Health Science Clinical Research

Nursing Care of Lower Rectal Cancer Patients with Colostomy with Comorbid Hypertension

2026-05-12T17:09:46+07:00

ABSTRACT
Rectal cancer is a major public health concern. While colostomy improves survival, it causes significant physical, psychological, and social impacts. For patients with comorbidities like hypertension, strict preoperative control is crucial to minimize complications such as infection or cardiovascular issues. Integrating the surgical nursing process with the Enhanced Recovery After Surgery (ERAS) program prepares patients and families, reduces risks, and promotes effective adaptation to living with a colostomy, thereby improving overall quality of life. This study aimed to analyze and evaluate the nursing care process for patients with lower rectal cancer undergoing colostomy surgery and presenting with comorbid hypertension, establishing evidence-based guidelines for healthcare professionals. This descriptive case study purposively selected one patient with lower rectal cancer undergoing colostomy surgery and presenting with comorbid hypertension (January to April 2026). Data were collected from the patient, caregivers, and medical records. A holistic nursing plan was developed, supported by literature reviews concerning patients with lower rectal cancer who underwent colostomy surgery and had comorbid hypertension. Consultations with multidisciplinary specialists and nurses caring for patients with lower rectal cancer undergoing colostomy surgery and presenting with comorbid hypertension guided continuous evaluation from outpatient visits to home care. The findings reveal that outpatient surgical nurses are pivotal in the comprehensive care of patients with lower rectal cancer undergoing colostomy surgery and having comorbid hypertension. Tailored interventions address physical limitations and psychological stressors, empowering patients in self-care. Promoting active family involvement and providing emotional support significantly boosts patient confidence and stoma acceptance, facilitating optimal quality of life. In conclusion, nursing care for this specific group is complex due to cancer treatments, comorbid hypertension, and lifestyle modifications. Outpatient nurses are critical in planning safe, continuous care to prevent complications. To enhance comprehension, developing visual teaching aids, such as illustrated handbooks or QR codes, is highly recommended over verbal instructions alone.

Management of Gingival Recession on the Mandibular Left Central Incisor Using a Connective Tissue Graft with an Epithelial Collar Technique

2026-06-11T15:25:41+07:00

ABSTRACT

44-year-old Thai female patient who has labial recession type 2 following Cairo classification in 2011, at the mandibular left central incisor received root coverage surgical surgery by connective tissue graft with epithelial collar and sling suture. The purpose of reducing the root-exposed area and increasing keratinized tissue width is esthetic and provides a stable result in the long term. At 1-year follow-up, the gingival margin remained stable with a constant recession level of 2 mm. from the CEJ (A reduction of 1.5–2 mm. from the baseline). The keratinized tissue width increased by approximately 2 mm. The patient was satisfied with the treatment outcome. The use of a connective tissue graft with an epithelial collar is an effective approach for managing recession type 2, Cairo classification in 2011, providing both tissue thickness and increased keratinized tissue width for long-term stability.

Pre-injury Factors Associated with Barthel Index Score at Discharge in Older Adults Post-Hip Fracture Surgery: A Retrospective Cohort Study

2026-02-16T12:13:06+07:00

Objective: Hip fracture in older adults is a major public health concern and a leading cause of functional decline and loss of independence. This study aimed to examine pre-fracture factors associated with basic activities of daily living (ADLs) at hospital discharge among older patients undergoing surgical treatment for fragility hip fracture.
Methods: This retrospective cohort study included patients aged 60 years and older who underwent surgical treatment for fragility hip fracture between January 2024 and December 2025. A total of 361 patients were analyzed. Associations between pre-fracture factors and Barthel Index scores at discharge were evaluated using descriptive statistics, univariable analysis, and multivariable linear regression to identify independent predictors
Results: Most patients were female, with a mean age of 77.43 years. The mean Barthel Index score at discharge (51.55 ± 19.87) was significantly lower than the pre-fracture score (91.33 ± 18.69; p < 0.001). In univariable analysis, age, pre-fracture Barthel Index score, cognitive impairment or dementia, and serum 25-hydroxyvitamin D level were significantly associated with Barthel Index at discharge (p < 0.05). In the final multivariable linear regression model, older age (B = −0.42; 95% CI −0.61 to −0.23; p < 0.001) and higher pre-fracture Barthel Index score (B = 0.55; 95% CI 0.46–0.64; p < 0.001) remained independently associated with Barthel Index at discharge. Comorbidities and 25-hydroxyvitamin D level were not independently associated with the outcome in the adjusted model. The final model explained 31.7% of the variance in Barthel Index at discharge (adjusted R² = 0.317).
Conclusions: Older age and pre-fracture functional status were key factors associated with basic ADLs at hospital discharge in older adults after hip fracture surgery. Early assessment of these factors may help guide care planning and rehabilitation.

Concordance Between Ultrasonography with ACR-TIRADS and Surgical Pathology in Thyroid Nodule in Uttaradit Hospital

2026-05-05T15:17:52+07:00

บทคัดย่อ
วัตถุประสงค์: เพื่อทำการศึกษาความสามารถในการวินิจฉัยก้อนต่อมไทรอยด์จากการตรวจด้วยคลื่นเสียงความถี่สูง (Ultrasound) และรายงานผลด้วยระบบ ACR TI-RADS ในการทำนายมะเร็งต่อมไทรอยด์เปรียบเทียบกับส่งตรวจชิ้นเนื้อทางพยาธิวิทยาจากการผ่าตัดต่อมไทรอยด์ในโรงพยาบาลอุตรดิตถ์
วิธีการศึกษา: เป็นการศึกษาเชิงพรรณนาโดยเก็บข้อมูลย้อนหลัง (Retrospective descriptive study) ของผู้ป่วยก้อนต่อมไทรอยด์ที่มีผลการตรวจด้วยคลื่นเสียงความถี่สูง (Ultrasound) ซึ่งรายงานผลด้วยระบบ ACR TI-RADS และได้เข้ารับการผ่าตัดต่อมไทรอยด์ ในโรงพยาบาลอุตรดิตถ์ตั้งแต่ตั้งแต่ 1 ตุลาคม 2564 – 1 ตุลาคม 2568
ผลการศึกษา: มีผู้ป่วยในการศึกษาทั้งสิ้น 95 ราย โดยเป็นเพศหญิง 88 ราย (ร้อยละ 92.6) อายุเฉลี่ยของผู้ป่วยคือ 50 ปี (50.42±12.73) ผลการตรวจวินิจฉัยด้วยคลื่นเสียงความถี่สูงด้วย ACR TI-RADS ในผู้ป่วยที่มีก้อนต่อมไทรอยด์เปรียบเทียบกับผลตรวจชิ้นเนื้อทางพยาธิวิทยาจากการผ่าตัดต่อมไทรอยด์มีค่า Sensitivity, Specifi city, Positive Predictive Value, Negative Predictive Value, Positive likelihood ratio, Negative likelihood ration และ Accuracy เท่ากับร้อยละ 80.6 (95% CI=64.0 - 91.8), 41.3 (95% CI=31.1 - 52.1), 34.9 (95% CI=24.8 - 46.2), 84.4 (95% CI=70.5 - 93.5), 1.37 (95% CI=1.09 - 1.74), 0.47 (95% CI=0.23 - 0.96), 52.34 (95% CI=43.34 - 61.24) ตามลำดับ
สรุป: การศึกษาความสามารถในการวินิจฉัยก้อนต่อมไทรอยด์จากการตรวจด้วยคลื่นเสียงความถี่สูง (Ultrasound) และรายงานผลด้วยระบบ ACR TI-RADS ในการทำนายมะเร็งต่อมไทรอยด์เปรียบเทียบกับส่งตรวจชิ้นเนื้อทางพยาธิวิทยาจากการผ่าตัดต่อมไทรอยด์ในโรงพยาบาลอุตรดิตถ์มีประโยชน์ในการคัดกรองและช่วยลดโอกาสพลาดในการวินิจฉัยมะเร็งเนื่องจากพบว่า Sensitivity และ Negative predictive value สูง มีประโยชน์ในการประเมินความเสี่ยงการเป็นมะเร็งของก้อนต่อมไทรอยด์และช่วยคัดกรองผู้ป่วยที่ควรได้รับการตรวจเพิ่มเติม อย่างไรก็ตาม เนื่องจากการศึกษานี้พบค่า Specifi city และ Positive predictive value ในระดับตํ่า การใช้การตรวจด้วยคลื่นเสียงความถี่สูง (Ultrasound) เพียงอย่างเดียวเพื่อประกอบการตัดสินใจผ่าตัดอาจนำไปสู่การผ่าตัดที่ไม่จำเป็นได้ ดังนั้น ควรพิจารณาร่วมกับข้อมูลทางคลินิก ผลการตรวจทางเซลล์วิทยา (Fine needle biopsy (FNA)) และปัจจัยเสี่ยงอื่น ๆ ก่อนวางแผนการรักษา

The Study of Accuracy of Intraoperative Diagnosis of Sentinel Axillary Lymph Node by Frozen Section Compared to Permanent Section in Breast Cancer at Buddhachinaraj Pisanulok Hospital

2026-05-05T15:08:07+07:00

ABSTRACT
Objective: To evaluate the diagnostic accuracy of frozen section examination of sentinel axillary lymph nodes compared with permanent section in breast cancer patients at Buddhachinaraj Phitsanulok Hospital.
Methods: A retrospective descriptive study was conducted including 265 female breast cancer patients who underwent sentinel axillary lymph node between 2015 and 2025. FS results were compared with permanent section, and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated.
Results: The mean patient age was 58.5 years, with an average of 3.8 lymph nodes examined per case. Frozen section demonstrated a sensitivity of 92.7%, specificity of 98.1%, PPV of 92.7%, NPV of 98.1%, and overall accuracy of 97.0%. Most discrepancies were associated with micrometastasis and technical limitations of frozen section preparation.
Conclusions: Frozen section examination of sentinel axillary lymph node in breast cancer shows high diagnostic accuracy and plays an important role in intraoperative decision-making, effectively reducing the need for reoperation. Future improvements should incorporate adjunct techniques such as immunohistochemistry, molecular assays, and digital pathology consultation to enhance diagnostic sensitivity and service quality.

Prediction Model of Physician-diagnosed Asthma among Children Aged 1–5 Years Presented with Wheezing Episode in Uttaradit Hospital

2026-05-05T15:45:18+07:00

ABSTRACT
Background: Wheezing is a common symptom in young children, particularly those under 5 years of age, and is associated with the subsequent development of asthma - one of the most prevalent chronic respiratory diseases in children worldwide. Diagnosing asthma before the age of 5 remains clinically challenging. Data from Uttaradit Hospital indicate that respiratory diseases represent a major health burden, with asthma ranking third among all respiratory conditions, underscoring the importance of studying the relationship between early wheezing episodes and asthma diagnosis in children.
Objective: To develop a prediction model estimating the probability of receiving a physician diagnosed asthma in children aged 1-5 years who present with wheezing episodes.
Methods: Children aged 1-5 years admitted to the pediatric ward of Uttaradit Hospital with a wheezing episode between January 1, 2020, and July 31, 2025, were included. Those with a prior physician-diagnosed asthma were excluded. Categorical and continuous variables were compared, and associations between potential risk factors and asthma diagnosis were assessed using univariable and multivariable logistic regression with backward elimination, applying a p-value threshold of 0.5. Odds ratios were subsequently converted to log-odds coefficients for model development. Model performance was evaluated across four domains: discrimination, calibration, internal validation, and clinical utility.
Results: The developed prediction model demonstrated moderate discriminative ability (AUROC 0.76; bootstrap-corrected 0.73) with good calibration (O:E ratio ≈ 1; calibration-in-the-large ≈ 0). Internal
validation confirmed model stability with no evidence of overfitting. Decision curve analysis demonstrated clinical utility beginning at a threshold probability of approximately 0.30.
Conclusions: The prediction model can satisfactorily classify and estimate the probability of physician-diagnosed asthma in children, with predictions consistent with observed outcomes. Further studies in larger and more diverse populations are warranted to confirm its accuracy and generalizability.

A Comparative Study on Progression of Kidney in Stage 3–4 Chronic Kidney Disease Patients with Symptomatic and Asymptomatic Hyperuricemia in Uttaradit Hospital

2026-06-08T16:40:46+07:00

ABSTRACT
Background: Chronic kidney disease (CKD) is a major global public health problem affecting over 10% of the population. Without appropriate care, CKD can progress to end-stage kidney disease requiring renal replacement therapy. Hyperuricemia is common and associated with several non-communicable diseases, including CKD. While symptomatic hyperuricemia may influence kidney disease progression, the effect of asymptomatic hyperuricemia remains debated. Clarifying this association is essential to inform effective treatment strategies.
Objective: To compare kidney disease progression between CKD patients with symptomatic versus asymptomatic hyperuricemia.
Methods: We identified 2,515 adults with hyperuricemia using ICD-10 codes M1099 and E790 between 1 January 2020 and 1 September 2024. Using fixed-sample sequential sampling, 622 records were reviewed; 200 patients with CKD stage 3–4 met eligibility criteria and were included. We compared clinical risk factors for kidney function decline and analyzed data using descriptive and inferential statistics.
Results: Of 200 CKD stage 3–4 patients with hyperuricemia, 107 were symptomatic and 93 asymptomatic. Baseline characteristics were comparable between groups: most patients were male (p=0.861), mean age was 73 years (p=0.344), and mean serum uric acid was 8.5 mg/dL (p=0.802). Colchicine use was more frequent in the symptomatic group (90.65% vs 35.48%, p < 0.001). Higher serum uric acid was associated with lower eGFR (β = –1.67, p = 0.001). Male sex (β = 3.99, p = 0.030), dyslipidemia (β = 6.67, p=0.044), and use of renin–angiotensin–aldosterone system inhibitors (RAAS inhibitors) (β = 5.07, p=0.003) were associated with higher eGFR. After adjusting for comorbidities and relevant medications, the difference in eGFR decline between symptomatic and asymptomatic hyperuricemia was not statistically significant (p = 0.162)
Conclusions: Among patients with CKD stage 3–4, kidney function trajectories did not differ significantly between symptomatic and asymptomatic hyperuricemia (p = 0.162). These findings underscore the ongoing uncertainty regarding the impact of asymptomatic hyperuricemia on CKD progression and highlight the need for targeted studies to guide management.