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/240783 <p style="text-align: justify;"><span style="font-weight: 400;">In the year 2020, nothing is more popular than Coronavirus disease 2019 (COVID-19). This also includes scientific publication. In just a few months, there are 1,228 articles on PubMed about COVID-19 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).</span><sup><span style="font-weight: 400;">1</span></sup><span style="font-weight: 400;"> Furthermore, articles in popular preprint server medRxiv and bioRxiv</span><sup><span style="font-weight: 400;">2</span></sup><span style="font-weight: 400;"> about COVID-19 and SARS-CoV-2 have reached 760. This is quite a phenomenon for scientific publishing as headlining by Jeffrey S. Flier as “Covid-19 is reshaping the world of bioscience publishing”</span><sup><span style="font-weight: 400;">3</span></sup></p> <p style="text-align: justify;"><span style="font-weight: 400;">Comparing to similar events of viral epidemic; severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), there were similarity in surges of scientific publications.</span><sup><span style="font-weight: 400;">4</span></sup><span style="font-weight: 400;"> We can expect many more research and publications to come as COVID-19 epidemic is still going on.</span></p> <p style="text-align: justify;"><span style="font-weight: 400;">However, it would be wise for scientific readers to be skeptical and cautious about validity of each study. Rushing and competition are risk factors to mistakes. For example, the recent study about efficacy of Favilavir in treatment of COVID-19 has been published in journal “</span><em><span style="font-weight: 400;">Engineering</span></em><span style="font-weight: 400;">”</span><sup><span style="font-weight: 400;">5</span></sup><span style="font-weight: 400;"> which is the official journal of the Chinese Academy of Engineering and Higher Education Press.</span><sup><span style="font-weight: 400;">6</span></sup><span style="font-weight: 400;"> This would initiate some doubts in validity of the study.</span></p> Chusak Okascharoen Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-03-31 2020-03-31 43 1 Distinguishing Renal Cell Carcinoma From Other Focal Renal Lesions on Multidetector Computed Tomography https://he02.tci-thaijo.org/index.php/ramajournal/article/view/176267 <p style="text-align: justify;"><strong>Background:</strong> The increased use of imaging modalities has led to a greater incidence in depicting solid renal mass. These lesions comprise a wide spectrum of malignant such as renal cell carcinoma (RCC) and benign histologies.</p> <p style="text-align: justify;"><strong>Objective:</strong> To determine the multidetector computed tomography (MDCT) features that discriminate RCC from other focal renal lesions.</p> <p style="text-align: justify;"><strong>Methods:</strong> A retrospective review was performed on 148 patients who underwent renal CT scan followed by renal surgery or biopsy during January 2008 to July 2014. Specific predictive MDCT features of RCC were determined by logistic regression analysis. Interobserver agreement (kappa [K] values) was also calculated for each CT feature.</p> <p style="text-align: justify;"><strong>Results:</strong> In 148 pathologic proved focal renal lesions, 91 (61.5%) were RCCs and 57 (38.5%) were non-RCCs. RCCs were more likely to be in male patients (OR, 5.39; 95% CI, 2.25 - 12.90), no internal fat component (OR, 46.50; 95% CI, 5.25 - 411.90), locate at peripheral (OR, 7.41; 95% CI, 1.63 - 33.73), and mixed central-peripheral locations (OR, 26.22; 95% CI, 4.23 - 162.58) of the kidney. There was moderate-to-excellent agreement among the readers over all these features (K<img title="" src="https://latex.codecogs.com/gif.latex?"> = 0.43 - 0.91).</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Focal renal lesion with no internal fat component in MDCT is the most useful characteristic in differentiating RCCs from others.</p> <p style="text-align: justify;">&nbsp;</p> Pornphan Wibulpolprasert Chompoonuch Thongthong Bussanee Wibulpolprasert Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-03-31 2020-03-31 43 1 1 12 10.33165/rmj.2020.43.1.176267 Cost-Effectiveness Analysis of Prenatal Screening Program for Thalassemia Between Semi-accelerated Screening Step and Current Program https://he02.tci-thaijo.org/index.php/ramajournal/article/view/227046 <p style="text-align: justify;"><strong>Background: </strong>Thalassemia is a genetic blood disorder with high incidence in Thailand. Its treatment includes blood transfusion and iron chelating therapy for life long that lead to high cost. Therefore, effective screening processes are required to prevent the newborn with thalassemia.</p> <p style="text-align: justify;"><strong>Objective:</strong> To determine the cost-effectiveness of prenatal screening program for thalassemia between a semi-accelerated screening program and the current program.</p> <p style="text-align: justify;"><strong>Methods:</strong> Decision tree model was developed under provider perspective. Cost, effectiveness and probabilities data were from literature review. One-way sensitivity analysis was performed to explore around inputs in the model.</p> <p style="text-align: justify;"><strong>Results:</strong> The expected costs of the semi-accelerated screening program and the current program were ฿609.29 and ฿462.44, respectively. The expected outcomes to detect a severe thalassemia in fetuses from the semi-accelerated program and the current program is 34 cases and 8 cases in 10 000 couples, respectively. Incremental cost-effectiveness ratio was ฿57 499.80 per case detected.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> The expected costs of the semi-accelerated screening program was higher than the current programs, but the number of fetuses with thalassemia detected from the semi-accelerated screening program was more than the current programs.</p> <p style="text-align: justify;">&nbsp;</p> Tham Laoarayawat Naruemon Bamrungsawad Piyameth Dilokthornsakul Peerapon Wong Nilawan Upakdee Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-03-31 2020-03-31 43 1 13 23 10.33165/rmj.2020.43.1.227046 Comparison of Knowledge, Attitude, and Behavior of Reproductive Health Between Thai and Immigrant Women Workers in Factories in Samut Sakhon, Thailand https://he02.tci-thaijo.org/index.php/ramajournal/article/view/238367 <p style="text-align: justify;"><strong>Background:</strong> Immigration of women workers from neighboring countries into Thailand to work in factories, usually have poor knowledge, attitude, and misbehavior on reproductive health. This can cause problems of reproductive health in Thai society.</p> <p style="text-align: justify;"><strong>Objective:</strong> To compare the knowledge, attitude, and behavior of reproductive health between Thai and immigrant women workers.</p> <p style="text-align: justify;"><strong>Methods:</strong> This analytic study compared 107 Thai and 107 immigrant workers in factories in Samut Sakhon, Thailand. All participants were recruited by purposive sampling. Data was collected by self-administered questionnaires which included personal characteristics, knowledge, attitude, and behavior related to reproductive health. Statistical tests were performed to analyze association between variables.</p> <p style="text-align: justify;"><strong>Results:</strong> Thai workers were older than immigrant workers (31.3 ± 9.5 years vs 25.3 ± 5.1 years; <em>P</em> &lt; .05) and more marriage (84.1% vs 72.0%; <em>P</em> &lt; .05). Compare with immigrant workers, Thai women workers had finished secondary school or lower (51.4% vs 36.4%; <em>P</em> &lt; .05), earned more than ฿15 000 per month (38.3% vs 3.7%; <em>P</em> &lt; .05), owned their own house (15.0% vs 0%; <em>P</em> &lt; .05), paid for their own healthcare (23.4% vs 11.2%; <em>P</em> &lt; .05), and used private hospitals for healthcare services (40.2% vs 17.8%; <em>P</em> &lt; .05). Thai workers had significantly better levels of knowledge and attitude (<em>P </em>&lt; .001). However, immigrant workers were found to have better levels of reproductive health behavior (70.1% vs 68.2%), especially in terms of the number of sexual partners, and a good level of pregnancy-related reproductive behavior (97.4% vs 84.3%), particularly in the practice of exclusive breastfeeding for 6 months or more.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Thai workers had more knowledge, attitude, and behavior of reproductive health than immigrant workers, despite their better attitude and behavior in terms of the number of sexual partners and the practice of exclusive breastfeeding 6 months or more.</p> <p style="text-align: justify;">&nbsp;</p> Rattanaporn Khamthanet Somsak Suthutvoravut Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-03-31 2020-03-31 43 1 24 34 10.33165/rmj.2020.43.1.238367 Measuring Service Quality of the Pain Clinic at Ramathibodi Hospital https://he02.tci-thaijo.org/index.php/ramajournal/article/view/183794 <p style="text-align: justify;"><strong>Background:</strong> Evaluating gap between patient’s expectation and perception of service quality of the pain clinic through the service quality model is necessary to improve service quality, which will lead to patient’s satisfaction.</p> <p style="text-align: justify;"><strong>Objective: </strong>To compare the difference between patient’s expectation and perception of service quality of the pain clinic at Ramathibodi Hospital.</p> <p style="text-align: justify;"><strong>Methods:</strong> A survey of patients of the pain clinic at Ramathibodi Hospital using the service quality questionnaire. The sample consisted of 266 patients who received pain treatment services from August 11, 2016, to December 10, 2016.</p> <p style="text-align: justify;"><strong>Results: </strong>Most patients were female (63.16%), married (61.28%), educational level lower than bachelor degree (57.52%), monthly income ≤ 30,000 Thai Baht (75.56%), attended treatment service more than 3 times (85.34%), and average age 56.47 ± 16.27 years. Overall expectation and perception and 4 subservice dimensions (tangible, reliability, responsiveness, and assurance) were not statistically significant. Empathy perceived higher than expectation. However, patients perceived the modern tool and equipment used in providing treatment services lower than expectation.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Overall service quality and 4 sub service dimensions of tangible, reliability, responsiveness, and assurance of the pain clinic met expectation. Empathy was higher than expectation, while modern tool and equipment used in the clinic were lower than expectation.</p> <p>&nbsp;</p> Supalak Sakdanuwatwong Pornchai Sakdanuwatwong Koravee Pasutharnchat Wanida Sodsee Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-03-31 2020-03-31 43 1 35 46 10.33165/rmj.2020.43.1.183794 Unit Cost Analysis for Health Academic and Operational Purposes https://he02.tci-thaijo.org/index.php/ramajournal/article/view/217894 <p style="text-align: justify;"><strong>Background:</strong> Unit cost estimation is one of the key planning tasks of organisation in order to allocate resources to each activity properly. Therefore, this study was conducted applying top-down costing approach, for academic unit cost estimation.</p> <p style="text-align: justify;"><strong>Objective:</strong> To estimate the unit costs using top-down allocation costing approach for academic and operational purposes of the Department of Clinical Epidemiology and Biostatistics (CEB) at Faculty of Medicine, Ramathibodi Hospital, Mahidol University.</p> <p style="text-align: justify;"><strong>Methods:</strong> A cross-sectional study of the cost of CEB in fiscal year 2018 was retrieved. Direct and indirect costs were allocated to CEB based on 3 main missions (education, research, and academic services) considering staffs’ activities and time spent for each mission. Three cost per unit of measures (cost per student, cost per publication, and cost per research consultation) were estimated accordingly to these 3 main missions.</p> <p style="text-align: justify;"><strong>Results:</strong> In the fiscal year 2018, direct and indirect costs were ฿15 178 761 and ฿737 496, respectively. As for staffs’ time spent for each mission activity, CEB mission costs were ฿6 807 282 for education (฿3 914 187 and ฿2 893 095 for MSc and PhD, respectively), ฿5 912 895 for research, and ฿2 186 280 for academic services.</p> <p style="text-align: justify;"><strong>Conclusions:</strong> Unit cost should be estimated properly to minimise and optimally allocate resources to each activity. This study should be useful for other departments as a guideline for their cost management and resource planning.</p> <p>&nbsp;</p> Paneevon Palakawong Na Ayutthaya Oraluck Pattanaprateep Ammarin Thakkinstian Copyright (c) 2020 Ramathibodi Medical Journal https://creativecommons.org/licenses/by-nc-nd/4.0 2020-03-31 2020-03-31 43 1 47 53 10.33165/rmj.2020.43.1.217894 Dysfunctional Team-Based Learning https://he02.tci-thaijo.org/index.php/ramajournal/article/view/227790 <p style="text-align: justify;">Team-based learning (TBL) is an innovative teacher-driven teaching method that uses a specific sequence of activities to foster individual and group responsibility in small groups of students that have been formed in order to answer questions and solve problems. TBL appears to have a number of benefits compared to conventional lecture-based teaching and traditional small group learning models. However, TBL has been modified in several ways for use in teaching within the curricula of medical schools. Research on the effects of TBL on the learning of students is still limited, and studies aimed at investigating whether the goals of TBL are achieved are rare. Medical schools that want to implement TBL in their curriculum and gain the benefits of TBL should ensure that those involved in the curricular process understand the essence of TBL. This review is primarily aimed at describing how dysfunctional TBL develops, and providing some suggestions regarding how to avoid it.</p> <p style="text-align: justify;">&nbsp;</p> Permphan Dharmasaroja Copyright (c) 2020-03-31 2020-03-31 43 1 54 61 10.33165/rmj.2020.43.1.227790