The Journal of Prapokklao Hospital Clinical Medical Education Center

Ya Ha Rak Remedy

2026-06-08T10:02:57+07:00

The Ha-Rak formula, also known as the Benja-Loke-Wichian or Kaew-Ha-Duang formula, is a traditional Thai herbal remedy documented in various ancient medical texts. According to the Taksila scripture, it is designated as the primary formula for antipyretic. The formula consists of five herbal roots: Capparis micracantha (Ching-chi), Tiliacora triandra (Ya-nang), Harrisonia perforata (Khon-tha), Clerodendrum indicum (Thao-Yai-Mom), and Ficus racemosa (Ma-duea Chumphon). Additionally, this remedy was included in Thailand’s National List of Essential Medicines in 2016. A literature review was conducted using the Scopus and Google Scholar databases to evaluate the pharmacological activities of the Ha-Rak formula. The findings revealed that the formula exhibits anti-inflammatory, anti-viral, anti-bacterial, analgesic, and antipyretic activities. However, most existing research remains in the preclinical stage. Consequently, further investigations into the acute, subacute, and chronic toxicity of the extracts, as well as clinical studies on their therapeutic efficacy, are highly recommended.

Editorial Article

2026-07-15T09:04:28+07:00

Diagnostic Accuracy of the 2019 Traumatic Brain Injury Guideline for Risk Stratification in Predicting Abnormal CT Brain Findings in a Community Hospital Setting

2026-03-26T09:28:58+07:00

BACKGROUND: Traumatic brain injury (TBI) is a common presentation in emergency departments. Selective use of computed tomography (CT) of the brain is crucial, particularly in resource-limited community hospitals. The 2019 Thai TBI Clinical Practice Guideline recommends CT indications based on risk stratification. However, its real-world diagnostic performance remains uncertain.

OBJECTIVES: To evaluate the diagnostic accuracy of the 2019 Thai TBI Clinical Practice Guideline for risk stratification in predicting abnormal CT brain findings among TBI patients in a community hospital.

METHODS: A retrospective study was conducted at Phanom Sarakham Hospital, Thailand, from January to June 2025. Patients aged≥15 years with blunt head trauma who underwent CT brain were classified into five CPG-based categories. Radiologist interpretations served as the reference standard. Proportions of abnormal CT findings, likelihood ratios, and area under the receiver operating characteristic curve (AUROC) were calculated.

RESULTS: Among 276 patients, 95 (34.4%) had abnormal CT findings. Abnormal CT rates increased with severity: 0% (mild low-risk), 33.3% (mild moderate-risk), 28.8% (mild high-risk), 69.3% (moderate TBI), and 90.0% (severe TBI). Positive likelihood ratios ranged from 1.1 to 17.2, while the overall AUROC was 0.61.

CONCLUSIONS: The 2019 Thai TBI Clinical Practice Guideline for risk stratification demonstrates a clear severity-dependent increase in abnormal CT findings but only modest diagnostic accuracy. Low-risk patients were safely identified. However, CT yield among mild TBI—particularly moderate-risk—was relatively low. Further refinement and prospective validation in community hospital settings are warranted.

Thaiclinicaltrials.org number, TCTR20260321008

The Association between Burnout and Metabolic Syndrome among the Staff of a Private Hospital in Songkhla Province

2026-03-13T08:22:40+07:00

BACKGROUND: Hospital staff in private hospitals work under substantial pressure, thus predisposing these individuals to burnout, which may be associated with metabolic abnormalities through chronic stress mechanisms. However, empirical evidence regarding the association between burnout and metabolic syndrome among private hospital staff in Thailand remains limited.

OBJECTIVES: To examine the association between burnout and metabolic syndrome (including its individual components) among hospital staff in a private hospital.

METHODS: A retrospective cross-sectional analytical study was conducted by using secondary data obtained from annual health examinations and burnout assessments of 477 hospital staff. Burnout was evaluated by using the Maslach Burnout Inventory (MBI). Metabolic syndrome was defined according to the Harmonized Definition (2009). Associations were analyzed by using multivariable logistic regression with adjustments for potential confounding factors.

RESULTS: The prevalences of burnout and metabolic syndrome were 15.5% and 24.7%, respectively. No association was observed between burnout and metabolic syndrome (adjusted odds ratio=1.53; 95%CI: 0.86–2.70). Similarly, no association was observed between burnout and any of the five individual components of metabolic syndrome after adjustments for confounding factors.

CONCLUSIONS: Burnout was not associated with metabolic syndrome in the study population. This relationship may be indirect or may require long-term cumulative exposure to chronic stress. Longitudinal studies are warranted to further clarify the underlying mechanisms involved.

Thaiclinicaltrials.org number, TCTR20260122003

The Influence of Health Literacy, the Health Belief Model, and Preventive Practices against Food Poisoning in the Service Area of Phanat Nikhom Hospital

2026-04-21T11:19:40+07:00

BACKGROUND: Food is a fundamental factor directly impacting human health. However, when food is contaminated with pathogens, toxins, or foreign substances, it leads to “food poisoning,” a critical public health issue worldwide. In Thailand, food poisoning can occur acutely and significantly affects the economy, healthcare resources, and the quality of life of consumers. According to the World Health Organization, the primary causes are microorganisms, microbial toxins, chemical contaminants, and natural toxins.

OBJECTIVES: The aim of this study was to investigate the demographic characteristics, Health Literacy, Health Belief Model (HBM) factors, and food poisoning Preventive Practices among residents in the service area of Phanat Nikhom Hospital. Furthermore, the influence of these variables was analyzed.

METHODS: This research is a cross-sectional analytical study. The sample consisted of 354 residents selected through convenience sampling. Data were analyzed using descriptive statistics and multiple regression analysis.

RESULTS: The majority of the participants were female, ranging from working age to early elderly, with primary to secondary education, and low income. Most were the primary food preparers in their households. Although Health Literacy was generally high, both the Health Belief Model and Preventive Practices were at a moderate level.

CONCLUSIONS: Health Literacy and Health Belief Model showed a statistically significant positive correlation with Preventive Practices (p<0.05). Therefore, health education programs should focus on reducing perceived severity and enhancing communication skills to effectively bridge the gap between knowledge and practice. Specifically, interventions should aim to heighten perceived susceptibility by illustrating how even ‘mild’ cases can lead to long-term health complications or economic loss for the family. By enhancing communication skills, residents can more effectively advocate for food safety standards within their households and local markets. Ultimately, focusing on reducing perceived barriers and enhancing self-efficacy will empower residents to manage household hygiene effectively.

Thaiclinicaltrials.org number, TCTR20260327001

Impact of Missed Outpatient Follow-Up on 1-Year Major Adverse Cardiovascular Events in Low-Risk STEMI Patients under a Shared-Care System: A Retrospective Nested Matched Case-Control Study

2026-04-22T09:00:13+07:00

BACKGROUND: ST-elevation myocardial infarction (STEMI) patients with a preserved left ventricular ejection fraction (LVEF≥50%) after primary percutaneous coronary intervention (PCI) are generally considered low-risk; however, major adverse cardiovascular events (MACE) still occur in 10–15% within the first year. In Thailand's Shared-Care system, post-STEMI patients transferred from tertiary to secondary hospitals for follow-up may experience care gaps, with missed appointments representing an unrecognized system-level risk signal.

OBJECTIVES: To evaluate the association between missed outpatient follow-up exceeding 60 days and 1-year MACE in STEMI patients with preserved LVEF under a Thai Shared-Care system.

METHODS: This retrospective, nested, matched case-control study was conducted at Pattaya Bhattamakun Hospital, Chonburi, Thailand (2020–2025). Cases experienced a MACE composite endpoint (cardiovascular death, nonfatal MI, ischemic stroke, unplanned revascularization, heart failure hospitalization) within 365 days post-discharge. Controls were matched by gender and age (±5 years) at variable ratios (1:7–1:10) and analyzed with exact conditional logistic regression. Two multivariable models were constructed: Model 1 (adjusted for diabetes mellitus and IV furosemide within 24 hours, used as a proxy for Killip class) and Model 2 (adjusted for diabetes mellitus).

RESULTS: The matched analysis included 100 patients (10 cases, 90 controls) from a cohort with an overall MACE incidence of 4.9%. Missed follow-up for >60 days was significantly associated with MACE in univariable analysis (OR=8.66, 95% CI: 1.67–44.93, p=0.01) and remained significant after multivariable adjustment (aOR=10.37, 95% CI: 1.75–61.60, p=0.01). Diabetes mellitus was an independent risk factor (aOR=7.08, 95% CI: 1.39–36.13, p=0.02). Complete revascularization within 45 days was protective only in univariable analysis (OR=0.18, 95% CI: 0.05–0.67, p=0.01).

CONCLUSIONS: Missed follow-up in a Shared-Care setting is significantly associated with 1-year MACE in STEMI patients with preserved LVEF. This system-level indicator may support post-STEMI risk stratification and proactive follow-up interventions.

Thaiclinicaltrials.org number, TCTR20260407003

Predictors of Hospital Length of Stay among Patients with Dementia: A Comparison of Ordinary Least Squares and Robust Regression

2026-04-16T09:57:53+07:00

BACKGROUND: Dementia is a major public health concern in aging societies. Patients with dementia frequently experience prolonged and highly variable hospital stays, placing a significant burden on healthcare systems. Conventional statistical approaches, such as Ordinary Least Squares (OLS) regression, may yield biased estimates when applied to clinical data with outliers or heteroscedasticity. Robust Regression offers a more appropriate alternative; however, its comparative performance in psychiatric hospital settings in Thailand remains underexplored.

OBJECTIVES: This study aimed to investigate the factors associated with hospital length of stay (LOS) among patients with dementia and to compare the performance of Ordinary Least Squares (OLS) regression and Robust Regression in a psychiatric hospital setting in Thailand.

METHODS: A retrospective analytical study was conducted using the medical records of 120 patients with dementia admitted to Suansaranrom Hospital between June and October 2025. The variables examined included age, Charlson Comorbidity Index (CCI), Clinical Dementia Rating (CDR), Behavioral and Psychological Symptoms of Dementia (BPSD), and length of stay (LOS).

RESULTS: The mean LOS was 29.3±15.2 days, with 8 outlier cases (6.7%) having a LOS longer than 60 days. OLS regression did not reveal any statistically significant overall relationships among the variables. In contrast, Robust Regression identified age, CCI, and CDR as significant predictors of LOS, with CDR exhibiting the strongest influence. BPSD was not statistically significantly associated with LOS in either analytical method. Furthermore, patients aged 60 years and older were more likely to experience prolonged hospitalization.

CONCLUSIONS: Robust Regression is more appropriate than OLS for clinical datasets containing outliers and heteroscedasticity, providing more reliable estimates of factors associated with LOS among patients with dementia. These findings may support individualized care planning, systematic management of behavioral and psychological symptoms, multidisciplinary collaboration, and the development of community-based preventive strategies aimed at reducing prolonged hospitalization among high-risk elderly patients.

Thaiclinicaltrials.org number, TCTR20260329010

Predictive Factors for Changes in Glomerular Filtration Rate in Pre-Dialysis Chronic Kidney Disease Patients

2026-05-11T08:39:31+07:00

BACKGROUND: Identifying predictive factors for estimated glomerular filtration rate (eGFR) decline is essential for enabling healthcare professionals to implement targeted strategies for delaying renal deterioration and postponing dialysis initiation in chronic kidney disease (CKD) patients.

OBJECTIVE: To examine predictive factors for one-year eGFR change in pre-dialysis CKD patients.

METHODS: A descriptive predictive correlational study using multiple regression analysis was conducted among 103 pre-dialysis CKD patients at the CKD Clinic, Samutprakan Hospital. Data were collected using a personal and medical history record form, a CKD-specific health literacy scale, a health behavior motivation scale, and a self-management behavior questionnaire. Descriptive statistics, Pearson's product-moment correlation, and multiple regression analysis were employed.

RESULTS: Urine protein and total cholesterol were the only statistically significant predictors of one-year eGFR change. The regression model was statistically significant (F=6.480, p<0.001), with urine protein (𝛽=0.584, p=0.005) and total cholesterol (𝛽=0.273, p=0.008) collectively explaining 29.3% of the variance in eGFR change (R²=0.293; adjusted R²=0.248), with higher levels of both being associated with greater eGFR decline.

CONCLUSION: These findings suggest that proteinuria and total cholesterol may be clinically relevant targets for monitoring in pre-dialysis CKD patients. Clinicians may consider integrating closer surveillance of these parameters into routine care, pending confirmation by longitudinal studies.

Thaiclinicaltrials.org number, TCTR20260601007

The Development of a Drug User Care Community-Based Treatment and Extended Care Model: CBTx Model in Chanthaburi Province.

2026-06-02T10:05:10+07:00

BACKGROUND: The drug problem is a serious issue in every country around the world. Drug use among people 15-64 years has increased by 26%. Therefore, community-based rehabilitation for drug users is crucial.

OBJECTIVES: To study the issues, develop a model, and evaluate the effectiveness of a community-based drug user care model in Chanthaburi Province.

METHODS: Research and development, analyzing the appropriateness and feasibility of the model, mean, and standard deviation, analyzing issues in drug user care in the community, using the model before and after receiving the Chanthaburi CBTx Model with the Wilcoxon Signed Ranks Test, setting the statistical significance level at 0.001.

RESULTS: The Chanthaburi CBTx model. Experimental results over a 4-week period showed significant improvements in risk behaviors related to substance use, family involvement, and continuity of care after using the model compared with the baseline (p<.001). The Chanthaburi CBTx Model is highly suitable and feasible for implementation (Mean=4.6, SD=0.4)

CONCLUSIONS: The Chanthaburi CBTx Model can be applied in Chanthaburi Province and has led to changes at the individual, family, and community levels, particularly by reducing risky behaviors, preventing relapse into substance use, and improving the sustainability of continuity of care.

Thaiclinicaltrials.org number, TCTR20250523001

Retrospective Study: Outcomes of Percutaneous Pedicular Screw Fixation VS Conservative Management in Unstable Burst Fracture Patients in Tertiary Care Center in Eastern Thailand

2026-05-26T15:14:21+07:00

BACKGROUND: Nowadays management of patients with thoracolumbar burst fracture who have the Thoracolumbar Injury Classification and Severity (TLICS) score equal to 4 are still controversial.

OBJECTIVE: To determine the outcome of patients who undergo surgical intervention and conservative management.

METHODS: Retrospective study was designed, and fifty patients who had thoracolumbar burst fracture and a TLICS score of 4 between 2023-2025 at Phrapokklao hospital were enrolled. The surgical and non-surgical groups were assigned. The data was collected via previous medical records. Demographic data, time to return to work, visual analog scale (VAS), Cobb angle and anterior vertebral body height loss were all collected. The data was analyzed by multivariable Gaussian linear regression.

RESULTS: The majority of participants were female (56%). The mean age of the patients was 50.7 years old. The most common level of injury was L1 (58%) and the main cause was from falling from heights (74%). The surgical group showed clinical outcomes demonstrating a significant reduction in time to return to work, with an adjusted mean difference of −18.84 days (95% CI: −35.37 to −2.32, p=0.027). A significant reduction in the Cobb angle was also observed, with an adjusted mean difference of −10.67 (95% CI: −14.64 to −6.70, p<0.001). Similarly, anterior height loss was significantly reduced with an adjusted mean difference of −23.16 (95% CI: −29.50 to −16.81, p<0.001). In contrast, there was no statistically significant difference in pain scores at 3 months, as measured by the Visual Analogue Scale (adjusted mean difference = −0.51, 95% CI: −1.66 to 0.63, p=0.37).

CONCLUSION: Surgical management for thoracolumbar burst fracture with a TLIC score equal to 4 resulted in better time to return to work and improve the Cobb angle and anterior vertebral body height loss within a 3-month period of the injury.

Thaiclinicaltrials.org number, TCTR20260316006

Factors Associated with Emergency Department Revisits among Psychiatric Patients with Substance Use Disorders at Thabo Crown Prince Hospital

2026-05-28T14:02:28+07:00

BACKGROUND: Mental health and substance use disorders represent significant public health concerns. Revisits to the emergency department among psychiatric patients with substance use disorders may indicate gaps in the continuity of care, as well as inadequate risk factor management, which can lead to increased burdens on patients, families, and on the healthcare system itself.

OBJECTIVE: To identify the factors associated with emergency department revisits among psychiatric patients with substance use disorders.

METHODS: A retrospective cross-sectional study was conducted using the data from 60 medical records of psychiatric patients with substance use disorders, who had presented at the emergency department. The data was collected from March 2024 to February 2025 using a structured record form, which had been developed for this study and which had a content validity index of 0.89. Descriptive statistics were used to summarize the data. Multiple logistic regression analysis was used to identify the factors that had been associated with the emergency department revisits. The magnitude of association was expressed as adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs).

RESULTS: The findings indicated that being of the female gender (AOR=4.82, 95% CI=1.45-16.03, p=0.011), having had prior emergency department visits within the past 12 months (AOR=7.26, 95% CI=1.38-38.21, p=0.019), not adhering to the medication guidelines (AOR=9.84, 95% CI=2.12-45.67, p=0.003), and being absent from post-discharge follow-up care (AOR=11.53, 95% CI=2.18-61.02, p=0.004) had all been significantly associated with emergency department revisits.

CONCLUSIONS: The factors, which were associated with emergency department revisits among psychiatric patients with substance use disorders, were as follows: 1) being of the Female gender, 2) having had prior emergency department visits within the past 12 months, 3) not adhering to the medication guidelines, and 4) being absent from post-discharge follow-up care.

Thaiclinicaltrials.org number, TCTR20260420009

The Impact of Virtual Patient Simulation on Sixth-Year Medical Student Satisfaction in Neurosurgical Education at Phrapokklao Medical Education Center

2026-05-27T09:52:18+07:00

BACKGROUND: Training in neurosurgery requires extensive practice. Traditional methods have limitations in terms of accessibility and repetition. The use of virtual patient simulation (VPS), therefore, represents a promising alternative that enables students to practice complex procedures in a safe and controlled environment.

OBJECTIVES: To examine the opinions, suggestions, and the impact of virtual patient simulation on medical students’ satisfaction in neurosurgery education.

METHODS: The quantitative component employed t-test and Pearson correlation statistics, while the qualitative component utilized open-ended questions with data analyzed through thematic analysis. The sample consisted of 23 medical students who had used virtual patient simulation.

RESULTS: The one-sample t-test revealed that the mean satisfaction score with the use of VPS (Mean Difference=1.386, SD=0.5) was statistically significantly higher than the moderate criterion baseline of 3 points (t(22) = 12.934, p<0.001). Pearson correlation analysis indicated a statistically significant, strong positive correlation between the overall experience of using VPS and satisfaction with the curriculum (r=0.643, p=0.001). Qualitative findings indicated that VPS effectively simulates patient dynamics and clinical environments, allowing learners to develop critical decision-making and patient management skills in near-realistic scenarios. However, system complexity and technical stability were identified as notable constraints.

CONCLUSIONS: Virtual Patient Simulation demonstrates high potential to enhance the quality of neurosurgery education, particularly for rare or complex clinical situations. To maximize the utility of this technology, future implementation should focus on improving system performance and stability, developing a more user-friendly interface, providing Thai language support, and considering increased user licensing and the development of a self-study version for out-of-hours practice, along with appropriate curriculum integration. This will contribute to the continued development of an effective neurosurgical education system.

Thaiclinicaltrials.org number, TCTR20251212014