The Bangkok Medical Journal

Subclinical Tuberculosis: Addressing the Hidden Threat to Tuberculosis Control and Disease Prevention

Nattanit Limpaowart — 2025-09-30

Subclinical tuberculosis (Subclinical TB) remains a significant yet frequently underdiagnosed contributor to the global TB burden. Due to its lack of noticeable symptoms and its potential for spreading pathogens, many subclinical TB patients face diagnostic delays and act as silent sources of infection. Consequently, subclinical TB is just as impactful as active TB in contributing to both individual health deterioration and the spread of TB within communities. Early identification and treatment of subclinical TB cases is essential for effective TB control and must be prioritized to make substantial progress toward TB elimination, especially in high-burden countries like Thailand. In addition to passive diagnostic systems, it is recommended that active case-finding strategies be proactively implemented within the population. These strategies would facilitate early diagnosis and prompt treatment, supporting secondary prevention by minimizing further damage to the patient’s health. Furthermore, they would contribute to primary prevention by halting the spread of TB, ultimately reducing both the incidence and overall burden of the disease. This paper explores the classification, prevalence, diagnostic challenges, and clinical significance of subclinical TB, underscoring the need for proactive screening strategies to reduce the TB burden and help achieve elimination goals, both globally and in Thailand

Effectiveness of Self-Management Supporting Programs Among People with Type 2 Diabetes Mellitus: A Systematic Review

Sutthiwit Panchaisee — 2025-09-30

OBJECTIVES: This systematic review aims to evaluate the impact of self-management support programs on clinical, behavioral, and psychosocial outcomes among adults with T2DM.

MATERIALS AND METHODS: This systematic review evaluates the effectiveness of self-management support programs on clinical, behavioral, and psychosocial outcomes among T2DM patients. A comprehensive literature search was conducted across PubMed, EMBASE, Cochrane Library, CINAHL, and Web of Science for randomized controlled trials (RCTs) published between 2012 and 2024. Eligible studies included adult T2DM patients participating in self-management interventions and reporting at least one relevant outcome, such as glycemic control (HbA1c), self-care behaviors, quality of life, or psychosocial factors. Methodological quality was assessed using the Cochrane Risk of Bias tool.

RESULTS: Of 2,485 studies identified, 15 met inclusion criteria. Self-management support programs significantly improved HbA1c levels, with a mean reduction of 0.48% (95% CI: -0.64 to -0.32) compared to standard care. Multi-component interventions (including education, behavioral strategies, and technology support) were more effective than single-component programs. Technology-enabled interventions demonstrated comparable efficacy to traditional face-to-face programs. Culturally tailored approaches were particularly beneficial for minority ethnic groups. However, the long-term sustainability of these interventions beyond 12 months remains uncertain.

CONCLUSION: Self-management support programs effectively enhance glycemic control and self-care behaviors, especially when multi-faceted, technologysupported, and culturally adapted. Future research should focus on long-term effectiveness, implementation in resource-limited settings, and standardized reporting of behavioral and psychosocial outcomes.

Factors Affecting Self- adaptation among Early Elderly People, Artsamat Subdistrict Health Promoting Hospital: Mixed Method Approach

Nuttiya Prommasaka Na Sakonnakhon — 2025-09-30

OBJECTIVES: This study employed an explanatory sequential mixed method design to investigate factors influencing self-adaptation among early elderly individuals and to explore their opinions and lived experiences related to adaptation. The research was conducted among residents in the service area of Artsamat Health Promoting Hospital.

MATERIALS AND METHODS: The quantitative phase involved 130 elderly individuals aged 60–69 years residing in Artsamat Subdistrict, Nakhon Phanom Province. Data collection tools included questionnaires on personal information, spiritual well-being, stress, self-perceived abilities, quality of life, and elderly adaptation. Descriptive statistics (frequency, percentage, mean, and standard deviation) and multiple regression analysis were used to analyze the data. The qualitative phase used thematic analysis to examine participants’ narratives.

RESULTS: Quantitative findings revealed that the majority of participants were female (56.9%) and 60 years old (14%). Most were married or in a committed relationship (70.8%) and had completed primary education (77.7%). Multiple regression analysis indicated that spiritual well-being was a significant positive predictor of adaptation (β = 0.376, p < 0.001), while quality of life showed a significant negative correlation with adaptation (β = -0.313, p < 0.001). Thematic analysis of the qualitative data identified five major themes: spiritual well-being, factors influencing spiritual well-being, adaptation strategies, health status, and overall quality of life. The findings suggest that both spiritual well-being and quality of life play critical roles in elderly adaptation.

CONCLUSION: To enhance adaptation among early elderly individuals, nurses should implement programs that promote spiritual well-being—such as religious or mindfulness-based activities—and strengthen physical, psychological, and social dimensions of quality of life. Such initiatives can support elderly individuals in adjusting effectively to the aging process.

The Ethical Behaviour of Registered nurses: A Comparison between Registered nurses’ and Clients’ Perceptions in a Private Hospital

Watchara Khaowphong — 2025-09-30

OBJECTIVES: This descriptive study aimed to examine and compare the ethical behaviours of registered nurses based on the perceptions of both nurses and their clients in an inpatient hospital setting.

MATERIALS AND METHODS: A total of 465 participants were recruited using purposive sampling, comprising 90 registered nurses and 375 clients. The research instrument was a validated ethical nursing behaviour questionnaire with a reliability coefficient (Cronbach’s alpha) of 0.98. Data were collected via self-administered questionnaires from March 1 to July 31, 2023. Data were analyzed using descriptive statistics, independent t-tests, and Chi-square tests.

RESULTS: The overall mean score of ethical behavior as perceived by registered nurses was at a very good level (4.54 ± 0.52), while clients rated it at an excellent level (4.71 ± 0.44). The comparison revealed that clients’ perceptions of nurses’ ethical behaviors were significantly higher than those of the nurses themselves (t = 2.947, p < .05). However, no statistically significant difference was found in the domain of respect for individual rights (t = 1.920, p = .057).

CONCLUSION: Clients perceived the ethical behaviour of registered nurses more favourably than the nurses’ self-assessments. Enhancing ethics education and fostering adherence to professional ethical standards are essential for improving the quality of nursing care and increasing client satisfaction in hospital settings.

Discovering the Essence of Spiritual Resilience of Patients Receiving Continuous Ambulatory Peritoneal Dialysis: A Study of Hermeneutic Phenomenology

Rattiya Thong-on — 2025-09-30

OBJECTIVES: This study aimed to explore the essence of spiritual resilience in patients receiving continuous ambulatory peritoneal dialysis (CAPD).

MATERIALS AND METHODS: The research design employed Van Manen’s hermeneutic phenomenology. Purposive sampling was utilized to select thirty participants. Semi-structured in-depth interviews were conducted from August 2023 to January 2024 to collect data.

RESULTS: The study found that patients defined spiritual resilience through reflections on Van Manen’s five lived worlds: 1) Lived space: Home gives me life; 2) Lived body: Letting go; 3) Lived time: Time to leave love behind; 4) Lived relationships: The people around you are important; and 5) Lived things: Dialysis gives life, not just time.

CONCLUSION: Spiritual resilience among CAPD patients is deeply rooted in their lived experiences, reflecting a holistic integration of physical, emotional, and spiritual adaptation to chronic illness. Healthcare providers should incorporate spiritual and existential support into CAPD care to enhance patients’ well-being and resilience, with interventions tailored to the personal and cultural meanings patients assign to their illness and treatment, aiming to support treatment adherence, bolster dialysis success, and protect against depression.

Posterior Column Triangle Fluoroscopic View for Posterior Column Screw Placement in Acetabular Surgery: A Novel Single Fluoroscopic View Technique

Eakachit Sikarinkul — 2025-09-30

OBJECTIVES: Posterior column screw placement is essential for achieving fracture stability in acetabular fractures involving the posterior column. The conventional technique requires multiple intraoperative fluoroscopic views, increasing both radiation exposure and operative time. This experimental study aimed to assess the efficacy and safety of a single intraoperative fluoroscopic view, guided by the “posterior column triangle” concept, for posterior column screw placement in a pelvic bone model, compared to the conventional two-view technique.

MATERIALS AND METHODS: The study was conducted using pelvic bone models and involved five surgeons with varying levels of experience in pelvic surgery, including pelvic and acetabular specialists and orthopedic trauma fellows. Each surgeon performed posterior column screw insertions using both the conventional two-view fluoroscopic technique (anteroposterior and iliac oblique views) and a novel single-view technique guided by the “posterior column triangle” concept. In this approach, the defined triangle served as the safe corridor for the entry and ending points of the screw trajectory. The optimal fluoroscopic angle for the single-view, termed the “posterior column triangle view,” was determined to be 10 degrees obturator tilt and 25 degrees inlet tilt. Data on screw insertion safety and radiation exposure were collected and analyzed.

RESULTS: The novel single-view fluoroscopic technique consistently enabled accurate K-wire placement within the safe corridor of the posterior column, with no cortical breaches observed in any of the tested bone models. Additionally, it was associated with significantly reduced radiation exposure compared to the conventional two-view method. These findings suggest that the single-view approach may serve as a viable alternative in clinical practice, particularly for managing high posterior column fractures.

CONCLUSION: The posterior column triangle-view technique offers a safe alternative for K-wire insertion in posterior column screw fixation while reducing radiation exposure. Implementation of this technique should be considered in high posterior column fracture line. Further larger-scale studies with different pelvic bone samples are warranted.

Effect of The Gel Positioning Pads Placement on Airway Pressure During Prone Percutaneous Nephrolithotomy: A Prospective Randomized Controlled Trial

Sethapad Promdee — 2025-09-30

Objective: To study the mean airway pressure levels when positioning the gel pad support transversely versus vertically during percutaneous nephrolithotomy (PCNL) surgery performed in the prone position.

Methods: A randomized controlled trial (RCT) was conducted on patients aged 18 years and older who were diagnosed with kidney stones requiring treatment via percutaneous nephrolithotomy in the prone position, with no contraindications for surgery. A total of 76 participants were randomly divided into two groups, 38 participants each, using block-of-four randomization via computer software. The experimental group received vertical gel pad placement, while the control group received transverse gel pad placement. Data were collected using a pressure recording sheet for airway pressure, peak inspiratory pressure (PIP), and plateau pressure (Pplat) after anesthesia induction and following the prone position change at 1, 5, 30, and 60 minutes, and at the conclusion of the surgery in the supine position. The differences between the experimental and control groups were analyzed using Chi-squared (χ²) tests or Fisher’s exact tests for categorical variables. The mean changes in airway pressure, peak inspiratory pressure, and end-inspiratory pressure at the specified time points were compared using Student’s t-tests. A p-value of <0.05 was considered statistically significant. The study was conducted from May 2021 to June 2024.

Results: The study found no statistically significant differences (p < 0.05) in the mean airway pressure, peak inspiratory pressure, and plateau pressure at 1, 5, 30, and 60 minutes after anesthesia induction and transitioning to the prone position, as well as at the conclusion of surgery in the supine position, between the transverse and vertical gel pad placement groups during percutaneous nephrolithotomy. Additionally, there were no significant differences in complications or blood loss volume between the experimental and control groups.

Conclusion: The transverse and vertical positioning of gel pad supports during surgery in the supine and prone positions did not affect airway pressure. This suggests that both transverse and vertical gel pad positioning can be safely and effectively applied during surgery, ensuring optimal and safe treatment for patients.

Predicting Cardiovascular Diseases Risk in Thai Population by Machine Learning

Gumpanart Veerakul — 2025-09-30

OBJECTIVES: To establish a clinical data lake for artificial intelligence (AI) and develop a machine learning model to predict cardiovascular disease (CVD) risk.

MATERIALS AND METHODS: Following IRB approval, de-identified clinical data from 2.9 million patients (2010–2019) across eight Bangkok Dusit Medical Services (BDMS) hospitals were collected in compliance with the Personal Data Protection Act (PDPA). Two datasets were constructed: BDMS-CVD-large (n = 9,072), comprising 3-year clinical records with 20 SHAP-selected features plus age and sex; and BDMS-CVD-Small (n = 107), incorporating coronary artery calcium scores (CACS) and time-from-test. XGBoost models were trained using 5-fold cross-validation, grid search, and repeated across 10 random splits.

RESULTS: The BDMS-CVD-Large model achieved strong performance (F1-score: Macro 0.93 ± 0.008; Weighted 0.97 ± 0.003), with age, HDL, and LDL as key predictors. Including CACS improved the F1-score (0.92 ± 0.032 vs. 0.87 ± 0.031), confirming its value. Limitations included potential occult CVD, exclusion of over 40% of cases due to incomplete data, and missing longitudinal data in many patients.

CONCLUSION: This study demonstrates the feasibility of machine learning (ML) based CVD prediction using large-scale clinical data under PDPA compliance. Prospective validation over 5–10 years is warranted, and integrating CACS may enhance future predictive accuracy.

Clinical Validation of AI-Assisted Mammography Analysis: Generalizability and Performance Evaluation in Breast Cancer Detection

Kewalin Rungsinaporn — 2025-09-30

OBJECTIVES: To evaluate the generalizability and clinical performance of Inspectra Mammography Model (MMG), an artificial intelligence (AI) system for breast cancer detection in mammography, across different clinical settings and to assess its utility as a second reader in reducing inter-radiologist variability.

MATERIALS AND METHODS: The Inspectra MMG model, developed on a modified EfficientNetV2 architecture, was evaluated using two out-of-domain datasets from Bangkok Dusit Medical Services (BDMS) hospitals: a Radiologist-validated Set (172 cases) and a Biopsy-confirmed Set (181 cases). Model performance was assessed by area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Clinical usability was further examined through concordance analysis with radiologists’ reports, expert acceptance ratings, and system usability scale (SUS) scores. To assess the potential second-reader benefit, the model’s impact was analyzed in 119 cases with documented inter-radiologist disagreements.

RESULTS: The model demonstrated robust performance, achieving AUROCs of 0.915 and 0.907 for cancer detection in the Radiologist-validated and Biopsy-confirmed sets, respectively. Lesion localization showed high accuracy with a lesion localization fraction (LLF) of 74.5 and a non-lesion localization fraction (NLF) of 0.53. Clinical usability assessment indicated strong concordance with radiologists’ reports (76.2% for classification, 77.9% for localization). Expert radiologists reported high acceptance of AI-generated results (94.5% and 94.0% acceptance rates). The system achieved SUS score of 69.33, reflecting good usability. In the second reader benefit analysis, the AI aligned with final radiological assessments in 71.4% of cases with inter-radiologist disagreement and identified additional potential findings in 16.8% of cases.

CONCLUSION: AI-powered mammography analysis maintained reliable performance across different clinical environments and effectively supported radiologists in breast cancer screening workflows, The system demonstrated potential to reduce inter-reader variability while enhancing detection sensitivity, supporting its role as a clinically valuable second reader

Comparison of Satisfaction Between Menstrual Pad-Based HPV Self-Collection and Clinician-Collected HPV DNA Testing in Thai Women

Piyapong suvansanya,MD — 2025-09-30

OBJECTIVES: Cervical cancer remains a significant public health concern in Thailand, where participation in screening programs is limited due to psychological, cultural, and logistical barriers. Menstrual pad-based HPV self-collection (Q-pad) presents a non-invasive, private, and potentially acceptable alternative to clinician-collected HPV testing. This study aimed to compare the acceptability of Q-pad self-collection with clinician-collected thin-layer liquid-based HPV DNA testing, and to explore factors influencing women’s screening preferences.

MATERIALS AND METHODS: A cross-sectional study was conducted among 158 Thai women aged ≥35 years undergoing annual health check-ups. Each participant underwent both clinician-collected HPV DNA testing and Q-pad self-collection at home. Satisfaction levels were assessed using a five-point Likert scale, and qualitative feedback was collected through open-ended responses. Descriptive analysis was performed to compare satisfaction levels and identify key themes related to user preferences and barriers.

RESULTS: Most participants (83.5%) reported equal satisfaction for both methods. For the Q-pad test, 91.8% of participants rated the experience as “very good” or “excellent,” while 98.1% did so for the clinician-collected test. A minority expressed a preference, with 13.3% favouring clinician collection due to perceived accuracy and 3.2% preferring self-collection for its privacy and comfort. Both screening methods received high levels of satisfaction. For the Q-pad test, 91.8% of participants rated the experience as “very good” or “excellent,” while 98.1% did so for the clinician-collected test.

CONCLUSION: Q-pad self-collection demonstrated high levels of participant satisfaction, nearly comparable to clinician-collected HPV testing. These findings suggest that Q-pad self-collection is an acceptable alternative screening approach that could complement existing clinician-based programs

The Influence of Effective Emergency Medical Teams and Antecedents on the Smart Emergency Service System in Northern Thailand

Kritwaroj Patchetphokin — 2025-09-30

OBJECTIVES: This research studies a causal relationship model of knowledge management (KM; systematic creation, sharing, and utilization of organizational knowledge), safety climate (SCL; collective perceptions of safety policies and practices), information technology capabilities (ITC; digital infrastructure and competencies), and effective emergency medical teams (EFT; coordinated performance of multidisciplinary responders) to smart emergency medical services (SEMS; technology-enhanced, data-driven emergency care systems) in Northern Thailand.

MATERIALS AND METHODS: This study employed a mixed-methods design with an explanatory sequential approach. In the quantitative phase, data were collected from 550 emergency medical services (EMS) personnel working in the public EMS system across Northern Thailand, selected through proportionate stratified random sampling to ensure representation by service type and geographic area. Eligible participants had at least one year of EMS experience, were literate in Thai, and provided informed consent; those unable to communicate in Thai or unwilling to participate were excluded. In the qualitative phase, three EMS experts with leadership roles and ≥ 5 years of professional experience were purposively recruited for in-depth interviews to contextualize and enrich the survey findings. Data analysis included descriptive and inferential statistics. Measurement model reliability and validity were assessed using confirmatory factor analysis (CFA), composite reliability (CR), and average variance extracted (AVE). Path coefficients were estimated using structural equation modeling (SEM) with maximum likelihood estimation (MLE), and statistical significance was determined through t-statistics generated by LISREL.

RESULTS: KM showed strong positive effects on ITC (β = 0.818, p < 0.001) and SCL (β = 0.883, p < 0.001), but no statistically significant direct effect on EFT (β = 0.056, not significant). SCL positively influenced EFT (β = 0.401, p < 0.05), ITC positively influenced SEMS (β = 0.125, p < 0.05), and EFT had the strongest effect on SEMS (β = 0.882, p < 0.001). KM exerted a significant indirect effect on SEMS through SCL and EFT (β_indirect = 0.312).

CONCLUSION: The study underscores the critical role of KM in enhancing EMS, SCL and EFT, demonstrating a transformative approach to improving healthcare response in Northern Thailand’s challenging geographical context.