The Journal of Prapokklao Hospital Clinical Medical Education Center

Editorial Article

Assoc.Prof. Pipat Kongsap — 2024-12-10

External Use Drug of Plai on Muscle Pain

Varinthorn Rompochee — 2024-12-10

External use drug of Plai is a Thai herbal medicine allowed to use for muscular and joint condition for along time. It is also listed in the list of herbal medicines in The Thai National List of Essential Herbal Medicine. The External use drug of Plai remedy consists of 3 medicinal plants, Indications for reducing muscle pain. Muscle pain Problems making it a health problem that can happen to anyone Therefore, it should be prevented, managed and treated before it compromises health

The Development of the Use of PEW Scores to Monitor Children in Critical Condition in Pediatric Wards at Phrapokklao Hospital

Kittima Nuwong — 2024-12-10

BACKGROUND: The Pediatric Early Warning Score (PEWS) is generally applied to patients, who have a wide range of ages. This results in a slow assessment of children in each age group. As a consequence, the symptoms of pediatric patients can deteriorate unexpectedly. For this reason, a new PEWS was created.

OBJECTIVES: To develop the use of the PEWS and to evaluate the effectiveness of the new PEWS in reducing the incidence of unplanned ICU admissions in pediatric patients in the pediatric ward.

METHODS: This research was a quasi-experimental study using The One-Group Posttest-Only Design. The sample group consisted of pediatric patients admitted to the pediatric ward, ranging in age from 7 days to 15 years. These patients were diagnosed by doctors with leukemia, pneumonia, sepsis, and febrile convulsion, with a total 30 cases. Data was collected between November 2022 to January 2023. The tool used in this research was the new PEWS (Pediatric Early Warning Score).

RESULTS: The majority of the sample group was male, with an average age of 3.07 years. Pediatric patients with febrile seizures constituted the highest proportion at 46.7%. The assessment scores showed that 8 patients (26.7%) had shown PEWS of 3-4, following this, 6 patients (20.0%) had shown PEWS of 6. It was also found that 6 patients had been transferred to the Pediatric Intensive Care Unit. From this, it was seen that patients with higher scores necessitate more attention and care compared to other pediatric patients.

CONCLUSIONS: The new PEWS was found to be effective in reducing the incidence of transfers to the pediatric intensive care unit. increase more.

Predictive Factors Associated with In-Hospital Mortality in Acute Myeloid Leukemia Patients after Induction Chemotherapy

Thiraya Akeboonyuen — 2024-12-10

BACKGROUND: Induction chemotherapy is a high-intensive regimen for remission induction among those with acute myeloid leukemia. Outcomes of treatment, complications and mortality rates tend to differ between centers depending on patients’ particular conditions, medical experiences, and resources.

OBJECTIVES: This study aimed to evaluate the factors associated with in-hospital mortality after induction chemotherapy, including complications and 30-day survival rates.

METHODS: This retrospective study included adult patients diagnosed with acute myeloid leukemia who were receiving induction chemotherapy between January 2016 and December 2022. Prognostic factors were analyzed by Cox regression analysis, and survival was analyzed by Kaplan Meier.

RESULTS: Ninety patients with a mean age of 44 were enrolled. Seventy-eight patients (86.6%) received the 7+3 regimen. The average length of hospital stay was 31.8 days, and 19 patients (21%) died during hospitalization within 30 days after chemotherapy. The leading cause of death (89%) was febrile neutropenia. In 47.3% of patients, complications arose due to multidrug-resistant organisms. Lung infection and septicemia were identified in 78.9% and 68.4% of cases, respectively. According to multivariate analysis, lung infection was a predictor of in-hospital death (HR 3.42, p=0.04), while the 30-day survival rate was 78.4%.

CONCLUSIONS: Patients who developed lung infection after induction chemotherapy were associated with 30-day mortality.

Thaiclinicaltrials.org number, TCTR20240810001

Enhancing Maternal Health Outcomes through the "One Province One Labor Room" Model to Reduce Direct and Indirect Maternal Mortality and Morbidity

Angkharn Triniti — 2024-12-10

BACKGROUND: The “One Province One Labor Room” project was initiated in Surin Province in 2015 and has successfully reduced postpartum hemorrhage mortality. However, most maternal deaths from 2018 to 2022 were attributed to medical conditions involving patients referred from network hospitals. Consequently, the care process was further developed to be more comprehensive and efficient.

OBJECTIVES: To develop and evaluate the outcomes of maternal health care through the “One Province One Labor Room” model in reducing direct and indirect maternal morbidity and mortality.

METHODS: This study employed Participatory Action Research (PAR) in four stages, comprising a situational analysis of maternal mortality through multidisciplinary brainstorming, planning and implementing solutions, and monitoring and evaluation, conducted from June 1, 2020 to May 31, 2024. Data analysis included descriptive statistics and comparative statistics using the Chi-square test and Independent t-test.

RESULTS: The development of the consultation and referral system, along with proactive care for high-risk groups through the establishment of a Preconception Care Clinic in collaboration with multidisciplinary teams, led to a significant increase in referrals due to medical conditions from 13 cases (1.6%) to 29 cases (3.5%) (p=0.03). The incidence of severe complications, such as HELLP syndrome, decreased from 7 cases (0.9%) to 1 case (0.1%), while cases of Eclampsia decreased from 4 (0.5%) to 0, both statistically significant (p<0.05). Maternal mortality rates decreased significantly from 9 cases (1.1%) to 1 case (0.1%) (p=0.01), with no postpartum hemorrhage-related deaths.

CONCLUSIONS: The development of the “One Province One Labor Room” system, in collaboration with a multidisciplinary team, significantly reduced maternal morbidity and mortality from both direct and indirect causes.

Thaiclinicaltrials.org number, TCTR20240915001

Depression, Caregiver Burden and Associated Factors among Caregivers of Patients with Serious Mental Illness with High Risk to Violence in Bang Bo Hospital, Samutprakan Province

Piraya Pithathitikul — 2024-12-10

BACKGROUND: The trend of patients with serious mental illness causing a high risk of violence is increasing. Caregivers play a crucial role in caring for these patients and are directly affected by the patients’ illnesses, often resulting in feelings of burden or mental health issues, such as depression.

OBJECTIVES: The aim of this study was to determine the prevalence and factors associated with depression and the feeling of burden among caregivers of psychiatric and drug-addicted patients with serious mental illness leading to a high risk of violence.

METHODS: This study employed a descriptive cross-sectional design. The sample consisted of 106 caregivers of psychiatric and drug-addicted patients with a high risk of violence who were receiving treatment at Bang Bo Hospital. Data were collected using a demographic questionnaire, the Thai version of the Patient Health Questionnaire-9 (PHQ-9), and the Thai version of the Zarit Burden Interview (ZBI). The data were analyzed using descriptive and inferential statistics, and logistic regression analysis.

RESULTS: The prevalence of depression and burden among caregivers were 22.6% and 33%, respectively. Most caregivers with depression experienced mild symptoms (16%), and the majority of those who felt burdened experienced it at low to moderate levels (23.6%). Statistically significant factors associated with caregiver depression included sources of income and frequency of patient relapse. Factors significantly related to caregiver burden included the caregiver’s relationship with the patient, income source, financial sufficiency, negative experiences in caregiving, and patient compliance with treatment.

CONCLUSIONS: Caregivers of patients with serious mental illness and high risk of violence have a higher prevalence of depression and caregiver burden compared to the general population. Mental health professionals should therefore screen caregivers for risk of depression and caregiver burden, provide them with counseling and continuous follow-up, monitor the risk of patient relapse or violent behavior, and offer social support to enhance the quality of life for both the patients and caregivers.

Thaiclinicaltrials.org number, TCTR20240830002

Effectiveness of a Peripheral Intravenous Access Training Program on Nurses’ Self Efficacy and First Insertion Success

Kleddao Chanthateero — 2024-12-10

BACKGROUND: The first insertion success of peripheral intravenous access is a vital role of nurses. A training program on peripheral intravenous catheterization for new undergraduate nurses must be provided to enhance their self-efficacy and skills for this complex procedure.

OBJECTIVES: To explore the effectiveness of a Peripheral Intravenous Access Training Program on new undergraduate nurses’ peripheral intravenous catheterization self-efficacy and first insertion success rate.

METHODS: This one group quasi-experiment used 3-time point measurement over the 1^st, 3^rd, and 6^th months after receiving the program was carried out from June to December 2023. The purposive sampling of 39 new undergraduate nurses were given the program developed based on the relevant literature, which comprised 1) a peripheral intraveous catheterization workshop for 2 days, and 2) on-the-job training at obstetrics, surgery, medical, and pediatric wards for 6 months. New undergraduate nurses’ peripheral intravenous catheterization self- efficacy and the first attempt success rate at the 1^st, 3^rd, and 6^th months were measured. The measurement of 95% confidence interval for the relative rate of the first attempt failure rate at the 1^st and 6^th months and the attributable fraction were also assessed.

RESULTS: The results showed statistical significance in terms of the increasing of new undergraduate nurses’ self-efficacy scores for peripheral intravenous catheterization (p<0.001). The first attempt insertion success rates at the 1^st, 3^rd, and 6^th months were 87.7% 93.7% and 97.0% respectively. The first attempt insertion failure rate at the 1^st month was significantly higher than at the 6^th month (12.3% and 3.0%, respectively), and the relative rate of the first attempt failure was 4.1 times (95%CI 1.86-8.85). The attributable fraction was 75.6%.

CONCLUSIONS: The Peripheral Intravenous Access Training Program can enhance new undergraduate nurses’ peripheral intravenous catheterization self-efficacy and effectively increase the first attempt success rate.

Treatment Outcomes of Diabetic Ketoacidosis Patients

Chayanid Rungtivasuwan — 2024-12-10

BACKGROUND: Diabetic ketoacidosis (DKA) is a serious emergency condition in diabetes patients and is associated with significant complications and mortality. Many affected patients experience prolonged hospital stays. In Thailand, data on the factors associated with the length of hospital stay remains limited.

OBJECTIVES: To assess the factors associated with length of hospital stay, mortality rate and precipitating factor among DKA patients.

METHODS: A retrospective study of DKA patients admitted to Bangbo Hospital from July 1, 2020 to June 30, 2024 was carried out. Various factors were analyzed using logistic regression to identify the predictors of longer hospital stays.

RESULTS: A total of 77 patients were included in the study, with their average age being 49.8 years. The majority of patients were female (61%). The mean length of hospital stay was 7.7 days, and the mortality rate was 5.2%. Multivariate logistic regression showed that community acquired infection was associated with a length of stay ≥7 days (adjusted odds ratio=5.03, 95% CI 1.61-15.71, P=0.005). Infections were the most common precipitating factor (59.7%), followed by poor compliance with treatments (45.5%).

CONCLUSIONS: Infection was found to be associated with a longer hospital stay for DKA. Infection and poor compliance remain the major precipitating factors. A strengthened educational program for preventing infections and raising awareness of diabetes control should be emphasized to reduce complications and mortality.

Thaiclinicaltrials.org number, TCTR20241110006

Renal Function Effect of ARV Combination Regimen Tenofovir/Lamivudine/Dolutegravir and Tenofovir/Emtricitabine/Rilpivirine in HIV Patients

Suchart Jenkriangkrai — 2024-12-10

BACKGROUND: In 2022, Thailand changed its primary antiretroviral therapy (ART) recommendation from Tenofovir disoproxil fumarate/Emtricitabine/Efavirenz (TEEVIR) to Tenofovir disoproxil fumarate/Lamivudine/Dolutegravir (TLD) due to the superior HIV viral suppression efficacy of TLD compared to TEEVIR. Since the regimen change, however, TLD has been found to cause increased creatinine levels. Tenofovir disoproxil fumarateemtricitabine (TENO-EM)+Rilpivirine (RPV) is another antiretroviral regimen that has been used due to its fewer side effects and less frequent elevation of creatinine levels.

OBJECTIVES: To compare the mean changes in the estimated glomerular filtration rate (eGFR) after switching from the original regimen (TEEVIR) to TLD and TENO-EM+RPV at 12, 24, and 48 weeks.

METHODS: A retrospective cohort study of HIV-infected patients who had previously received ART and achieved viral suppression at Maharat Nakhon Ratchasima Hospital from January 2022 to December 2023 was carried out. Data were retrieved from medical records and analyzed for changes in eGFR using Generalized Estimating Equations.

RESULTS: A total of 212 HIV-infected patients visited the outpatient clinic at Maharat Nakhon Ratchasima Hospital, with 78 receiving TLD, and 134 receiving TENO-EM+RPV. The majority were male, with 38 (48.7%) and 71 (53.0%), and the mean ages were 39.4±10.5 years and 39.7±10.2 years in the TLD and TENO-EM+RPV groups, respectively. The mean initial eGFR was 105.1±15.4 mL/min/1.73 m² in the TLD group and 102.6±15.5 mL/min/1.73 m² in the TENO-EM+RPV group. The mean changes in eGFR after switching from TEEVIR to TLD at 12, 24, and 48 weeks decreased by 15.7, 15.1, and 19.3 mL/min/1.73 m², respectively. The decreases in the group that switched to TENO-EM+RPV were 8.9, 7.6, and 11.9 mL/min/1.73 m², respectively. When comparing the mean changes in eGFR between the two groups at 12, 24, and 48 weeks, there were statistically significant differences of 6.8, 7.5, and 7.4 mL/min/1.73 m², respectively.

CONCLUSIONS: HIV-infected patients who switched to either TLD or TENO-EM+RPV experienced a decrease in mean eGFR with both regimens. The TLD regimen resulted in a statistically significantly greater mean eGFR decrease than TENO-EM+RPV.

Thaiclinicaltrials.org number, TCTR202410300006

The Development of Nursing Supervision Model in Nursing care for Sepsis Patients

Wantana Salee — 2024-12-10

BACKGROUND: Unsuitable nursing supervision on sepsis, unclear nursing guidelines and nursing supervision model negatively impact nursing and patient outcomes, leading to increased risk of mortality among patients.

OBJECTIVES: This research and development study aimed to develop a Supervision Model for Nurses to Care for Sepsis patients (SNS), and to examine the effectiveness of the model.

METHODS: This study utilized a research and development design. Samples comprised registered nurses at Phraputthabat Hospital, including 25 nursing supervisors, 50 supervised nurses, and 67 sepsis patients. The experimental instrument was the SNS. Additional instruments included the assessment form for nursing knowledge about sepsis care and the nursing care practice following the sepsis care guidelines, as well as the supervision knowledge assessment form for nurse supervisors and satisfaction with the SNS. These instruments were tested for validity by an expert panel with reliability between 0.80 and 0.90 retrospectively. The research methodology included 3 phases that comprised the situation analysis, the development of the SNS, and the implementation of the SNS. Data were collected from May 1, 2024 to August 31, 2024. Study data were analyzed by using content analysis, frequency, percentage, mean, S.D., Chi-square, and t-test.

RESULTS: After using the SNS, the results showed that the nurse supervisors had average scores for supervision knowledge that were statistically and significantly higher than before using the model (p<0.001). The satisfaction scores of the nurses with the SNS were at a higher level (4.4±0.7). The supervised nurses had average scores for sepsis care knowledge and nursing care following the guidelines of sepsis that were statistically and significantly higher than before using the model (p<0.001). The satisfaction scores for the nurses to the SNS were at a higher level (4.2±0.2). The patient outcomes showed that the complications and patient mortality of the group using the SNS were statistically and significantly lower than the group not using the SNS (p<0.05).

CONCLUSION: The SNS enhances the quality of care and outcomes of sepsis patients.

Thaiclinicaltrials.org number, TCTR20241030011

A Comparison of Cure Rates between the Gufoni Maneuver and the Barbecue Maneuver in Patients with Geotropic Horizontal Canal Benign Paroxysmal Positional Vertigo: A Randomized, Single-Blind Study

Rawiwan Weerawong — 2024-12-10

BACKGROUND: Geotropic horizontal canal benign paroxysmal positional vertigo (HC-BPPV) is usually treated with the Barbecue roll maneuver. However, this method tends to be time-consuming and difficult for patients who are obese, elderly, or have mobility problems. The Gufoni maneuver is thought to be a quicker and easier alternative, though there is no clear data comparing the cure rates of these two methods in Thailand.

OBJECTIVES: To compare the cure rates between the Gufoni maneuver and the Barbecue roll maneuver in Geotropic HC-BPPV, and to compare the side effects of canal switch and severe vomiting after treatment.

METHODS: A randomized, single-blind study was carried out on 40 patients who were assigned treatment by either the Gufoni maneuver (n=20) or the Barbecue maneuver (n=20). The outcomes were assessed at 1 week, 2 weeks and 1 month.

RESULTS: Data from the 40 patients in the study showed that the cure rates were 65% and 55% at 1 week (p=0.75), and 90% and 80% at 2 weeks (p=0.67) for the Gufoni group and Barbecue group, respectively, with 100% of patients cured at 1 month in both groups. No side effects of canal switch or severe vomiting were found after treatment.

CONCLUSIONS: Comparison showed the results between the cure rates of the Gufoni maneuver and the Barbecue maneuver were not statistically significant. However, the Gufoni maneuver was found to be easier, less time-consuming, and involve fewer limitations in patients with difficulty in movement.

Thaiclinicaltrials.org number, TCTR20240703006

Development of Nursing Practice Guideline for Prevention of Unplanned Extubation in the Medicine Department

Sarissa Wongprakod — 2024-12-10

BACKGROUND: Critically ill patients with respiratory failure who require intubation must receive care according to established standards to prevent complications. Figures concerning the incidence of unplanned extubation (UPE) at the Internal Medicine Department of Phrapokklao Hospital exceed the hospital's target of fewer than 2 per 1,000 intubation days.

OBJECTIVES: This study aimed to evaluate the effect of nursing practice guidelines for preventing UPE based on the skills and feasibility of nurses to follow the guidelines in clinical practice.

METHODS: This research was conducted using a research and development (R&D) design. The study included two sample groups comprising 30 registered nurses working in the intermediate care unit, and 46 new patients intubated and ventilated who were admitted to the same unit between May and August 2023. The nursing practice guidelines were developed based on Soukup’s (2000) framework, which consists of three phases: Phase 1 involves identifying clinical problems and reviewing evidence-based literature. Phase 2 involves the implementation of the guideline. Data were collected before and after the implementation using a questionnaire to assess the nurses' skills and the feasibility of preventing UPE. Phase 3 evaluated the implementation process and outcomes, with data analyzed using paired t-tests.

RESULTS: After implementing the nursing practice guidelines to prevent UPE, the sample group showed significantly improved mean scores for nurses' knowledge and skills (t=12.88, df=29, p<0.001 and t=11.34, df=29, p<0.001, respectively). The feasibility of implementing these nursing practice guidelines in caring for patients with endotracheal tubes to prevent UPE was rated at the highest level, (mean=4.59). Additionally, the incidence of UPE decreased significantly (t=6.78, p<0.007).

CONCLUSIONS: Department at hospitals charged with caring for intubated patients with ventilator can use these nursing practices guideline to reduce the incidence of UPE

Thaiclinicaltrials.org number, TCTR20240908009

Clinical Quiz

Porntip Nitikarun — 2024-12-10

Biomimetic Calcium-Phosphate-Based Toothpaste, an Alternative in Modern Oral Care

Chayanuch Angkaew — 2024-12-10

For several decades, dental caries has been one of the most common infectious diseases worldwide, and the use of fluoride toothpaste is widely known as the gold standard for dental caries prevention among both adults and children. Recently, biomimetic calcium-phosphate-based toothpastes, such as hydroxyapatite (HAP), casein phosphopeptide amorphous calcium phosphate (CPP-ACP), and calcium sodium phosphosilicate (CSPS) as an active ingredient in fluoride-free toothpastes, have been developed and become options for dental caries prevention. Since calcium and phosphate are the main components of tooth structure, calcium-phosphate-based molecules enhance remineralization of dental hard tissue, improve enamel surface hardness in early caries lesions, decrease surface roughness of white spot lesions, and reduce dentin hypersensitivity by occluding exposed dentinal tubules. This article aims to review the benefits of calcium-phosphate-based toothpastes in terms of remineralization, treating white spot lesions, antimicrobial effect, and desensitizing hypersensitive dentine. Clinical studies have shown that calcium-phosphate-based toothpaste’s performances in enhancing remineralization were comparable to fluoride-containing toothpaste; for reducing white spot lesions, occluding dentinal tubule and desensitizing sensitive dentine, calcium-phosphate-based toothpaste was superior to fluoride-containing toothpaste, while zinc-carbonate hydroxyapatite (Zn-CHA)-containing toothpaste performed notably in antimicrobial and antibiofilm formation.