity to perform the tasks. 2) Budget: There should be budget support to increase personnel and procure adequate equipment and tools. 3) Equipment and tools: There should be adequate and appropriate equipment and tools for the tasks, especially software to support revenue collection. 4) Management: The administrative structure should be appropriate for the nature of related tasks, and there should be a plan for operations to be in the same direction. There should also be a committee to control, supervise, monitor, and evaluate the revenue collection process on an ongoing basis.

Conclusion: The development of the revenue collection system can improve the efficiency of revenue collection, resulting in improved financial condition of the hospital. Therefore, it is important to continuously support the development of the revenue collection system in all four areas for sustainability.

Sensitivity and specificity of focused CT for the diagnosis of acute appendicitis

Theerarat Manmanee — Tue, 28 May 2024 00:00:00 +0700

Background: Contrast-enhanced CT abdomen and pelvis plays the key role in the workup of acute appendicitis. With increasing rates of CT scans, concerns about the risks from radiation exposure are also increased. Focused CT is one of alternative protocols that has been suggested considering to radiation dosage. Therefore, accuracy of focused CT for the diagnosis of acute appendicitis was studied.

Objective: To determine accuracy of focused CT for the diagnosis of acute appendicitis

Method: Retrospective review of 270 patients with CT scans for evaluation of suspected appendicitis in Krabi hospital from April 2023 to September 2023 were included in this study. From those CTs, we reconstructed images with limited scan range from superior border of L3 to superior border of pubic symphysis which served as the focused CT. These focused CTs were reviewed, assessing for appendix visualization and diagnosis of acute appendicitis or other diseases. The reference standard was obtained from medical records, intra-operative findings, and/or histopathology.

Results: The appendix was completely covered by focused CT in 269 cases and partially covered in 1 case. 94 cases (34.81%) showed acute appendicitis, 73 cases (27.04%) showed other diseases, whereas 103 cases (38.15%) showed no relevant findings. The sensitivity, specificity, positive predictive value, and negative predictive value of focused CT were 92.86%, 98.26%, 96.81%, and 96.02%, respectively.

Conclusion: For the diagnosis of acute appendicitis, CT scan range can be limited to cover from superior border of L3 to superior border of pubic symphysis.

Comparison of the Quality of Bowel Preparation for Colonoscopy in Inpatients Versus One-Day Surgery Patients

Jukkapong Jaturawanit — Tue, 04 Jun 2024 00:00:00 +0700

Background: Currently Most of Thungsong Hospital colonoscopy patients are inpatients. One-day surgery system reduces congestion in hospitals, reduces the length of hospital stay, reduces the risk of infection, and saves costs for patients and hospitals

Objectives: To study and compare bowel preparation results for colonoscopy between inpatients and One-day surgery patients.

Method: Retrospective observational study. By collecting data on colonoscopy patients Between 1 April 2023 and 30 June 2023, there were 186 patients, divided into 126 inpatients and 60 outpatients. By comparing 2 parts of information: Part 1 includes gender, age, BMI, and underlying diseases, and part 2 is an assessment of results of bowel preparation, Length of colonoscopy, and colonoscopy results

Results: One-day surgery and inpatient were female 60% and 57.9% (p-value = 0.789), Average age was 53.7 ± 8.65 years and 60.25 ± 10.81 years (p-value <0.001), No underlying diseases were found 81.7 and 53.2(p-value < 0.001), respectively. One-day surgery patients had bowel preparation results of Good/Excellent 1.05 times (Unadjusted RR = 1.05, 95%CI: 0.75, 1.48) with no statistical significance (p-value = 0.780) and length of colonoscope of both groups that no Statistically significant difference (p-value = 0.073).

Conclusion: The comparison of bowel preparation in the colonoscope between inpatients and one-day surgery patients found no difference.

Factors Influencing Stress Coping among Pregnant Women during the COVID-19 Pandemic

Parichat Wunchooserm, Auksaranut Sutthiprapa, Anucha Thaiwong — Fri, 17 May 2024 00:00:00 +0700

Background: Coping with stress is a crucial mechanism for pregnant women, particularly in the context of the COVID-19 pandemic. Despite the challenges posed by the outbreak, limited research exists on the factors influencing stress coping among pregnant women.

Objectives: To investigate the factors influencing stress coping among pregnant women during the COVID-19 pandemic.

Method: The sample comprised 120 pregnant women attending the antenatal care department at Maha Sarakham Hospital, selected based on specific criteria between October 2021 and December 2022. Research instruments included a personal data record form, a revised version of the Pregnancy Coping Scale, Hardiness Scale for Women with Gestational Diabetes, and Uncertainty in Illness Scale. Predictive relationships were analyzed using multiple regression analysis, and personal information was examined using descriptive statistics.

Results: The sample group had an average age of 27.93 ± 5.85 years. The majority of the participants (58.33%) had received information about the 2019 coronavirus infection. Multiple regression analysis indicated that uncertainty (Beta=-156; p<.05), and hardiness (Beta= .320; p<.05) collectively significantly predict stress coping through planning and preparation. Additionally, family income (Beta=-.224; p<.05) cans predict stress coping using a positive spirit style with statistical significance. Moreover, age (Beta=.239; p<.05), uncertainty (Beta=.214; p<.05), and hardiness (Beta=.285; p<.05) together predict non-productive coping with statistical significance. Nurses should leverage the insights from this study to design programs that promote appropriate stress coping. Additionally, assessing hardiness and uncertainty is crucial for planning nursing activities, providing essential information for promoting effective stress management among pregnant women.

Outcomes of Thungsong sepsis treatment protocol in sepsis management, Thungsong Hospital Nakornsrithammarath Province

Piamsook Sarikprueck — Wed, 05 Jun 2024 00:00:00 +0700

Introduction: Sepsis is condition with high mortality rate and current public health problem. The treatment process includes administration of fluids, rapid and empirical antibiotics, proper administration of inotropic drugs and eliminates the source infection.

Objective: To compare mortality rates and results of the treatment process before and after using the treatment guideline.

Methods: A quasi-experimental retrospective study. Collect all patient data from inpatient medical records who diagnosed sepsis and septic shock, pretreatment group from Jan 1 to June 3 2022 and post treatment group between July 1 and Dec 31 2022

Results: This study enrolled 169 patients before guideline implementation and 277 patients after the guideline. The outcomes showed an increase in ICU admission that went from 12.4% to 23.8% (P=0.04). Doctors that used the guidelines increased from 53.3% to 63.3% (P=0.01) and assessed early warning signs that rosed from 42.6 to 52.8% (P=0.02). By using the guideline, the duration of blood draw process for culture and initial antibiotics were increased from 30 minutes to 20 minutes (P<0.001). Treatment by the administering was more than 30cc/kg/hour of fluid in patients with low blood pressure (septic shock). It was found that after using the guidelines, fluid administration increased from 55.1% to 71.7% (P=0.042). The result of mortality rate after deducting palliative care decreased from 11.8% to 9%(P=0.339)

Conclusion: The results of the treatment process after using the guidelines were found that the treatment process improved. Meanwhile the results of mortality rate were not signifincantly decreased.

Effects of the self-efficacy promotion program on self-management behavior of patients with chronic kidney disease state 3 in primary care service of the Surat Thani hospital

Plearnta Raungsung, sadakan eamchunprathip — Wed, 19 Jun 2024 00:00:00 +0700

Backgrounds: Chronic Kidney Disease is a global public health problem, that every country is facing and is having an increasing trend around the world. It is a disease that cannot be completely cured. Continuous treatment is required and treatment costs are high.

Objective: To study the Effects of the self-efficacy promotion program on self-management behavior of patients with chronic kidney disease state 3 in primary care service of the Surat Thani hospital.

Methods: The sample group was patients with chronic disease, stage 3, in primary care centers in the Surat Thani hospital network. A glomerular filtration rate test result of 45 - 60% in the 6 months before joining the research project. The sample was randomly selected using the label picking method. The sample size from calculating the influence value (Effect size) to be equal to .70. The statistical significance level at .05, test power value at .80. Open Cohen's table, a sample size of at least 25 people per group. Analysis data were compared using independent t-test.

Results: Self-management behavior, knowledge of self-management, glomerular filtration rate (GFR) and creatinine (Cr), after receiving the program, it was found that self-management behavior and knowledge of self-management of the experimental group had a higher mean score than the control group. Creatinine of the experimental group was lower than of the control group. The glomerular filtration rate was significantly higher than the control group, p<.05.

Conclusions: The program promotes self-efficacy in self-management behavior of patients with stage 3 chronic kidney disease. It can improve knowledge and change self-management behavior and can lead to kidney function in patients with stage 3 kidney disease.

The factor associated with moderate to high disease activity of Rheumatoid arthritis

Patamarwadee Chitpet — Mon, 24 Jun 2024 00:00:00 +0700

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterised by joint inflammation and destruction. RA has been noted as a major cause of inflammatory disability and increased mortality. Early detection of the disease and initiation of disease-modifying drugs can reduce the progression of disease to severe state.

Objective: This study aimed to characterize the clinical presentation of RA and to describe the factors associated with disease severity among patients with RA.

Method: This was a cross-sectional study conducted among patients with confirmed RA attending the Rheumatic outpatient clinic, Surat Thani hospital, between September 2023 and January 2024. Demographic data and clinical factors associated with disease severity were collected. RA disease activity was assessed using the RA Disease Activity Score (DAS28)-ESR.

Results: A total of 465 participants were enrolled, the majority of the participants were female. The median age of the population was 58 (IQR 50,65) years. Forty-four percent of the study population had moderate and high disease activity. Only 3.4 percent had high disease activity based on the DAS28-ESR. Female, Diabetes, early joint space narrowing and Glucocorticoid use were significantly associated with moderate to severe disease activity (OR 2.7, 95%CI 1.4-5.0, p=0.002; OR 2.7, 95%CI 1.2-5.9, p=0.015; OR 1.6 95%CI 1.1-2.6, p=0.029; OR 2.3 95%CI 1.5-3.6, p< 0.001, respectively).

Conclusion: Female, Diabetes, early joint space narrowing and Glucocorticoid use were associated with disease severity, close monitoring and tight control strategy in these patients can achieve better clinical outcomes.

Impact of mindfulness program on stress and blood pressure in Members with risk hypertension, Mueang district health service network Surat Thani

Punyanuch Kongsanae, Sadakan Eamchunprathip — Mon, 24 Jun 2024 00:00:00 +0700

Background: High blood pressure is a major health problem for people around the world, and it is the cause of premature death. Mindfulness stimulates the functioning of the nervous system and blood flow in the brain, stimulates the release of more dopamine, causing the body to relax, heart rate decreased but regularity increased. Therefore, causing the pressure in the blood vessels to decrease into blood pressure therefore decreases.

Objectives: To study the effects of a mindfulness program on stress and blood pressure in groups at risk for high blood pressure

Method: The sample group is people who have been screened as being at risk. There is a blood pressure level >120/80-139/89 mmHg, age 35 years and over, purposive sampling, random sampling into experimental and control groups by drawing lots. Matching the similarity of gender groups, ages, and educational levels, and meditation experience. The sample size was determined with the G*Power program, resulting in a total sample size of 70 people. The tool used in the experiment was the mindfulness program Mindfulness – Base Stress Reduction (MBSR). The content validity of the CVI was 0.87. The data were analyzed and compared using statistics: independent t-test and pair t-test.

Results: Found that stress and blood pressure before receiving the program were not different between the experimental group and the control group. But after receiving the program, it was found that the experimental group's stress and blood pressure were lower than those in the control group with statistically significant.

Conclusion: Mindfulness program can reduce stress and lower blood pressure levels at risk group with statistical significance.

Comparative effect of telemedicine on glycemic control management among Diabetes Mellitus Type II Patients in Suratthani’s prison healthcare unit.

Thanita Somton — Thu, 27 Jun 2024 00:00:00 +0700

Background: Telemedicine offers many benefits to conventional care such as decreased travel cost and time, decreased risk of transmission of communicable diseases. However after the end of COVID-19 outbreak the researcher concerns the comparative effect of telemedicine on glycemic control between telemedicine and in-person care.

Objectives: to evaluate the effect of telemedicine on behaviors and blood sugar control among diabetes patients in Suratthani’s prison healthcare unit.

Methods: A Quasi-experimental study into 2 groups Telemedicine and In-person care, using a questionnaire in Type II diabetes patients during December 1^st, 2023 to April 1^st, 2024. Descriptive statistics were used with Independent t test and Paired t-test.

Results: There were 45 participants enrolled the study. The behaviors scores between two groups are moderate =3.09, S.D.= 0.33 and =2.94, S.D.= 0.33, respectively slightly different non- significant (P=0.14). The comparative impact on glycemic control (FBS and Hba1c) in the telemedicine group decrease less than In-person care (Tele: Pre FBS =119.8 ,Post FBS =114.4), (In-person:Pre FBS =128.9 ,Post FBS =125.2), (Tele:Pre Hba1c =7.1, In-person:Post Hba1c =6.9) and (In-perdson:Pre Hba1c =7.9 ,Post Hba1c =6.9), respectively non significant. Paired different Hba1c reduction in telemedicine group was 0.21% non significant (P=0.46) and In-person group was 1.11% significantly (P<0.05).

Conclusions: Telemedicine benefits diabetes patients in prison to decrease blood sugar control. It increases patients’ accessibility and save cost of the treatment. Therefore telemedicine could improve the workflow of hospitals and prison health care unit in the future.