Ramathibodi Medical Journal https://he02.tci-thaijo.org/index.php/ramajournal <p>Ramathibodi Medical Journal (RMJ) publishes article on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics. We welcome submissions from authors worldwide.</p> <p>ISSN 0125-3611 (Print)&nbsp;</p> <p>ISSN 2651-0561 (Online)</p> <p>Indexed in:&nbsp;&nbsp;<strong>&nbsp;&nbsp;<a title="ASEAN CITATION INDEX" href="https://www.asean-cites.org/" target="_blank" rel="noopener"><img src="/public/site/images/nuanphan_cha2/aci-logo-v41.png" width="100" height="40"></a>&nbsp; &nbsp;&nbsp;</strong><a title="ศูนย์ดัชนีการอ้างอิงวารสารไทย:Thai Citation Index (TCI) centre" href="https://tci-thailand.org/" target="_blank" rel="noopener"><img title="tci" src="/public/site/images/tci_admin/tci.png" width="86" height="38" border="0"></a>&nbsp;&nbsp; &nbsp;<a title="Crossref" href="https://search.crossref.org/?q=ramathibodi&amp;container-title=Ramathibodi+Medical+Journal" target="_blank" rel="noopener"><img src="/public/site/images/nuanphan_cha2/images.png" width="77" height="50">&nbsp;</a>&nbsp; &nbsp;&nbsp;<a title="Google Scholar" href="https://scholar.google.co.th/citations?user=N7b2p9MAAAAJ&amp;hl=th&amp;authuser=1" target="_blank" rel="noopener"><img src="/public/site/images/nuanphan_cha2/scholar_logo_64dp_(1).png" width="155" height="26"></a></p> Faculty of Medicine Ramathibodi Hospital, Mahidol University, THAILAND en-US Ramathibodi Medical Journal 0125-3611 Editor's Note https://he02.tci-thaijo.org/index.php/ramajournal/article/view/258486 <p style="text-align: justify;">As of June 2022, the Thai Personal Data Protection Act BE 2019 (PDPA) has been effective after delaying for a few years due to the COVID-19 pandemic. However, the excitement and wariness seemed to fade as time passed without apparent enforcement.</p> <p style="text-align: justify;">Many readers may know that the Thai PDPA is aligned with European General Data Protection Regulation (GDPR), which has been effective since 2018. Since then, there have been quite a few cases of GDPR enforcement that we can learn. One recent case is related to journal publication.</p> <p style="text-align: justify;">The case occurred in 2021; a physician was fined €5,000 for publishing a patient's medical records without obtaining that patient’s specific consent. The story is as follows:</p> <p style="text-align: justify;">“The physician downloaded medical records about a patient she treated at a local hospital from the hospital’s online archive system, including images taken during surgery. The physician used these records for a presentation at <br>a medical conference and also included them as documentation supporting a scientific research paper she submitted for a competition hosted by a surgeons’ association. The physician’s paper was ultimately selected as the winner of that competition, resulting in the publication of her work on the association’s website”<sup>1</sup></p> <p style="text-align: justify;">The Italian GDPR supervisory committee found the physician to be guilty with following reasons:</p> <p style="text-align: justify;">1)&nbsp;&nbsp; Lack of valid consent: GDPR and Thai PDPA state that there is an exemption of consent for using patient data for scientific research purposes. However, a case presentation (as well as a case report) is not scientific research. So, the patient’s consent is needed.</p> <p style="text-align: justify;">2)&nbsp;&nbsp; Lack of authorization: Although GDPR and Thai PDPA state that there is an exemption of consent for using patient data for scientific research. The exemption is for the data controller, which is the hospital. So, the physician should have asked permission from hospital authorization to use the patient’s data. However, the physician personally acquired the data without proper authorization.</p> <p style="text-align: justify;">3)&nbsp;&nbsp; Failure to effectively anonymize the data: In GDPR and Thai PDPA, there is a statement that whenever <br>a patient’s data is used, proper de-identification procedures are needed to ensure that there is no direct or indirect identification. However, the physician presented the patient’s initials, age, details of hospitalizations, medical history, and several images from the patient’s surgery. All of this information combined together were considered indirect identification.</p> <p style="text-align: justify;">4)&nbsp;&nbsp; Open dissemination of health data: This is similar to the article in Thai Health Act BE 2007. The physician presented indirect identifiable patient health data at a medical conference and published on website. So, the physician violated both the professional ethical code and GDPR.&nbsp; &nbsp;&nbsp;</p> <p style="text-align: justify;">It is to be noted that the nature of the clinical case report is very similar to this case. Elsevier, a publishing group, also required informed consent for case report publication.<sup>2</sup> To comply with PDPA, after June 1, 2022, RMJ will required patient’s informed consent or Certificate of Ethics Approval (which states that there is proper informed consent) for any case report or case series that would like to be published.</p> <p style="text-align: justify;">&nbsp;</p> Chusak Okascharoen Copyright (c) 2022 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2022-06-27 2022-06-27 45 2 Efficacy of Basic Life Support and Automatic External Defibrillator Educational Program for High School https://he02.tci-thaijo.org/index.php/ramajournal/article/view/243657 <p><strong>Background:</strong> Bystander-initiated cardiopulmonary resuscitation (CPR), the automatic external defibrillator (AED), and rapid activation of emergency medical service have major roles in the chain of survival of out-of-hospital cardiac arrest patients. To integrate the basic life support (BLS) knowledge into the high school curriculum, teachers are the key person.</p> <p><strong>Objective:</strong> To examine the effectiveness of the BLS training program for high school teachers.</p> <p><strong>Methods: </strong>In this prospective study of 146 participants, before and immediately after 2 hours lecture and 3 hours hands-on activity of BLS training program consisting of instruction on CPR, AED, and first aid for foreign body aspiration, written tests were done to assess knowledge while participants’ attitudes were evaluated by a questionnaire survey.</p> <p><strong>Results:</strong> A total of 146 participants, BLS knowledge increased in all parts (early activation, chest compression, and defibrillation increased by 27.3%, 51.3%, and 82.1% with adjusted OR 13.81, 19.08, and 849.47, respectively; <em>P </em>&lt; .001), as well as participant’s confidence increased from 47.6% to 95.8% (adjusted OR, 31.69;<em> P</em> &lt; .001).</p> <p><strong>Conclusions:</strong> BLS training in high school teachers increased both knowledge of chains of survival and confidence.</p> <p> </p> Panvilai Tangkulpanich Natsinee Athinartrattanapong Kathawan Vongchaisaree Copyright (c) 2022 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2022-06-27 2022-06-27 45 2 1 7 10.33165/rmj.2022.45.2.243657 The Effect of Problem–Based Learning on Knowledge in Electronic Medical Records for Registered Nurses https://he02.tci-thaijo.org/index.php/ramajournal/article/view/255724 <p><strong>Background:</strong> The private hospital changed from paper to electronic medical records (EMRs), which were implemented in accordance with international and other relevant requirements. The hospital’s chief of nursing and registered nurses oversee the transition from paper to EMRs.</p> <p><strong>Objective:</strong> To study the effects of problem-based learning (PBL) on the knowledge of EMR for registered nurses.</p> <p><strong>Methods:</strong> This was a quasi-experimental research design. This research assigned the population from the registered nurses of the BNH Hospital, Bangkok, Thailand. There were 128 subjects comprising 64 subjects in the experimental group, and 64 subjects in the control group. Each assigned session was 6 hours with traditional learning and PBL in EMR. The instruments used were multiple-choice questions, case scenarios, and satisfaction questionnaires.</p> <p><strong>Results:</strong> The average score of PBL of the posttest was higher in the experimental group compared to the control group, with statistically significant differences (mean [SD], 38.91 [1.84] and 27.13 [2.50] points, respectively; <em>P</em> &lt; .05). Overall, the satisfaction level of PBL was strongly satisfied (mean [SD], 4.55 [0.50] points).</p> <p><strong>Conclusions:</strong> This study found that PBL resulted in registered nurses being more involved in learning EMR than in traditional learning and having a good satisfaction with learning.</p> <p> </p> Kanpitchanon Sanngoen Vorawan Vanicharoenchai Tripop Lertbunnaphong Copyright (c) 2022 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2022-06-27 2022-06-27 45 2 8 16 10.33165/rmj.2022.45.2.255724 Effectiveness of a Weight Loss Program on Body Mass Index and Adipose Tissue of Overweight People https://he02.tci-thaijo.org/index.php/ramajournal/article/view/249011 <p><strong>Background:</strong> Overweight and obesity have a negative impact on health. Adipose tissue is the most accurate indicator of obesity.</p> <p><strong>Objective:</strong> To study the effectiveness of a weight management program by comparing body weight and adipose tissue before and after joining the program.</p> <p><strong>Methods:</strong> A weight control program of the personnel of the Faculty of Medicine Ramathibodi Hospital, Mahidol University, was organized. It consisted of 1) individual counseling, 2) monthly healthy cooking group activities, 3) 3-day weekly exercise group activities, and 4) LINE group communication. The data were collected by a body composition measure and were analyzed, using descriptive statistics and paired <em>t</em> test statistics.</p> <p><strong>Results:</strong> A total of 78 participants had lower mean body weight after participating in the program than before participating in the program with significantly statistical implication (mean [SD], 64.8 [13.01] and 66.6 [13.09] kg, respectively; <em>P</em> &lt; .05), and had lower mean adipose tissue than before participating in the program with significantly statistical implication (mean [SD], 34.6 [6.93] and 35.5 [6.97] % of body weight, respectively; <em>P</em> &lt; .05).</p> <p><strong>Conclusions:</strong> The weight control program which focused on individuals and group activities as well as group communication was effective, enabling the participants to promote health behavior to better control weight.</p> <p> </p> Wasana Srisuk Preeya Leelahagul Jutarath Pataragesvit Copyright (c) 2022 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2022-06-27 2022-06-27 45 2 17 27 10.33165/rmj.2022.45.2.249011 Gastric Granulocytic Sarcoma as a Localized Blastic Crisis in a Patient With Polycythemia Vera https://he02.tci-thaijo.org/index.php/ramajournal/article/view/253353 <p>Granulocytic sarcoma is a tumor of immature granulocytic cell that can be found at any organ outside the bone marrow. It has been rarely reported and most cases are associated with leukemia. This report presented a case of granulocytic sarcoma originating from the stomach of a polycythemia vera patient. He was a 66-year-old Thai patient who passed melena for many times in 2 days. Two years prior this presentation, he had been diagnosed as having polycythemia vera and treated with occasional phlebotomy and hydroxyurea. The gastroscopy showed multiple sessile polyps at gastric body of which the pathology showed diffuse infiltration by myeloblasts; the tumor cells diffusely marked with LCA, CD34, CD117, sparsely marked with MPO, compatible with blastic phase of myeloproliferative neoplasm. The diagnosis of gastric granulocytic sarcoma or localized blastic transformation at the stomach with underlying polycythemia vera was concluded.</p> <p> </p> Likhasit Sanglutong Somchai Insiripong Copyright (c) 2022 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2022-06-27 2022-06-27 45 2 52 57 10.33165/rmj.2022.45.2.253353 Long COVID Care for Older Adults in Community After COVID-19 Infection: A Case Study https://he02.tci-thaijo.org/index.php/ramajournal/article/view/255733 <p>Patients with the coronavirus disease 2019 (COVID-19) infection, had signs and symptoms that can last for 6 to 7 months or more after recovery from acute phase. Long COVID referred to physical and mental symptoms persist for more than 12 weeks after acute phase. Common physical symptoms include fatigue, muscle weakness, shortness of breath, cough, joint pain, chest pain, and cognitive dysfunction. Common mental symptoms include post-traumatic stress disorder (PTSD), depression, anxiety, and insomnia. This article presented a case study of long COVID care for the older adults in community after COVID-19 infection, a 76-year old Thai male living in a community. The results showed that the patient who had the long COVID symptoms including muscle weakness, dyspnea on exertion, anxiety, and poor social relationship. Care management for patient and caregiver, including health education on symptoms management, exercise enhancement, promoting ambulation, pulmonary rehabilitation, and home health care. The evaluation showed that the patient can be able to walk with walker, reduced dyspnea, and decreased anxiety. Furthermore, relationship with other more people improved.</p> <p> </p> Pramote Thangkratok Kwansiri Promin Natchaya Palacheewa Patcharatida Pinrat Copyright (c) 2022 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2022-06-27 2022-06-27 45 2 28 42 10.33165/rmj.2022.45.2.255733 Fixed Scale-Referenced Versus Minimal Passing Level-Referenced Scaling Methods for Grading: The Perspective for Practice https://he02.tci-thaijo.org/index.php/ramajournal/article/view/255947 <p>Setting standards is an important aspect of a grading system, which should be fair, reasonable, practical, and transparent. Distinct types of assessments result in different score distributions and different pass grades, and substantial errors can occur during aggregation of scores from multiple types of assessment. Thus, converting scores to a common grade structure is therefore essential. Different methods for the final grading of a course can cause the potential of disparity in course grades. The present work provides illustrative examples of 2 fixed scale-referenced grading methods and the minimal passing level-referenced grading method to demonstrate the potential of discrepancy of different grading scales. Perspectives for practice are provided.</p> <p> </p> Permphan Dharmasaroja Copyright (c) 2022 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2022-06-27 2022-06-27 45 2 43 51 10.33165/rmj.2022.45.2.255947