The Journal of Prapokklao Hospital Clinical Medical Education Center

Clinical Quiz

Wasit Kanokwongnuwat — Thu, 13 Jun 2024 00:00:00 +0700

A 65-year-old woman with breast cancer came for a bone scan for initial staging. She was injected with 20 mCi of Technetium-99m MDP (methylene diphosphonate) intravenously. She was scanned 2 hours after the injection with planar images. SPECT/CT (single photon emission computed tomography/computed tomography) at the thoracic spine and pelvic bones was done at the end of the study. The planar images showed focal increased uptake at the T7, which was suspected of bone metastasis. Another focal lesion at the right sacroiliac joint was compatible with degenerative change. Soft tissue uptake at the left anterior chest wall was in keeping with primary breast cancer. There is no suspicious osteolytic or osteoblastic lesion in the CT suspected of bone metastasis at the T7. However, the appearance of a vertebral hemangioma is seen as a vertical trabecular pattern referred to as “corduroy cloth,” which is most clearly seen on a lateral view. On an axial view, a vertebral hemangioma presents as sparse thickened hyperdense trabeculae and appears as “polka-dot”. Therefore, the T7 lesion suggests vertebral hemangioma, rather than bone metastasis. Overall, the patient had no evidence of bone metastasis in this scan.

Myofascial pain syndrome VS Sahastara remedy

Panupong Sanasit, Surasak Im-iam — Thu, 13 Jun 2024 00:00:00 +0700

Sahastara remedy 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 Sahastara remedy consists of 21 medicinal plants, Indications for reducing muscle pain. Myofascial pain syndrome is a challenging condition for both patients and physicians. Many peoples have experienced of muscle pain at some time of their lives, regardless of gender, age, or economic status, which should receive to prevent, management and treatment that symptom.

Editorial

Assoc.Prof.Pipat Kongsap — Thu, 13 Jun 2024 00:00:00 +0700

Oral Health in Patient with Metabolic Syndrome

Nattapat Khongsirisombat, Kampol Rattinthiwanon — Thu, 13 Jun 2024 00:00:00 +0700

The current lifestyle changes and inappropriate food consumption behaviors may lead to oral health problems and metabolic syndrome, a crucial risk factor for heart and vascular diseases, as well as type 2 diabetes. Previous studies have highlighted the relationship between metabolic syndrome and its components with oral health. Therefore, emphasizing the importance of oral health care is essential for individuals with metabolic syndrome. The objective of this article is to review the literature related to oral health in patients with metabolic syndrome and the components of metabolic syndrome. This review aims to provide insights into promoting and caring for comprehensive health for individuals within this group.

Critical Analysis Report: Effectiveness of Glaucoma Drainage Device Implant Surgery in Glaucoma Patients Treated in Ratchaburi Hospital

Supaporn Trakanwitthayarak — Thu, 13 Jun 2024 00:00:00 +0700

The objective of this academic paper is to analyze and report the treatment results in terms of both the efficacy and safety of glaucoma drainage device implant surgery. To reduce intraocular pressure in glaucoma patients and to analyze the problems and obstacles in the operation. In this example, the surgery for glaucoma patients was done by inserting a glaucoma drainage device implant directly in the eyes in Ratchaburi Hospital. It was found that choosing the right glaucoma patients, the treatment involves surgical insertion of a glaucoma drainage device implant into the eyes and having good control of intraocular pressure. This surgery reduces the use of eyedrops to decrease intraocular pressure and reduces complications from eyedrops. In the operation, there are some problems and obstacles that can lead to continuous development in the future.

Assessing the Efficacy of Artificial Intelligence in Left Ventricular Function Screening Using Parasternal Long Axis View Cardiac Ultrasound Video Clips

Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: Echocardiography serves as a fundamental diagnostic procedure for managing heart failure patients. Data from Thailand's Ministry of Public Health reveals that there is a substantial patient population, with over 100,000 admissions annually due to this condition. Nevertheless, the widespread implementation of echocardiography in this patient group remains challenging, primarily due to limitations in specialist resources, particularly in rural community hospitals. Although modern community hospitals are equipped with ultrasound machines capable of basic cardiac assessment (e.g., parasternal long axis view), the demand for expert cardiologists remains a formidable obstacle to achieving comprehensive diagnostic capabilities. Leveraging the capabilities of Artificial Intelligence (AI) technology, proficient in the accurate prediction and processing of diverse healthcare data types, offers a promising alternative for addressing this prevailing issue. This study is designed to assess the effectiveness of AI in evaluating cardiac performance from parasternal long axis view ultrasound video clips obtained via a smartphone application.

OBJECTIVES: To evaluate the effectiveness of AI in screening cardiac function from parasternal long axis view cardiac ultrasound video clips obtained through a smartphone application.

METHODS: The authors developed a smartphone application that could be used to collect parasternal long axis view video clips and use artificial intelligence “Easy EF” to evaluate cardiac function. Out of 923 samples that were evaluated for LVEF by certified cardiologists, 739 clips were used to train AI, while the remaining 184 clips were used to test whether AI could process the results correctly. Artificial intelligence aims to classify cardiac function into three groups: Reduced EF, Mildly Reduced EF, and Preserved LV.

RESULTS: Out of 184 test video clips, AI achieved 96% classification results. The proposed AI was able to classify Reduced EF with 97% accuracy (36 from 37 clips), Mildly Reduced EF with 71% accuracy (12 from 17 clips), and Preserved LV with 97% accuracy (129 from 131 clips) P=0.0147. Overall accuracy was 96.2% (177 from 184 clips).

CONCLUSIONS: Artificial Intelligence in the form of “Easy EF” has been demonstrated to be promising screening tool for the assessment of cardiac function from parasternal long axis video clips. However, further development is needed, particularly to enhance accuracy in the Mildly Reduced EF group.

ClinicalTrials.gov Identifier, NCT06330103

Factors Related to Residential Hygienic Household Management Behavior in Bangsai Sub-district, Mueang Chonburi District, Chonburi Province

Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: In Chonburi Province, there was a high increase in the number of households from 2019 to 2021, which resulted in a corresponding increase in the number of healthcare problems in residential areas. These problems could have been prevented through more effective residential healthcare management and appropriate residential healthcare management behaviors.

OBJECTIVES: The objective of this research was to study the factors related to hygienic household management behavior in Bangsai Sub-district, Mueang Chonburi District in Chonburi Province.

METHODS: This was a quantitative research that studied the factors related to hygienic household management behaviors among those living in Bangsai Sub-district, Mueang District in Chonburi Province from July 2022 to February 2023. Samples comprised 170 household representatives who were selected by the multi-stage sampling method. The research equipment included questionnaires used to collect data concerning general information, perceived severity of inappropriate residential household healthcare management, health motivation for residential hygienic household management, and residential hygienic household management behavior.

RESULTS: The research found that residential hygienic household management behavior was positively related to the number of housekeepers (r=0.26, p<0.001) and the number of people in the household (r=0.162, p=0.04). Further, the length of host stay was negatively related to residential hygienic household management behavior at a significant level (r=-0.21, p=0.007). In addition, residential hygienic household management behavior was significantly related to perceived susceptibility of inappropriate residential healthcare management (r=0.30, p<0.001), perceived severity of inappropriate residential healthcare management (r=0.31, p<0.001), perceived benefit of appropriate residential healthcare management (r=0.36, p<0.001), perceived barriers to inappropriate residential healthcare management (r=0.44, p<0.001), and internal motivations (r=0.68, p<0.001) as well as external motivations (r=0.21, p=0.006).

CONCLUSIONS: The number of people in a household, number of housekeepers, length of host stay, health belief model and health motivation were found to be significantly related to residential hygienic household management behavior. The results from this research should be beneficial in guiding disease prevention through more effective residential household healthcare management behaviors.

Effectiveness of Health Literacy and Activity Development to Promote Quality of Life in the Elderly Based on the Principle of Sufficiency Economy Philosophy in Chanthaburi Province

Nattaphat Janchai, Yoonsic Kim, Pakkarawat Sitthikoson — Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: Thailand is becoming an aging society with more than 28% of the population due to deteriorating health. Elderly people therefore have more physical needs such as proper eating, emotional support and exercise. Most elderly people feel that their self-esteem has decreased significantly. This causes instability, irritability, and depression, resulting in increased dependency.

OBJECTIVES: This research aimed to examine the quality of life of the elderly covering all dimensions. Evaluate health intelligence. Develop activities to promote quality of life. Experiment with activities to promote the quality of life, and Evaluate activities to promote quality of life according to the Sufficiency Economy Philosophy.

METHODS: This participatory action research included qualitative research method and the development of activities allowing the elderly to participate. The experimental activities were evaluated using Health Literacy and Activity Development Program (HLaADP), while data collection tools include in-depth interviews, health literacy assessment form, satisfaction assessment form and WHOQOL quality of life assessment. Data were analyzed using paired sample t-test.

RESULTS: The findings revealed the majority of the elderly had a very good level of health knowledge (76.7%), but the disease prevention scores showed that most still had incorrect health care behaviors regarding infectious diseases at a poor level (73.3%). The health knowledge scores of the elderly after the activity was higher than health knowledge before the activity with a statistical significance of 0.05 (p<0.001), and quality of life was at a good level (23.3%). The mental health score, environment and social relationships were at 100 percent.

CONCLUSIONS: The results of the quality-of-life level after participating in the activity were at a good level than before the activity with a statistical significance of 0.05 (p<0.001) and the highest level of satisfaction of average 4.7. It is shown that Health Literacy and the development of activities to promote the quality of life of the elderly through community participation based on the philosophy of sufficiency economy is consistent with the context of the community in many ways. To enable the elderly to be sustainably self-reliant and create self-esteem for the elderly, health literacy should be promoted to improve the elderly's self-care in communicable and non-communicable diseases to develop their potential in taking care of their own health Sustainable.

Factors Associated with Sub-Target Dose of Renin-Angiotensin Blockage among Chronic Heart Failure with Reduced Ejection Fraction Patients

Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor-neprilysin inhibitors (ARNIs), or angiotensin receptor blockers (ARBs) are recommended by the guidelines for all patients with chronic heart failure with reduced ejection fraction. However, in real-world data, most patients are unable to achieve the targeted dose of these medications. In Thailand, there has been no study conducted on the factors associated with sub-target doses of ACEIs/ARBs/ARNI.

OBJECTIVES: To analyze the factors associated with heart failure with reduced ejection fraction patients who have received sub-target doses of ACEIs/ARBs/ARNI among the Thai population.

METHODS: This retrospective cohort study was conducted in Trat and Phrapokklao Hospitals from January 2016 to December 2020. Out-Patient Clinic medical records of those with heart failure with reduced ejection fraction were reviewed using case record forms. Thirteen factors were analyzed by logistic regression to determine the association with the sub-target dose group.

RESULTS: A total of 396 patients were included in this study, and 289 patients were treated with the sub-target dose. After adjusting all factors, it was found that NYHA class III/IV was associated with the sub-target dose (odds ratio 1.75, 95%CI 1.06-2.88, p = 0.03). Receiving over 50% of the target dose of Beta-blockers was the protective factor (odd ratios 0.37, 95%CI 0.23-0.61, p<0.001).

CONCLUSIONS: NYHA class III/IV was the factor that increased the risk of receiving the sub-target dose; however, receiving ≥50% of the target dose of Beta-blockers was the factor that decreased the risk. Furthermore, both of these factors were variable.

ClinicalTrials.gov Identifier, NCT06382571

Factors of Control Hypertension or Non-insulin-dependent Diabetes Mellitus Type 2 on The Severity of Stroke and Survival Rates Within 1 year in Trat Province

Panuwat Soponlertpong, Nisarat Pirompak, Panussada Phianlum, Nuntinee Hanpon — Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: The situation of non-communicable disease groups is a leading health problem in the world. For the situation in Thailand, an increase in the number of new diagnoses and death cases among stroke patients was found from 2017-2022. For the situation in Trat Province, it was found that the sickness rates tended to be stable. As for the death rate per 100,000 people from stroke, there was a continuous upward trend. Therefore, a research project was organized to study the factors for control of diseases (hypertension or non-insulin-dependent diabetes mellitus type 2) concerning the severity of strokes and survival rates during 1 year, which could be used as information for future patient care.

OBJECTIVES: To study the factors that influence the severity of strokes and correlate them with survival rates within 1 year in Trat Province.

METHODS: This was a retrospective analytic cohort study. Data were collected using a Case Record Form (CRF) to record information from a total of 291 cases involving hypertension and non-insulin-dependent diabetes mellitus type 2 patients who entered the stroke treatment system at Trat Hospital during the year 2022. Data were analyzed by Chi-square statistics to test the relationship of NCD control with the severity of strokes. The Kaplan-Meier Curve was used to test the hypotheses for comparing survival rates using Log-rank test statistics.

RESULTS: It was found that the patients had good control of hypertension, which resulted in reduced severity of strokes. However, there was little to no effect on the patient's survival rate in one year. Controlling type 2 diabetes and hypertension in type 2 diabetes patients did not affect the severity of strokes or the survival rates of patients over a period of 1 year.

CONCLUSIONS: The patients with hypertension control will find the first-time severity of the stroke to be lower than the uncontrolled groups.

ClinicalTrials.gov Identifier, NCT06288269

Development Model of Fall Prevention among Elderly People in Khon Kaen Province

Rungtong Vacharanukulkieti, Wanakorn Tabandu, Nittaya Termkaew — Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: The elderly are at a significantly increased risk of falls, and there is currently no clear model for preventing falls among the elderly.

OBJECTIVES: 1) To study the situation of falls among the elderly, and 2) to develop and study the effectiveness of fall prevention models for the elderly.

METHODS: This study used a research and development (R&D) approach in 4 phases. Phase 1 involved studying the situation of falls among 330 elderly by randomly selected, while Phase 2 created fall prevention models for the elderly. Phase 3 investigated and developed the fall prevention models among the elderly, and Phase 4 involved experimentation and evaluation using both experimental and control groups, with each comprising 30 individuals. The research tools used in the study included 1) a questionnaire concerning the factors related to falls among the elderly, 2) a focus group discussion guide, 3) self-assessment of the ability to perform daily activities, 4) a mini-mental state examination –Thai version, 5) a Thai falls risk assessment test (Thai-FRAT) developed for community-dwelling Thai elderly, and 6) a questionnaire concerning the perceptions and fall prevention behaviors of the elderly.

RESULTS: The fall prevention model for the elderly consists of 1) analyzing the problem jointly, 2) promoting health literacy regarding falls among the elderly, 3) organizing health promotion activities within elderly clubs, and 4) supporting budgets and resources for fall prevention among the elderly. It was found that the overall perceived risk of falls and prevention behaviors among the elderly in the experimental group had significantly higher average scores than the control group (p<0.01).

CONCLUSIONS: The study results indicate that the process of developing a fall prevention model for the elderly is advantageous and can effectively enhance fall prevention among the elderly.

Weaning of Mechanical Ventilator Success in Patients with Brain Injuries: A Systematic Review

Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: The use of invasive mechanical ventilation in patients brain injuries helps treat life-threatening conditions. Long-term usage of the invasive mechanical ventilator, however, will result in poor outcomes such as ventilator-associated pneumonia (VAP).

OBJECTIVES: To summarize knowledge regarding successful weaning from invasive mechanical ventilation in patients with brain injuries.

METHODS: The systematic review of literature had a sample consisting of research conducted on successful weaning from mechanical ventilation in patients with brain injuries by searching for keywords according to the PICO principle from 2018–2023. The research tools included an appraisal form and a data extract form developed by the Joanna Briggs Institute with a critical appraisal checklist for descriptive research form. The results yielded 7 studies meeting the inclusion criteria, for which the results cannot be compared. Therefore, a content summary was used to summarize the knowledge obtained from the systematic literature review.

RESULTS: The results showed that weaning success in patients with brain injuries placed on an invasive mechanical ventilator was evaluated based on level of consciousness, ability to cough, swallow, and reductions in the quantity of sputum along with daily assessment of readiness for weaning from mechanical ventilation, self-breathing exercises, assessment of readiness to wean, and record of weaning.

CONCLUSIONS: The conclusions that correspond with the research analyzing weaning success in patients with brain injuries placed on an invasive mechanical ventilator are that weaning reduces the duration of mechanical ventilation, length of stay in the ICU or hospital, and pulmonary complications.

The Development of a Service System for Tuberculosis Inmates Following the STOP TB Program in the Central Prison of Samut Prakan Province

Wee Rojanasiraprapa — Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: Bang Bo Hospital provides treatment services for prisoners at Samut Prakan Central Prison. Despite these efforts, there have been ongoing tuberculosis outbreaks in 2021-2022. As such, it is crucial to investigate the current situation and the development of the service system, as well as the effectiveness of such systems in caring for prisoners with tuberculosis.

OBJECTIVES: This study aims to assess various situations and needs of the service system required to care for tuberculosis patients. The goals are to develop a service system for prisoners with tuberculosis and to evaluate the outcomes of the service system in accordance with the STOP TB program at Samut Prakan Central Prison.

METHODS: This research and development project consisted of three phases. Phase 1 involved analyzing the current situation through questionnaires distributed to prisoners diagnosed with tuberculosis and interviews with all professionals involved in prisoner care. Phase 2 focused on developing a service system using the AIC process in collaboration with multidisciplinary professionals, followed by a trial and feasibility study of the system. Phase 3 involved evaluating the program by measuring score levels before and after participation.

RESULTS: The results indicate that the STOP TB service system requires further development in areas such as disease screening procedures, treatment, telemedicine, and tool maintenance. The multidisciplinary team expressed high feasibility in using the program (49.7±4.6). Post-trial, the experimental group exhibited significantly higher average scores in knowledge about tuberculosis, self-efficacy, and adherence to the tuberculosis treatment plan compared to pre-trial scores (p<0.001). Additionally, the knowledge and self-efficacy levels of the experimental group were significantly higher than those of the control group (p<0.05). Overall program development satisfaction among the multidisciplinary team was high, at 90 percent.

CONCLUSIONS: The operation of the service system for prisoners with tuberculosis according to the STOP TB program meets its objectives and can be effectively utilized to care for prisoners in collaboration between host hospitals and Samut Prakan Central Prison.

Thaiclinicaltrials.org number, TCTR20240406004

Factors Related to Family as Centered Role of Caring Group of Children Allergic to Major Food Allergens

Kulyaporn Cheypho, Sipana Pummarak, Yupa Phopa, Pantipa Chatchatee — Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: A food allergy is a particular immunological reaction of the body to certain proteins in food the occurs by producing antibodies. It was shown that the age group with the highest prevalence of allergies was youngsters between the ages of 5 and 12. Seafood, dairy products, eggs and wheat flour were the food groups that triggered the greatest allergic reactions. In providing care for newborns with food allergies, the family is crucial.

OBJECTIVES: To study the healthcare behaviors of children with food allergies and the top eight allergies of the family. Factors that correlate with the role of family-centered care in the care of children with food allergies in the top eight allergens group are: Perceived severity of food allergies, perception of the risk of food allergies, recognizing the duration of illness, elements of a mobile application and the role of the family in care. The top eight allergies need to be identified and properly treated.

METHODS: This study uses a cross-sectional design to examine variables related to the role of the family in providing for children with the eight major food allergens. One hundred families with children who had food allergies made up the sample group. The researcher developed a questionnaire to gather data, which included the following topics: components of mobile applications, risk perception of illness duration, perceived severity of food allergies and the role of families in providing care for children with food allergies. Included in the questionnaire were the eight main types of food allergies, as based on health belief patterns.

RESULTS: The average score of caregiver perceptions of the risk of food allergies was found to be high (X̄=21.7), while the perceptions of the caregivers on the severity and duration of food allergies were found to be moderate (X̄=17.0). A high level of a variety of mobile application elements (X̄=14.8), a moderate level of illness (X̄=5.7) and a high level of the role of families with children with food allergies (X̄=82.6) were observed. The predictive elements correlation analysis results are related to the role of families whose children have severe food allergies. Out of all the categories, mobile application components have the strongest correlation (r=0.50), while all four characteristics might predict how a family will handle food-allergic children (27.4 percent of the time).

CONCLUSIONS: The findings of this study offer guidance on the care of children with food allergies in the family. Public health professionals ought to inform teachers, school nurses, families and communities regarding the severity of food allergies and the length of each type of allergy. There are mobile applications that provide first aid and dietary recommendations.

Iron Status Assessment among Hospitalized Patients with Acute Upper Gastrointestinal Bleeding

Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: Data on iron status assessment and iron deficiency anemia (IDA) prevalence in acute upper gastrointestinal bleeding (UGIB) are limited.

OBJECTIVES: In this study, we aimed to investigate iron status assessment and prevalence of IDA and its associated factors in patients with anemia hospitalized for acute UGIB.

METHODS: We retrospectively reviewed the medical records of patients with endoscopically confirmed UGIB who were admitted between January 2016 and December 2019 and presented with anemia upon admission. The outcomes were iron status measurement and IDA incidence. A logistic regression model was used to determine the factors affecting outcomes.

RESULTS: Among the 867 patients, 180 (20.8%) were evaluated for iron status. Of these patients, 108 (60.0%) had IDA. Factors of iron status assessment were ischemic heart disease (adjusted odds ratio [aOR] 3.88, p=0.001), non-steroidal anti-inflammatory drug use (aOR 1.56, p=0.03), traditional medicine use (aOR 2.84; p=0.01), and mean corpuscular volume (MCV) <80 fL (aOR 1.52, p=0.03), however, older age (aOR increased 0.984 for every 1 year; p=0.01), variceal bleeding (aOR 0.14; p<0.001) and AIMS65 score >2 (aOR 0.69, p=0.002) were intervening factors for iron status assessment. Female sex (aOR 2.69, p=0.05) and MCV <80 fL (aOR 2.00, p=0.04) were independent risk factors for IDA, but diabetes mellitus was a protective factor for IDA (aOR 0.32, p=0.001).

CONCLUSIONS: Iron status assessment among patients with acute UGIB and anemia was low, while the incidence of IDA was high. Our results indicate the importance of evaluating iron status and factors associated with IDA to improve the management of anemia secondary to acute UGIB.

ClinicalTrials.gov Identifier, NCT06299007

Factors Associated Bone Flap Resorption Following Pediatric Autologous Cranioplasty in Kalasin Hospital

Supachai Srichantha — Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: Children account for roughly 4.1% of TBI-related deaths. The most frequent surgery is a decompressive craniectomy (DC) followed by a cranioplasty (CP), which involves a high rate of surgical complications.

OBJECTIVES: This study aimed to assess the risk factors for bone flap resorption (BFR).

METHODS: A retrospective analysis was conducted at Kalasin Hospital, Thailand, utilizing 22 patients who underwent CP with autologous bone flaps from October 2020 to May 2023. Data were collected utilizing medical records and CT brain scans. Data were analyzed by mean and standard Deviation (SD) or median and Interquartile range (IQR) and compared by Fisher’s exact test and Mann-Whitney U test.

RESULTS: Using an autologous bone flap, 22 patients were enrolled in the trial. The mean age was 15±4 years. The most frequent reason for DC was TBI. The median time between DC and CP was 90 days (80-137). The median bone flap size was 73 cm² (49-122). Surgical complications were experienced by 3 patients (13.6%), with the most frequent complications being BFR (13.6%), which required repeat surgical intervention, implant dislodgement (4.5%), and hydrocephalus (9.1%); one patient required a VP shunt. It was observed that large bone flaps (p=0.04), bone flap size larger than 115 cm² (p=0.02), and contusional hemorrhage at first admission (p=0.006) were associated with a higher rate of BFR.

CONCLUSIONS: Because of the patient's financial situation and cosmesis, autologous cranioplasty was primarily performed at our hospital. Therefore, it is important to choose a good patient to avoid BFR. Finally, patients with large bone flaps and contusional hemorrhage should also be monitored closely and persistently to track the BFR.

KEYWORDS: pediatric cranioplasty, autologous cranioplasty, bone flap resorption, complication

Thaiclinicaltrials.org number, TCTR20240609003

Validation of the Ipswich Touch Test for Diabetic Peripheral Neuropathy Screening in Primary Care

Ponlawat Hanchana, Dolnapa Kaewpaitoon, Rangsan Suttiprapa — Thu, 13 Jun 2024 00:00:00 +0700

BACKGROUND: Diabetic foot, a severe complication of diabetes, significantly impairs the quality of life for affected individuals. However, it can be prevented through screening for loss of protective sensation in the foot. Currently, standard screening methods still require specialized equipment and trained medical professionals.

OBJECTIVES: This study aims to assess the accuracy of screening for diabetic peripheral neuropathy by comparing the Ipswich touch test with the 10-g monofilament test in patients diagnosed with type 2 diabetes.

METHODS: This diagnostic study with a cross-sectional design focused on a group of 274 patients with type 2 diabetes who were receiving services at Nong Khantee Sub-district Health Promoting Hospital in Phra Phutthabat District, Saraburi Province. Participants underwent both the Ipswich touch test and the 10-g monofilament test. Statistical analysis included the evaluation of sensitivity, specificity, negative predictive value, positive predictive value, negative likelihood ratio, positive likelihood ratio, and Cohen’s kappa statistic to assess the diagnostic reliability of the Ipswich touch test.

RESULTS: The majority of patients were women, accounting for 64.2%, with an average age of 62.5 years. When compared to the 10-g monofilament test, the accuracy of the Ipswich touch test showed a sensitivity of 73.4%, specificity of 99.0%, positive predictive value of 95.9%, negative predictive value of 92.4%, positive likelihood ratio of 77.11, and negative likelihood ratio of 0.27. The Kappa index, indicating agreement, was 0.79 (p <0.001).

CONCLUSIONS: The Ipswich touch test exhibited good sensitivity, high specificity, and concordance with the 10-g monofilament test, suggesting its potential application for screening diabetic peripheral neuropathy, especially in primary healthcare units where equipment is limited.

ClinicalTrials.gov Identifier, NCT06288555