The Journal of Prapokklao Hospital Clinical Medical Education Center

Editorial Article

2025-11-14T15:29:32+07:00

Parental Acceptance of Behavior Management Techniques Used at the Pediatric Dental Clinic, Faculty of Dentistry, Western University, Pathum Thani Province

2025-09-03T16:41:39+07:00

BACKGROUND: Parental knowledge and attitudes toward child-rearing and pediatric dental treatment have evolved over time, requiring behavior management approaches in dental clinics to adapt accordingly. Techniques that were once widely accepted may no longer be suitable in the current context.

OBJECTIVES: This study aimed to evaluate parental acceptance of pediatric dental behavior management techniques used by the Pediatric Dental Clinic, Faculty of Dentistry, Western University, and to examine whether parental demographic factors affect their acceptance.

METHODS: Participants completed an online questionnaire via Google Forms, which consisted of two sections. Section 1 gathered demographic information, including parental age, education level, monthly income, and prior experience with dental treatment. Section 2 assessed parental acceptance of five behavior management techniques. Namely-Tell-Show-Do, Voice Control, Active Restraint, Passive Restraint, and Parental Presence/Absence. Each technique was presented with a brief explanation, illustrative photographs, and a video clip.

RESULTS: The results showed that most parents rated all five techniques as “highly acceptable.” Tell-Show-Do received the highest acceptance score, while Voice Control received the lowest acceptance score. Among the demographic factors, only parental age showed a statistically significant correlation with the acceptance of Passive Restraint. Parents aged 41-59 and those 60 years and older were significantly less accepting of the technique than parents aged 20-40. Meanwhile, other personal factors had no influence on the acceptance of behavior management techniques.

CONCLUSIONS: In conclusion, parental acceptance varied among behavior management techniques. Tell-Show-Do was the most accepted technique, while Voice Control was the least accepted. Parental age was found to significantly influence acceptance of Passive Restraint

Thaiclinicaltrials.org number, TCTR20250624004

Development of a Health System for the Management of Colorectal Cancer in Sakaeo Province

2025-07-23T21:23:00+07:00

BACKGROUND: Colorectal cancer is the third most common form of cancer in Sakaeo Province, Thailand. However, most patients fail to seek treatment until the advanced stages, leading to increased morbidity and mortality rates. Key challenges include shortages of FIT kits, long waits for colonoscopy, poor follow-up, and low awareness.

OBJECTIVE: To develop a colorectal cancer management system in Sakaeo Province aimed at improving service efficiency, comparing knowledge, perception, and behavior before and after intervention, and assessing the coverage of screening and diagnostic services.

METHODS: This participatory action research (PAR) employed a mixed-methods approach based on the Health Belief Model (HBM). The research was conducted in five phases comprising problem identification, system development, implementation, evaluation, and lesson learned. Participants included 45 stakeholders and 400 at-risk individuals aged between 50–70 years, selected through stratified random sampling. Data were collected via pre and post intervention questionnaires, in-depth interviews, and a focus group. Quantitative data were analyzed using a paired samples t-test, while qualitative data were analyzed through content analysis.

RESULTS: The developed system significantly improved knowledge scores (from 7.88 to 11.10), perception scores (from 51.4 to 57.3), and behavior scores (from 23.4 to 24.1), all with statistical significance (p<0.0001). Screening coverage via FIT increased from 65.42% to 80.33%, while colonoscopy coverage rose from 65.31% to 71.29%.

CONCLUSIONS: The development of a Health System for the Management of Colorectal Cancer in Sakaeo Province effectively enhanced knowledge, perception, and health-seeking behavior. It also increased screening and diagnostic coverage. These improvements are expected to facilitate early cancer detection, timely treatment, and better health outcomes. Key success factors included annual planning, proactive community health worker engagement, and multi-channel communication. Long-term follow-up is recommended along with continued collaboration with the Provincial Service Plan Committee, Cancer Division.

Thaiclinicaltrials.org number, TCTR20250811006

Patient’s Fear and Anxiety Related to Dental Radiography at the Radiology Clinic, Western University

2025-07-05T21:10:18+07:00

BACKGROUND: Fear and anxiety have been linked to behaviors related to the avoidance of dental visits, which may lead to impaired oral health and poor oral health-related quality of life. Intraoral radiography, which is often the first procedure patients receive after oral examination, could impact such fear and anxiety.

OBJECTIVES: To evaluate the severity and prevalence of dental fear and anxiety from intraoral radiography and its influencing factors.

METHODS: Data were collected between 7 January and 28 February 2025 via a questionnaire consisting of 3 parts, including part I for general information, part II concerning past experience (5-level Likert scale), pain, dental fear and anxiety (visual analog scale), regarding intraoral radiography, and part III concerning the number of images taken and time consumed. All independent variables were examined for their effects on patients’ fear and anxiety related to dental radiography via multiple linear regression at a confidence level of 95%.

RESULTS: The samples included 110 patients, consisting of 33 males (30%) and 77 females (70%). Pain during intraoral radiography was at 2.2±2.5 points. Dental fear and anxiety, regarding intraoral radiography, was at 0.8±1.8 points. Pain was the only positive influencing factor to dental fear and anxiety (p=0.015).

CONCLUSIONS: Pain had a statistically significant influence on dental fear and anxiety. Training to achieve non-traumatic radiographic skill is crucial to decrease patients’ fear and anxiety for better acceptance of subsequent treatments.

Thaiclinicaltrials.org number, TCTR20250731016

Effectiveness of Low-dose Intravenous Dexmedetomidine in Preventing Shivering in Total Knee Arthroplasty under Spinal Anesthesia: A Randomized Controlled Trial

2025-08-04T09:32:42+07:00

BACKGROUND: Shivering is a common complication during anesthesia that causes discomfort, interferes with vital sign monitoring, and increases the risk of perioperative myocardial infarction.

OBJECTIVES: To evaluate the effectiveness of low-dose dexmedetomidine in preventing shivering during spinal anesthesia in elderly patients, and to observe its other side effects.

METHODS: This randomized controlled trial was conducted with 80 patients aged 55–85 years with ASA physical status I-II who underwent total knee arthroplasty under spinal anesthesia. Patients were randomly assigned into two groups of 40 each. The intervention group received 10 micrograms of dexmedetomidine diluted in 10 ml of normal saline, whereas the control group received 10 ml of normal saline at the same infusion rate via the intravenous route. During the operations and in the recovery room, shivering was recorded, vital signs were monitored, and other side effects were observed.

RESULTS: The incidence of shivering in the dexmedetomidine group was seven cases (17.5%), which was lower than that in the control group, with 10 cases (25%), but the difference was not statistically significant (p=0.12). Sedation scores and other side effects also showed no statistically significant differences between the groups.

CONCLUSIONS: Low-dose dexmedetomidine showed a preventive effect on shivering during spinal anesthesia in elderly patients, but the difference was not statistically significant.

Thaiclinicaltrials.org number, TCTR20250712001

Comparison of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) between Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis Alone Versus Combined with Mechanical Thrombectomy at Chonburi Hospital

2025-09-15T11:13:47+07:00

BACKGROUND: Research suggests that a higher Alberta stroke program early computed tomography score (ASPECTS) is associated with better outcomes after recombinant tissue plasminogen activator (rt-PA) treatment, highlighting the important role of early computed tom

ography (CT) brain scans in selecting patients for thrombolytic therapy. In addition, a recent study suggests that adding mechanical thrombectomy can significantly improve outcomes for patients with moderate to severe symptoms and low ASPECTS scores, as it allows for restoration of blood flow in patients who may have a poor prognosis with rt-PA alone.

OBJECTIVES: To compare ASPECTS between acute ischemic stroke patients treated with intravenous thrombolysis alone versus combined with mechanical thrombectomy at Chonburi Hospital, to further develop and improve the treatment for better efficiency.

METHODS: A retrospective cohort of 180 patients with acute ischemic stroke (stroke fast track stroke onset < 4.5 hours) who underwent CT brain scans at Chonburi Hospital. from January 1, 2020 to December 31, 2024, were studied.

RESULTS: The results showed that patients who received rt-PA alone had an ASPECTS of 8.90±1.29 compared to the rt-PA plus thrombectomy group, which had ASPECTS of 8.50±0.93. The sample size was calculated using the STATA program to compare two independent means using power 0.08, significance level 0.05, and a one-sided t-test. The proportion of patients undergoing mechanical thrombectomy to those who received rt-PA alone was 0.3. The National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to assess neurological severity by emergency medicine physicians and neurologists.

CONCLUSION: Pre-treatment CT brain assessment using ASPECTS can help in deciding the appropriate treatment methods for acute ischemic stroke patients (with fast track strokr onset<4.5 hours) and improve patient care.

Thaiclinicaltrials.org number, TCTR20250826005

Comparative Study of the Effectiveness of Screening Guidelines for Patients with Ischemic Heart Disease in Screening for ST Elevation Myocardial Infarction at Samut Prakan Hospital

2025-09-16T10:21:26+07:00

BACKGROUND: ST elevation myocardial infarction (STEMI) is a life-threatening emergency that requires timely diagnosis and treatment. Samut Prakan Hospital revised its screening protocol to enhance diagnostic accuracy and reduce time to care.

OBJECTIVES: To compare the effectiveness of the previous and updated screening protocols for patients suspected of ischemic heart disease in identifying STEMI.

METHODS: This retrospective cross-sectional study analyzed 503 patient records divided into two groups, comprising one group of 252 screened using the previous protocol and another group of 251 using the updated protocol. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and time to EKG were analyzed.

RESULTS: The updated protocol yielded a sensitivity of 90%, specificity of 50%, PPV of 26%, and NPV of 96%, with no statistically significant differences compared to the previous protocol. However, patients under the new protocol had a higher proportion of EKG performed within 10 minutes (49% vs. 46%), and the median time to EKG was reduced significantly from 5 to 4 minutes (p=0.031).

CONCLUSIONS: The updated protocol maintained high sensitivity but demonstrated only modest improvements in specificity and predictive accuracy. Further refinement is necessary to improve the screening process, especially in terms of reducing false positives while maintaining prompt care.

Thaiclinicaltrials.org number, TCTR20250803005

Effects of the GROW Program on Grandparents’ Health Literacy in Promoting Early Childhood Development

2025-07-24T22:20:26+07:00

Background: Developmental problems in early childhood arise from multiple factors. Therefore, strengthening the capacity of caregivers, particularly grandparents, to possess adequate health literacy in promoting early childhood development is essential.

Objective: To examine the effects of the GROW program on grandparents’ health literacy in promoting early childhood development.

Methods: This quasi-experimental study employed a two-group pretest-posttest design. The participants comprised 60 grandparents caring for children aged 0–3 years. The participants were assigned equally to experimental and comparison groups. The experimental group received the GROW program, which applied House’s concept of social support, including informational, instrumental, appraisal, and emotional support to strengthen health literacy based on the Ministry of Public Health’s V-shape framework for 5 weeks. This framework comprises six dimensions including access, understanding, questioning, decision-making, adaptation, and communication. Data were collected using a researcher-developed health literacy questionnaire, validated for content (IOC = 0.93) and reliability (Cronbach’s alpha = 0.91). Descriptive statistics, independent sample t-test, and paired sample t-test were employed for data analysis.

Results: The findings revealed that, after the intervention, the experimental group demonstrated significantly higher mean scores for health literacy in promoting early childhood development, both overall and individual dimensions, compared with pretest scores and with the comparison group (p< 0.05).

Conclusion: The GROW program is effective in enhancing grandparents’ health literacy in promoting early childhood development and can be implemented within families as well as communities to strengthen the capacity of caregiving.

Thaiclinicaltrials.org number, TCTR20250222004

Factors Affecting Mortality From Electrical Injuries in Rural Areas of Thailand

2025-10-08T11:04:36+07:00

Background: Electrical injuries are a significant problem in rural areas of Thailand. These problems result in losses of both lives and medical treatment budgets. Knowledge of the incidence, medical costs, and factors associated with mortality from electrical injuries will help in determining future preventive measures.

Objective: To study factors affecting mortality from electrical injuries, incidence, and medical costs incurred in patients in Chanthaburi Province.

Methods: This was a Retrospective cohort study collecting data from medical records of patients diagnosed with electrical injuries (ICD-10: T75.0, T75.4) and treated at Prapokklao Hospital from 1 January 2015 to 31 December 2024. Factors associated with mortality were analysed using Multivariable logistic regression.

Results: A total of 300 patients were diagnosed with electrical injuries, comprising 250 males (83.30%) and 50 females (16.70%), with a mean age of 31.80 years. The majority resulted from occupational accidents, 159 cases (53.00%). The average medical cost per case was 71,932.10 baht. Nineteen patients died (6.30%). Factors statistically significantly associated with mortality were: burn area greater than 40%TBSA (adjOR=44.74, p=0.017), serum CPK level greater than 1,527 U/L (Adjusted Odds Ratio 12.77, p=0.031), intensive care unit admission (adjOR=25.71, p=0.001), intravenous albumin infusion (adjOR=0.02, p=0.047), and shock within the first 24 hours post-injury (adjOR=20.14, p=0.012).

Conclusion: Electrical injuries in Chanthaburi Province predominantly caused by occupational accidents, particularly amongst middle-aged males, with a mortality of 6.30%. The average medical cost per case was 71,932.10 baht. Factors statistically significantly associated with mortality were: burn area greater than 40%TBSA, serum CPK level greater than 1,527 U/L, intensive care unit admission, intravenous albumin infusion, and shock within the first 24 hours post-injury.

Thaiclinicaltrials.org number, TCTR20250801003

Urgent-Start Peritoneal Dialysis Versus Urgent-Start Temporary Hemodialysis in Advance CKD Stage V in Surin Hospital: A Randomized Controlled Study During the Years 2019-2024

2025-10-27T10:37:45+07:00

BACKGROUND: At present, most patients with end-stage kidney disease require urgent initiation of renal replacement therapy. The majority begin dialysis with a temporary hemodialysis catheter, which carries a high risk of complications. In recent years, there has been an increasing trend toward urgent-start peritoneal dialysis (PD), however, comparative data regarding its safety and outcomes remain limited. Therefore, this study aimed to provide additional evidence in this area.

OBJECTIVES: To compare technique survival outcomes between Urgent-Start Peritoneal Dialysis (PD) versus Urgent-Start Hemodialysis (HD), and to evaluate secondary outcomes including patient survival and complications.

METHODS: This was an open-label randomized controlled trial conducted in patients with end-stage kidney disease at Surin Hospital between 2019 and 2024. A total of 210 patients were randomized to either the urgent-start HD or the urgent-start PD group (105 patients per group) and followed up at 6 weeks and 52 weeks.

RESULTS: The technique survival rate at 6 weeks was 92% in HD group versus 93% in PD group. At 52 weeks, the technique survival rate was 69% versus 66%, showing no significant difference (p>0.05). Six-week mortality was higher in the HD group compared with the PD group (6% vs. 0%), with statistical significance (p=0.029), while 52 weeks mortality did not differ significantly between the two groups (p=0.88).

CONCLUSIONS: Urgent-start peritoneal dialysis demonstrated higher short-term patient survival compared with urgent-start temporary hemodialysis, particularly within the first 6 weeks. Technique survival and overall patient survival at 52 weeks were not significantly different between the two modalities.

Thaiclinicaltrials.org number, TCTR20251016002

Senna

2025-11-13T14:29:35+07:00

Senna has an important chemical compound is anthraquinone, which consists of sennoside A, B, C, D, emodin and rhein. The most popular part used in the treatment of diseases is the leaves and pods. It is used as a laxative in patients with constipation. The form used can be found in a variety of forms, such as leaves and pods to boil drinking water. Grind into a drinking powder or grind into a powder to make capsules. This is more convenient and appropriate for those who use it, it can be said that currently no toxicity in humans. Therefore, senna is safe, suitable for used to relieve constipation.

Roles and Responsibilities of Authors in the Use of Artificial Intelligence (AI) for Academic Publication

2025-11-13T15:19:11+07:00