Thammasat University Hospital Journal Online

Effectiveness of Thai Royal Massage Therapy Combined with Herbal Compress in Office Syndrome Patients with Neck Pain, Kapho Hospital, Pattani Province

Nurulhuda Cheteh, Amram Panoh — Thu, 11 Apr 2024 00:00:00 +0700

Background: Based on the database of Kapho Hospital has people receiving treatment for office syndrome, there were 131 people in 2019, 162 people in 2020, and 201 people in 2021.

Objectives: The aim of this study was to compare the degree of neck movement and the level of neck pain before and after treatment among the group that received Thai royal massage therapy combined with herbal compression.

Research Methodology: The sample group consisted of 60 office syndrome patients who received services in the outpatient department at Kapho Hospital. The patients were splitted into two groups(30 patients for the experimental group, and 30 patients for the control group). The research instruments for data collection were the general information questionnaire, neck movement assessment, and neck pain level measurement. The data were analyzed by percentage, mean, and standard deviation to compare the differences between mean scores within a group, and compare the differences in mean scores between groups by the Wilcoxon signed range test by using the STATA version 12 package.

Discussion and Results: The results showed that the group that was treated with Thai royal massage therapy combined with an herbal compression received the neck movement measurement before-after, 10 minutes of neck and shoulder stretching, 45 minutes of Thai royal massage therapy, 15 minutes of applying herbal compresses to the shoulders and neck area, and 3 times follow-up treatment results with appointments every other day. There were mainly female (73.3%), 49.8% of average age between 31 - 40 years. 20.3% were government service/state enterprise employees. The major cause of neck pain (40.6%) was due to work postures for a long period. 70% medications had no underlying disease, and 63.3% had pain relief by taking.

Conclusion: The degree of movement for the neck after treatment increases, and the level of pain and stiffness in the neck reduces significantly.

The Effect of “Raman PPH Model” to Prevent Postpartum Hemorrhage in Raman Hospital

Ranee Yuming, Niya Suenee, Romelah Chewae, Nalina Waree — Thu, 11 Apr 2024 00:00:00 +0700

Background: Through the analysis of data on related diseases in childbirth units at Raman Hospital, Postpartum hemorrhage is a significant problem with an increasing trend. The annual incidence of postpartum hemorrhage in 2019-2022 was 2.08, 2.04, 0.84 and 1.54 respectively.

Objectives: The research and development study aims to investigate the situation of postpartum hemorrhage, shock, and maternal mortality rates related to postpartum hemorrhage. The goal is to create and enhance a nursing model for preventing postpartum hemorrhage, examining the effects of the developed nursing model before and after using the "Raman PPH Model."

Material and methods: The research had been conducted from 1 September 2018 to 31 May 2023 purposive sampling comprising 1) 12 professional nurses and 2) pregnant women delivering at Raman Hospital. The tools used for developing the nursing model "The Raman PPH Model" included 1) guidelines for caring for pregnant women at risk of postpartum hemorrhage, 2) risk assessment tools based on medical standards, and 3) innovations for preventing postpartum hemorrhage. The data collection tools consisted of recording forms for maternal postpartum hemorrhage incidents and 2) an assessment form of the Raman PPH Model for registered nurse, which was a checklist form.

Results: The Raman PPH Model guidelines improved the assessment and diagnosis of postpartum hemorrhage risks comprehensively and rapidly. Following the Raman PPH Model, 95% of the rate of adherence to preventive measures increased, resulting in a 0.77% decrease in postpartum hemorrhage rates and a 0.24% incidence of shock due to postpartum hemorrhage.

Conclusion: The "Raman PPH Model" guidelines effectively prevent postpartum hemorrhage and requires implementation from the antenatal care, antepartum, labour and postpartum period.

The Study of Comparison Self-compression and Standard Techniques of Mammogram at Bangkok Phuket Hospital

Thu, 11 Apr 2024 00:00:00 +0700

Background: Some Female employees at Bangkok Phuket Hospital who opted not to undergo mammogram examinations. Fear and pain emerge as notable factors influencing this decision-making process.

Objective: The primary objective of this study is to conduct a comparative analysis of pain levels, anxiety, satisfaction, and the time required for mammogram examinations between two groups: one utilizing self-administered breast pressure control techniques (control group) and the other following standard techniques (experimental group).

Material and methods: The research was conducted with a pool of 440 female employees aged 35 and above, using specific inclusion and exclusion criteria. Participants were chosen randomly through lottery sampling and invited to join the research after receiving information about the research procedures from the ethics committee.

Result: 1. Pain levels in the control group were reported as mild, whereas the experimental group was statistically non-significant (p-value>0.05). 2. Anxiety levels in the control group were moderate, while the standard technique group were statistically non-significant. (p-value>0.05). 3.Satisfaction levels in the control group, whereas the experimental group reported a good level that was statistically non-significant (p-value >0.05). 4. The time taken for examinations in the control group and the experimental group were statistically significant (p-value < 0.05).

Conclusion: The comparison of pain, anxiety, and satisfaction levels among patients during mammogram examinations using self-administered breast pressure control techniques versus standard techniques showed no significant differences in pain and anxiety levels. However, the study revealed statistical significance in terms of examination duration, with the experimental group requiring less time. These insights can inform the development of services aimed at creating improved experiences for future service recipients.

A study of discrepancies of diagnosis and procedures of patients in the field of Internal Medicine of Thammasat University Hospital

Nongnuchr Nokputsa — Thu, 11 Apr 2024 00:00:00 +0700

Background: The summary of diagnosis and medical procedures sometimes were in complete in its details and accuracy. These issues have affected the reimbursement of medical expenses, causing expenses, from related aqencies and leads to loss of income of the hospital.

Objective: 1) To study inaccuracy in the summary disease of diagnosis and procedures from the In-Patient Summary document of the Internal Medicine Department of Thammasat University Hospital. 2) To compare the difference in AdjRW, and medical expenses before and after detecting discrepancies in the summary disease of diagnosis and procedures from the In-Patient Summary document.

Material and methods: The sample group was medical records of patients in the field of internal medicine from January to June 2021 with specific reimbursement rights such as. rights belonging to the Comptroller General’s Department and civil servants Bangkok local government organization,universal health insurance,and social security. We were reviewed used the criteria to evaluate the summary assessment of diagnosis and procedures, summary assessment(SA) version 2018, Data were analyzed by a descriptive method about frequency and percent and compare the difference in AdjRW of expense for medical treatment.

Result: A sample of 1,184 cases were reviewed. discrepancies in 455 documents (38.43%) were found. Based on discrepancies ,1465.4207 AdjRW was increded. The total amount was 17,066,879 baht which were highlighted in (58.68%) of the Agency rights under The Comptroller General’s Department moreover, the summary diagnoses of comorbidities, complications of the incorrect disease, and procedure summary (SA) were not summarized in 42.86%.

Conclusion: The summary of disease diagnosis and procedures must be accurate, and complete. These are important for the hospitals, reimbursement. therefore the hospital will receive more compensation from its service.

Effect of Telerehabilitation via Video Conference on Activity Daily Living in Patients with Stroke

Nurulhuda Madeeyoh, Hasmah Masaka — Thu, 11 Apr 2024 00:00:00 +0700

Background: Stroke is a condition that leads to motor impairments in patients, affecting their daily activities. Rehabilitation is essential within 6 months after the onset of stroke. However, due to the COVID-19 pandemic, the physical therapy unit at Raman Hospital is temporarily closed. The patients might miss the chance to recover, which could lead to future disabilities. We utilize telerehabilitation to help patients regain their daily life abilities as close to normal as possible.

Objective: To investigate the effects of telerehabilitation via video conference on the activity of daily living in patients with stroke.

Material and methods: The patients with a stroke were divided into two groups: the control group provided telephone follow-ups and advice for 10 minutes once a week for 8 weeks, and the telerehabilitation via video conference group received 45 minutes of rehabilitation with a physical therapist once a week for 8 weeks. The assessment for the activity of daily living was conducted using the Modified Barthel Index (BI) on baseline after 4 weeks and after 8 weeks of rehabilitation.

Result: After 8 weeks of rehabilitation, the study found that telerehabilitation via video conference group had a statistically significant improvement in BI score. The difference in BI score between the control group and telerehabilitation via video conference group was statistically significant in 4 weeks and 8 weeks.

Conclusion: Telerehabilitation via video conference can improve the activity of daily living for stroke patients.

Light Guiding Shelf (LGS) system for safety of pharmaceutical care

Rattiyaporn Kaewsu, Panadda Husen — Thu, 11 Apr 2024 00:00:00 +0700

Background: Medication error is one of the important hospital problems. From 2020-2022, dispensing error rates were 3.33, 2.62, and 3.23 times per 1000 prescriptions respectively. In addition, there were three events this error with severity level E of sentinel event. The most inconsistent process is taking the wrong type of drug or the wrong strength. The Pharmaceutical department recognizes the importance of such problems and creates an LGS project that works with LED lights to identify drug locations. It can help to manage the corrected drug as effectively as possible.

Objective: 1. Reduce errors in the drug arrangement of wrong type or wrong strength medicine in outpatient dispensaries by more than 70.00 percent in fiscal year 2023. 2. Reduce errors in the drug arrangement of narcotics and case-specific drugs of the wrong type or strength by 100.00 percent in fiscal year 2023, including being to run reports on drug arrangement by 100.00 percent.

Material and methods: This project was conducted according to the Plan Do Check Act framework as 1. Install a drug cabinet and Light Guiding Shelf system with LEDs to indicate drug location. 2. Invented a drug access control system for narcotics and case-specific drugs. 3. Created a program to connect the LGS system with the hospital's program. 4. Arrange the drug by data processing into the computer with the hospital's program, send the data to the LGS system, pick up the drug according to the position of the LED light, and complete the process by turning off the lights. 5. Fixed errors and improved weak points caused by the system, collected data and analyzed performance results.

Result: 1. Pre-dispensing error rate in 2023 compared to 2022 decreased from 8.22 to 2.33 per 1,000 prescriptions (70.95% decrease). 2. The incidences of dispensing errors in 2023 compared to 2022 decreased from 16 to 3 times (81.25% decrease). 3. The incidences of dispensing errors with narcotic and case-specific drugs decreased from 1 to 0 times (100% decrease) and 100.00 percent of pharmaceutical arrangements report was achieved.

Conclusion: The Light Guiding Shelf (LGS) system is a semi-automated system that is suitable for the hospital context and costs less than other automated systems. LGS can effectively reduce the discrepancy of taking the wrong type of drug or the wrong strength. But it is also a system that relies on the human co-organization of drugs. So, this causes the opportunity to cause errors from not following the system. Therefore, monitoring and development are necessary to ensure further sustainability.

Relationship between transformational leadership and soft skills of the director of sub-district health promotion hospital in Chachoengsao Province

Phanthakan Yuenyong, Suradej Samranjit — Thu, 11 Apr 2024 00:00:00 +0700

Background: Transformational leadership affects organizational performance, attitude, and satisfaction. It Includes a commitment to the organization and the development of personnel within the organization to change perspectives or work methods and inspiration, encourage the application of these skills to the unique characteristics or qualities of individual leaders, and influence the development of followers. The development of personality traits and competencies results in efficient work performance and effective communication with others.

Objective: This study aimed to explore the level of transformational leadership and soft skills and the relationship between transformational leadership and soft skills of the director of the sub-district health promotion hospital in Chachoengsao Province.

Material and methods: This study was a descriptive study. The population is 139 personnel, including district health office, district health assistants, and the director of a sub-district health promotion hospital. A sample group of 102 people was calculated using Krejcie and Morgan's calculation formula. The tool used was a questionnaire with a confidence value of 0.99. The data were analyzed using descriptive statistics and a Pearson product-moment correlation coefficient at the 0.01 significance level.

Results: Overall, the study found that the level of transformational leadership is high, while soft skills are also at a high level ( =4.44, SD=0.47). There is a significant positive correlation between transformational leadership and soft skills at a very high level of significance (p<0.01, r=0.896). The detailed findings reveal of that there is a highly significant positive correlation in the same direction, with a significance level of 0.01, including consideration of individual differences (r = 0.860), intellectual stimulation (r=0.851), and creating inspiration (r = 0.842).

Conclusion: The overall transformational leadership and specific dimensions are significantly correlated with soft skills at a high level. It is possible to make management plan. It is the basis of information for the development of the director of a sub-district health promotion hospital in management. It also practice brings guidelines including knowledge, skills, and experiences that are ready to be transferred to followers.

A Study of Outcomes of Care for COVID-19 patients in the Cohort Isolation and Negative Pressure Room: Thammasat University Hospital

ladawan Ritklar — Thu, 11 Apr 2024 00:00:00 +0700

Background: Patients infected with the COVID-19 virus may have high mortality and mortality. If they do not receive appropriate care. The disease can cause severe symptoms and death.

Objective: To study outcomes of care for COVID-19 patients who were admitted in the cohort isolation room and negative pressure unit.

Methodology: This retrospective study was conducted from April 2021 to February 2023, based on medical records. The samples were selected by purposive sampling from inclusion criteria (n=1,294). The data collection instrument was developed from the literature review by the researcher: 1) a diagnosis, treatment, and nursing information recording form; 2) the results of care for patients with COVID-19.

Results: 1) The sample had an average age of 67.21 ± 19.22 years. 92.27% of them had concomitant diseases such as hypertension, hyperlipidemia, diabetes, cardiovascular disease, and kidney disease. Common symptoms are cough, fever, dyspnea, sputum, and fatigue. 55.33% of them have never been vaccinated. 2) The majority had a Ct value between 0-30, a CRP>10 value, and a D-Dimer value >550. The majority of antiviral drugs were favipiravir (57.21%), remdesivir (24.43%), and molnupiravir (18.20%). Some patients received steroids (69.71%), anticoagulants (41.42%) and required oxygen therapy (69.32%). Based on nursing care records, all patients received evaluation upon admission, nursing diagnosis, nursing care plan, nursing practice, nursing evaluation, risk assessment, and monitoring, and 99.42% received a discharge plan.
3) The results of care for patients found that the common length of stay was 6-10 days. The expenses are in the range of 10,001-30,000 baht. The important complications were acquired pneumonia (0.93%) and catheter-associated urinary tract infection (0.70%). The complications related to nursing included pressure ulcers (0.85%), incontinence-associated dermatitis (0.39%), phlebitis (0.31%), medication errors (0.15%). 42.97% of patients were discharged home.

Conclusion: Caring for patients with COVID-19 infection in the isolation room and negative pressure unit with good management and cooperation with all parties results in good outcome.

The Role of Nurses in managing toenail problems in People with diabetes

Chayaphon Siriniyomchai, Nirucha Nitichai, Pannapha yimphray — Thu, 11 Apr 2024 00:00:00 +0700

Toenail problems in people with diabetes include thick toenails, fungal infections, and ingrown toenails, which are the causes of foot ulcers. If the wound becomes infected, it can eventually lead to the toe or leg being amputated. The initial management of toenail problems in people with diabetes should be performed by the nurse before referring them to the doctor. Encouraging people with diabetes to properly care for their toenails helps prevent foot ulcers and can be applied to other patients who have problems with toenails.

Nursing Care of Acute Stroke Patient with Fatigue: Case Study

Supachai Rakkaew — Thu, 11 Apr 2024 00:00:00 +0700

Stroke is a common cause of disability that requires proper and ongoing care. To reduce mortality, reduce disability and promote rehabilitation. If not properly cared for, it can cause post-stroke fatigue, which is a major obstacle to inefficient recovery. Therefore, the management of fatigue in patients with acute stroke is of great importance.

In this study, the study authors selected cases of acute stroke patients with fatigue who were assessed and developed a nursing care plan for managing fatigue using empirical evidence and applied theory. In behavior modification that focuses on education about fatigue management related to sleep, nutrition, and physical activity, together with building confidence in walking. The results of nursing showed that it could reduce the level of fatigue and increase physical ability in acute stroke patients.