The Journal of Prapokklao Hospital Clinical Medical Education Center

Prasachandaeng Remedy

Panisara Krongmongkol — 2026-01-22

Prasachandaeng remedy is one of the traditional herbal formulations included in the Thailand National List of Essential Medicines. It consists of twelve medicinal herbs and is traditionally used to relieve fever (toxic fever) and alleviate internal heat and thirst. In addition, pharmacological studies have been conducted on its antipyretic and anti-inflammatory activities through the inhibition of nitric oxide (NO), as well as its antibacterial activity against both Gram-positive and Gram-negative bacteria using a 95% ethanol extract of the Prasachandaeng formulation. Furthermore, its safety regarding liver function has been investigated using Prasachandaeng powder.

Editorial Article

Assoc. Prof. Pipat Kongsap — 2026-01-22

Factors Related to Antibiotic Use Behavior Among Patients Benchalak Hospital Commemorating His Majesty the King’s 80th Birthday, Sisaket Province

Riawfang Saidee — 2026-01-22

BACKGROUND: The overuse of antibiotics is a critical global issue. Not only does the inappropriate use of antibiotics cause adverse drug reactions and unnecessary costs, but it also significantly contributes to the emergence of antibiotic-resistant bacteria.

OBJECTIVES: To investigate the factors, which are associated with rational behaviors pertaining to antibiotic usage, and to identify factors related to behavior among patients at BENCHALAK HOSPITAL COMMEMRATING HIS MAJESTY THE KING’S 80 SISAKET PROVINCE, Thailand.

METHODS: This was a cross-sectional analytical study. The sample group consisted of 249 outpatients, selected through simple random sampling. The data was collected using a researcher-developed questionnaire. Descriptive statistics, means, percentages, and standard deviations, as well as inferential statistics, were employed for the data analysis. Multiple logistic regression analysis was conducted on the relationship between personal factors and knowledge factors related to the behaviors encompassing antibiotic usage.

RESULTS: The results revealed that the majority of participants had exhibited a moderate level of knowledge about antibiotics (51.0%), a moderate level of attitude toward antibiotic usage (59.4%), and reasonable antibiotic use behaviors related (50.6%). Furthermore, the factors found to be significantly associated with antibiotic usage behaviors (p<0.05) were composed of age (p<0.001), income (p<0.001), and the patients’ knowledge of antibiotics. (p=0.007)

CONCLUSIONS: Consequently, it is essential to continuously promote knowledge and understanding to the public regarding the appropriate use of antibiotics. Such efforts can help to foster behavioral changes toward rational antibiotic use and can contribute to reducing the long-term risk of antimicrobial resistance.

Thaiclinicaltrials.org number, TCTR20250828004

The Effect of Palliative Care on the Life Sustaining Treatment in End-of-Life Care of Cancer Patients

Natchanok Suetrong — 2026-01-22

BACKGROUND: In the terminal stage of cancer, patients frequently experience severe symptoms that require palliative care to manage distressing conditions effectively. However, evidence on the effects of palliative care on the utilization of life-sustaining treatments among hospitalized cancer patients at the end of life in Thailand remains limited.

OBJECTIVES: To compare life-sustaining treatment utilization and associated charges between patients receiving palliative care versus usual care and to examine the association between advance care planning and end-of-life life-sustaining treatment decisions.

METHODS: This retrospective study included 181 cancer patients aged 18 years and older who died at Queen Savang Vadhana Memorial Hospital between January 1, 2023, and January 1, 2025. The patients were divided into two groups: 87 cases received palliative care, and 94 cases received standard care. Data were analyzed using descriptive and inferential statistics.

RESULTS: The patients in the palliative care group demonstrated significantly reduced utilization of life-sustaining treatments and lower associated charges (p=0.006 and p=0.033, respectively). Advance care planning was significantly associated with avoidance of mechanical ventilation and cardiopulmonary resuscitation (CPR) (p<0.001 for both interventions); however, no significant association was observed with central venous catheter insertion (p=0.062). Additionally, the collaborative palliative care group had a significantly lower rate of hospital readmissions within the three months before death (p<0.001).

CONCLUSIONS: Palliative care reduces mechanical ventilation and CPR use, thereby decreasing end-of-life healthcare charges. Furthermore, advance care planning promotes alignment of treatment with patient preferences and values.

Thaiclinicaltrials.org number, TCTR20250914003

Effects of Music Therapy on Anxiety, Relaxation, and Vital Signs among Patients Undergoing Lower Extremity Surgery Under Spinal Anesthesia

Nalinrat Pumyanwantana — 2026-01-22

BACKGROUND: Spinal anesthesia is a type of regional anesthesia in which the patient remains conscious, often leading to anxiety, especially during orthopedic surgery, where the sound of surgical instruments can intensify stress and affect vital signs.

OBJECTIVES: This study aimed to examine the effects of music therapy on patients’ average anxiety levels, relaxation, and vital signs undergoing lower limb orthopedic surgery under spinal anesthesia.

METHODS: This quasi-experimental study used a control and an experimental group. Seventy patients were recruited and divided into two groups of 35 each. The experimental group listened to self-selected music during surgery, while the control group received standard nursing care. Anxiety levels were assessed using the Visual Analogue Scale for Anxiety (VAS-A) before and after surgery. Relaxation and vital signs were also measured. Data were analyzed using independent t-tests and Chi-square tests.

RESULTS: The results revealed that the experimental group had significantly lower average anxiety scores than the control group (p<0.001). Although the relaxation level was higher in the experimental group, the difference was not statistically significant (p=0.06). The mean arterial pressure and respiratory rate were significantly lower in the experimental group (p=0.003 and p=0.012, respectively), while there was no significant difference in heart rate(p=0.67).

CONCLUSIONS: Overall, music therapy effectively reduces anxiety, promotes relaxation, and encourages the regulation of vital signs in patients undergoing surgery under spinal anesthesia.

Thaiclinicaltrials.org number, TCTR20250901002

Comparing Glycemic Outcomes Between a Family Medicine–Led Modified NCD Clinic and a General Practice Clinic: A Retrospective Cohort Study

Baramee Barameethavorn — 2026-01-22

BACKGROUND Type 2 diabetes remains a significant health issue in Thailand, with many patients failing to achieve optimal glycemic targets and facing increased risks of complications. In 2022, Queen Savang Vadhana Memorial Hospital launched a Modified NCDs clinic led by family medicine physicians. This “one-stop” service model focuses on comprehensive management, personalized counseling, and care continuity, differing from the conventional general practice (GP) clinic in staffing structure, patient load, and follow-up approach.

OBJECTIVES: This study aimed to compare glycemic outcomes, measured by HbA1c, between patients managed at a Modified NCDs clinic and those at a GP clinic.

METHODS: This retrospective cohort study included 152 adult patients (85 from the Modified NCDs clinic and 67 from the GP clinic) with type 2 diabetes who received continuous care every three months from April 1^st, 2023, to March 31^st, 2024. Clinical and laboratory data, including demographics, comorbidities, treatments, complication screening, and HbA1c, were extracted from medical records.

RESULTS: Baseline characteristics, including age, sex, and comorbidities, were similar between the two groups. Glycemic control (HbA1c, FBS) showed no overall significant difference, except that the Modified NCDs clinic used more oral diabetes medications than the GP clinic. There was a significantly greater proportion of patients in the Modified NCDs clinic who achieved controlled HbA1c levels (49.4% vs. 31.3%, p=0.025) and also had a substantially higher rate of diabetic complication screening, retinopathy (97.7% vs. 79.1%, p< 0.001), nephropathy (91.8% vs. 74.6%, p=0.013), and neuropathy (81.1% vs. 0%, p< 0.001).

CONCLUSIONS: A family medicine–led, integrated NCD clinic achieved superior long-term glycemic control and a higher rate of diabetic complication screening compared with a GP clinic. These findings highlight the potential benefits of one-stop, holistic, and continuous care in improving diabetes management outcomes within the family medicine framework.

Thaiclinicaltrials.org number, TCTR20251117007

Comparative Study of In-Hospital Mortality in ST-Segment Elevation Myocardial Infarction (STEMI) Patients between Obese and Non-obese Groups

Phutharet Chaturonrutsamee — 2026-01-22

BACKGROUND: The impact of obesity on clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) remains unclear. This study aimed to compare demographic characteristics, procedural features, and in-hospital as well as 30-day outcomes between obese and non-obese STEMI patients.

METHODS: This retrospective cohort study included patients with acute ST-segment elevation myocardial infarction (STEMI) who presented within 12 hours of symptom onset and underwent primary percutaneous coronary intervention (PCI) at Rayong Hospital between 2023 and 2024. Patients were categorized into either non-obese or obese groups based on body mass index (BMI). Collected data included demographic characteristics, clinical presentation, coronary lesion characteristics, and procedural details.

RESULTS: A total of 418 patients were included (235 non-obese and 183 obese). The non-obese group was older and had higher mortality both during hospitalization (11.9% vs. 5.5%, p=0.023) and at 30-day follow-up (13.2% vs. 6%, p=0.015). In multivariable logistic regression, cardiogenic shock and respiratory failure requiring intubation were the strongest predictors of mortality, significantly increasing the risk of both in-hospital and 30-day mortality (OR 12.242 and 6.963; OR 9.488 and 5.129, respectively; p<0.001).

CONCLUSIONS: Although obesity was associated with lower in-hospital and 30-day mortality in the univariate analysis, this relationship did not persist after adjustment for covariates in the multivariable logistic regression. The findings suggest a protective trend consistent with the ‘obesity paradox,’ but do not support obesity as an independent predictor of survival.

Thaiclinicaltrials.org number,TCTR20250926001

Trends in the Application of Telehealth in Pediatric Medication Management: Roles and Challenges of Professional Nurses in Primary Care – An Integrative Review

Chutima Nilphet — 2026-01-22

BACKGROUND: Digital transformation and communication innovations have propelled the worldwide adoption of telehealth services, enhancing healthcare accessibility. Pediatric medication management, however, remains a vulnerable area due to children’s higher risk of medication errors compared to adults. Primary care nurses play a central role in promoting safe medication use, yet they face resource limitations and challenges in community follow-up.

OBJECTIVES: This study aimed to explore the role of primary care nurses in implementing telehealth for pediatric medication management, analyze trends in its adoption, identify challenges, and synthesize policy recommendations to improve effectiveness and medication safety.

METHODS: An integrative review was conducted using Whittemore and Knafl’s framework. Literature was retrieved from both international and Thai databases between 2020 and 2025, with quality appraisal guided by the Joanna Briggs Institute (JBI) criteria. A total of 15 eligible articles were included, encompassing quantitative, qualitative, and mixed-method studies.

RESULTS: Telehealth applications were classified into teleconsultation, telemonitoring, and telepharmacy. These approaches reduced medication errors, improved treatment adherence, and supported the management of chronic diseases in children. Telehealth also enhanced nurses’ digital competencies and professional roles. However challenges remained in infrastructure, data security, and caregiver readiness.

CONCLUSIONS: Telehealth has excellent potential for pediatric medication management by reducing errors, improving quality of life, and strengthening the role of primary care nurses. Achieving sustainable implementation requires investing in infrastructure, establishing legal standards, and developing digital skills among healthcare providers and caregivers.

Thaiclinicaltrials.org number, TCTR20251225002

Social and Health Determinants of Oral Health-Related Quality of Life among Thai Older Adults: A Multidimensional Cross-Sectional Study

Nattapat Khongsirisombat — 2026-01-22

BACKGROUND: Oral health-related quality of life (OHRQoL) is an important component of overall well-being in older adults. In the context of Thailand’s aging society, problems such as tooth loss and chewing difficulties persist. Simultaneously, research studies on social, health, and psychosocial determinants in the context of Thai older adults remain limited.

OBJECTIVES: To examine the oral health, functional, and psychosocial determinants associated with OHRQoL among Thai older adults.

METHODS: A cross-sectional study investigated 421 Thai older adults aged 60 years and above in Ang Thong Province. Data collection involved structured interviews using questionnaires and oral examinations. Key variables such as demographics, general and oral health status, oral health behaviors, masticatory function (CUMI), and aging perception (Thai AAQ-SF) were analyzed using binary and multivariate linear regression techniques to identify the key determinants of OHRQoL (OHIP-14 Thai).

RESULTS: Participants had a mean age of 70.4 years (SD=7.2), and 70.3% were female. The mean OHIP-14 score was 5.46 (SD=7.8). Physical pain was the most frequently reported domain. Three factors showed significant associations with poorer OHRQoL: eating difficulties, avoiding group meals, and lower masticatory function scores (all p<0.001), whereas a more positive perception of aging was associated with better OHRQoL. The multiple linear regression model identified the significant determinants of OHRQoL scores (p<0.001) and explained 32.3% of its variance (adjR²=0.323).

CONCLUSIONS: Masticatory function and psychological well-being are important contributors to OHRQoL among Thai older adults. The findings emphasize the need for integrated, multidisciplinary strategies that can promote oral health and enhance quality of life in the aging population.

Thaiclinicaltrials.org number, TCTR20251116003

A Study of Absenteeism, Presenteeism, and Common Mental Health Problems among Back-office Workers in a University Hospital

Phakanat Ritkarjorn — 2026-01-22

BACKGROUND: Back-office workers provide critical support in healthcare settings. Given their various responsibilities, they are at risk for mental health issues that can negatively affect their work.

OBJECTIVES: To examine the factors associated with absenteeism, presenteeism and common mental health problems, including depression, anxiety, and stress, among back-office workers at a medical school.

METHODS: A cross-sectional study was conducted among 290 back-office employees at a medical school. Participants completed standardized questionnaires, including the Depression, Anxiety, and Stress Scale (DASS-21), and the absenteeism and presenteeism sections of the Health and Work Performance Questionnaire (HPQ). Test-retest reliability was assessed using intraclass correlation coefficients (ICC), and multivariable linear regression was applied to identify associated factors.

RESULTS: ICC values for absenteeism and presenteeism ranged from 0.471 to 0.814, indicating moderate to good reliability. Most participants were female (77.6%), with a mean age of 37.7 years. Depression was significantly associated with lower work performance, as measured by absolute (β=-0.53, p<0.001) and relative presenteeism (β=-0.25, p=0.044). Stress was also positively associated with relative presenteeism (β=0.24, p=0.020).

CONCLUSIONS: Depression appears to be a key mental health factor negatively impacting work performance, especially presenteeism, among back-office workers at a medical school. These findings highlight the importance of mental health support to improve productivity at academic institutions.

Thaiclinicaltrials.org number, TCTR20251219003

Efficacy of Resilience Quotient Compared to Mindfulness-Based Brief Intervention in Reducing Stress among Personnel at Phrapokklao Hospital

Theeraphong Tunakh — 2026-01-22

BACKGROUND: Uncontrollable stress requires medical attention as it can lead to fatigue, burnout, reduced work efficiency, and an increased risk of depression. It can also impair quality of life, weaken immunity, and contribute to chronic diseases.

OBJECTIVES: To compare the effectiveness of Resilience Quotient (RQ) training and Mindfulness-Based Brief Intervention (MBBI) in reducing stress among hospital personnel.

METHODS: The authors conducted a randomized controlled trial among 88 volunteers who were randomly assigned to either the RQ group (n=44) or the MBBI group (n=44). Both interventions were delivered with a 1-month follow-up. Stress resilience, stress index, heart rate variability, and fatigue index were assessed using biofeedback.

RESULTS: The RQ group showed a greater increase in stress resilience compared with the MBBI group (9.2 ± 18.4 vs. 1.3 ± 18.1; p=0.047). The stress index decreased significantly more in the RQ group (−10.9 ± 22.7 vs. −0.2 ± 2.4; p=0.029). Heart rate variability increased in both groups (4.3 ± 10.7 vs. 0.5 ± 9.8), but the difference was not significant (p=0.074). The fatigue index decreased in the RQ group (−4.1 ± 26.7) but increased in the MBBI group (+3.3 ± 26.2), with no significant difference (p=0.190).

CONCLUSIONS: RQ training is more effective than MBBI in improving stress resilience and reducing stress levels and fatigue, with a tendency to enhance heart rate variability.

Thaiclinicaltrials.org number, TCTR20250319018

Incidence and Risk Factors of Congenital Hypothyroidism Among Newborns Delivered at Phrapokklao Hospital: A 7-year Retrospective Study

Thapana Roonghiranwat — 2026-01-22

BACKGROUND: According to the national newborn screening program of Thailand, all infants are required to undergo blood screening for congenital hypothyroidism. However, no prior data have been collected on this population in Chanthaburi Province, resulting in a lack of baseline information for local healthcare planning and service development.

OBJECTIVES: To determine the incidence and perinatal factors associated with congenital hypothyroidism among infants born at, or referred for initial screening to, Phrapokklao Hospital between 2015 and 2022, and to follow affected infants for at least three years in order to evaluate treatment outcomes as either transient or permanent.

METHODS: This retrospective cohort study was conducted using newborn, maternal, and follow-up data. Descriptive statistics and Pearson’s Chi-square test were applied, with statistical significance set at p<0.05.

RESULTS: Among 29,967 screened infants, 72 were diagnosed with congenital hypothyroidism, yielding an incidence of 1:416. Factors significantly associated with the condition included gestational age less than 37 weeks, birth weight under 2,500 grams, the presence of congenital anomalies, particularly Down syndrome, and maternal hypertension. Follow-up for at least three years showed that 22 infants had transient hypothyroidism, whereas in 16 cases, the condition was permanent, highlighting the importance of an effective follow-up system.

CONCLUSIONS: The incidence of congenital hypothyroidism at Phrapokklao Hospital was higher than that reported in other studies, likely due to its role as a tertiary referral center for high-risk pregnant woman and newborns. Therefore, effective screening, appropriate clinical care, and close follow-up are essential to prevent long-term adverse developmental outcomes.

Thaiclinicaltrials.org number, TCTR20250505005

Comprehensive Measures for Prevention and Control of COVID-19 Outbreak in Factories in Thailand

Hansa Ruksakom — 2026-01-22

BACKGROUND: The coronavirus 2019 pandemic has impacted health and the economy in Thailand, especially in factories, during 2021-2022. Suitable measures for use in the factories with no high investment or stopping of manufacturing process operations were required.

OBJECTIVE: This study aimed to develop and provide comprehensive measures for implementation in factories to prevent and control the COVID-19 outbreak in Thailand with no high investment or stopping of manufacturing process operations.

METHODS: An action research study was undertaken using four steps as follows: 1) Review measures and COVID-19 situation analysis; 2) design and development of measures; 3) implementation of measures; and 4) monitoring and evaluation concerning the application of the new measures. This research was conducted from May 2021 to December 2022, which proceeded with a short field study in purposive sampling voluntary factories in Bangkok (19 factories) and Tak Province (2 factories), pilot integration in Ayutthaya Province, and then implementation in factories in Thailand.

RESULTS: The ″Measures of Bubble and Seal for Factories (MBBSF)" include comprehensive measures for factories, which apply the epidemiological principles of early detection, early control, and consideration for balancing economic recovery. The measures consist of two programs comprising 1) a prevention program for the factories that are COVID-19-free, and 2) a control program for the factories experiencing COVID-19 based on three levels of COVID-19 outbreak, including 1) low-level control (COVID-19 prevalence < 10 per cent); 2) moderate-level control (COVID-19 prevalence ≥ 10 per cent); and 3) high-level control (at least two out of three criteria, i.e., the COVID-19 prevalence > 10 per cent, cases among more than 100 workers, and factories continually found cases in 14 days out of 28 days). After implementing and evaluating the MBBSF at factories, it was found that factories could adapt the MBBSF to their factory contexts for the prevention and control of COVID-19 outbreaks.

CONCLUSION: The MBBSF can prevent and control COVID-19 outbreaks without the need to stop manufacturing process operations. These measures may be applicable to emerging infections for workers’ occupational health. Lessons learned, and a value-based evaluation should be conducted in future studies.

Thaiclinicaltrials.org number, TCTR20260110001