The Journal of Prapokklao Hospital Clinical Medical Education Center

Model Development of Professional Nursing Competency by Simulation-Based Learning for Urgent Management of Service Patients in the Outpatient Department, Phrapokklao Hospital

2026-01-15T08:38:31+07:00

Background: The incidence of outpatient deterioration during waiting periods is preventable through effective screening systems, surveillance systems, and the development of nurses' competencies in assessing and managing emergencies. This can be achieved through an appropriate and effective competency development model. The use of simulations enables nurses to practice, experiment, and solve problems in ways that mirror real-world situations, thereby enhancing patient safety.

Objective: To create and assess the effectiveness of a competency development model.

Methods: This was an action research study. The sample included 49 professional nurses and 50 patients. The research was conducted at the outpatient department of
Phrapokklao Hospital from January to December 2025. The research instrument was the professional nurse competency development model, which was approved by three experts and had a validity of 0.7. Data collection instruments included a general information questionnaire, a knowledge assessment scale (reliability 0.9), a competency assessment scale, and a satisfaction assessment scale for professional nurses and patients (reliability 0.9, 1.0, 0.9, respectively). Statistical analyses included percentages, means, and standard deviations.

Results: A professional nurse competence development model using simulation learning was developed. It consisted of three modules, utilizing a rotating role of the attending nurse, followed by a review of events and group discussions. The model results showed that the proportion of knowledge meeting the criteria increased from 65.3% to 93.9%. Competency and decision-making increased from 61.2% to 93.9%, meeting the criteria. Nurse and patient satisfaction were high (M = 4.5, 4.4, respectively). No worsening of the condition was observed after three months of monitoring.

Conclusions: The competency development model enhances nurses' knowledge, skills, and decision-making in emergency management, improving patient safety.

Burnout Syndrome and Work Passion among Thai Nurses: A Study from Bangkok

2026-01-20T09:44:15+07:00

BACKGROUND: Nurse burnout has increased substantially following the COVID-19 pandemic, affecting the mental health and work performance of professional nurses. Work passion, a positive emotional and cognitive state reflecting meaningful professional engagement, may serve as a protective factor against burnout.

OBJECTIVES: This study examined the relationship between burnout and work passion, as well as factors supporting work passion, among professional nurses at Siriraj Hospital, Bangkok, Thailand, during the period from September 2024 to June 2025.

METHODS: A descriptive cross-sectional study was conducted among 363 nurses using a self-administered questionnaire assessing demographic data, burnout, and work passion. Data were analyzed using descriptive statistics, Chi-square tests to examine associations between demographic variables and levels of burnout or work passion. Spearman’s rank correlation coefficient to explore relationships among burnout, work passion, and related subfactors.

RESULTS: Burnout was most prevalent in surgical, obstetric, and internal medicine units. Work passion differed significantly by age and education level, with nurses aged over 40 years and those holding a master’s degree reporting higher levels of passion. Work passion was negatively correlated with burnout (r=–0.296, p<0.01). Factors most strongly associated with lower burnout included autonomy, fairness, work-life balance, psychological support, collaboration, role model, recognition and spirituality.

CONCLUSIONS: Work passion helps mitigate burnout among nurses by enhancing psychological resilience and overall well-being. Promoting fairness, supportive work environments, and meaningful collaboration—particularly in high-acuity units—can reduce burnout and foster long-term professional retention and sustainable, high-quality patient care.

Sustainable Health Services for Hepatocellular Carcinoma Survivors in Thailand: Financial and Social Experiences from a Cross-Sectional Study

2026-01-05T08:26:45+07:00

BACKGROUND: Despite advances in medical treatments that have extended survival among patients with hepatocellular carcinoma (HCC) in many developed countries, significant challenges continue to persist in Thailand, even with the Universal Coverage Scheme.

OBJECTIVES This study aimed to understand the socioeconomic experiences of HCC survivors to inform improvements in national health insurance policies and clinical care.

METHODS: A multicenter cross-sectional survey was conducted at major Thai liver cancer centers. HCC patients attending outpatient clinics were invited to participate and provide information on demographic characteristics, social experiences, financial barriers, perspectives on existing support policies, and the perceived benefits of increased public awareness. Ethical approvals were obtained from all participating centers.

RESULTS: Among the 92 respondents (mean age 62.1±11.5 years; 78.3% male), 65.2% reported that medical expenses influenced their treatment decisions, and 71.7% experienced family-related financial difficulties. Socially, 97.8% felt understood by friends and family, while 47.8% reported that their illness affected personal relationships. Most participants indicated a need for mental support (98.9%), financial assistance (91.3%), and improved public awareness to enhance their quality of life (98.9%).

CONCLUSIONS: Thai HCC survivors face significant financial barriers to access advanced treatments but receive considerable community support. These findings highlight the need to refine Thailand’s health insurance framework to better address the financial and social needs of HCC patients.

Development of a Surveillance System for Fungemia to Assist in Rapid Diagnosis and Treatment to Reduce the Mortality Rate in Nakhon Phanom Hospital

2026-02-16T09:21:50+07:00

BACKGROUND: Fungemia is a severe infection associated with high mortality. Blood fungal cultures require several days to yield definitive results, leading to delays in diagnosis and treatment. Empirical antifungal therapy is therefore essential in patients with suspected fungemia before culture confirmation.

OBJECTIVES: This study compared mortality rates among patients with fungemia before and after the implementation of a surveillance system. Mortality was the primary outcome, while length of hospital stays, medical costs, and treatment complexity were the secondary outcomes.

METHODS: A retrospective cohort study was conducted among hospitalized patients with laboratory-confirmed fungemia at Nakhon Phanom Hospital between January 1, 2017, and December 31, 2024. An integrated surveillance system incorporating laboratory-based alerts, LINE notifications, and ward-based communication was implemented to streamline clinical workflows and facilitate the timely initiation of empirical antifungal therapy within 24 hours after preliminary blood culture results indicated yeast or molds.

RESULTS: A total of 108 patients were included in the analysis, comprising 74 patients in the pre-implementation control period (2017–2022) and 34 patients in the post-implementation intervention period (2023–2024). The intervention group had a significantly lower mortality rate than the control group (38.2% vs. 74.3%; p<0.001). Implementation of the surveillance system was associated with a substantial reduction in mortality, with a hazard ratio of 0.26 (95% CI, 0.13–0.50), corresponding to a 74% reduction in the risk of death.

CONCLUSIONS: Implementation of an integrated surveillance system was associated with reduced mortality in patients with fungemia by enabling earlier detection and timely empirical antifungal therapy. Hospital stay lengths and costs increased, but improved survival highlighted the clinical value of this system-level intervention.

Cost-Effectiveness of Breast Cancer Screening with Mammography and Ultrasound: A Study among Women in Phanat Nikhom District and Network Areas

2026-02-16T08:53:22+07:00

BACKGROUND: Breast cancer rates in Thailand are increasing, with a concerning trend of diagnosis in younger women. Early detection increases the survival rate to 94.4%, with economic evaluation studies required to ensure the efficient allocation of budgets and screening tools across different regions.

OBJECTIVES: This cross-sectional analytical research was integrated with an economic evaluation to assess the cost-effectiveness of breast cancer screening using mammography combined with ultrasound (MMG+US).

METHODS: The study focused on 383 high-risk women aged 40–75 years in Phanat Nikhom District and the Chonburi provincial network. A Decision Tree Model was employed to compare opportunistic screening with systematic MMG+US screening. Outcomes were measured in Life-Years Gained (LYG) and the Incremental Cost-Effectiveness Ratio (ICER).

RESULTS: The sample was mostly (70%) aged between 50 and 69. Screening identified BIRADS 4–5 abnormalities in 8.3% of the participants. The proportion of Stage 0 and 1 breast cancer detected in the screened group was significantly higher than in the non-screened group. Consequently, the average life expectancy for the screened group increased from 19.87 to 23.01 years, representing Life Years Gained (LYG) of 3.14 years. The screening cost was 2,400 THB per person, with an Incremental Cost-Effectiveness Ratio (ICER) of 764 THB per LYG, indicating that, based on Thailand’s current threshold, the program was cost-effective.

CONCLUSIONS: Among high-risk women who underwent MMG+US screening, earlier stage detection (Stage 0–I) was more frequent than expected under opportunistic screening. Economic modeling based on observed stage distribution indicated that MMG+US screening was highly cost-effective within the Thai context. These findings support the targeted use of combined screening in high-risk women, particularly those aged 50 years and older.

Comparison of Propofol-Lidocaine and Propofol-Fentanyl for Total Intravenous Anesthesia during Day-Case Colonoscopy: A Randomized Controlled Trial

2026-02-19T09:04:26+07:00

BACKGROUND: Colonoscopy is generally considered an uncomfortable procedure.

OBJECTIVES: To compare recovery time, intraoperative adverse events, and total propofol consumption between propofol-lidocaine and propofol-fentanyl regimens for day-case colonoscopy.

METHODS: This randomized, double-blind, controlled study was conducted in 60 patients with American Society of Anesthesiologists (ASA) physical status I–II, aged 18–64 years and of either sex. Thirty patients were randomly assigned to each group. The propofol-fentanyl (PF) group received fentanyl 1 µg/kg, whereas the propofol-lidocaine (PL) group received lidocaine 1.5 mg/kg intravenously, followed by induction with propofol 1 mg/kg. Hemodynamic parameters, intraoperative adverse events, total propofol consumption, and recovery time were assessed.

RESULTS: The PL group had a longer recovery time (4.2 (2.5–7.5) vs. 2.4 (2.1–4.4) min; p=0.027), greater total propofol consumption (170 (130–200) vs. (130 (90–180) mg; p=0.005), and longer induction time (67 (54–94) sec vs. 47 (37-66) sec; p=0.002) than the PF group. Adverse events were comparable. The reduction in mean arterial pressure from baseline during the first 7.5 min after induction was significantly less pronounced in the PL group.

CONCLUSIONS: Propofol-lidocaine TIVA was associated with longer induction and recovery times and greater total propofol consumption than propofol-fentanyl, while intraoperative adverse events were comparable between groups. Lidocaine attenuated the severity of hypotension during early induction

Development of Clinical Prediction Score for Failure of Antithyroid Drug Treatment in Graves’ disease Patients

2026-03-19T15:51:14+07:00

BACKGROUND: The current modalities for treatment of Graves’ disease include antithyroid drugs, radioactive iodine ablation, and total thyroidectomy. The patient’s decision depends on clinical characteristics and the patient’s needs. Although long-term antithyroid drug treatment is another choice for patients, nearly half of patients experience failure of antithyroid drug treatment and undergo radioiodine ablation or thyroidectomy.

OBJECTIVES: To develop a clinical prediction score using prognostic factors for failure of antithyroid drug treatment in Graves’ disease patients.

METHODS: The study was a retrospective observational cohort design. 630 Graves’ disease patients at Surin hospital from 2018 to 2025 were reviewed. Important clinical data from multivariable logistic regression were collected to compute the coefficient, which was then transformed into a score.

RESULTS: All 630 Graves’ disease patients were divided into two groups: 306 patients with antithyroid drug failure and 324 patients in remission. The clinical prediction score was developed using five significant clinical parameters, including relapse history, thyroid gland size(≥45 g), thyroid-related orbitopathy, FT4>3.5 ng/dL, and MMI dose at 6^th month ≥ 10 mg/d. The prediction score ranged from 0-7, with a score of 0-4 denoting a low risk (PPV= 38.9%) and a score of 4.5-7 a high risk (PPV=81.3%) for failure of antithyroid drug treatment. The AuROC of the score was 0.78 (95% CI 0.74-0.82)

CONCLUSIONS: Graves’ disease patients who have a clinical prediction score of 4.5-7 have a high probability for failure of antithyroid drug treatment. Physicians should recommend these patients be treated with radioactive iodine or thyroidectomy.

Psychological Well-being of Patients with End-Stage Renal Disease Undergoing Hemodialysis: Concurrent Mixed Methods Design

2026-03-13T10:38:37+07:00

BACKGROUND: Hemodialysis patients face a higher risk of mental health problems compared to the general population. Identifying factors influencing psychological well-being is essential for developing holistic care approaches.

OBJECTIVE: To examine factors affecting psychological well-being and psychological experiences of hemodialysis patients.

METHODS: A concurrent mixed-methods study was conducted with 100 participants for the quantitative component and 15 participants for the qualitative component. Instruments included a demographic and illness data form, the General Mental Well-Being Scale, the Resilience Scale, the Health Locus of Control Scale, and a semi-structured in-depth interview guide. Content validity indices ranged from 0.81 to 1.00, and Cronbach's alpha coefficients ranged from 0.76 to 0.97. Data were analyzed by descriptive statistics, Pearson's correlation, multiple regression analysis, and content analysis.

RESULTS: Resilience, hemoglobin levels, and health locus of control together accounted for 16.9% of the variance in psychological well-being, with resilience emerging as the strongest predictor (b=0.289, 95% CI [0.019, 0.559], p<0.05). Qualitative data synthesis yielded three overarching themes: emotional distress arising from functional limitations and role loss; the psychological transition process from resistance to acceptance; and the role of interpersonal relationships and social support systems.

CONCLUSION: The psychological experiences of patients undergoing hemodialysis are complex and dynamic in nature, evolving across the trajectory of treatment. These findings underscore the need to establish a systematic and continuous psychological well-being assessment framework, alongside effective anemia management strategies, while concurrently fostering resilience among patients throughout all phases of care.

Integrating Primary Health Care Systems between the Provincial Public Health Office and the Chanthaburi Provincial Administrative Organization

2026-03-12T09:11:55+07:00

BACKGROUND: The transfer of primary health care functions in accordance with the Decentralization Act B.E. 2543 (2000) has encountered several challenges, obstacles, and operational limitations.

OBJECTIVE: This study aimed to examine the current situation and to develop integrated guidelines for strengthening the primary health care system between the Provincial Public Health Office and the Provincial Administrative Organization in Chanthaburi Province.

METHODS: A mixed-methods study employing a convergent parallel design was conducted. Quantitative data were collected using structured questionnaires from 342 participants selected through simple random sampling. Qualitative data were obtained from 29 key informants through focus group discussions. Quantitative data were analysed using descriptive statistics (mean and standard deviation) and inferential statistics (ANOVA), while qualitative data were analysed through content analysis. The study was conducted between October 2024 and April 2025.

RESULTS: Quantitative findings significantly supported the qualitative results, revealing statistically significant differences in perceptions between organizations regarding roles and responsibilities, the workforce, and performance indicators (p<0.001). The proposed integration framework emphasized service quality and equitable access for the population through a dual governance structure. Under this structure, the Provincial Public Health Office assumes responsibility for academic oversight and standard setting, while the Provincial Administrative Organization is responsible for operational management. This arrangement operates under clearly defined shared governance mechanisms and aligns with the six components of the health system based on the Six Building Blocks framework, alongside the principles of Primary Health Care.

CONCLUSION: The integrated framework for the primary health care system following decentralization clearly delineates the relationship between regulatory (oversight) roles and administrative (managerial) roles. The application of these findings should consider contextual limitations and local variations to ensure appropriateness and sustainability across different settings.

Treatment Outcomes of Non-Small Cell Lung Cancer Adenocarcinoma in Locally Advanced and Metastatic Stages Following EGFR Mutation Testing from Tissue or Plasma Samples

2026-04-07T10:32:10+07:00

BACKGROUND: Lung cancer is a leading cause of mortality in Thailand. EGFR mutation testing plays a crucial role in guiding targeted therapy selection. However, prolonged turnaround times remain a barrier to timely treatment access.

OBJECTIVE: This study aimed to evaluate 1) Lean process optimization for EGFR mutation testing, 2) access to targeted therapy among lung cancer patients, and 3) treatment outcomes by comparing overall survival (OS) and progression-free survival (PFS) between mutation-positive and mutation-negative groups.

METHODS: This mixed-methods study was conducted in two phases. Phase one involved in-depth interviews with the head of the genomics laboratory staff, integrated with Lean process optimization to reduce testing turnaround times. Phase two comprised a retrospective analysis of lung cancer patients treated at the Prapokklao Cancer Center of Excellence, Prapokklao Hospital, between February 2021 and July 2022. EGFR mutation testing was performed on tissue and plasma samples. Patients were classified by mutation status, and OS and PFS were compared using the Kaplan–Meier method and Log-Rank test.

RESULTS: Lean implementation reduced turnaround times from 21 to 6.1 days for tissue and from 14 to 2 days for plasma. Among 203 patients (60.6% male; 39.4% Stage IIIB, 60.6% Stage IV), EGFR mutations were detected in 57 cases (28.1%), predominantly Ex19Del, L858R, and Ex20Ins. Female sex was significantly associated with mutation-positive status (p<0.001). Of the mutation-positive patients, 73.7% (42/57) accessed targeted therapy within a mean of 33 days. The mutation-positive group showed significantly longer median OS (531 vs. 183 days) and median PFS (149 vs. 98 days) compared with the mutation-negative group.

CONCLUSION: Lean optimization of EGFR mutation testing substantially reduced turnaround times, enabling faster access to targeted therapy and improved survival outcomes, offering a practical model for cancer care in public.

Posaconazole

2026-03-13T08:22:10+07:00

Posaconazole is a triazole derivative antifungal agent available in three formulations: oral suspension, delayed-release tablet, and intravenous injection. It was approved by the United States Food and Drug Administration on September 15, 2006; November 25, 2013; and March 14, 2014, respectively. Clinically, posaconazole is used to prophylaxis of invasive fungal infections caused by Aspergillus spp. and Candida spp. in patients aged 13 years and older. It is also prescribed for the treatment of oropharyngeal candidiasis (OPC), including cases refractory to itraconazole and fluconazole. Posaconazole is a potent inhibitor of the enzyme lanosterol 14α-demethylase, which catalyzes a essential step in ergosterol biosynthesis, thereby inhibiting fungal cell growth.

Editorial Article

2026-04-20T16:18:24+07:00